Governing Body

To be held on Thursday 20

th April 2017

From 1pm until 4pm

in the Boardroom, Sovereign House, Heavens Walk, Doncaster DN4 5HZ

Governing Body

To be held on Thursday 20th April 2017 Commencing at 1pm – 4pm

In the Boardroom, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ

PUBLIC AGENDA

Presenter Enc

1. Welcome and Introductions

Chair Verbal

2. Apologies

Chair Verbal

3. Declarations of Interest

Chair Verbal

4. Questions from Members of the Public (See our website for how to submit questions – required in advance)

Chair Verbal

5. Minutes of the previous meeting held on 16th March 2017

Chair Enc A

6. Matters Arising

Chair Verbal

Strategy

7. Children & Young People Plan Presentation

Mr Golze Presentation

8. Outcome of the consultations on the Hyper Acute Stroke Unit and Children’s Surgery & Anaesthetics

Mr Goodall Enc B

Assurance

9. Quality & Performance Report

Spotlight report on Cancer 62 Day Wait

Mr Russell & Mr Fitzgerald

Enc C

10. Finance Report

Mrs Tingle Enc D

11. Assurance Framework Report Quarter 4 and 2017/18 starting position

Mrs Atkins Whatley

Enc E

Standing Items

12. Chair & Chief Officer Report

Dr Crichton & Mrs Pederson

Enc F

13. Locality Feedback

Locality Leads Verbal

14. Receipt of Minutes

Engagement & Experience Committee – Minutes of

the meetings held on 2 February 2017 and 2 March 2017. Executive Committee – Minutes of the meeting held on 1

March 2017.

Working Together Joint Committee of CCGs – Minutes of the meeting held on 21 February 2017

Working Together Joint Committee of CCGs Terms of Reference – For noting by the Governing Body

South Yorkshire & Bassetlaw Sustainability and Transformation Plan Collaborative Partnership Board – Minutes from the meetings held on 13 January 2017

and 17 March 2017.

Chair Enc G

15. Any Other Business

Chair Verbal

16. Date and Time of Next Meeting Thursday 18 May 2016 at 1pm in the Boardroom, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ

Chair Verbal

To resolve that representatives of the press, and other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest Section 1(2) Public Bodies (Admission to Meetings) Act 1960.

Chair

Verbal

Item 1

Welcome & Introductions

Verbal

Item 2

Apologies for Absence

Verbal

Item 3

Declarations of Interest

Verbal

Item 4

Questions from Members of the Public

Enc A

Item 5

Minutes of the previous meeting

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Minutes of the Governing Body Held on Thursday 16th March 2017 commencing at 1pm

In the Boardroom, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ Members Present:

Dr David Crichton – NHS Doncaster CCG Chairman (Chair) Miss Anthea Morris – Lay Member and Vice Chair of the Governing Body Mrs Linda Tully – Lay Member Mrs Sarah Whittle – Lay Member Dr Emyr Wyn Jones – Secondary Care Doctor Member Dr Nick Tupper – Locality Lead, Central Locality Dr Jeremy Bradley – Locality Lead, North East Locality Dr Andy Oakford – Locality Lead, North East Locality Dr Pat Barbour – Locality Lead, South East Locality Dr Khaimraj Singh – Locality Lead, South East Locality Dr Lindsey Britten – Locality Lead, South West Locality Dr Karen Wagstaff – Locality Lead, South West Locality Mrs Jackie Pederson – Chief Officer Mrs Hayley Tingle – Chief Finance Officer

Formal Attendees present

Mrs Sarah Atkins Whatley – Chief of Corporate Services Mrs Laura Sherburn – Chief of Partnerships Commissioning and Primary Care Dr Rupert Suckling – Director of Public Health Mrs Deborah Hilditch – Healthwatch Representative (Attending on behalf of Mr Stephen Shore)

In attendance:

Mrs Jayne Satterthwaite – PA (Taking Minutes) Mr Ian Carpenter, Head of Communications & Engagement Mrs Ailsa Leighton – Deputy Chief of Strategy & Delivery – Urgent Care (attending on behalf of Mr Fitzgerald) Mrs Suzannah Cookson – Deputy Chief Nurse, Designated Nurse for Safeguarding & Looked After Children (LAC) (Item 10 – Corporate Parenting Board Looked After Children Report) )

ACTION

1. Welcome and Introductions Dr Crichton welcomed everyone to the Governing Body meeting. There were 4 members of the public in attendance at the meeting.

2. Apologies Apologies for absence were received from:

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Dr Marco Pieri – Locality Lead, North West Locality

Dr Niki Seddon – Locality Lead, North West Locality

Mr Andrew Russell – Chief Nurse

Mr Anthony Fitzgerald – Chief of Strategy & Delivery

Mrs Kim Curry – DMBC Representative

3. Declarations of Interest The Chair reminded members of their obligations to declare any interest they may have on any issues arising at meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group. Declarations declared by members are listed in the CCG’s register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link www.doncasterccg.nhs.uk The meeting was noted as quorate. Declarations of interest from sub-committee/working groups: None declared. Declarations of interest from today’s meeting: Dr Crichton declared a Financial interest in Item 10, Corporate Parenting Board Looked After Children report. Dr Crichton provides Initial Health Assessments (IHAs) for Looked After Children however as the report was for noting by the Governing Body rather than for a decision, Dr Crichton was not excluded from the meeting for this item. Dr Britten informed the Governing Body that she has ceased practicing at the Scott Practice in Balby, Doncaster and now practices at the Church View Practice in Denaby Main, Doncaster. Dr Crichton requested that Dr Britten complete a Declarations of Interest form to reflect the change.

Dr Britten

4. Questions from Members of the Public/ Patient Stories Questions from Members of the Public It was noted that there were no questions from members of the public received for this meeting. Patient Story Dr Crichton introduced Becci, Mica and Tracey Cusack, Partnership Officer for the Doncaster Children’s Trust to the Governing Body meeting and explained that both Becci and Mica had experienced first-

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hand the services for Looked After Children. A short video featuring an interview by Tracey with Becci and Mica followed. Becci and Mica described how they were taken into foster care as a result of drug, alcohol and mental health issues at home. Mica has been living independently since the age of 18 which resulted in debt. These financial difficulties led to skin problems and feeling exhausted. Dr Barbour commented that she appreciated the video and enquired if there was any aspect of the provision of health services which could have been better. Mica reported that she had visited her GP 6 times and had an 18 month wait for a referral to Dermatology for her treatment of Psoriasis. The Governing Body remarked on the importance of commissioning for joined up care and identifying emerging needs for group of patients like Looked After Children early. Mrs Cookson informed the Governing Body that this cohort of children often assume a parental role and that of young carer. The Governing Body noted the importance of supporting young carers. Mrs Hilditch stated that Healthwatch is keen to engage with young people to ensure their voice is heard and would welcome their thoughts on methods of how this may be accomplished. Various options were discussed. Dr Crichton commented that the Health & Wellbeing Board ambition is to work in a more integrated way across all organisations in Doncaster to ensure progress is made in partnership across care pathways, and that our ambition is that this should smooth the pathways to care. Tracey Cusack asked if she could take a photograph of Members with Becci and Mica which will be used as evidence of their visit and the Governing Body agreed. Dr Crichton thanked Becci, Mica and Tracey for their valuable contribution.

5. Minutes of the Previous Meeting held on 16th February 2017 The minutes of the meeting held on 16th February 2017 were agreed as an accurate record.

6. Matters Arising Primary Care Commissioning Committee Quarterly Report Mrs Satterthwaite confirmed that the post meeting note had been added to the Governing Body minutes of 19th January 2017 to reflect the update.

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Quality & Performance Report 62 day Cancer waits - Mrs Leighton reported that 85% of patients were seen within 73 days. Work is being undertaken to establish the breakdown. A&E 4hour wait – in January 2017 95% of patients were seen within 7 hours and 42 minutes. Work is ongoing to understand the breakdown. The action for Dr Seddon to provide feedback on how the 50% target for IAPT had been established was carried forward to the Governing Body meeting on 20th April 2017.

Dr Seddon

7. Delivery of the CCG Commissioning Strategy Mrs Leighton explained that, at the November meeting of the Governing Body, the Commissioning and Contracting Intentions for 2017 – 2019 were received. The Intentions reflected the:

Focus of the Doncaster Place Plan

Focus of the South Yorkshire & Bassetlaw Sustainability and Transformational Plans (STP)

NHS Operational Planning and Contracting Guidance, including delivery of the 9 National “must be dones”

Quality, Innovation, Productivity and Prevention (QIPP) requirements

The Governing Body agreed that The CCGs 5 year strategic vision should continue to build upon three connecting service areas required for systematic transformational change:

Care Out of hospital.

Care of the Elderly.

Co-ordinated Care.

The NHS Doncaster CCG Commissioning and Contracting teams enacted the intentions into the 2 year contracts with the main providers of care Rotherham Doncaster and South Humber Mental Health Foundation Trust (RDASH) and Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTHFT). These contracts were signed on 23rd December 2016. Individual Delivery Plans for the agreed priority areas have been developed in collaboration with Clinical Leads, CCG teams and partner organisations. These plans have been discussed and debated at the Strategy and Organisation Development sessions. Each Delivery Area has a partnership delivery group and associated dashboard to monitor implementation and impact. It is the intention to present the dashboards at monthly Governing Body meetings as part of the current performance report.

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Mrs Leighton requested that the Governing Body note and approve the following Delivery Plans for 2017 – 2019:

Urgent Care

Planned Care

Intermediate Care

Cancer

Mental Health

Learning Disabilities

Primary Care

Community Services

Children’s and Young People

Dementia

Medicines Management Mrs Whittle commented that the Delivery Plans were well presented however as the plans were presented to the Public, suggested that acronyms be replaced with full terminology. Mrs Whittle also highlighted that it is important to know when patient engagement is taking or has taken place. There are some good examples of this reflected within the plans but some of the plans omit how patients have been actively involved. The Engagement & Experience Committee (EEC) recently held a workshop where it was discussed how Committee members could start to liaise with the Commissioning Managers for each of the 12 CCG priority areas to introduce additional patient engagement methodologies. Mrs Leighton agreed to liaise with the Commissioning Managers within the Strategy & Development Team and stated that each plan will require a different element of engagement. Dr Barbour referred to the Primary Care Delivery Plan and the absence of reference to an appropriate length of appointment time in General Practice. There is currently a shortage of practitioners with more leaving as a result of work pressures and it would be beneficial to consider a minimum length of consultation time. Mrs Sherburn explained that this had not been featured as an implicit intention due to it being covered within the GP Forward View Releasing Time for Care Programme and there are therefore opportunities under Responsive Primary Care to explore different methods of working. Dr Crichton commented that this had been discussed nationally however there was no definitive answer and questioned whether there was a need to be so explicit. Currently practices have the ability to offer as long a consultation as is necessary. Dr Crichton suggested that this be discussed in more detail at the Primary Care Commissioning Committee. Miss Morris acknowledged that a lot of work had been invested in the development of the plans however observed that there was some duplication albeit worded differently. The plans should be smarter in respect of targets and chronological timings for example. Dr Tupper agreed with Miss Morris comments and stated that there could be more rigour in our thinking for clarity.

Mrs Leighton

Mrs Leighton

Mrs Sherburn & Mrs Tully

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Mrs Pederson stated that the intention was to hold subsequent ‘Market Place Session’ but diary commitments had not thus far permitted; this could be arranged in the new financial year. The Governing Body noted and approved the Delivery Plans for 2017-2019 with the proviso that the Governing Body’s comments are acknowledged and incorporated into the plans.

8. Future Child Health Service Model Mrs Sherburn presented the Care of the Acutely Unwell Child Case For Change to the Governing Body and explained that The Working Together Partnership Vanguard has been progressing work to review the current provision of care for the acutely unwell child, and moderately ill child within the context of national standards for child health. In December 2015, acute care providers within the Working Together Partnership Vanguard were asked to undertake a self-assessment of the hospital care provision against the national standard in ‘Facing the Future’. These national standards cover the care provided within an acute setting in relation to child health. At the same time, Clinical Commissioning Groups (CCGs) were also asked to undertake an assessment of local provision against national standards ‘Facing the Future’. In September 2016 the Clinical Senate was requested to review the outline Case for Change and supporting best practice review and scenario appraisal and provide comment and advice. It is proposed that the outline Case for Change is supported as evidence of the need to progress a more detailed piece of work which should include the following as a minimum:

Options development and appraisal.

Equality Impact Assessments on options.

Financial planning / analysis against options.

Public engagement and potential consultation.

Sustainability & Transformation Plan (STP) links and support.

Yorkshire & Humber Senate review of options.

NHS Assurance processes. Mrs Sherburn requested that the Governing Body consider the outline strategic Case for Change and support the work-up of some options to support sustainable care across providers, within the context of the STP. Dr Barbour stated that when assessing themselves Doncaster and Sheffield Trusts provided a good, quality service, but consistency was needed across the Sustainability & Transformation Plan area. Dr Tupper commented that the Governing Body has been asked to comment on the Case for Change previously. Mrs Sherburn explained

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that this has not yet been discussed in the public arena. Mrs Hilditch requested that the Governing Body acknowledge the lessons learned from the public consultations on the Hyper Acute Stroke Unit and the Children’s Surgery and Anaesthesia when developing a plan for communications and consultation with the public. The Governing Body considered the outline strategic Case for Change and supported the work-up of some options to support sustainable care across providers, within the context of the STP.

9. Continuing Healthcare Hosted Services Dr Crichton informed the Governing Body that, as Mr Russell had been detained on an urgent matter Mrs Tingle would present this item. Mrs Tingle reminded the Governing Body of the journey which had led to NHS Doncaster CCG hosting services for Continuing Health Care (CHC) and Previously Un-assessed Periods of Care (PUPoC). The PUPoC service manages claims from appellants for previously un-assessed periods of care that may have been eligible for funding from the NHS under the auspices of the Continuing Health Care Framework. The PUPoC process is mandated and follows national guidance. The period covered by this scheme was between 2004 and 2012 with all assessments and initial decisions completed by March 2017. NHS Doncaster CCG agreed to host the PUPoC service (PUPoC Shared Service) on behalf of 12 CCGs (including NHS Doncaster CCG); 9 of these were within Yorkshire and Humber with a further 3 in Leicester. NHS Doncaster CCG also agreed to host a shared service for Continuing Health care (CHC Shared Service) across 5 CCGs that managed:

Appeals

Complaints coordination

Performance reporting

Education/Professional Development

Responsibility for managing current requests for assessment and funding through CHC returned to the individual CCGs. The CHC Shared Service continues to manage appeals relating to current patients from those CCGs covered and coordinates data reporting and complaints in line with the agreed service requirements. NHS England required all claims within the current PUPoC period to be completed by March 2017 with an aspiration to complete them sooner if possible. NHS Doncaster CCG, on behalf of the collaborative, committed to complete all cases by the end of January 2017. Additional resources were identified to support this commitment and with the exception of three cases, this was achieved. This was a significant achievement for the team and the collaborative.

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NHS England has indicated that there will be a further scheme opened for appellants to requests reviews for Previously Un-assessed Periods of Care. As such there is a need to maintain a team with sufficient capacity to undertake this. The formal guidance for this period is expected imminently from NHS England but it is expected to cover the period from 2012 onwards. The Governing Body previously approved in principle for NHS Doncaster CCG to continue to host the PUPoC Shared service on behalf of the collaborative. The collaborative now includes 9 CCGs within Yorkshire and Humber. There was a mutual decision for the Leicester CCGs to withdraw from the collaborative at the end of March 2017. The CHC Shared Service was reviewed and the 5 CCGs committed to continue with the current model albeit with some alteration in relation to some of the Professional leadership and education functions. Both shared services will continue to operate out of their current Base at 722 Prince of Wales Road, Sheffield which is the NHS Sheffield CCG headquarters. A new Memorandum of Understanding (MOU) will need to be agreed across the collaborative for all parts of the shared services. CCGs have agreed in principle to the staffing model and final finance modelling is underway to finalise the detail within the MOU. The costs of the service are shared by all CCGs within the collaborative and it has been agreed that the methodology for determining the cost split is to use CCG population size. Mrs Tingle requested that the Governing Body note the contents of the paper and the on-going progress in relation to the hosted services. Mrs Whittle queried if any challenges had arisen in the management of the team located remotely in Sheffield. Mrs Tingle reported that there are complexities with the team being off site however they were consulted on whether they wished to remain at Sheffield and as many reside there they wished to remain. Mr Russell visits the team on a regular basis; they are included in the Organisational Development sessions, Staff Briefings and were invited to the NHS Doncaster CCG Christmas Lunch in December 2016. Dr Britten queried if there are alternatives for hosting the service for other CCGs. Mrs Tingle explained that there are other organisations which can provide a service however the cost is in excess of what NHS Doncaster CCG can deliver. The CCG has received a formal approval from NHS England to host the services in parallel with the Lead Provider Framework. The Governing Body gave its support to the on-going process in relation to the hosted services.

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10. Quality & Performance Report Mrs Leighton stated that the Quality and Performance Report was for noting by the Governing Body and would answer questions as required. Mrs Whittle observed that the response rate in respect of patient experience feedback within the Friends and Family Test (FFT) for both Doncaster and Bassetlaw Teaching Hospitals Foundation Trust (DBTHFT) and Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) were lower than the national average and queried what action the Trusts were taking to ensure improvements are made. Mrs Leighton stated that there have been a number of attempts for completion of the FFT trialled within the A&E department at the beginning and end of the patient’s attendance and whilst they are waiting to be attended to however it has been difficult to obtain feedback as the patients are keen to be seen and return home. One possibility is the use of IT but there are uncertainties of how feedback may be captured using this method. Co-Create were commissioned to review the service in the A&E department and detailed their suggestions for improvement within their report which has been considered by the Engagement & Experience Committee (EEC). Mrs Leighton agreed to address the issue in the Strategic Contracting meetings. Dr Oakford enquired what actions were being taken by Fylde Coast Medical Services (FCMS) regarding the GP Out of Hours Home Visits. All consultations are to be completed within 1 hour and are all IT based. Mrs Leighton reported that it is difficult to gain a good understanding regarding home visits to patients as we receive intelligence in respect of initial triage outcomes however we do not receive details of exceptions. Mrs Leighton agreed to investigate this further. Dr Jones assured the Governing Body that the Quality & Patient Safety Committee is actively challenging DBHTFT and there is significant engagement with the Trust on such issues. Looked After Children Report Mrs Cookson presented the Looked After Children (LAC) report to the Governing Body and stated that she had been asked by the Corporate Parenting Board in her role as Designated Nurse to prepare the report together with the Designated Doctor for Looked After Children. It was also presented to the Executive Committee on 4th January 2017. As commissioners of high quality, safe healthcare, NHS Doncaster CCG has a responsibility for ensuring the timely and effective delivery of health services to Looked After Children and Young People; this is through effective commissioning arrangements and partnership working.

Mrs Leighton

Mrs Leighton

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Over the last 2 years a mixed model of DBHTFT (children aged 0-5ys) and GPs (children aged 5-18yrs) have been completing the Initial Health Assessment (IHAs), due to changes in staffing and vacancies this model has resulted in a decline of IHA completed in 20 working days however a new service has been commissioned which commenced on 1st January 2017. To enhance this service, the LAC Nursing Team from RDASH will be offering a holistic assessment to all children to capture the voice of the child and provide the opportunity to explore sexual health, and risk taking behaviours. This model should provide us with a robust service going forward. Looked After Children were involved in the design of their own unique Your Opinion Counts feedback questionnaire which is issued to them following their review Health Assessment. This enables us to gauge how useful children and young people found talking to a nurse about their health. The responses were measured among children aged 11+ using a sliding scale 0 -10, 10 being high. The comments received from the children were all positive in nature. Mrs Cookson reported that the Corporate Parenting Board has queried whether additional membership from NHS Doncaster CCG on the Board would be possible and requested that the Governing Body give consideration to who could attend with her. Dr Crichton thanked Mrs Cookson for attending the meeting and stated that consideration will be given to who may attend the Corporate Parenting Board in the future. The Governing Body noted the report and supported the recommendations within the report. The Governing Body noted the Quality & Performance report.

11. Finance Report Mrs Tingle stated that the Finance Report was for noting by the Governing Body however wished to highlight that NHS Doncaster CCG is currently forecasting to achieve all of its financial targets for 2016/17. NHS Doncaster CCG set aside £4.8m, (1% of the CCG’s recurrent allocation) as per the business rules, for non-recurrent investment. However, the CCG had to ring-fence this funding to provide funds to insulate the wider health economy from financial risk. It has now been confirmed that this funding will not be released to CCG’s for utilisation due to the wider NHS England financial position. Mrs Tingle presented the high level Summary of 2017/2018 Budget Book to the Governing Body for approval and explained that the preparation of the book has been completed earlier this year. Mrs Tingle highlighted the following points:

The total budget for 2017/2018 is £491m compared to £490m in 2016/2017.

Resources available to use is limited.

The growth amount allocated has been offset by the Acute Tariff.

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NHS Doncaster CCG has £11.6m efficiency savings to achieve. Miss Morris queried if, as a Governing Body, we are being challenging enough in respect of our efficiency savings. Mrs Tingle welcomed additional challenge and stated that NHS England is also challenging our efficiency savings. Category M drugs are set at a national level and NHS England has benefitted in previous years however CCGs have benefitted from this cohort of drugs this year. Dr Suckling queried when it was anticipated that the Governing Body would see evidence of the Delivery Plans delivering against the £11.6m efficiency savings. Mrs Tingle acknowledged that we need to be robust and try to build in mitigation. The Governing Body approved the high level Budget Book Summary for 2017/18.

12. Chair and Chief Officer Report Mrs Pederson reported that the Chair and Chief Officer report was for noting however highlighted that Mrs Atkins Whatley would present a proposal regarding a change to the Constitution for consideration by the Governing Body. Mrs Atkins Whatley explained that our Constitution currently contains, as appendices, the Terms of Reference for each of the Committees of the Governing Body. As the Terms of Reference are included in the Constitution, any minor updates have to be consulted upon with our Member Practices. This increases the administrative burden placed upon on Member Practices because we have to consult them more frequently on minor matters. A number of CCGs have taken the decision to remove the Terms of Reference of Committees and instead place them on their website so that they can be updated on a more “live” basis. To reduce the administrative burden upon our Member Practices, it is recommended that the Terms of Reference for each of the Committees of the Governing Body be removed from the Constitution and placed on our website alongside the Constitution. Any changes to Committee Terms of Reference are already subject to Governing Body approval, on which Member Practices are represented by elected Locality Leads. Mrs Atkins Whatley requested that the Governing Body consider this proposal, and make any resulting recommendations to our Member Practices for their consideration. Miss Morris queried the notice period for the amendment. Dr Crichton stated that the Membership will be consulted on the change; more complex modifications will be presented to the Governing Body in the first instance then to the Membership in the future. Mrs Atkins Whatley suggested that she could visit Localities if necessary.

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The Governing Body agreed the proposal to make the recommendation to our Member Practices for their consideration. The Governing Body noted the report.

Mrs Atkins Whatley

13. Locality Feedback Locality Leads gave the following feedback from their Locality meetings: North East Locality – Dr Bradley reported the following items were discussed:

Miss Sessions attended the meeting to give a briefing on the GPfind Website.

Mr Dalton and Mrs Rhodie attended the meeting to give an update on prescribing finance.

The Bulletin, Rapid Response and the Organisational Round Up were discussed.

North West Locality – In the absence of Dr Pieri and Dr Seddon, Mrs Sherburn reported the following items were discussed:

Miss Sessions attended the meeting to give a briefing on the GPfind Website.

Mr Dalton and Mrs Rhodie attended the meeting to give an update on prescribing finance.

The Bulletin, Rapid Response and the Organisational Round Up were discussed.

South East Locality – Dr Singh reported that there was no feedback to be given from the South East Locality as no meeting had been held. South West Locality – Dr Britten reported the following items were discussed:

Miss Sessions attended the meeting to give a briefing on the GPfind Website.

Mr Dalton and Mrs Rhodie attended the meeting to give an update on prescribing finance.

The Bulletin, Rapid Response, the Issue Log and the Organisational Round Up were discussed.

Central Locality - Dr Tupper reported that there was no feedback to be given from the South East Locality as no meeting had been held. The Governing Body noted the feedback.

14. Standing Orders (SOs), Standing Financial Instructions (SFIs) & Scheme of Delegation (SoD) Mrs Tingle reported that as part of its role, the Audit Committee reviews the Standing Orders (SOs), Standing Financial Instructions

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(SFIs) and Scheme of Delegation (SoD) on an annual basis, making any recommendations for amendments to the Governing Body. The document has been reviewed by the Chief Finance Officer and the Chief of Corporate Services from both a financial and governance perspective and the following amendments are recommended:

Change Quality & Safety Committee to Quality & Patient Safety Committee.

Change Delivery & Performance Committee to Executive Committee and amend the delegated roles.

Add reference within the Standing Orders and Scheme of Delegation to the Joint Committee of CCGs which has been established for the Working Together programme.

Remove reference to the obsolete NHS England definition of relevant and material interests, and replace with reference to the CCG’s Standards of Business Conduct & Conflicts of Interest Policy.

Add reference to the role of the Conflict of Interest Guardian.

Remove references to the Audit Commission.

Updating of Section 17 on Tendering and Contracting in line with the latest national guidance.

The Audit Committee considered these amendments at its meeting on 9th March 2017 and recommended the amendments to Governing Body for approval. Mrs Tingle requested that the Governing Body consider and approve the recommended amendments. Dr Tupper referred to Pages 3 and 4 of the document, Items 1.2.5 and 1.2.20, ‘Chair of the CCG’ and ‘Locality Lead’ respectively and highlighted that the individuals are elected and not appointed into the role. Mrs Atkins Whatley acknowledged the wording should change and agreed to amend the document accordingly. Dr Tupper also referred to Page 19, Items 6.11 and 6.11.1 and queried why ‘Patient’ had been added to the Quality & Safety Committee and commented that the safety element should not be confined to patient safety. Dr Jones explained that the majority of the reports received by the Committee relate specifically to patient safety. Mrs Atkins Whatley confirmed that the Membership had also agreed that the Committee be re-named. The Governing Body considered and approved the recommended amendments. It will be implemented from 1 April 2017.

Mrs Atkins Whatley

15. Receipt of Minutes The following minutes were received and noted by the Governing Body:

Audit Committee – Minutes of the meeting held on 12th January 2017.

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Quality & Patient Safety Committee – Minutes from the meeting held on 1st September 2016, 3rd November 2016 and 19th January 2017.

Executive Committee – Minutes from the meeting held on 4th January 2017.

Primary Care Commissioning Committee – Minutes from the meeting held on 8th December 2016 and 9th February 2017.

Revised Remuneration Committee Terms of Reference. Miss Morris presented the revised Terms of Reference for the Remuneration Committee to the Governing Body and requested that Members note and approve the amendment to the Terms of Reference relating to the removal of the Human Resources Policies for approval by the Remuneration Committee. The proposal is that the policies be ratified by the Executive Committee in the future. The Governing Body agreed the proposal and the amendment to the Terms of Reference. Miss Morris referred to the Executive Committee minutes and requested clarification on the minute relating to the Future Leaders GP Fellow as it referred to both Mr and Dr Patterson. Mrs Sherburn confirmed that she had spoken with Dr Patterson and requested that the minute be amended. Post Meeting note The Executive Committee minutes have been amended accordingly.

Mrs Satterthwaite

16. Any Other Business Dr Crichton requested that Governing Body Members ensure that all papers for discussion at the Governing Body meetings are completed and forwarded to Mrs Satterthwaite 7 days in advance of the meeting date in order for them to be circulated to Members, uploaded onto Boardpad and available to the Public on the NHS Doncaster CCG website in a timely manner.

All

17. Date and Time of Next Meeting 1:00pm on Thursday 20th April 2017.

It was resolved that representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest Section 1(2) Public Bodies (Admission to Meetings) Act 1960

Verbal

Item 6

Matters Arising

Verbal

Item 7

Children & Young People Plan Presentation

Enc B

Item 8

Outcome of the consultations on Hyper Acute Stroke Unit Services and Children’s

Surgery & Anaesthesia

Meeting name Governing Body

Meeting date 20 April 2017

Title of paper

Independent analysis of the public consultation for hyper acute stroke services and children’s surgery and

anaesthesia services

Executive / Clinical Lead(s)

Mr Andrew Goodall, Healthwatch Doncaster

Author(s) Helen Stevens, Associate Director of Communications and Engagement

Purpose of Paper - Executive Summary

Commissioners Working Together (CWT) conducted a consultation to get the views of patients, public and others with an interest in proposals to change hyper acute stroke services and children’s surgery and anaesthesia services in South Yorkshire, Bassetlaw and North Derbyshire. It ran from 3 October 2016 and until 14 February 2017. An independent analysis of the responses has now taken place, with headline findings and concluding comments. The analysis is being shared with relevant steering groups and also be widely available to the public, staff and stakeholders on the CWT website. A decision on the proposals will be taken by Joint Committee of CCGs at its May meeting when it considers the Decision Making Business Case.

Recommendation(s)

Governing Body members are asked to note the contents of the enclosed paper.

Impact analysis

Quality impact As per paper

Equality impact

As per paper; full EIA will be part of Business Case stage

Sustainability impact Review and redesign is necessary for

sustainability of these services into the future

Financial implications Not yet known, to be completed as part of

the Business case

Legal implications

Nil

Management of Conflicts of Interest N/A

Consultation / Engagement (internal

departments, clinical, stakeholder & public/patient) As per paper

Report previously presented at

Risk analysis

To be completed at Business Case stage

Assurance Framework 1.2,1.3,4.1,4.2,4.3

Independent analysis of the public consultation for hyper acute stroke services and children’s surgery and anaesthesia services

JOINT COMMITTEE OF CLINICAL COMMISSIONING GROUPS

18 April 2017 1. Summary Commissioners Working Together (CWT) is a collaborative of eight clinical commissioning groups and NHS England across South and Mid Yorkshire, Bassetlaw and North Derbyshire. CWT works with all local hospitals and care providers, staff and patient groups to understand how best to ensure that everyone experiences the highest quality and safest services possible across the region’s combined population of 2.8 million people. In 2016, CWT carried out a review of children’s surgery and anaesthesia services and hyper acute stroke services across the region. Pre-consultation engagement took place between January – April 2016 as part of this review, during which CWT gathered the views of key stakeholders, including patients and the public, to inform plans for the future of services. Following this engagement, CWT proposed changes for both children’s surgery and anaesthesia and hyper acute stroke services that aim to use what is available in the best possible way to get the best services for everyone. For children’s surgery and anaesthesia, three options have been developed and put forward for consideration, including CWT’s preferred option. For hyper acute stroke services, one option has been developed and put forward for consideration. The consultation to get the views of patients, public and others with an interest in these issues was launched on 3 October 2016 and ran until 14 February 2017. The original closing date for the consultation of 20 January 2017 was extended to take account of the Christmas period and to allow as many people as possible to take part in the consultation. The attached report is an independent analysis of the responses to the consultation received during this period. 2. Key issues The consultation process The following channels were provided for people to respond to each of the consultations throughout the consultation period:

Online consultation questionnaire hosted on the Commissioners Working Together website http://www.smybndccgs.nhs.uk. The survey included some closed questions to measure levels of support around the service options proposed and a number of open questions around the proposals to allow respondents to express views in their own words. Information about demographics and the context in which people were responding to the consultation were also asked for sub-group analysis.

Paper surveys were also available which contained the same questions as the online survey with a freepost return option. There were no requests for translation into additional languages. Easy Read versions of the survey were also available.

Meetings and events – a number of public events, stakeholder meetings, staff meetings and discussion groups were held during the consultation period.

Submissions in the form of letters and petitions could be submitted to the consultation by post or by email.

Representative telephone survey – a telephone survey of 740 local residents, broadly representative by geography and demographics, was conducted across South and Mid Yorkshire, Bassetlaw and North Derbyshire.

Online poll – a short poll was devised at the mid-point stage (following analysis that the narrative was complex and it was difficult to engage people on the issues). The results do not inform the main survey analysis and are simply intended to provide further data on people’s opinions.

Communications and engagement activity Commissioners Working Together (CWT), each of the CCGs and provider organisations developed tailored communications and engagement plans for the consultations in their local areas. North Derbyshire CCG and Hardwick CCG agreed to conduct joint engagement activities. An overview of the range of channels and engagement opportunities for the consultations is below.

Digital communications and engagement through dedicated webpages, which were established and updated throughout the consultation period, banners and links through to the CWT website. 8,318 unique visitors used the CWT website during the consultation period, with more than 62,000 page visits to the specific consultation webpages.

Broadcast and print media releases with a local, regional and national reach, resulting in 13 pieces of media coverage about the consultations between October 2016 – February 2017 and a further 6 pieces in the lead up to the consultation.

Social media using Commissioners Working Together’s Twitter and Facebook profiles. Tweets about the consultations generated more than 55,000 impressions and CWT’s 21 Facebook posts reached 16,991 people and saw 939 users take action (including clicking a link, liking, commenting or sharing a post).

Public consultation events took place locally in Barnsley, Bassetlaw, Doncaster, North Derbyshire and Hardwick and Sheffield.

Specific interest engagement via email, hard copies of the consultation documents and meetings with groups with an interest in stroke and children’s targeted across each local area.

Seldom heard group engagement via email, hard copies of the consultation documents and discussion groups.

Stakeholder briefings including local MPs and councillors, Health and Wellbeing Board, Health Overviews and Scrutiny Committees.

Staff briefings via internal communications channels, newsletters, forums and groups

Hard copies of the consultation documents, postcards and flyers distributed to hospitals, GP practices, libraries and children’s centres, dental practices, campaign groups, town halls, community venues and organisations and at public events. 50,000 copies of the consultation document were printed and distributed on request and through these channels.

Consultation responses A total of 1109 responses were received for the consultation to change hyper acute stroke services and 1268 responses for the consultation to change children’s surgery and anaesthesia services.

Consultation channel Hyper acute stroke services responses

Children’s surgery and anaesthesia

services responses

Surveys

Consultation survey – online 282 405

Consultation survey – paper 58 83

Telephone survey 740* 740*

Written and telephone submissions

Submissions from individuals 6 (2*) 3 (2*)

Submissions from organisations and elected representatives

Barnsley Hospital 1* 1*

Chesterfield Royal Hospital 1

Dan Jarvis MP 1* 1*

Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust

1* 1*

Barnsley Save Our NHS 1* 1*

Sheffield Teaching Hospitals NHS Foundation Trust

1

The Rotherham NHS Foundation Trust 1* 1*

Meetings (including focus groups, public and stakeholder meetings)

Public meetings (NHS facilitated)

Sheffield 1

Barnsley 1* 1*

North Derbyshire and Hardwick (stroke centre) 1

Doncaster 1* 1*

Bassetlaw 1* 1*

Goldthorpe 1* 1*

Matlock 1

Penistone 1* 1*

Engagement outreach and local groups

Consultation channel Hyper acute stroke services responses

Children’s surgery and anaesthesia

services responses

Speak Up Self Advocacy group (Rotherham)

1* 1*

PPG Kiveton (Rotherham) 1* 1*

Older People’s Forum (Rotherham) 1* 1*

Stroke Café (Rotherham) 1

Parent and carer group (Rotherham) 1

Newbold School (Chesterfield) 1

Highfield School (North Derbyshire and Hardwick)

1

Outpatients visits, Chesterfield Royal Hospital

11

Mother & Toddler Group, St Thomas’ Centre, Chesterfield

2

Nightingale Ward, Chesterfield Royal Hospital

1

Focus groups

Barnsley Together AGM 1* 1*

Barnsley Mencap 1* 1*

Age UK (Barnsley) 1

BME Young People and Carers Group (Rotherham)

1* 1*

BME discussion group (Doncaster) 1* 1*

Petition

https://you.38degrees.org.uk/petitions/save-barnsley-s-specialist-stroke-service

(5022 signatures)

1

https://you.38degrees.org.uk/petitions/keep-children-s-surgery-and-anaesthesia-services-at-barnsley-hospital (785 signatures)

1

TOTAL 1109 1268

* shows where one response covers both consultation issues 3. Headline findings For the children’s surgery and anaesthesia services consultation, three options have been developed and put forward for consideration, including CWT’s preferred option. For the hyper acute stroke services consultation, one option has been developed and put forward for consideration.

Attitudes towards the proposals in each of these consultation areas were consistent across the different ways in which people responded so are summarised thematically by service area below. Children’s surgery and anaesthesia services Respondents were asked whether they agreed or disagreed with the proposal to change the way children’s surgery and anaesthesia services and were asked to explain the reasons behind their expressed view. The table shows that respondents tend to agree with the proposed changes (63% of telephone survey respondents agree and 43% of self-selecting survey respondents agree). However, there are over a third of self-selecting respondents (39%) who disagree with the proposals compared to 13% of randomly selected telephone survey respondents.

Consultation survey respondents

Telephone survey respondents

Actual % Actual %

Agree 210 43% 466 63%

Disagree 190 39% 98 13%

Don't know 86 17.6% 176 24%

Did not respond 2 0.4% 0 0%

Total 488 100% 740 100% Higher levels of disagreement tend to come from Barnsley, Bassetlaw, Wakefield, North Derbyshire and Hardwick. All of these areas are particularly impacted by proposed changes to Barnsley Hospital and Chesterfield Royal Hospital. There were over a third of self-selecting respondents (39%) who disagreed with the proposals compared to 13% of randomly selected telephone survey respondents. There were higher levels of disagreement with the proposals from self-selecting consultation survey respondents. These responses tended to come from Barnsley, Bassetlaw, Wakefield, North Derbyshire and Hardwick. Where people disagreed, themes were:

Not being able to access high quality care closer to home

Impact on patient outcomes and patient safety

Other concerns (if staffing is an issue, this should not impact on patients and families, some people had had good experiences and could not see the need for change and some were sceptical about the motivation for change)

Where people agreed, themes were:

Better quality of care and better health outcomes for children

Fairer and equal access to the best services

More effective allocation of resources

Trust in NHS locally

A number of respondents felt they could not comment on the proposed changes (especially from the telephone survey where respondents had been less likely to have been aware of the consultation or have read the consultation document). The options People were asked which of the options they preferred through a closed question and to explain their reasons why through an open question. The table below shows that almost one in four consultation survey respondents (23%) did not agree with any of the options. 42% of these support option 1. Conversely, with telephone survey respondents, 64% state that option 2 is their preferred option. This is also the preferred option of CWT.

Consultation survey Respondents

Telephone survey respondents

Preferred option Actual % Actual %

Option 1 203 42% 248 34%

Option 2 154 32% 475 64%

Option 3 18 4% 17 2%

None of these 109 23% 0 0%

Total 484 100% 740 100%

Almost one in four consultation survey respondents (23%) did not agree with any of the options

42% of consultation survey respondents supported option 1

Telephone survey respondents 64% stated that option 2 was their preferred option

The highest lack of support for these options came from consultation respondents in the Barnsley area

The highest level of support for option 1 was from North Derbyshire Alternative suggestions People were also asked if there were other options they would like CWT to consider. The majority of people did not have alternative suggestions. Of those who did, the key alternatives raised were:

A plea to keep things as they are

To have centres in all of the areas

Keeping services at Barnsley District General Hospital (most commonly cited)

Just have one place specialist children’s hospital

Isolated cases for services to be offered at Bassetlaw and Rotherham

4. Hyper acute stroke services Respondents were asked whether they agreed or disagreed with the three centre option to change the way hyper acute stroke services were provided.

The table below shows that there is mixed response to this question. 54% of self-selecting consultation survey respondents disagree with this option and 50% of telephone survey responses agree with it.

Consultation survey

respondents

Telephone survey

Respondents

Actual % Actual %

Agree 136 40% 373 50%

Disagree 185 54% 249 34%

Don't know 19 6% 118 16%

Total 340 100% 740 100% The patterns of agreement were similar across both survey channels – a) paper and online survey (self selecting responses) and b) telephone survey (taking a random representative sample of the population) - except for Bassetlaw, Sheffield and Wakefield where the majority of self-selecting consultation survey respondents disagreed with the three centre option compared to the telephone survey respondents in those areas. There were high levels of support for the three centre option in Doncaster and North Derbyshire and Hardwick (which cover hospitals where the hyper acute stroke services are being proposed). There was low level of support for this option in the Barnsley CCG area. Where people disagreed, themes were:

Not being able to access high quality care quickly and patient safety

Social impact

Other concerns (lack of funding for the NHS, wish to have a centre in local area so could access high quality care, additional pressure on the ambulance service)

Where people agreed, themes were:

Quick and easy access to high quality care

Better quality of care and improved health outcomes

More effective allocation of resources

Other comments (support for Chesterfield to be one of the three centres, positive personal experiences at the Royal Hallamshire Hospital and a small number of respondents said they trusted the commissioners to make the right decision)

A number of respondents felt they could not comment on the proposed changes (especially from the telephone survey where respondents had been less likely to have been aware of the consultation or have read the consultation document). Alternative suggestions Almost half of the consultation survey respondents had alternative suggestions to make. The majority were making the case for Barnsley District General Hospital to have a hyper acute stroke unit to make sure that local people could have quick access to time-critical care. The other main suggestions were to have a hyper acute stroke unit in every hospital and to start investing in the right calibre of staff to make this happen.

5. Concluding comments As with all public consultations, the response cannot be seen as representative of the population but it is representative of interested parties who were made aware of the consultation and were motivated to respond. Within the analysis we cannot be clear the extent to which responses are informed by the supporting information that has been provided. The telephone survey was undertaken with a randomly selected and representative cross-section of residents to ensure that the consultation process accurately captured the views of the wider population of South and Mid Yorkshire, Bassetlaw and North Derbyshire. A consistent picture emerges from the different strands of the consultation. There is mixed support for many of the proposals outlined in the consultation document including the preferred options for the purpose of the consultation. Potential changes to services, particularly where loss of services are involved, understandably cause apprehension among those who may be affected. There has been clear and vocal opposition where this is potentially the case (for example, in the Barnsley area). The main concern highlighted across all consultation strands is the impact on the ability to patients and families to access high quality care closer to home if specialised centres are introduced. It is important to recognise that the outcomes of the consultation process will need to be considered alongside other information available about the likely impact of each of the proposed options. The purpose of the analysis is to explain the opinions and arguments of those who have responded to the consultation but it is not to recommend any option or variations of these options. In their deliberations, the members of JC CCG will review the evidence and considerations that have emerged during consultation while also taking account of all the other relevant evidence that will help them make their final decisions. The independent analysis is being shared with relevant steering groups, the Joint Overview and Scrutiny Committee and will also be widely available to the public, staff and stakeholders on the CWT website. 6. Recommendations The Joint Committee of Clinical Commissioning Groups will be asked to consider the independent analysis in advance of the May Decision Making Business Case. Paper prepared by Helen Stevens Date 3 April 2017

Enc C

Item 9

Quality & Performance Report

Meeting name Governing Body

Meeting date 20 April 2017

Title of paper

Quality & Performance Report

Executive / Clinical Lead(s)

Mr Andrew Russell, Chief Nurse Mr Anthony Fitzgerald, Chief of Strategy & Delivery

Author(s) Performance and Intelligence Team Quality Team

Purpose of Paper - Executive Summary

This report sets out the key quality and performance issues to be noted by the NHS Doncaster Clinical Commissioning Group (NHS Doncaster CCG) Governing Body. The report covers 4 main sections this month:

Provider Performance - main local healthcare providers

Other services commissioned by NHS Doncaster CCG

NHS Constitution measures

The performance rating, indicated by Red, Amber or Green status, denotes the current month performance and does not reflect the historic trends. This is supported by a detailed appendix (Appendix 1) which highlights performance for NHS Doncaster CCG and all local providers with regards to the main performance indicators. The key areas of change, both positive and negative, to note since the last report are: Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTHFT)

18 week Referral to Treatment Times - The position for incomplete pathways in February improved slightly to 90.5% in line with trajectory but remained below standard (92% of patients waiting under 18 weeks).

There was a 52 week wait reported for February. This patient was treated in March.

March 2017 A&E performance improved to 92.7% against the agreed aim of 90%, but remained below the national standard of 95%.

Handovers over 60 minutes deteriorated to 66 during January 2017.

Two cancer standards were not met during January 2017, Two week wait from referral to date first seen: all urgent cancer referrals and 62 day wait for first treatment from NHS cancer screening service referral.

Rotherham, Doncaster & South Humber NHS Foundation Trust (RDASH)

IAPT Recovery Rate achieved target at 56.2% for the 7th consecutive month during February 2017.

2

Other Commissioned Services

N/A

Local Delivery Plans

None applicable

Recommendation(s)

The NHS Doncaster CCG Governing Body is asked to:

Note the key quality performance areas for attention

Impact analysis

Quality impact As identified in the report

Equality impact

Neutral

Sustainability impact

Nil

Financial implications

As identified in the report

Legal implications

Nil

Management of Conflicts of

Interest

The report is for information – no conflicts of interest identified. It should be noted that some Governing Body members may be

employed in secondary employment by organisations referenced in this report: please see Register of Interests for details.

Consultation / Engagement

(internal departments,

clinical, stakeholder & public/patient)

N/A

Report previously

presented at N/A

Risk analysis

Risks are captured in the Executive Summary

Assurance Framework

2.1, 2.2, 2.4

3

INTRODUCTION This report sets out the key quality and performance issues to be noted by the NHS Doncaster Clinical Commissioning Group (NHS Doncaster CCG) Governing Body using February data unless noted. The report covers 4 main sections this month:

Provider Performance - main local healthcare providers

Other services commissioned by NHS Doncaster CCG

NHS Constitution measures

Items for escalation regarding Local Delivery Plan in year delivery

The report is supported by a detailed appendix (Appendix 1) which highlights performance for NHS Doncaster CCG and all local providers with regards to the main performance indicators.

SECTION 1: PROVIDER PERFORMANCE REPORT

The following section of the report details performance for each main local provider, namely DBTHFT and RDASH. Performance is across a range of quality and more traditional “performance” measures. As such the report includes performance as a whole for DBTHFT and Doncaster sites for RDASH, and does not simply relate to services commissioned by NHS Doncaster CCG.

Doncaster & Bassetlaw Hospitals NHS Foundation Trust

Governance

Time Period

December 2016 January 2017 February 2017

Changes to the Board

The Chair of Doncaster and

Bassetlaw Hospitals (DBH), Chris Scholey, stepped down from his

position on 31 December 2016.

Suzy Brain England,

started in post as Trust Chair on 1 January

2017.

None applicable None applicable

Mortality

The Trust's rolling 12 month HSMR performance further improved during December and remains better than expected at 87.0.

Contractual actions

2016/17 Contract Queries: No further contract queries were issued during February 2017. The Trust has provided the CCG with regular updates against the open Contract Query regarding data quality and the action plan continues to be monitored.

Performance Notices: zero.

Number of serious incidents reported

(CCG)

Q2 2016/17 – 10 Q3 2016/17 – 3 Q4 2016/17 – 16

Please note that the above figures include incidents which may be

4

subsequently de-logged as a SI.

Patient Experience

Time Period

November 2016 December 2016 January 2017 February 2017

Complaints/concerns Opened

104 87 109 120

The number of complaints and concerns increased again in February, rising to just above the median though still less than 0.3 complaints per 1000 occupied bed days. There has been a slight improvement in complaints being resolved within agreed timeframes of the complainant and work continues in this regard.

Friends & Family Test

Inpatients

A&E

Outpatients

During January DBTHFT had a higher percentage of inpatients, outpatients and A&E attenders recommending services than the England average. Response rates for each, except inpatients, were below the England average.

Friends & Family test

Antenatal

5

Birth

Postnatal

All Doncaster maternity services achieved a higher level of patients recommending those services than the England average.

Workforce

Time

Period

January 2017

From 01 May 2016, Care Hours Per Patient Day (CHPPD) has become the principle indicator of nursing and healthcare support worker deployment. Utilising actual versus planned staffing data submitted to UNIFY and applying the CHPPD calculation the care hours for February 2017 are;

Site Registered

midwives/nurses Care Staff Overall

Bassetlaw 4.5 3.2 7.7

Doncaster Royal Infirmary

4.2 3.1 7.2

Montagu 2.1 3.0 5.1

Trusts 4.1 3.1 7.2

Safety

Time Period July 16 Aug 16 Sep 16 Oct 16 Nov 16 Dec 16 Jan 17 Feb 17

Number of Never Events 0 0 0 0 0 1 1 1

6

(cumulative during financial

year)

There was a new Never Event in December 2016 in relation to a retained wire. Initial meetings around this event have taken place with Commissioners being involved. The root cause analysis investigation has taken place and a draft report produced which has received comments from partners. A final report will be submitted to the Incident Management Group in the near future.

MRSA (cumulative

during financial year)

1 1 1 1 2 2 2 2

There have been a total of 2 cases of MRSA for the year to date.

C-Diff Actual

Trajectory (NHSE cum. target 40)

10 11 14 16 20 22 24 25

12 15 18 20 23 26 29 32

Hospital Acquired Pressure Ulcers

(category 3, 4 and ungradeable,

target of less than 60 in 2016/17)

Q2 2016/17 – 6 Q3 2016/17 - 10 January 2017 - 9 February 2017 - 9

Performance in February was better than the same month in 2015/16. Current year to date performance was 16.66% better than at the same point last year. The position is prior to the Root Cause Analysis process being completed.

Serious Falls (target of less than 29 during

2016/17)

Q2 2016/17 - 2 Q3 2016/17 - 2 January 2017 - 0 February 2017 - 0

There were no falls resulting in significant harm in February. Year to date performance since April 2016 is 33.33% better than the same period 2015/16. The Q3 position is prior to the Root Cause Analysis process being completed.

Operational Effectiveness

Time Period

Jul 16 Aug

16 Sep 16 Oct 16 Nov 16 Dec 16 Jan 17 Feb

17

18 week Referral to Treatment Times Incomplete Waits

(target 92%)

England

92.6% 92.0% 92.1% 91.7% 91.3% 90.1% 90.3% 90.5%

91.3% 90.9% 90.8% 90.4% 90.6% 89.8% 90.0% N/A

The position for Incomplete pathways in February improved slightly in February but remained below standard (92% of patients waiting under 18 weeks). The latest England benchmark is for January where on average 90.0% of patients were treated within 18 weeks. Eight specialties failed to meet 92% in February:

General Surgery

Urology

General Medicine

Dermatology

Trauma and Orthopaedics

ENT

R

7

Ophthalmology

Rheumatology Key issues during the month have been:

workforce/capacity to meet demand along with the productivity of clinics and list underutilisation due to withheld theatre slots for training.

cancellations due to bed availability.

Growing PTL due to time involved to validate patients having doubled (CaMIS)

Failing to book in chronological order

Validation below 18 weeks is identifying an error rate of over 30%

Lack of pathway management support in Care Groups.

There are a number of actions underway which have been previously reported including:

Secure additional capacity both internally and externally through outsourcing

Turnaround sessions planned with each Care Group commencing 18/01/17

To ensure chronological booking of patients to support RTT delivery

Collaboration with CCG on referral management and support in reducing demand

Workforce Business Case/Requests by specialty

To provide a situation report of Care Group Review Lists and identify risks and issues

Increase Pre-Assessment capacity to support recovery plans

Interim service line management in place

Dedicated Pathway Co-ordinators in Care Groups to manage specialty level pathways to improve planning and performance

Validation process between Care Group and DQ Team agreed with weekly monitoring in place on completion

Identify best practice PTL management to enhance Trust reporting and information

Exploration of external support; Consultant Resources, PTL management; cleanliness, validation, knowledge and skills

Clean PTL completed by w/e 03/02/17

Enhance Business Intelligence to support performance conversations at Accountability meetings - new Care Group Dashboard with planned care metrics

6 week referral to Diagnostic test

times (target 99%)

Jul 16 Aug 16

Sept 16 Oct 16 Nov 16 Dec 16 Jan 17 Feb 17

99.2% 98.96

% 98.9% 99.2% 99.4% 99.3% 98.1% 98.9%

R

8

England 98.6% 98.3% 98.5% 98.9% 98.9% 98.3% 98.3% N/A

Diagnostic waits failed to meet the standard during February at 98.9% against the target of 99%. The Diagnostic measure failed due to demand pressures and availability of staff and equipment in Audiology and Sleep Studies. The Audiology department have new staff in post from March onwards and additional sessions have been requested. Further information regarding pressures in Sleep Studies is awaited.

52 Week Waits – Incomplete Pathway

Jun 16

Jul 16

Aug 16

Sept 16

Oct 16

Nov 16

Dec 16

Jan 17

Feb 17

DCCG 4 3 2 1 1 1 0 1 1

Other 0 2 0 0 0 0 0 0 1

NHSE 0 0 0 0 0 0 0 0 0

The two 52 week breaches reported above for February occurred in ENT and General Surgery (GI). The general surgery breach first occurred in December but was not identified until Unify reporting in February. In addition to this a further breach for a Doncaster CCG patient was identified in ENT for the January reporting period. One ENT and the GI patient have been scheduled to be treated in March 2017, with the 2

nd ENT patient schedules for early April. A

Breach report has been completed and shared with commissioners. The ENT department has received targeted training and have appointed to a post to look specifically at pathway management in ENT.

4 Hour access - total time in the A&E department

(target 95%)

England

FCMS – Urgent Care Centre (UCC)

Performance contributing to

Total A&E Performance above

Aug 16

Sept 16

Oct 16

Nov 16

Dec 16

Jan 17

Feb 17

Mar 17

91.9% 93.9% 92.6% 90.7% 86.6% 85.0% 88.7% 92.7%

91.0% 90.6% 89.1% 88.4% 86.2% 77.6% N/A N/A

100% 100% 100% 100% 100% 100% 100% 100%

Total time in A&E: 4 hours (95

th

percentile HH:MM) 5:48 5:00 5:34 6:02 7:15 7:42 6:19 N/A

A&E admitted patients total time

in A&E (95th

percentile HH:MM)

9:48 8:52 9:03 9:57 11:47 12:59 10:35 N/A

A&E non-admitted patients total time

in A&E (95th

percentile HH:MM)

3:59 3:58 3:58 3:59 4:51 5:22 4:30 N/A

DBTHFT’s March position improved again to 92.7%, though remained below the standard of 95% of patients being admitted, transferred or discharged

9

within 4 hours. Quarter 4 performance was 88.9% with the year as a total 91.4% Pressures have continued with internal waits in both EDs due to the shortage of medical staff. The bed position has improved through March which can be seen in the improved 95

th percentile time for admitted patients to 10:35 hours

from 12:59 hours in February. A Doncaster Urgent Care Improvement Plan has been developed and shared with the System Resilience Group and the A&E Delivery Board. This includes a recovery trajectory for A&E 4 hour performance and actions aligned to national initiatives and the CCG Delivery Plan, spanning attendance avoidance, patient flow in the ED, admission avoidance, patient flow in hospital and the discharge process.

Handovers – numbers waiting

over 60 min

Jul 16 Aug 16 Sep 16 Oct 16 Nov 16 Dec 16 Jan 17

4 15 28 5 8 12 66

Due to the continued pressure in January further handover delays were experienced, however YAS have reported that demand has eased during February.

Cancelled Operations

(target <0.8%)

Jul 16 Aug 16 Sept 16 Oct 16 Nov 16 Dec 16 Jan 17 Feb 17

1.2% 1.1% 1.4% 1.5% 1.5% 1.8% 1.8% 1.3%

Cancelled operations (on the day of operation) decreased to 1.3% in February 2017.

Cancelled Operations - 28 Day

Standard

July 16 Aug 16 Sept 16 Oct 16 Nov 16 Dec 16 Jan 17 Feb 17

1 3 3 1 1 6 1 2

There was 1 breach of the 28 day standard during January which is an improvement of 5 from December. All patients cancelled last minute in December and not re-booked within 28 days have now had their operations.

Two week wait from referral to date first seen: symptomatic

breast patients (target 93%)

June 16

July 16

Aug 16 Sep 16 Oct 16 Nov 16 Dec 16 Jan 17

93.8% 92.5% 97.9% 100% 93.5% 100% 93.2% 93.1%

England Average 92.0% 92.2% 92.2% 92.2% 96.1% 96.1% 95.2% 93.8%

Two week wait from referral to date first

seen: all urgent cancer referrals

(cancer suspected) (target 93%)

94.0% 94.5% 94.4% 94.4% 95.3% 94.3% 94.6% 90.4%

England Average 93.9% 94.4% 94.0% 94.1% 94.8% 95.1% 95.5% 94.0%

31 day wait from diagnosis to first

definitive treatment (target 96%)

98.6% 100% 100% 100% 99.1% 99.2% 100% 99.2%

10

England Average 97.6% 97.7% 97.3% 97.3% 97.3% 97.2% 97.9% 96.5%

31 day wait for subsequent

treatment – surgery (target 94%)

100% 100% 100% 100% 100% 100% 100% 94.1%

England Average 96.3% 96.0% 95.3% 95.2% 95.7% 94.6% 95.5% 94.1%

31 day wait for subsequent

treatment – anti cancer drug

regimen (target 98%)

100% 100% 100% 100% 100% 100% 100% 100%

England Average 99.4% 99.3% 99.4% 99.2% 99.3% 99.5% 99.5% 98.9%

31 day wait for subsequent treatment –

Radiotherapy (target 94%)

100% 100% 100% 100% 100% 100% 100% 100%

England Average 97.1% 97.3% 96.6% 96.5% 97.3% 97.8% 98.2% 96.2%

62 day wait for first treatment from

urgent GP referral to treatment (target

85%)

86.0% 86.6% 86.2% 84.7% 81.0% 85.8% 80.8% 85.2%

England Average 82.5% 82.1% 82.6% 81.2% 80.9% 81.9% 82.7% 79.4%

62 day wait for first treatment from NHS

cancer screening service referral

(target 90%)

100% 100% 87.0% 94.7% 90.9% 83.3% 100% 87.5%

England Average 92.1% 92.5% 92.9% 91.8% 91.4% 92.5% 93.5% 90.6%

Cancer Summary The Two week wait from referral to date first seen: all urgent cancer referrals and 62 day wait for first treatment from NHS cancer screening services both failed to meet target during January 2017. Key issues are patient choice and the Trust’s staffing capacity in dermatology, urology and gynaecology. The issues in dermatology and gynaecology are directly related to staff sickness. In regards to the 2 week wait measure, patients are contacted when they cancel their appointment within 14 days in order to highlight the importance of

11

been seen at the earliest possible date. Patient choice is still counted as a breach. Work is ongoing to improve 62 day waiting times standards including:

Monitoring via flagging at days 28, 30 and 50

Individual breach reports discussed with MDT to embed learning, and also analysed with the CCG and Clinical Lead

Capacity and Demand modelling both within Care Groups and in conjunction with the CCG

Trust and CCG joint involvement in the Cancer Alliance and work streams

Outliers (Daily averages)

Medicine to Orthopaedics Medicine to S12 Medicine to surgery Medicine to gynaecology

December 2016 January 2017

Most Outliers

Least Outliers

Average Outliers

Most Outliers

Least Outliers

Average Outliers

10 3 7 12 0 6

12 2 6 6 0 3

26 13 20 27 6 14

16 4 10 11 2 6

The number of outliers is monitored and is raised through appropriate joint Trust and CCG Groups as necessary. The trend for the amount of outliers from medicine to surgery has continued to rise during January 2017.

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CQUINs

2016/17

1 Patient Safety Achieved Q3

This CQUIN was developed to ensure patient safety is maintained and improved based on 15/16 attainment. The target areas are as follows – Process reliability measurement and improvements in safety critical steps:

Prevention of delayed diagnosis in ED

Ensuring the results of tests and investigations are appropriately acted upon

Reducing avoidable falls by demonstrating assessment, care management plans and actions are completed

Managing deterioration Outcome measure and improvement of prevention of falls

5% Reduction in repeat fallers

Any reduction in avoidable harm with reduced death and severe harm from in-patient falls and to establish a moderate harm baseline

Follow up of SI investigations including an audit to include follow up of investigations in relation to falls, to understand where problems have occurred and to measure how changes have reduced falls based on investigation outcomes. The effectiveness for prevention in delayed diagnosis in ED will be illustrated via a reduced rate of SIs via:

Audits

Investigation of IT systems

Missed fracture reporting

Education

Process mapping The work in ED (prevention of delayed diagnosis in ED) continues to focus on reducing misdiagnosis of fractures or other imaging findings and the tables below show that there have been no serious incidents and those that have consist of a mixture of issues related to ED activity and demand.

Cumulative to end Q3 16/17

Asthma - failure/delay in diagnosis

Diagnosis - other

Fracture - Dx failed or delayed

Some other medical condition Total

Delay in diagnosis for no specified reason 0 6 3 2 11

Delay/failure in acting on complication of treatment 2 1 1 0 4

Diagnosis - wrong 0 0 1 0 1

Diagnostic images / specimens - inadequate / incomplete 0 1 1 1 3

Failure/delay to order correct tests, image etc 0 0 0 1 1

History insufficient or symptoms unaccounted for 0 0 0 1 1

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Total 2 8 6 5 21

A working group has been established for improving compliance of following up from tests which shows 80% of the ICE system results being read on the system with some printed reports still being used. Plans were made to connect ICE to CAMIS and this is proving useful. Additionally a pop up message has been introduced on the electronic system for all users when they sign in and warns the user of their duty to comply with policy to review tests and act on results. There was 1 SI reported in Q2 from an incident that occurred in 2011. Incidents for Q1 and 2 are shown below.

Cumulative to end Q3 16/17

None (No harm caused)

Low (Minimal harm caused - Non-permanent up to 1 month)

Severe (Permanent or long term harm caused) Total

General medicine 2 1 0 3

Emergency Department / A & E 0 2 0 2

Gastroenterology 1 1 0 2

Medical Imaging 2 1 0 3

Paediatrics 2 0 0 2

Cardiology 0 1 0 1

Care of the Elderly Medicine 0 1 0 1

General Surgery 1 0 0 1

Maternity 0 2 0 2

Medical other 0 1 0 1

Gynaecology 1 0 0 1

Thoracic/Respiratory medicine 0 0 1 1

Clinical haematology 1 0 0 1

Trauma and orthopaedics 1 1 1 3

Total 11 11 2 24

A policy for enhanced care assessment and support has been developed and approved, with the clinical records committee review of the updated falls care plan and the enhanced care assessment tool being taken forward with design to prepare for the implementation roll out. The falls action plan has been presented to the Acute Clinical Quality Review Group. The implementation plan is to be rolled out to all adult areas and is scheduled for 1st March. MSK&F care group and Bassetlaw site have already implemented the tool, as piloted and developed across these areas. 88%(Q1) and 90% (Q2) and 86% (Q3) of incidents reported about deterioration were reported as having no harm. The monitoring of vital signs is being changed to focus on clinical observation safety steps with a separate fluid balance chart completion. This is part of an improvement change to support sepsis and AKI management identified from learning from past serious incidents.

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Repeat fallers are below trajectory based on 15/16. In quarter 1 there were 31 repeat falls and in Q2 there were 29 and in Q3 there were 31 which are all below the trajectory set at 40. All severe harm and death from falls are reported as a serious incident and to date there have been 6 reported. The Trust is also identifying patients who have fallen and have a diagnosis of Dementia. This is between 5 – 10% month on month and data over past years has shown a statistically significant reduction in the number of falls in this patient group. In the first 2 quarters there have been 31 falls for patients with Dementia across the 3 Trust sites. Follow up of SI investigations and audits have identified themes and trends which are shown below:

Falls risk assessment compliance

Documentation of risk and patient management plans

Post fall management issues

Falls risk assessment tool deficit The Trust are forecast to achieve Q4 milestone

2 End Of Life Achieved Q3

Joint MDT reviews continue to be undertaken on a monthly basis and has a wide membership which has included attendance from a GP and Care Home Manager. The MDT form has been reviewed to capture whether patients have accessed acute and either Dementia, Children’s Community, Mental Health or LD services. The joint MDT meetings continue to be beneficial on other areas of joint working such as:

Improving general communication and professional working relationships

Raising awareness of services between professionals and providers

Raising awareness of the skill set in each part of the pathway

Informing the service review process Action logs continue to be developed, reviewed and moved forward. Themes identified are as follows:

Communication

Documentation

Systems

Patient Transfers

Staff Education

Medication Within Q3 there was a discussion of a case that had been brought to the attention by the CCG and in doing so enabled a thorough review of multifactorial elements and was an excellent example of the kind of progress this group has made. The Trust are forecast to achieve Q4 milestone

3 Discharge Pathways Achieved Q3

The CQUIN has continued from last year where a Community Nursing form was developed and implemented. The process for information sharing was agreed between providers and the interface between organisational patient record systems is being discussed as part of the local digital roadmap work stream. The review of the audit/case note review tool continues to be undertaken where themes and trends have been identified and fed through to an action log which is taken forward by the multi-disciplinary team. In quarter one the Older Peoples Mental Health and Learning Disability business divisions from RDASH inputted into the group and are currently reviewing the documentation to ensure their patients are fully considered as part of the MDT process.

15

The group have continued to update the directory of services (which include referral information) which provides staff with information on where to signpost patients and carers to relevant services. This includes voluntary sectors and is being broadened to include Learning Disability and Older Peoples Services. This has been shared and published further throughout the Trust DBHFT in conjunction with RDASH have developed an education plan and training pack which is delivered by the Discharge Planning Team Sister. Staff have attended sessions and work is starting on developing an e-learning package. The discharge passport launched as part of the 2015 CQUIN informs patients and carers of the discharge process and views are obtained via a post discharge follow up telephone call. An audit of this is currently being undertaken. Views of patient carers and staff are also gained from patient experience reports and feedback processes. Staff log formal feedback in Datix and retain copies of the positive feedback in professional portfolios. The Trust are forecast to achieve the Q4 milestone

4 Pressure Ulcer Reduction (Year-end payment)

This is an end of year trajectory of a 5% reduction set against last year’s outturn. The Trust has reported the following to date

Pressure Ulcers 2016/17

Q1 Q2 Oct Nov Dec Q3

Ungradeable

3 6 1 1 3 5

Cat 3

3 3 2 2 1 5

Cat 4

1 0 0 0 0 0

Deterioration 2 – 3

1 0 0

The Trust are forecast to achieve the Q4 milestone

5 NATIONAL Health and Wellbeing

Achieved Q3

The Trust have provided a plan to promote 3 main initiatives

Introducing a range of physical activity schemes for staff

Improving physiotherapy services for staff

Introducing a range of mental health initiatives for staff. The CCG provided some feedback on this plan which included the need for set trajectories in year. This feedback has been acted upon and the plan has been signed off. The Trust submitted a national data return to UNIFY which provided information on a number of areas in relation to food provided to patients, staff and visitors. This included:

Franchises

Suppliers of vendors

Type of sales outlet

Supplier contract dates, values and finance information

Profit share agreements

Volume of sugar sweetened beverages The Trust have early reported that they have achieved over 75% of front line staff having received a flu vaccination this year and therefore met the target ahead of the Q3 milestone. They have been approached by several other Trusts to share

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their process given the high success rate they have achieved. The Trust are forecast to achieve the Q4 milestone

6 NATIONAL Sepsis

The Trust has provided data against the Sepsis indicators. The first is in relation to timely identification and treatment in emergency departments and the second covers inpatient wards. Both expect that a review of antibiotics prescribed is carried out within 72 hours. ED attainment

Q1 Q2 Q3 Q4

Screened 54% 74% 86.6%

Timely provision of Antibiotics 39%* 80% 64%

72 Hour review completed 86%

* agreed deferment due to changes in NICE guidance Ward attainment

Q1 Q2 Q3 Q4

Screened 43% 92% 75%

Timely provision of Antibiotics 42% 75% 67%

72 Hour review completed 86%

The Trust are forecast to partially achieve the Q4 milestone

7 National Cancer 62 Days Achieved Q2

The Trust achieved 85% for Q3 against a trajectory of 85% for patient’s first treatment from Urgent GP referral within 62 days. Root cause analysis has been undertaken on long wait cases (more than 104 days) and clinical review has also been undertaken. No serious incidents have been identified as part of this process. Below is the data provided by the Trust. Clinical views sought have not identified any change to treatment intent, therefore, no apparent harm has been identified. To help improve the output from this process, the clinical harm outcome review will be altered to allocate a code to the outcome. These are:

No apparent harm at the time of review

No preventable harm – safe clinical practice with complex pathway and treatment

Treatment intent has changed The Trust are forecast to achieve Q4 milestone

8 NATIONAL Antimicrobial Resistance Achieved Q3

The data for 14/15 and 15/16 has been submitted onto the National dataset system. The most recent prescribing data shows that the: Total antibiotic consumption per 1000 admissions is 7.28% fewer. Total consumption of carbapenem per 1000 admissions is 1.24% higher, however it should be taken into account that the Trust already had a very low baseline and although there is a slight increase the Trust prescribe 31.3% less against England average and are well below the national average. Total consumption of piperacillin-tazobactam per 1000 admissions is 6.65% fewer. This is a quarter 4 payment based on a 1% reduction at year end. Additionally 72 hour review trajectories have been set nationally. The table below shows the attainment each quarter.

Q1 Q2 Q3 Q4

72 hour review of Anti-biotic Prescriptions

89.3% 91% 91%

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Local Intelligence Issues

Time Period Aug 2016 Sept 2016 Oct 2016 Nov 2016 Dec 2016

Stroke: Proportion of patients scanned under 1 hour of clock start (target

48%)

55.1% 52.2% 47.8% 56.0% 54.3%

Stroke: Proportion of patients directly admitted to a stroke unit under 4

hours (target 90%)

67.3% 71.1% 60.9% 66.0% 62.9%

Stroke: Proportion of eligible patients

(according to the RCP guideline minimum

threshold) given thrombolysis (target 90%)

100% 100% 100% 100% 100%

Stroke: Proportion of applicable patients

receiving a joint health and social care plan on

discharge (target 90%)

97.7% 92.3% 94.4% 85.0% 93.1%

Stroke: Percentage of patients treated by a stroke skilled early

supported discharge team (target 40%)

70.5% 60.0% 78.4% 71.1% 70.6%

Stroke: Percentage of applicable patients who

are discharged who were given a named person to contact after discharge

(target 95%)

95.5% 95.0% 97.2% 82.2% 79.4%

Stroke: TIA patients assessed and treated within 24 hours (target

60%)

80.0% 77.3% 77.8% 85.7% 64.3%

Stroke Summary Two measures failed to achieve target in December; the Proportion of patients directly admitted to a stroke unit under 4 hours and the percentage of applicable patients discharged who were given a named person to contact after discharge

The Trust are forecast to achieve Q4 milestone

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Thirty five patients were discharged in December; 13 were not admitted within 4 hours, 4 due to lack of stroke beds, 6 due to pathway issues mainly related to transfer from Bassetlaw District General Hospital and 3 due to the patients’ conditions. The stroke pathway process has been reviewed to improve direct access for CT Angiography and a new assessment area in the Emergency Department for stroke assessment is being identified. The number of direct access beds for hyper acute stroke is being increased across the stroke unit. Pathways for the stroke service out of the hospital to Mexborough Montagu Hospital and early supported discharge are being reviewed to ensure adequate bed capacity.

Rotherham, Doncaster & South Humber NHS Foundation Trust

Governance

Time Period

Nov 2016 Dec 2016 Jan 2017 Feb 2017 Mar 2017

Number of serious incidents reported

6 12 11 18 11

Contractual Actions

No contractual actions were undertaken during March 2017.

Patient Experience

Friends and Family Test Mental Health

The percentage of patients who recommended mental health services at RDASH fell to 83% in January, below the England average. Detailed comments for all FFT areas are shared with DCCG’s Patient Experience Manager and the Trust share learning across their service teams.

Friends and Family Test Community

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The percentage of people recommending community services improved in January and was above the national average. As above these results are shared with DCCG’s Patient Experience Manager and the Trust share learning across their service teams.

Workforce

Time Period

February 2017

Overview by exception Skelbrooke – One red rating for the month of February 2017 on a day shift for qualified staff which was due to staff sickness. The bed manager was made aware and a plan put in place that staff from open wards would assist where necessary. Coral – One red rating for the month of February 2017 on day shift for qualified staff due to long term sick leave. The shortfall was made up by non-professionally qualified staff. Hawthorne - Red ratings in February 2017 on both day and night shifts for qualified staff. Red ratings due to long term sickness and maternity. Recruitment drive underway. Magnolia - One red rating for February 2017 on day shift for qualified staff. Red rating due to redeployment and suspensions. The ward has improved slightly utilising bank and agency staff. Jubilee - Red rating for the month of January 2017 on day shift for non-professionally qualified and two red ratings for February 2017 on day and night shifts for non-professionally qualified. This was due to sickness, long term and last minute, and being unable to find cover.

Safety

Time Period

Aug 16 Sept 16 Oct 16 Nov 16 Dec 16 Jan 17 Feb 17

Number of Never Events

0 0 0 0 0 0 0

MRSA (cumulative during financial

year)

0 0 2 2 2 2 2

Both were classed as unavoidable to RDASH with no lapses in care identified.

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Operational Effectiveness

Time Period

Aug 16 Sept 16 Oct 16 Nov 16 Dec 16 Jan 17 Feb 17

Improved access to psychological services - the

proportion of people who complete

treatment who are moving to recovery

(Target – 50%)

52.4% 53.7% 58.5% 50.0% 50.6% 54.5% 56.2%

Improving Access to Psychological

Therapies (IAPT), cumulative – Access

(Target 4.38% per quarter, 17.5%

annually)

8.6% 10.2% 12.0% 13.8% 15.2% 17.0% 18.6%

IAPT – Reliable Improvement (no

target)

69.1% 73.7% 72.3% 72.0% 68.8% 73.5% 73.0%

Percentage of referrals to IAPT who

have received 1st

treatment within 6 weeks (target 75%)

78.7% 87.7% 87.6% 87.6% 90.2% 87.0% 89.8%

Percentage of referrals to IAPT who

have received 1st

treatment within 18 weeks (target 95%)

99.5% 99.4% 99.3% 99.1% 99.6% 99.7% 99.6%

IAPT DNAs 13.5% 12.5% 11.4% 11.2% 11.7% 11.9% 12.8%

Adults receiving a 12 month S117 review compliance (Target

94.1% 94.9% 94.6% 94.2% 95.1% 93.0% 93.7%

There are a total of 36 patients currently awaiting a review, a number of

C-diff Actual

(cumulative during financial year)

1 1 1 1 1 1 1

These cases are attributed to NHS Doncaster CCG and apportioned to RDASH. If RDASH services are involved in the clinical management of the patient the root cause analysis is carried out by the RDASH Infection Prevention and Control Team.

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95%)

which are not actively engaging with mental health services. This indicator is being reviewed at the joint meeting between commissioners and providers monthly to ensure that reviews are completed where possibly in a timely manner.

The percentage of older people

requiring non urgent treatment (mental

health) who receive treatment within 6

weeks of assessment (8 week pathway)

(Target 85%)

82.6% 72.3% 85.8% 77.2% 86.3% 86.9% 83.3%

The percentage of new patient waits for

podiatry within 18 weeks incomplete waits (target 95%)

100% 100% 100% 100% 100% 100% 100%

The percentage of patients seen within 18 weeks of referral to Evergreen Falls Prevention Service incomplete waits

(target 95%)

100% 100% 100% 100% 100% 100% 100%

The percentage of patients seen within 18 weeks of referral

to Dietician incomplete waits

(target 95%)

96.1% 100% 100% 100% 100% 100% 100%

Percentage of urgent referrals to CAMHS triaged within 24 hours of receipt

(target 95%)

100% 100% 99.2% 100% 100% 100% 100%

Percentage of non-urgent CAMHS

referrals assessed within 4 weeks

(target 95%)

81.0% 94.1% 86.0% 90.6% 96.1% 90.0% 95.6%

(New local measure) Percentage of

CAMHS patients classed as an

emergency who are assessed within a

100% 100% 100% 100% 100% 100% 100%

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maximum of 4 hours (target =>98%)

Percentage of assessed CAMHS

patients starting their treatment plan within

8 weeks of referral (target 98% for

2016/17)

92.6% 94.7% 85.3% 93.9% 92.3% 94.7% 97.3%

There was 1 breach during February. The service is currently extending the weekend sessions as required. Staff are being transferred between clinical pathways and the service is exploring the use of appropriate agency staff to provide additional support with the current referral demands.

CQUINs

2016/17

Quarter 1 The quarter 1 evidence was received and a breakdown of achievement was provided in the October 2016 Governing Body Report.

Quarter 2 The quarter 2 evidence was received and a breakdown of achievement was provided in the January 2017 Governing Body Report.

Quarter 3 The quarter 3 evidence was received and a breakdown of achievement was provided in the March 2017 Governing Body Report.

Quarter 4 The quarter 4 evidence has now been received by the Trust and a breakdown of achievement will be provided within the next Governing Body Report.

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SECTION 2: OTHER COMMISSIONED SERVICES 2.1 FCMS

Urgent Care Centre

June 16

July 16

Aug 16

Sept 16

Oct 16

Nov 16

Dec 16

Jan 17 Feb 17

FCMS – Urgent Care Centre (UCC) Performance against

4 hour A&E target

100% 100% 99.9% 100% 100% 100% 100% 100% 100%

Out of Hours

Definitive Clinical Assessment

Jun 16 Jul 16 Aug 16 Sept 16 Oct 16 Nov 16 Dec 16 Jan 17 Feb 17

Telephone clinical assessment - <20 min

(target 95%)

98.32% 97.34% 99.00% 98.27% 98.59% 98.04% 97.05% 96.67% 97.91%

Telephone clinical assessment - <60 min

(target 95%)

96.50% 89.40% 98.83% 99.25% 98.49% 94.29% 94.64% 92.71% 95.82%

Surgery Jun 16 Jul 16 Aug 16 Sept 16 Oct 16 Nov 16 Dec 16 Jan 17 Feb 17

Face to face assessment (base) – triaged as emergency in <1 hour (target 95%)

100.0% (5/5)

81.82% (9/11)

75.00% (6/8)

28.57% (2/7)

75.00% (3/4)

100% (2/2)

84.62% (11/13)

82.35% (14/17)

75.00% (6/8)

Face to face assessment (base) –

triaged as urgent in <2 hours (target 95%)

89.03% (138/ 155)

71.50% (143/ 200)

90.27% (167/ 185)

86.76% (118/ 136)

89.69% (173/ 194)

80.33% (196/ 244)

81.76% (241/ 296)

88.86% (311/ 350)

83.83% (254/ 303)

Face to face assessment (base) –

triaged as urgent in <6 hours (target 95%)

97.72% 97.35% 98.16% 97.88% 98.10% 98.32% 98.01% 98.56% 98.27%

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Face to face assessment within 1 hour: 2 cases were not seen within time, these may have been either the earliest available appointment or by patient choice. Face to face assessment urgent 2 hour cases: 49 cases were not seen within time, details of these below;

Six breaches were due to reporting issues and should not have been

recorded as breaches.

Seven of these cases were due to the patient arriving late for their

appointment.

Nineteen of the cases that are over the two hour period may have been due to

either patient choice or that time was the first available appointment. All cases

were completed with a green priority.

Three cases breached due to a re-triage time from NHS 111 calls. Emails

have been distributed to staff ensuring that appointments are now booked

from the time displayed on the NHS111 consultation.

Fourteen cases were a breach caused by clinician delay.

Visits Jun 16 Jul 16 Aug 16 Sept 16 Oct 16 Nov 16 Dec 16 Jan 17 Feb 17

Face to face assessment (visit) –

triaged as emergency in <1 hour (target 95%)

50.0% (2/4)

60.0% (3/5)

83.3% (5/6)

100% (3/3)

60.0% (3/5)

100% (2/2)

83.33% (5/6)

36.36% (4/11)

85.71% (6/7)

Face to face assessment (visit) –

triaged as urgent in <2 hours (target 95%)

72.0% (36/50)

89.2% (58/65)

92.7% (38/41)

75.8% (47/62)

81.4% (48/59)

87.5% (35/40)

69.49% (41/59)

85.33% (64/75)

84.85% (56/66)

Face to face assessment (visit) –

triaged as urgent in <6 hours (target 95%)

96.6% 96.3% 98.7% 99.0% 98.8% 99.4% 92.75% (243/ 262)

97.12% 96.15%

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Performance has improved for visits with February 2017’s figures higher than at the same point last year. Face to face 1 hour visit: 1 case was not seen within time however this was incorrectly recorded as a red priority and should have been a green priority and would have met target. Face to face 2 hour visit: 10 cases were not seen within time due to capacity available within the ECP service. Due to the high volume of work load of ECPs, visits that have been given an amber or red priority by GP should not be passed to ECP and the GP themselves will now do these visits. This is due to both workload and priority of the patient. Same Day Health Centre

Jun 16 Jul 16 Aug 16 Sept 16 Oct 16 Nov 16 Dec 16 Jan 17 Feb 17

Face to face appointment – triaged as emergency seen in <1 hour (local target

95%)

32.00% (8/25)

66.67% (20/30)

58.33% (14/24)

50.00% (12/24)

66.67% (10/15)

56.00% (14/25)

81.25% (13/16)

85.00% (17/20)

75.00% (12/16)

Face to face appointment – triaged as emergency seen in <2 hours (local target

95%)

74.09% (143/ 193)

72.56%(119/ 164)

69.87% (109/ 156)

71.19% (126/ 177)

85.63% (143/ 168)

79.47% (151/ 190)

82.32% (163/ 198)

85.20% (167/ 196)

83.90% (172/ 205)

Face to face appointment – triaged as emergency seen in <24 hours (local target

95%)

99.21% 99.69% 99.62% 99.66% 99.40% 100% 99.75% 99.68% 100%

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Amber and red performance for February 2017 is higher than at the same point in 2016. Face to face 1 hour: 4 cases were recorded as not seen within time due to a mixture of patient choice, appointment availability and clinician delay. Face to face seen within 2 hours: 33 cases were recorded as not seen within time:

Eighteen of the cases that are over the two hour period may have either been

the first available appointment or due to patient choice. All cases were

completed with a green priority.

Two due to reporting issues and should not have been recorded as breaches

Twelve cases were due to clinical delay of ranging from a 49 second delay to

a 37 minute delay.

One case breached due to the patient going to the wrong location

2.2. Yorkshire Ambulance Service (YAS) Performance during Ambulance Response Programme Pilot

June July August September October

1st

to 19th YTD at Sept

Red < 8 min 62.5% 63.2% 66.8% 65.4% 68.3% 65.0%

Amber R < 19 min 89.4% 58.8% 83.4% 76.8% 74.3% 78.6%

Amber T < 19 min 66.7% 53.4% 73.6% 63.5% 63.6% 67.2%

Amber F < 19 min 62.5% 55.7% 74.1% 69.6% 67.4% 72.2%

Green F <60 min 100% 76.0% 82.5% 90.8% 96.1% 77.1%

Green T <60 min 78.9% 68.1% 74.9% 73.4% 67.4% 73.3%

Green H <60 min 100% 97.5% 99.2% 100% 100% 99.8%

Please note that performance standards for the new categories have not yet been confirmed.

YAS is continuing to participate in NHS England’s Ambulance Response Programme (ARP) pilot. The next stage, Phase 2.2, has been developed by listening to feedback from ambulance staff, GPs, healthcare professionals (HCPs) and patients and was implemented from 20 October 2016.

This revised process will give four main options for ambulance responses:

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Cardiac arrest or peri-arrest (Purple response standard - within 8 minutes) Life-threatening emergency (Amber response standard - within 19 minutes) Serious but not life-threatening emergency (Yellow response standard - within

40 minutes) Non-emergency (Green response standard - 1 to 4 hours)

November December January February March

Category 1 < 8min

59.3% 58.4% 59.5% 60.1% 64.6%

Category 2T < 19 min

72.9% 67.4% 66.7% 70.7% 75.3%

Category 2R < 19 min

78.9% 81.4% 83.3% 82.1% 82.2%

Category 3T < 40 min

69.4% 64.5% 63.8% 65.5% 77.6%

Category 3R < 40 min

79.2% 64.9% 74.9% 77.1% 85.0%

Category 4 < 90 min

76.4% 64.8% 72.8% 64.9% 66.8%

Category 4H (triage) < 90 min

96.6% 94.6% 98.2% 100% 100%

00:08:05 00:09:00 00:08:44 00:09:01 00:08:59

00:00:00

00:07:12

00:14:24

00:21:36

00:28:48

00:36:00

00:43:12

00:50:24

00:57:36

APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB

DD

:HH

:MM

75% Tail of performance

Category 1

Category 2R

Category 2T

Category 3R

Category 3T

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2.3 Nursing / Care Homes / Domiciliary Care Providers

The information provided within this section is taken up to 31st March 2017. Since the last Governing body meeting there have been 0 new embargo’s against admissions / new care packages placed.

At present there is 1 provider within Doncaster with an embargo in place and 1 provider with a restriction in place.

2.4 Serious Case Reviews / Lesson Learnt Reviews

There have been no new Serious Case Reviews / Lessons Learnt Reviews commissioned during March 2017. 2.5 Domestic Homicide Reviews There was a Domestic Homicide Review commissioned during November 2016. The initial meeting for this review has been held and an independent chair has been appointed. The GP records for this review have now been obtained from Capita. The health input into this case is minimal therefore a summary is required rather than a full Individual Management Review.

There has been a further Domestic Homicide Review commissioned during March 2017. The initial meeting has been held and an independent chair has been appointed. It has been agreed that the chair for both Domestic Homicide Reviews will be the same person in order for the reviews to run in parallel. The GP records for this review have been received.

00:13:11 00:14:18 00:13:56 00:13:29 00:14:55 00:14:59 00:00:00

00:28:48

00:57:36

01:26:24

01:55:12

02:24:00

02:52:48

APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB

DD

:HH

:MM

95% Tail of Performance

Category 1

Category 2R

Category 2T

Category 3R

Category 3T

SECTION 3: NHS Constitution measures The following section shows Doncaster CCG performance against the NHS Constitution standards and benchmarks against the England average and also the CCG’s RightCare Peer Group where possible. These are the 10 CCGs most demographically similar to Doncaster. They are: Hartlepool and Stockton-on-Tees CCG Barnsley CCG Durham Dales, Easington and Sedgefield CCG Wigan Borough CCG Rotherham CCG Wakefield CCG Mansfield and Ashfield CCG North East Lincolnshire CCG Darlington CCG Tameside and Glossop CCG

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Referral to Treatment

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

Commissioner Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG 92.76% 92.74% 92.62% 93.59% 93.68% 93.21% 93.01% 92.41% 92.20% 91.87% 91.45% 90.43% 90.75%

Rightcare Peer Group 92.49% 92.55% 92.27% 92.22% 92.23% 91.59% 91.17% 90.78% 90.66% 90.73% 90.48% 89.66% 90.17%

England 92.00% 92.12% 91.47% 91.67% 91.89% 91.63% 91.37% 91.02% 90.76% 90.51% 90.57% 89.79% 90.02%

Target 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92%

85%

86%

87%

88%

89%

90%

91%

92%

93%

94%

95%

Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Patients on incomplete non-emergency pathways who have been waiting no more than 18 weeks

Doncaster CCG Rightcare Peer Group England Target

31

Diagnostic Waiting Times

Patients waiting less than 6 weeks for a diagnostic test

Commissioner Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG 99.36% 99.61% 98.39% 98.99% 99.52% 99.61% 99.36% 98.78% 98.83% 99.18% 99.32% 99.25% 98.16%

Rightcare Peer Group 98.34% 99.04% 98.44% 97.81% 98.30% 98.56% 99.03% 98.63% 98.80% 98.90% 98.75% 97.68% 97.77%

England 97.85% 98.72% 98.25% 98.19% 98.57% 98.53% 98.64% 98.32% 98.52% 98.90% 98.92% 98.33% 98.27%

Standard 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99%

95%

96%

96%

97%

97%

98%

98%

99%

99%

100%

100%

Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Patients waiting less than 6 weeks for a diagnostic test

Doncaster CCG Rightcare Peer Group England Standard

32

A&E

A&E attendances under 4 hours from arrival to admission, transfer or discharge

Provider Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Doncaster & Bassetlaw NHS FT 94.44% 95.06% 93.12% 92.28% 92.78% 91.86% 94.13% 92.82% 90.73% 86.58% 84.96% 88.70% 92.70%

England 91.07% 90.01% 90.24% 90.55% 90.27% 90.97% 90.64% 89.05% 88.40% 86.20% 77.60%

Standard 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

60%

65%

70%

75%

80%

85%

90%

95%

100%

Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

A&E attendances under 4 hours from arrival to admission, transfer or discharge

Doncaster & Bassetlaw NHS FT England Standard

33

Cancer Waiting Times

2 week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP

Commissioner Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG 93.76% 97.05% 95.21% 93.68% 94.01% 93.45% 95.58% 95.70% 96.24% 95.56% 93.88% 94.73% 89.10%

Rightcare Peer Group 95.81% 95.43% 95.83% 95.19% 95.46% 95.38% 95.24% 94.61% 94.73% 95.32% 95.95% 96.48% 95.21%

England 93.55% 96.02% 94.88% 93.04% 94.04% 93.87% 94.40% 93.97% 94.12% 94.84% 95.10% 95.47% 94.00%

Target 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93%

84%

86%

88%

90%

92%

94%

96%

98%

Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG Rightcare Peer Group England Target

34

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

Commissioner Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG 93.88% 98.88% 95.00% 92.11% 96.97% 93.67% 93.33% 97.62% 100.00% 92.00% 100.00% 91.30% 88.64%

Rightcare Peer Group 94.97% 95.60% 94.84% 94.03% 93.85% 95.24% 95.96% 94.90% 95.73% 98.13% 97.45% 96.94% 95.97%

England 92.36% 94.53% 93.67% 91.58% 92.06% 91.96% 92.16% 92.19% 95.67% 96.11% 96.10% 95.19% 93.80%

Target 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93%

82%

84%

86%

88%

90%

92%

94%

96%

98%

100%

102%

Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG Rightcare Peer Group England Target

35

31-day wait from diagnosis to first definitive treatment for all cancers

Commissioner Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG 95.97% 94.19% 96.00% 92.76% 98.06% 97.24% 98.06% 97.78% 98.47% 99.24% 97.62% 98.36% 95.59%

Rightcare Peer Group 97.21% 97.40% 98.70% 97.41% 98.50% 98.35% 98.36% 97.68% 97.40% 98.29% 97.19% 98.25% 97.18%

England 96.86% 97.62% 97.65% 97.26% 97.59% 97.58% 97.71% 97.34% 97.27% 97.31% 97.20% 97.86% 96.50%

Target 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96%

88%

90%

92%

94%

96%

98%

100%

Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG Rightcare Peer Group England Target

36

31 day wait for subsequent treatment where that treatment is surgery

Commissioner Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG 85.00% 81.82% 86.36% 88.89% 100.00% 100.00% 92.86% 100.00% 100.00% 100.00% 100.00% 100.00% 94.74%

Rightcare Peer Group 96.08% 97.92% 94.83% 95.88% 93.65% 96.98% 98.34% 98.48% 97.60% 98.91% 97.12% 96.59% 97.32%

England 94.47% 95.78% 95.43% 94.53% 94.75% 96.27% 96.01% 95.73% 95.21% 95.74% 94.60% 95.53% 94.10%

Target 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94%

80%

82%

84%

86%

88%

90%

92%

94%

96%

98%

100%

Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG Rightcare Peer Group England Target

37

31 day wait for subsequent treatment where that treatment is drug regimen

Commissioner Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG 97.30% 100.00% 97.92% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Rightcare Peer Group 98.60% 99.71% 99.69% 99.71% 99.70% 99.71% 100.00% 99.72% 99.71% 99.40% 99.74% 99.68% 99.74%

England 98.55% 99.58% 99.50% 99.19% 99.51% 99.42% 99.37% 99.35% 99.18% 99.33% 99.50% 99.54% 98.90%

Target 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98%

95%

96%

97%

98%

99%

100%

101%

Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG Rightcare Peer Group England Target

38

31 day wait for subsequent treatment where that treatment is radiotherapy

Commissioner Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG 100.00% 100.00% 97.37% 100.00% 100.00% 100.00% 95.56% 97.92% 96.15% 97.44% 97.78% 96.55% 100.00%

Rightcare Peer Group 98.40% 99.64% 99.40% 98.77% 98.88% 98.58% 98.53% 98.65% 96.01% 98.64% 98.53% 98.89% 98.09%

England 95.85% 97.98% 97.74% 96.67% 97.44% 97.06% 97.30% 96.55% 96.44% 97.28% 97.80% 98.16% 96.20%

Target 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94%

91%

92%

93%

94%

95%

96%

97%

98%

99%

100%

Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG Rightcare Peer Group England Target

39

62-day wait from urgent GP referral to first definitive treatment for cancer

Commissioner Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG 75.47% 81.13% 84.21% 81.13% 83.58% 81.54% 81.16% 83.33% 75.00% 72.88% 82.76% 77.55% 71.43%

Rightcare Peer Group 80.97% 82.55% 86.45% 85.74% 83.08% 82.94% 83.62% 82.50% 81.17% 82.82% 83.03% 81.65% 83.24%

England 80.84% 80.82% 83.83% 82.60% 81.27% 82.46% 82.11% 82.60% 81.33% 80.93% 81.90% 82.86% 79.40%

Target 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85%

70%

72%

74%

76%

78%

80%

82%

84%

86%

88%

Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG Rightcare Peer Group England Target

40

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

Commissioner Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG 75.00% 87.50% 100.00% 92.31% 100.00% 100.00% 100.00% 81.82% 100.00% 75.00% 100.00% 88.89% 83.33%

Rightcare Peer Group 92.83% 97.83% 96.55% 91.01% 94.29% 95.00% 90.00% 95.29% 95.31% 96.91% 95.19% 96.67% 93.48%

England 92.68% 90.03% 92.80% 90.93% 90.79% 92.06% 92.46% 92.86% 91.86% 91.35% 92.50% 93.51% 90.60%

Target 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%

70%

80%

90%

100%

Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG Rightcare Peer Group England Target

41

62-day wait from referral from consultant upgrade to first definitive treatment for all cancers

Commissioner Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG 83.33% 88.89% 89.47% 86.36% 70.59% 69.23% 76.19% 76.92% 92.31% 82.35% 85.00% 84.62% 77.78%

Rightcare Peer Group 89.34% 85.82% 95.52% 88.98% 87.24% 90.10% 89.84% 89.05% 84.48% 85.71% 87.86% 89.05% 85.31%

England 87.65% 86.87% 89.34% 88.98% 87.23% 89.95% 88.57% 89.18% 87.81% 87.97% 89.70% 90.10% 87.00%

60%

65%

70%

75%

80%

85%

90%

95%

100%

Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG Rightcare Peer Group England

42

Mixed Sex Accommodation

Breaches of Mixed Sex Accommodation

Commissioner Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG 0 0 0 0 0 0 0 0 0 0 0 0 0

Mental Health Targets

People under adult mental illness specialities on CPA who were followed up within 7 days of discharge from psychiatric inpatient care during the period

Commissioner 2014-15 q2 2014-15 q3 2014-15 q4 2015-16 q1 2015-16 q2 2015-16 q3 2015-16 q4 2016-17 q1 2016-17 q2 2016-17 q3

Doncaster CCG 98.18% 98.28% 100.00% 100.00% 97.14% 100.00% 96.67% 100.00% 100.00% 100.00%

Rightcare Peer Group 99.24% 99.22% 99.41% 97.75% 97.80% 98.38% 97.82% 98.97% 95.65% 97.78%

England 98.49% 97.82% 98.15% 96.32% 96.97% 97.37% 98.17% 98.11% 98.40% 96.70%

Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

92%93%94%95%96%97%98%99%

100%101%

2014-15 q1 2014-15 q2 2014-15 q3 2014-15 q4 2015-16 q1 2015-16 q2 2015-16 q3 2015-16 q4 2016-17 q1 2016-17 q2Doncaster CCG Rightcare Peer Group England Target

People under adult mental illness specialities on CPA who were followed up within 7 days of discharge from psychiatric inpatient care during the period

43

People waiting 6 weeks or less from referral to entering a course of IAPT treatment (Completed)

Commissioner Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16

Doncaster CCG 84.78% 30.00% 41.38% 45.45% 54.90% 60.00% 66.10% 72.00% 68.00% 80.00% 82.00% 83.00% 87.00%

England 83.96% 84.35% 83.41% 83.65% 84.56% 84.29% 84.82% 85.18% 86.98% 87.83% 87.71% 88.80% 89.40%

Target 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16

People waiting 6 weeks or less from referral to entering a course of IAPT treatment - Completed

Doncaster CCG England Target

44

People waiting 18 weeks or less from referral to entering a course of IAPT treatment (Completed)

Commissioner Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16

Doncaster CCG 100.00% 60.00% 72.41% 74.55% 80.39% 80.00% 84.75% 92.60% 90.00% 93.00% 97.00% 96.00% 98.00%

England 96.52% 96.37% 96.47% 96.72% 97.05% 97.22% 97.47% 97.65% 98.02% 98.25% 98.23% 98.50% 98.50%

Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16

People waiting 18 weeks or less from referral to entering a course of IAPT treatment - Completed

Doncaster CCG England Target

45

IAPT Access

Commissioner 2015-16

q1 2015-16

q2 2015-16

q3 2015-16

q4 2016-17

q1 2016-17

q2 2016-17

q3 2016-17

q4

Doncaster CCG 4.51% 8.67% 13.15% 20.53% 5.21% 10.20% 15.16% 15.16%

England 3.76% 7.49% 11.38% 15.57% 4.00% 7.81% 11.67% 11.67%

Target 3.75% 7.50% 11.25% 15.00% 3.75% 7.50% 11.25% 15.00%

0%

5%

10%

15%

20%

25%

2015-16 q1 2015-16 q2 2015-16 q3 2015-16 q4 2016-17 q1 2016-17 q2 2016-17 q3

IAPT Access Rate

Doncaster CCG England Target

46

IAPT Recovery Rate

Commissioner Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16

Doncaster CCG 48.15% 48.91% 49.30% 46.58% 45.45% 44.83% 44.74% 41.99% 42.16% 43.92% 50.29% 50.86% 51.20%

England 46.32% 47.95% 47.70% 48.19% 48.53% 48.59% 48.89% 48.72% 48.55% 48.44% 48.60% 48.80% 48.80%

Target 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%

0%

10%

20%

30%

40%

50%

60%

Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16

IAPT Recovery Rate

Doncaster CCG England Target

47

IAPT Reliable Recovery Rate

Commissioner Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16

Doncaster CCG 67.39% 30.00% 55.17% 60.00% 54.90% 55.38% 56.80% 52.10% 55.00% 62.00% 63.00% 63.00% 64.00%

England 62.38% 63.97% 63.89% 63.29% 65.15% 64.60% 64.64% 64.55% 64.55% 64.67% 64.95% 64.85% 63.94%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16

IAPT Reliable Recovery Rate

Doncaster CCG England

48

Patients starting treatment for Early Intervention in Psychosis within 2 weeks of referral

Commissioner Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Doncaster CCG 77.78% 100.00% 100.00% 77.78% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 66.67% 100.00% 100.00%

England 58.37% 65.30% 64.40% 64.95% 67.81% 73.32% 74.62% 76.62% 77.46% 76.61% 77.59% 74.38% 76.20%

Target 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%

40%

50%

60%

70%

80%

90%

100%

110%

Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17

Patients starting treatment for Early Intervention in Psychosis within 2 weeks of referral

Doncaster CCG England Target

49

Healthcare Acquired Infections

Doncaster CCG responsible cases of Clostridium Difficile (C-Diff)

Month Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17

Target 6 6 6 7 7 8 9 10 9 5 4

Target 6 12 18 25 32 40 49 59 68 73 77

Actual 3 1 6 1 17 11 6 5 5 3 1

Actual 3 4 10 11 28 39 45 50 55 58 59

Doncaster CCG responsible cases of MRSA

Month Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17

Target 0 0 0 0 0 0 0 0 0 0 0

Cumulative 0 0 0 0 0 0 0 0 0 0 0

Actual 0 0 0 0 0 0 0 0 0 0 0

Cumulative 0 0 0 0 0 0 0 0 0 0 0

0

20

40

60

80

100

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17

Doncaster CCG responsible cases of Clostridium Difficile (C-Diff)

Target Actual

SECTION 4: NHS Doncaster CCG Local Delivery Plans- Items to note There were no items of escalation this month.

Indicator Pass Condition Fail Condition Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

TA&E waiting time -Maximum waiting time of 4 hours in the A&E department

(DBHFT)

Equal to or greater

than 95%Less than 95% 95.1% 93.1% 92.2% 92.8% 91.9% 93.9% 92.6% 90.7% 86.6% 85.0% 88.7% 92.7%

11365 12632 11834 12165 11798 11555 10986 11678 11976 12225 11658 11856

Less than baseline Greater than 5% 11762 11950 12487 12047 11453 11409 11372 10869 10934 10771 9794 11271

14396 15058 14729 14396 14396 14399 13603 14396 13370 13734 13175 14679

Less than baseline Greater than 5% 13550 13797 13547 14046 14217 14303 13914 13450 13496 13334 12062 13986

7540 7935 7902 8139 7825 7688 7143 7747 7079 7376 7767 7360

N/A N/A 7811 7701 8365 8656 8245 7397 7387 6948 6981 7017 7343 7349

% of patients seen within 4 hours at DRIEqual to or greater

than 95%Less than 92% 93.3% 89.0% 89.2% 90.1% 88.0% 91.1% 89.5% 87.9% 78.9% 76.3% 84.0% 90.2%

3825 4020 3932 4026 3973 3867 3843 3931 3933 3918 3891 4496

N/A N/A 3951 4249 4122 4492 4139 4012 3985 3921 3953 3754 3337 3922

% of patients seen within 4 hours (Bassetlaw)Equal to or greater

than 95%Less than 95% 96.3% 96.1% 94.7% 94.9% 95.9% 96.7% 97.0% 93.1% 91.5% 91.3% 94.5% 94.8%

T Trolley waits in A&EEqual to or less than

12 Hours

Greater than 12

Hours0 0 0 0 0 0 0 0 0 0 0 0

TAll handovers between ambulance and A&E must take place within 15 minutes -

those over 30 minutes0 Greater than 1 75 76 75 40 81 59 62 73 124 130

TAll handovers between ambulance and A&E must take place within 15 minutes -

those over 60 minutes0 Greater than 1 11 12 11 4 15 28 5 8 12 66

Red Under 8- 8 minute response time DONC TBC TBC 68.5% 66.1% 62.5% 63.2% 66.8% 65.4% N/A

Amber R- 19 minute response time DONC TBC TBC 86.8% 79.9% 89.4% 58.8% 83.4% 76.8% N/A

Amber T- 19 minute response time DONC TBC TBC 76.2% 66.5% 66.7% 53.4% 73.6% 63.5% N/A

Amber F- 19 minute response time DONC TBC TBC 87.0% 73.4% 62.5% 55.7% 74.1% 69.6% N/A

Green F- 60 minute response time DONC TBC TBC 86.2% 76.3% 100.0% 76.0% 82.5% 90.8% N/A

Green T- 60 minute response time DONC TBC TBC 77.5% 75.9% 78.9% 68.1% 74.9% 73.4% N/A

Green H- 60 minute response time DONC TBC TBC 100.0% 100.0% 100.0% 97.5% 99.2% 100.0% N/A

Red Under 8- 8 minute response time YAS TBC TBC 73.0% 71.0% 68.1% 66.3% 70.5% 68.8% N/A

Amber R- 19 minute response time YAS TBC TBC 83.1% 77.7% 74.7% 71.6% 78.5% 75.6% N/A

Amber T- 19 minute response time YAS TBC TBC 76.8% 68.6% 66.4% 60.5% 69.6% 63.0% N/A

Q4Q3

T A&E Attendances (Type1) DBHFT

Baseline

T A&E Attendances (All) DBHFT

Baseline

A&E Attendances (DRI)Baseline

Doncaster CCG 2016/17 Performance Report Q1 Q2

A&E

Ambulance

A&E Attendances (Bassetlaw)Baseline

Doncaster CCG 2016/17 Performance Report CCG

DBHFT

RDaSH

Misc Delivery Plans

Key: T = Trust Targets

C = CCG related Targets

ND No Data Available

1

Indicator Pass Condition Fail Condition Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Q4Q3Doncaster CCG 2016/17 Performance Report Q1 Q2

Doncaster CCG 2016/17 Performance Report CCG

DBHFT

RDaSH

Misc Delivery Plans

Key: T = Trust Targets

C = CCG related Targets

ND No Data Available

Amber F- 19 minute response time YAS TBC TBC 86.8% 75.6% 72.2% 66.4% 70.9% 64.7% N/A

Green F - 60 minute response time YAS TBC TBC 92.2% 87.4% 85.1% 85.4% 88.4% 91.1% N/A

Green T- 60 minute response time YAS TBC TBC 84.2% 79.5% 77.6% 73.9% 79.2% 75.2% N/A

Green H- 60 minute response time YAS TBC TBC 99.8% 99.6% 99.7% 99.3% 99.4% 99.6% N/A

Category1- 8 minute response time DONC TBC TBC N/A 59.3% 58.4% 59.5% 60.1% 64.6%

Category2T- 19 minute response time DONC TBC TBC N/A 72.9% 67.4% 66.7% 70.7% 74.9%

Category2R- 19 minute response time DONC TBC TBC N/A 78.9% 81.4% 83.3% 82.1% 82.2%

Category3T- 40 minute response time DONC TBC TBC N/A 69.4% 64.5% 63.8% 65.5% 77.8%

Category3R- 40 minute response time DONC TBC TBC N/A 79.2% 64.9% 74.9% 77.1% 85.0%

Category4T- 90 minute response time DONC TBC TBC N/A 76.4% 64.8% 72.8% 64.9% 67.0%

Category 4H- 90 minute response time DONC TBC TBC N/A 96.6% 94.6% 98.2% 100.0% 100.0%

Category1- 8 minute response time YAS TBC TBC N/A 65.7% 64.2% 65.8% 66.0% 69.5%

Category2T- 19 minute response time YAS TBC TBC N/A 70.7% 67.3% 70.9% 71.6% 75.7%

Category2R- 19 minute response time YAS TBC TBC N/A 75.9% 76.5% 78.9% 79.9% 84.0%

Category3T- 40 minute response time YAS TBC TBC N/A 69.3% 66.2% 70.0% 68.2% 78.1%

Category3R- 40 minute response time YAS TBC TBC N/A 77.2% 71.7% 78.0% 76.3% 83.4%

Category4T- 90 minute response time YAS TBC TBC N/A 77.0% 73.0% 74.9% 65.1% 69.8%

Category 4H- 90 minute response time YAS TBC TBC N/A 95.8% 95.3% 98.0% 99.2% 99.6%

C All cancer two week waitEqual to or greater

than 93%Less than 88% 93.7% 94.0% 93.5% 95.6% 95.7% 96.2% 95.6% 93.9% 94.7% 86.4%

* The new standards are defined at the bottom of the report. The Data provided is prior to signoff via YAS and is subject to change.

Cancer

2

Indicator Pass Condition Fail Condition Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Q4Q3Doncaster CCG 2016/17 Performance Report Q1 Q2

Doncaster CCG 2016/17 Performance Report CCG

DBHFT

RDaSH

Misc Delivery Plans

Key: T = Trust Targets

C = CCG related Targets

ND No Data Available

C Two week wait for breast symptoms (where cancer was not initially suspected)Equal to or greater

than 93%Less than 88% 92.1% 97.0% 93.7% 93.3% 97.6% 97.6% 92.0% 100.0% 91.3% 93.5%

CPercentage of patients receiving first definitive treatment within one month of

a cancer diagnosis

Equal to or greater

than 96%Less than 91% 93.0% 98.1% 97.2% 98.1% 97.8% 98.5% 99.2% 97.6% 98.4% 97.3%

C 31-day standard for subsequent cancer treatment - anti cancer drug regimensequal to or greater

than 98%Less than 87% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

C 31-day standard for subsequent cancer treatments- radiotherapyEqual to or greater

than 94%Less than 89% 100% 100% 100% 95.6% 97.9% 96.2% 97.4% 97.8% 96.6% 95.7%

C 31-day standard for subsequent cancer treatments- surgeryEqual to or greater

than 94%Less than 89% 88.9% 100% 100% 92.9% 100% 100% 100% 100% 100% 100%

CPercentage of patients receiving first definitive treatment for cancer within two

months (62 days) of an urgent GP referral for suspected cancer

Equal to or greater

than 85%Less than 80% 81.1% 82.8% 81.5% 80.6% 83.3% 74.5% 71.9% 82.8% 77.6% 80.0%

CPercentage of patients receiving first definitive treatment for cancer within 62-

days of referral from an NHS Cancer Screening Service

Equal to or greater

than 90%Less than 85% 92.3% 100% 100% 100% 81.8% 100% 75.0% 100% 88.9% 87.5%

CPercentage of patients receiving first definitive treatment for cancer within 62-

days of a consultant decision to upgrade their priority status

Equal to or greater

than 85%Less than 80% 86.4% 70.6% 69.2% 76.2% 76.9% 92.3% 82.4% 85.0% 84.6% 73.3%

3

Indicator Pass Condition Fail Condition Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Q4Q3Doncaster CCG 2016/17 Performance Report Q1 Q2

Doncaster CCG 2016/17 Performance Report CCG

DBHFT

RDaSH

Misc Delivery Plans

Key: T = Trust Targets

C = CCG related Targets

ND No Data Available

T All cancer two week wait.Equal to or greater

than 93%Less than 88% 93.1% 93.1% 94.0% 94.5% 94.4% 94.4% 95.3% 94.3% 94.6% 90.4%

T Two week wait for breast symptoms (where cancer was not initially suspected)Equal to or greater

than 93%Less than 88% 93.4% 95.8% 93.8% 92.5% 97.9% 100% 93.5% 100% 93.2% 93.1%

TPercentage of patients receiving first definitive treatment within one month of

a cancer diagnosis

Equal to or greater

than 96%Less than 91% 99.3% 99.4% 98.6% 100% 100% 100% 99.1% 99.2% 100% 99.2%

T 31-day standard for subsequent cancer treatments-anti cancer drug regimensEqual to or greater

than 98%Less than 87% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

T 31-day standard for subsequent cancer treatments-surgeryEqual to or greater

than 94%Less than 89% 100% 100% 100% 100% 100% 100% 100% 100% 100% 94.1%

TPercentage of patients receiving first definitive treatment for cancer within two

months (62 days) of an urgent GP referral for suspected cancer

Equal to or greater

than 85%Less than 82% 86.6% 89.7% 86.0% 86.6% 86.2% 84.7% 81.0% 85.8% 80.8% 85.2%

TPercentage of patients receiving first definitive treatment for cancer within 62-

days of referral from an NHS Cancer Screening Service

Equal to or greater

than 85%Less than 82% 93.3% 100% 100% 100% 87.0% 94.7% 90.9% 83.3% 100% 87.5%

0 0 0 0 0 0 0 0 0 0 0

0 Greater than 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0

0 Greater than 0 0 0 1 1 1 1 1 2 2 2 2

0 0 0 0 0 0 0 0 0 0 0

0 Greater than 0 0 0 0 0 0 0 0 2 2 2 2

6 13 20 26 33 40 46 53 60 66 73

Equal to or less than

66Greater than 66 3 4 10 11 28 39 45 50 55 58 59

3 6 9 12 15 18 20 23 26 29 32

Equal to or less than

24Greater than 24 0 4 7 10 11 14 16 20 22 24 25

T

Mental Health Measure – Care Programme Approach (CPA) - The proportion of

those patients on Care Programme Approach (CPA) discharged from inpatient

care who are followed up within 7 days (stretch local target)

Equal to or greater

than 95%Less than 90.25% 100% 100% 100% 96.0% 95.8% 100% 100% 100% 100% 100% 100%

Incidence of healthcare associated infection: MRSA bacteraemia

T Incidence of healthcare associated infection: MRSA bacteraemia

T Incidence of healthcare associated infection: C. difficile

Infection Control

Mental Health

C Incidence of healthcare associated infection: C. difficile

T Incidence of healthcare associated infection: MRSA bacteraemia

C

4

Indicator Pass Condition Fail Condition Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Q4Q3Doncaster CCG 2016/17 Performance Report Q1 Q2

Doncaster CCG 2016/17 Performance Report CCG

DBHFT

RDaSH

Misc Delivery Plans

Key: T = Trust Targets

C = CCG related Targets

ND No Data Available

1.7% 3.3% 5.1% 6.8% 8.6% 10.2% 12.0% 13.8% 15.2% 17.0% 18.6%

T

Mental Health Measure- Improved access to psychological services - The

proportion of people who complete treatment who are moving to recovery

(Target)

Equal to or greater

than 50%Less than 47.50% 44.1% 46.1% 44.4% 46.6% 52.4% 53.7% 58.5% 49.8% 51.0% 54.5% 56.2%

C Mixed Sex Accommodation (MSA) Breaches CCG 0 Greater than 0 0 0 0 0 0 0 0 0 0 0 0

T Mixed Sex Accommodation (MSA) Breaches (DBHFT) 0 Greater than 0 0 0 0 0 0 0 0 0 0 0 0

T Mixed Sex Accommodation (MSA) Breaches (RDASH) 0 Greater than 0 0 0 0 0 0 0 0 0 0 0 0

TCancelled Operations - All patients who operations cancelled for non clinical

reasons to be offered another binding date within 28 days0 Greater than 0 0 2 2 1 3 3 1 1 6 1 2

T Stroke: proportion of patients scanned within 4 hours of arrival at hospitalEqual to or greater

than 90%Less than 85.5% 69.6% 70.0% 67.4% 71.2% 67.3% 71.1% 60.9% 66.0% 62.9%

T Stroke: proportion of patients scanned within 1 hour of arrival at hospitalEqual to or greater

than 50%Less than 45% 42.9% 52.5% 50.0% 53.8% 55.1% 52.2% 47.8% 56.0% 54.3%

TStroke: Proportion of patients scanned within 24 hours of first contact with a

professional

Equal to or greater

than 60%Less than 57% 66.7% 60.5% 71.8% 82.4% 80.0% 77.3% 77.8% 85.7% 64.3%

TStroke: Proportion of eligible patients (according to the RCP guideline minimum

threshold) given thrombolysis

Equal to or greater

than 90%Less than 89.9% 100% 100% 100% 100% 100% 100% 100% 100% 100%

TStroke: Proportion of applicable patients receiving a joint health and social care

plan on discharge

Equal to or greater

than 90%Less than 89.9% 87.5% 77.1% 91.7% 90.0% 97.7% 92.3% 94.4% 85.0% 93.1%

TStroke: Percentage of patients treated by a stroke skilled early supported

discharge team

Equal to or greater

than 40%Less than 39.9% 73.6% 67.6% 82.5% 66.7% 70.5% 60.0% 78.4% 71.1% 70.6%

TStroke: Percentage of applicable patients who are discharged who were given a

named person to contact after discharge

Equal to or greater

than 95%Less than 94.9% 79.2% 73.0% 82.5% 75.0% 95.5% 95.0% 97.2% 82.2% 79.4%

Other

Stroke & TIA

Mixed Sex Accommodation

Mental Health Measure- Improved access to psychological services - The

proportion of people that enter treatment against the level of need in the

general population (the level of prevalence addressed or ‘captured’ by referral

routes)

TEqual to or greater

than 16.1%Less than 15%

5

Indicator Pass Condition Fail Condition Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Q4Q3Doncaster CCG 2016/17 Performance Report Q1 Q2

Doncaster CCG 2016/17 Performance Report CCG

DBHFT

RDaSH

Misc Delivery Plans

Key: T = Trust Targets

C = CCG related Targets

ND No Data Available

C

Number of 52 week Referral to Treatment Pathways - the number of admitted

pathways greater than 52 weeks for admitted patients whose clocks stopped

during the period on an adjusted basis

0 Greater than 0 1 0 0 0 1 0 0 0 1 0

C

Number of 52 week Referral to Treatment Pathways - the number of non-

admitted pathways greater than 52 weeks for non-admitted patients whose

clocks stopped during the period

0 Greater than 0 0 0 0 1 3 1 1 1 0 0

C

Number of 52 week Referral to Treatment Pathways - the number of

incomplete pathways greater than 52 weeks for patients on incomplete

pathways at the end of the period

0 Greater than 0 0 0 4 3 2 1 1 1 0 1

T Diagnostic test waiting timesEqual to or greater

than 99%Less than 99% 99.2% 99.5% 99.6% 99.2% 99.0% 98.9% 99.2% 99.4% 99.3% 98.1% 98.1%

C Diagnostic test waiting timesEqual to or greater

than 99%Less than 99% 99.0% 99.5% 99.6% 99.4% 98.9% 98.9% 99.2% 99.3% 99.3.% 98.2%

TThe percentage of incomplete pathways within 18 weeks for patients on

incomplete pathways at the end of the period

Equal to or greater

than 92%Less than 87% 92.9% 93.1% 92.8% 92.6% 92.0% 92.1% 91.7% 91.3% 90.1% 90.30% 90.5%

CPercentage of incomplete pathways within 18 weeks for patients on incomplete

pathways at the end of the period

Equal to or greater

than 92%Less than 87% 93.6% 93.7% 93.2% 93.0% 92.4% 92.2% 91.9% 91.5% 90.4% 90.8%

Waiting Times

6

Cancer 62 Day Referral to Treatment: Improvement Update

April Governing Body Meeting

Incidence of Cancer in Doncaster is higher than the

national average, and has been increasing. Yet,

One Year Survival has improved each year, and

under 75 mortality, whilst above the national

average, has also reduced over time.

Incidence rate

Incidence of Cancer has increased from 598 cases per

100,000 population in 2001 to 659 cases in 2014.

One-year survival (Net survival index for adults). One

Year survival has increased from 59.7% surviving after

one year in 1999 to 68.9% surviving in 2014.

Under 75 Mortality

Mortality in under 75s has reduced from 208.3 per

100,000 population in 2002 to 180.3 in 2014 (however

coding prior to 2011 means the data is not directly

comparable prior to 2011. 2011 mortality was 188.4).

Over 10,000 2WW referrals have been made

each year for Doncaster patients since 2014/15,

and over 1800 patients had a first treatment in

2015/16.

2WW referrals including Breast

Symptomatic increased up to

2015/16, however they have

reduced by 108 in 2016/17

compared to the same period last

year.

April to February data has been used for all

years to provide a fair comparison to

2016/17.

First treatments have also reduced

in 2016/17 compared to the same

period last year by 188, and are 46

lower than 2014/15 and 26 lower

than 2013/14.

108

188

DCCG 62 day performance has not met the

standard since Q3 2013/14 and is currently below

the England average performance

However Doncaster patients treated by

DBTHFT have met the 62 day standard

every quarter back to Q1 15/16

Doncaster patients

treated by STHFT

are not treated

within the standard,

and this has

deteriorated.

Note: This needs to be taken in

context of the complexity of

patients treated locally vs the

Tertiary Centre, and the reasons

for delays to treatment

Analysis of breaches shows the largest reported

reason was due to referrals for treatment being

made late in the pathway from DBTHFT to STHFT

(63 patients (53% of breaches) year to date).

To improve this, the SYBND Cancer Alliance are in

the process of agreeing an Inter Provider Transfer

Policy. The policy sets out the process and content of

a referral to the tertiary centre.

This is supplemented with new

national breach allocation guidance

(left), which better incentivises both

the referring and treating provider to

ensure the patient is treated within 62

days.

This aims to clarify what work up is

needed for each tumour group in the

referring Trust, to make the referral

more streamlined and efficient, and

by what day in the pathway the

referral will be made.

More detailed breach analysis has identified that

delays within DBTHFT mainly relate to first

outpatient appointment and diagnostic waits.

April 2016 to January 2017

65% of patients not treated in 62 days YTD

had a first outpatient appointment 10 days+

after referral (whilst the standard is 2 weeks,

patients being seen as close to 7 days as

possible supports a timely pathway).

52% of patients not treated in 62 days had a delay to their treatment starting following MDT

discussion.

60% of patients not treated in 62 days YTD had a wait for diagnostics, where

either the test was more than a week after the outpatient appointment, there were delays between tests, or the histology

was delayed. The largest cause was MRI, followed by CT delays.

Please Note: This analysis shows patients who were

not treated in 62 days and each patient may have had

multiple reasons for the delay to starting treatment.

Only 20% of patients not treated in 62 days had a

delay in the MDT discussion taking place.

However patients with the following Tumour groups are the lowest proportion treated in 62 days Q1-3 16/17: Head and Neck, Lung, Urology and Lower GI.

When looking at specific tumour groups, Doncaster Patients with Breast, Gynaecological, Skin, Upper GI and Other tumour groups are being treated within the standard.

Tumour Type

Brain/Central

NervousSys

Acute

Leukaemia Breast Children Gynaecological

Haematology (xcl

Leukae) Head & Neck Lower Gastrointestinal Lung Other Sarcoma Skin Testicular Upper Gastrointestinal

Urological (xcl

Testicular) TOTAL

Total Seen 0 0 94 0 39 23 25 49 30 6 5 84 0 43 129 527

Seen by 62 days 0 0 94 0 35 16 12 32 20 5 4 83 0 37 91 429

Issues within the tumour groups

with the longest waits include:

Head and Neck

Late referrals to Tertiary Provider due

to pathway delays,

Complex treatment pathways due to

nature of tumour site

Lung

Waits for EBUS at STH,

Waiting times for PET scans,

Complexity of diagnosis

Urology

MRI demand vs capacity available,

Outpatient and Elective capacity at

both DBTHFT and STHFT

Lower GI

Delays for Endoscopy and histology

Actions already undertaken to improve

the timeliness of pathways include:Action Impact

DCCG – Doncaster Cancer Programme Board Action Plan in placecovering Prevention, Early Identification Screening and Diagnostics, Treatment and Living With and Beyond Cancer. Built from Cancer Alliance Delivery Plan, National Cancer Strategy and local intelligence

Clear actions and accountability for the Doncaster system to improve pathways,

DCCG – Quarterly Intelligence Dashboards presented to Doncaster Cancer Programme Board showing detailed pathway analysis and identified areas for improvement

Provides evidence of where to focus improvement efforts

DCCG – Detailed Breach analysis of all 62 day breaches Provides evidence of where to focus improvement efforts

DCCG – Working with the Cancer Alliance to agree the IPT Policy, develop a joint intelligence dashboard, understanding how to move towards joint accountability for improvement

Relationships formed with Providers and Commissioners across the Alliance and better understanding of the context and performance trends across SYBND Alliance footprint. Clear policy for managing referrals and transfers of care to the Tertiary Provider which incentivises treatment for patients in 62 days.

DCCG and DBTHFT – Monthly meetings between DCCG P&I andthe Cancer Performance Manager at DBTHFT and performance discussed at FPIG and Strategic Contracting Meetings.

Awareness of performance issues and holding to account

DCCG – performance updates obtained regularly from Sheffield CCG and STHFT

Awareness of performance issues and holding to account

DCCG and DBTHFT – Monthly Capacity and Demand group in place to forecast Cancer growth and map across pathways

Feeds into DBTHFT’s Care Group capacity and demand planning, but specific to forecasted growth for Cancer.

Actions already undertaken to improve the

timeliness of pathways include (Cont):

Action Impact

DBTHFT - Flagging of patients at specific days in their pathway to the consultant, MDT Coordinator and Performance Manager

Key staff prompted to proactively progress pathways with delays at various points before treatment

DBTHFT - Centralising the booking of 2WW into the Cancer Management Team and review of administration pathways to optimise

Improved level of control over when patients are booked in for their 2WW appointment, utilising knowledge of cancer pathways

DBTHFT – Implemented local delivery of Template Biopsies for Prostate Improved waiting times and less travel for patients moving this from STH to DRI

DBTHFT - PET Scanning provider changed Improved waiting times for PET scans

DBTHFT - Kingsgate Capacity and Demand model being implemented within Care Groups

Improved management of capacity vs demand

DBTHFT - Electronic transfer of referral information in place with STHFT for Lung and Urology

Improved processes to speed up referral and reduce inefficiencies

DBTHFT & DCCG - 2WW slots live on the Electronic Referral System as of April 2017 with further work underway

Work towards more streamlined processes, increased control over slots made available, whilst providing clear choice to patients

Next Steps: (draft timescales)

ActionTimeline 2017/18

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

DBTHFT & DCCG - Further implementation of the Cancer Programme Board Action Plan

DBTHFT - Business Case for new CT scanner underway

DBTHFT & DCCG - Business Case for local EBUS underway

DBTHFT & DCCG - IPT Policy Agreement

DBTHFT & DCCG - Continuation of Capacity and Demand work

DCCG – implement High Value Pathways as they are published, with providers

DCCG and DBTHFT – Review Straight to Test pathways for further improvement/ implementation

FYFV Delivery Plan impact –Radiotherapy upgrade

FYFV Delivery Plan impact – Rapid Diagnostic and Assessment Centres

DBTHFT & DCCG - STP Elective and Diagnostic Workstream –Radiology and Pathology

Through to March 2019

Through to 2021

Enc D

Item 10

Finance Report

1

Meeting name Governing Body

Meeting date 20 April 2017

Title of paper

2016/17 Finance Report February 2017 (Month 11)

Executive / Clinical Lead(s)

Hayley Tingle Chief Finance Officer

Author(s) Tracy Wyatt Deputy Chief Finance Officer

Purpose of Paper - Executive Summary

This report sets out the financial position as at the end of February 2017. The CCG is currently forecasting to achieve all of its financial targets for 2016/17. The report also outlines:

The key risk areas identified in 2016/17 planning and any current issues

A summary of the CCG Efficiency Savings plan for 2016/17 (Appendix 2)

A summary of the CCG’s Resource Allocation (Appendix 3)

A summary of the CCG’s Reserve position (Appendix 4)

Recommendation(s)

Members are asked to

Receive the report and note the financial position for 2016/17

2

Impact analysis

Quality impact

None identified

Equality impact

None identified

Sustainability impact

Nil

Financial implications

As highlighted within the report

Legal implications

None identified

Management of Conflicts of Interest

None Identified

Consultation /

Engagement (internal

departments, clinical,

stakeholder &

public/patient)

N/A

Report previously

presented at None

Risk analysis

The CCG identified a number of risks as part of the Financial planning for 2016/17. These included:

Prescribing and High Cost Drugs Expenditure

Over performance against the main acute contracts

Individual Placements

Non delivery of parts of the Efficiency Savings programme

A small contingency fund which equates to 0.5% of the CCG’s allocation was set aside to mitigate against these risks as required by the business rules. It has not been possible to flex investment reserves due to the national ring fencing of the 1% headroom and

therefore should the contingency fund not be sufficient the CCG will have to increase efficiencies, seek to risk share with other

organisations or seek additional support from NHS England.

Assurance Framework

1.2, 1.4, 2.4, 3.1, 3.2, 6.2

3

NHS DONCASTER CCG 2016/17 FINANCE REPORT MONTH 11 - FEBRUARY 2017 1. Introduction

This report provides the financial position for NHS Doncaster CCG for 2016/17 as at the end of February (Month 11). The CCG is forecasting to achieve all of its financial targets for 2016/17. 2. Current Position The year to date position reflects a surplus of £7,107k which is consistent with the year to date target of £7,079k. The annual target is a surplus of £7,722 which the CCG is forecasting to achieve. The year to date and forecast position is summarised in the Operating Cost Statement included at Appendix 1. 3. Key Messages and Risks

The largest financial risks identified as part of the Financial Planning process were Prescribing and High Cost Drugs. Work to address the variations in both outcomes and costs will be taken forward as part of the Primary Care Strategy, specifically the medicine optimisation work. A prior approval process was initiated with the Acute Trust and implemented from 1st April 2016; this was to address any non-compliance with NICE guidance and correct charging through the PbR tariff mechanism. This is having a positive impact on costs. Other risks identified include the over performance on acute contracts, increased Individual placements ( including Continuing Healthcare , Specialist Placement and Section 117 packages) and the non-delivery of parts of the efficiency savings. If the efficiency savings fail to deliver there will be increased pressure on the CCGs statutory duty to breakeven. The pressures around Emergency and A&E activity are continuing within the DBH NHS FT contract. The contract is forecast to overspend by £2m. Some of the smaller contracts are also forecast to over perform including Sheffield Teaching Hospitals, Sheffield Children’s and Barnsley NHS FT. There are also some pressures in relation to S117 and Specialist Placement activity due to increased activity levels and cases being stepped down from NHS England, however some of this is offset by a reduction in Continuing Healthcare costs. This is being be closely monitored in year. An additional risk has arisen in year in relation to the nationally agreed rates for Funded Nursing Care (FNC) which has caused an additional cost pressure of approximately £600k. Following a national review, the rate has increased by 39% from £112 per week to £156.25 per week; the CCG has had no choice but to implement this rate. The further national review on the agency element of the FNC has now been completed and will have no further impact in 2016/17. However a

4

slight reduction to the rate has been agreed with effect from 1st April 2017 to £155.05. To help manage and offset the risks a small contingency fund of £2.2m was established. This equated to 0.5% of the CCG’s allocation and is in line with planning guidance. If this is insufficient the following actions would need to be considered;

Seeking further efficiencies and decommissioning opportunities

Risk sharing with other CCGs

Seeking repayable financial assistance from other NHS organisations

Seeking further support from NHS England In previous years flexing of investment funds have supported mitigation to manage unexpected risks however this is not an option for 2016/17. 4. Efficiency Savings Programme

All contract values negotiated with providers were net of efficiency saving targets where appropriate. A summary of the schemes, current progress and forecast are shown in Appendix 2. The Prescribing LES scheme was launched earlier in the year and all practices signed up to the scheme which started in August. The scheme aims to reduce overall spend across several areas of prescribing and rewards practices with a percentage of the savings made. Information is now available for the period August to October and overall costs have increased by £464k on the same period last year after adjusting for prices and population changes. Despite the overall increase a small number of practices have reduced spend and this has resulted in an estimated gain share payment of £18k. Further updates will be provided as more information becomes available from the BSA. Savings have materialised overall in the prescribing budget as it was set net of a £5.1m efficiency target and is only forecasting an overspend of £1.7m as at Month 11. However most of these savings are fortuitous and are linked to the nationally determined Cat M prices. Savings have also materialised in the DBH contract in relation to High Cost Drugs due to the impact of transferring patients onto bio-similars and the prior approval processes. There are also some savings against other elements of the contract due to activity being lower than expected in some areas, mainly outpatients, audiology and critical care. This equates to approximately £1.2m so far this year and a forecast of £1.5m. The continuation of the rigorous controls around CHC following the review in 2015/16, are continuing to have a positive impact on the financial position with estimated savings this year of £3.5m. The total savings achieved so far across all areas are approximately £7.4m with a forecast achievement of £8.4m against an original target of £8.8m.

5

5. 1% Non Recurrent Headroom The CCG set aside £4.8m, (1% of the CCG’s recurrent allocation) as per the business rules, for non-recurrent investment. However, the CCG had to ring-fence this funding to provide funds to insulate the wider health economy from financial risk. It has now been confirmed that this funding will not be released to CCG’s for utilisation due to the wider NHS England financial position but that CCG’s need to release this against their bottom line thus increasing their surplus. For NHS Doncaster CCG this will now mean reflecting a surplus of £12.5m rather than £7.7m in Month 12. 6. Further Allocations The CCG has not received any new allocations in Month 11. 7. Capital Resource

The CCG has not received any capital funding in 2016/17. 8. Other Key Financial Targets Below is a summary table outlining all the key financial targets for the CCG, the current performance and the forecast, there are no areas of concern to be noted.

Key Duty Target Actual Forecast

Surplus Achieve annual target of £7,722k, YTD £6,435k

£7,107 £7,753k

BPPC

95% + invoices paid within 30 days (NHS)

97.70% 98%

95% + invoices paid within 30 days (non NHS)

98.59% 98%

95% + invoice values paid within 30 days (NHS)

99.92% 98%

95% + invoice values paid within 30 days (Non NHS)

98.50% 98%

Cash Drawdown

1.25% of monthly drawdown remaining at period end

1.11% 1.25%

Running Costs

Maintain spend within annual target of £6,977k, YTD £5,863k

£5,262k £6,478k

Capital Resources

Expenditure not to exceed allocation (N/A)

N/A N/A

6

Key

Red High risk - significant risk of target not being achieved

Amber Medium Risk - some issues around current performance, actions in place

Green Low risk - target being achieved, no areas of concern

9. Better Care Fund The Better Care Fund is governed via the signed Section 75 Framework Agreement with Doncaster Council, the total pooled budget is £23,907k. Both the CCG’s £14.9m and the DMBC’s £7m are funded via the CCG’s allocation. The £14.9m is made up of historical CCG contracts which are linked to common priorities with the local authority. The £7m DMBC element is used jointly for shared priorities such as Intermediate Care. The Q3 position and forecast are summarised in Table 1 below, both are in line with budget. A summary of the overall budget by theme is also shown in Table 2 for information. Table 1 – Summary of budget by commissioner

Budget £000's

Spend to Q3 £000’s

Forecast £000’s

CCG 14,902 11,178 14,902

DMBC 7,040 4,847 7,040

DFG 1,965 1,531 1,965

Totals 23,907 17,556 23,907

Table 2 – Summary of the budget by theme

Theme Budget £'000

People are independent with good health and wellbeing 4,572

When in need of care / or support it is personalised flexible & appropriate

4,322

Where people are in urgent need of care or crisis, there will be responsive services that meet their needs

14,722

Enablers 79

Programme Management 212

Total 23,907

The plans for 2017/18 are currently being developed; however as part of the Intermediate Care project providers will need time to take capacity and costs out of the system whilst transitioning to the new delivery models, therefore services will need a period of ‘double running’ to ensure safe and effective implementation to the

7

new models of care. This period of ‘double running’ whilst new services are properly established and appropriately staffed is critical to the success of the transformation programme and the BCF will be used to support this. 10. Primary Medical Care Delegated Commissioning The CCG assumed devolved responsibility for Primary Medical Care commissioning with effect from April 2016. The total allocation devolved from NHS England was £41m and expenditure is currently forecast to be contained within this budget. The financial position will be discussed regularly at the Primary Care Committee including developments for 2017/18 and implementation of the Primary Care Forward View. The CCG is currently developing an offer of a non-financial support package for vulnerable practices to enable them to become sustainable for the future. This will be taken forward through the Primary Care Committee. 11. Conclusion and Recommendations Members are asked to: Receive and note the Finance Report for February 2017 (Month 11).

8

NHS DONCASTER CLINICAL COMMISSIONING GROUP Appendix 1

2016/17 FINANCE REPORT FEBRUARY 2017

Recurrent

Budget

£000s

Non Rec

Budget

£000s

Total

Budget

£000s

Recurrent

Budget

£000s

Non Rec

Budget

£000s

Total

Budget

£000s

Forecast

Outturn

£000s

Variance

(Under)/ Over

£000s

Recurrent

Budget

£000s

Non Rec

Budget

£000s

Total Budget

£000s

YTD Actual

£000s

Variance

(Under)/

Over

£000s

Baseline Allocation -479,863 -9,722 -489,585 -479,863 -9,722 -489,585 0 -489,585

Running Cost Allowance -6,806 0 -6,806 -6,806 0 -6,806 0 -6,806

Initial Allocation -486,669 -9,722 -496,391 -486,669 -9,722 -496,391 0 -496,391

In year changes

Vanguard Q1 Sheffield Teaching Hospitals 0 -175 -175 0 -175

Q1 Eating Disorder Service 0 -173 -173 0 -173

PYE Transfer of One Health July-March 2017 -22 0 -22 0 -22

PYE Transfer of Claremont July-March 2017 -5 0 -5 0 -5

NHS Carcroft Colposcopy Contract transfer from NHS England -67 0 -67 0 -67

Transfer of NHSE support re Embed and Third Party Contracts 0 -1 -1 0 -1

Learning Disability transformation Funding to TCPs 0 -570 -570 0 -570

PYE transfer of Claremont April - June 2016 -2 0 -2 0 -2

PYE transfer of One Health April - June 2016 -7 0 -7 0 -7

GP Development Prog - reception and clerical training 0 -27 -27 0 -27

Suspended Doctors Budget Transfer back to NHSE 34 0 34 0 34

Vanguard Q2 Sheffield Teaching Hospitals 0 -194 -194 0 -194

CYP Local Transformation Mental Health M7 - NHS Doncaster CCG 0 -72 -72 0 -72

Q3 Vanguard Funding - Working Together Partnership ACC 0 -83 -83 0 -83

Q1&2 Local Evaluation Funding - Working Together Partnership ACC 0 -25 -25 0 -25

CEOV adjustment 0 447 447 0 447

Quality Premium Awards 2015/16 0 -517 -517 0 -517

ACC - WTP vanguard Q4 funding 0 -306 -306 0 -306

ACC - WTP vanguard 3rd qtr local evaluation funding 0 -13 -13 0 -13

Perinatal / IAPT underspend allocation M10 0 -25 -25 0 -25

CYP WL & WT Reduction: 2nd tranche 0 -72 -72 0 -72

Mitigate impact of NHS PS move to market rents 0 -108 -108 0 -108

Mitigate impact of NHS PS move to market rents 0 -68 -68 0 -68

0 0 0 0

0 0 0 0

TOTAL ALLOCATIONS -486,669 -9,722 -496,391 -486,738 -11,704 -498,442 0 -498,442 -445,949 -445,949 0

Acute Contracts - DBHFT 186,060 907 186,967 185,940 907 186,847 188,874 2,027 171,276 0 171,276 173,134 1,858

Acute Contracts - Other NHS 35,728 81 35,809 35,777 -371 35,406 36,232 826 31,461 0 31,461 32,247 787

Acute Contracts - Other Providers Non NHS 4,267 0 4,267 4,289 1 4,290 4,763 473 3,932 0 3,932 4,404 472

Acute Contracts - Urgent Care 2,608 0 2,608 5,829 -28 5,801 5,999 198 5,317 0 5,317 5,519 202

Acute - Non Contract Activity 5,773 0 5,773 2,608 0 2,608 2,600 -8 2,391 0 2,391 2,382 -9

Total Acute Services 234,436 988 235,424 234,444 509 234,952 238,468 3,516 214,376 0 214,376 217,686 3,310

Mental Health Contracts - RDaSH FT 34,104 610 34,714 34,153 645 34,798 34,798 0 31,739 0 31,739 31,711 -28

Mental Health Contracts - Other NHS 347 0 347 348 0 348 382 34 319 0 319 351 32

Mental Health Contracts - Other Providers 15,704 0 15,704 15,704 20 15,724 17,515 1,791 14,414 0 14,414 15,751 1,337

Mental Health - Non Contract Activity 29 0 29 29 0 29 6 -23 27 0 27 6 -21

Total Mental Health Services 50,184 610 50,794 50,234 665 50,899 52,701 1,802 46,498 0 46,498 47,818 1,320

Community Contracts - RDaSH FT 30,945 82 31,027 30,951 554 31,505 31,445 -60 28,752 0 28,752 28,758 6

Community Contracts - Other NHS 366 0 366 368 0 368 397 29 337 0 337 364 27

Community Contracts - Other Providers 10,650 0 10,650 10,752 0 10,752 11,095 343 9,856 0 9,856 10,213 358

Total Community Services 41,961 82 42,043 42,071 554 42,625 42,937 312 38,945 0 38,945 39,336 390

Prescribing 61,738 0 61,738 61,738 0 61,738 63,411 1,673 56,533 0 56,533 58,068 1,534

Oxygen Services 573 0 573 573 0 573 603 30 525 0 525 552 27

Other Primary Care Services 2,030 1,559 3,589 4,022 -183 3,839 3,863 24 3,348 0 3,348 3,373 25

GPIT 800 0 800 800 0 800 1,317 517 698 0 698 768 70

Medical Recommendations 0 0 0 0 0 0 0 0 0 0 0 0 0

Delegated Co-Commissioning 41,348 0 41,348 40,948 183 41,131 40,812 -319 35,707 0 35,707 35,289 -419

Primary Care Services 106,489 1,559 108,048 108,081 0 108,081 110,006 1,925 96,812 0 96,812 98,050 1,238

Continuing Healthcare 34,146 1,117 35,263 34,146 2,395 36,541 29,354 -7,187 33,672 0 33,672 28,175 -5,497

Continuing Healthcare Services 34,146 1,117 35,263 34,146 2,395 36,541 29,354 -7,187 33,672 0 33,672 28,175 -5,497

Non Recurrent Programmes 0 0 0 0 0 0 9 9 0 0 0 -75 -75

Non Recurrent Programmes 0 0 0 0 0 0 9 9 0 0 0 -75 -75

Medicines Management 507 0 507 507 0 507 495 -12 465 0 465 458 -7

Safeguarding 39 0 39 39 0 39 39 0 36 0 36 36 0

Mental Health Assessments 60 0 60 0 0 0 0 0 0 0 0 0 0

NHS Property Services Recharge 2,404 0 2,404 2,404 0 2,404 2,404 0 2,203 0 2,203 2,097 -107

Quality Premium 0 0 0 0 517 517 517 0 0 0 0 0 0

Corporate non running costs 3,010 0 3,010 2,950 517 3,467 3,455 -12 2,704 0 2,704 2,591 -113

Chief Pharmacist 87 0 87 87 0 87 85 -1 79 0 79 78 -1

Admin & Business Support 896 0 896 901 -102 799 810 11 294 0 294 306 11

Contract Management 413 0 413 413 0 413 441 28 379 0 379 414 35

Finance 792 0 792 792 0 792 730 -63 727 0 727 655 -72

Corporate Costs & Services 397 0 397 397 0 397 536 139 364 0 364 512 148

Human Resources 82 0 82 82 0 82 94 12 75 0 75 70 -6

Health & Safety 20 0 20 14 0 14 11 -3 13 0 13 5 -9

Patient & Public Involvement 186 0 186 150 18 168 152 -16 155 0 155 137 -19

Communications & PR 5 0 5 5 0 5 6 1 5 0 5 6 1

Performance 823 0 823 823 0 823 818 -6 755 0 755 697 -58

Quality Assurance 614 0 614 650 -18 632 535 -97 578 0 578 468 -109

Primary Care Support 208 0 208 208 0 208 132 -75 190 0 190 1 -190

Strategy & Development 962 -171 790 962 -1 960 745 -216 880 0 880 649 -232

Governing Body 1,493 0 1,493 1,493 0 1,493 1,384 -109 1,368 0 1,368 1,266 -102

Corporate Running Costs 6,978 -171 6,806 6,977 -103 6,874 6,478 -396 5,863 0 5,863 5,262 -601

Total Corporate Costs 9,988 -171 9,816 9,927 414 10,341 9,934 -407 8,567 0 8,567 7,853 -714

1% Non Recurrent Headroom Reserve 4,799 4,799 4,799 4,799 4,799 0 0 0 0 0 0

Contingency Reserve 0.5% 2,482 0 2,482 2,482 0 2,482 2,482 0 0 0 0 0 0

Investments 0 0 0 0 0 0 0 0 0 0 0 0 0

Total Reserves 2,482 4,799 7,281 2,482 4,799 7,281 7,281 0 0 0 0 0 0

TOTAL APPLICATION OF FUNDS 479,686 8,983 488,669 481,385 9,335 490,720 490,689 -31 438,871 0 438,871 438,842 -29

SURPLUS 1% REQUIREMENT* 7,722 7,722 0 -7,722 7,079 0 -7,079

TOTAL 496,391 498,442 490,689 -7,753 445,949 438,842 -7,107

* As directed by NHS England - All CCGs are required to make a surplus of at least 1%

OPERATING COST STATEMENT

Opening Budget FORECAST YEAR TO DATE

NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 2

Savings / Efficiency Programme 2016/17

Project 2016/17 Target

£000's

Achieved YTD

£000's

Forecast

£000's

Risk

Prescribing 2920 3407 Medium

DBH - move to biosimilars and prior approval processes 601 725 Medium

DBH outpatients and audiology 486 582 Medium

DBH Critical Care - non recurrent underspend 138 170 Medium

Continuing Healthcare - continuation of rigorous controls 3208 3500 Medium

Other schemes as part of Working Together and STP 0 0 Medium

2016/17 TOTAL 8,882 7,353 8,384

Note: Risk assessed on the basis of management experience

A summary of the progress in each year is summarised below -

The prescribing LES has been launched and all practices have signed up to the scheme which started in August. Information is now available

for August to October and costs have increased by £464k overall, however a small number of practices have made some savings and therefore

an estimated payment of £18k will need to be made. It should also be noted that prescribing budgets were reduced by £5.1m this year and the

budgets are only forecast to overspend by £1.4m, the majority of this saving is linked to the nationally determined Cat M prices.

DBH Contract - savings in relation to High Cost Drugs are due to the move to Bio-similars and the prior approval processes.

Other savings in relation to outpatients and audiology are also materialising due to reduced activity in these areas together with a non recurrent

underspend against critical care activity.

Continuing Healthcare - the continuation of the rigorous controls following the review of criteria is continuing to have an impact with an expected

underspend of £3.5m this year.

NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 3

SUMMARY OF RESOURCE ALLOCATIONS AS AT MONTH 11 FEBRUARY 2016

Recurrent Non Recurrent Total

£000's £000's £000's

Recurrent Baseline -438,097 -438,097

Primary Care Delegation -41,766 -41,766

Non Recurrent Surplus from prior years -9,722 -9,722

Running Cost Allowance -6,806 -6,806

Total Resources Available at Plan Stage -486,669 -9,722 -496,391

Adjustments to the Resource Limit:

Month 01 April

No adjustments 0 0 0

0 0 0

Month 02 May

No adjustments 0 0 0

0 0 0

Month 03 June

Vanguard Q1 Sheffield Teaching Hospitals 0 -175 -175

Q1 Eating Disorder Service 0 -173 -173

PYE Transfer of One Health July-March 2017 -22 0 -22

PYE Transfer of Claremont July-March 2017 -5 0 -5

Colposcopy Contract transfer from NHS England -67 0 -67

-94 -348 -442

Month 04 July

Transfer of NHSE support re Embed and Third Party

Contracts

0 -1 -1

Learning Disability Transformation Funding to TCPs 0 -570 -570

0 -571 -571

Month 05 August

PYE Transfer of One Health April - June 2017 -7 0 -7

PYE Transfer of Claremont April - June 2017 -2 0 -2

GP Development Programme - Reception and Clerical

training 0 -27 -27

-9 -27 -36

Month 06 September

Suspended Doctors Budget Transfer back to NHSE 34 34

Vanguard Q2 Sheffield Teaching Hospitals -194 -194

34 -194 -160

Month 07 October

CYP Local Transformation Mental Health M7 - NHS

Doncaster CCG -72 -72

Q3 Vanguard Funding - Working Together Partnership ACC -83 -83

Q1&2 Local Evaluation Funding - Working Together Partnership ACC -25 -25

0 -180 -180

Month 08 November

CEOV Adjustment 0 447 447

0 447 447

Month 09 December

Quality Premium -517 -517

0 -517 -517

Month 10 January

Q4 Vanguard Funding - Working Together Partnership ACC -306 -306

Q3 Local Evaluation Funding - Working Together Partnership ACC -13 -13

Perinatal / IAPT underspend allocation M10 -25 -25

CYP WL & WT Reduction: 2nd tranche -72 -72

Mitigate impact of NHS PS move to market rents (Programme) -108 -108

Mitigate impact of NHS PS move to market rents (Admin) -68 -68

0 -592 -592

Month 11 February

No adjustments 0

0 0 0Revised Resources available as at Month 11 February

2017 -486,738 -11,704 -498,442

NHS DONCASTER CLINICAL COMMISSIONING GROUP APPENDIX 4

SUMMARY OF RESERVES AS AT MONTH 11 FEBRUARY 2017

RESERVES Recurrent Non Total

Recurrent

£000's £000's £000's

RISK RESERVES AND CONTINGENCIES

1% Non Recurrent Headroom

Initial Plan 0 4,799 4,799

Budget Transfers

No transfers as at Month 11 - funding uncommitted and 0

ringfenced as per NHSE Guidance 0

0

0

0

0

0

0

0

0

0

0

0

0 4,799 4,799

0.5% Contingency

Initial Plan 2,482 0 2,482

Budget Transfers

No transfers as at Month 11

2,482 0 2,482

2,482 4,799 7,281

Cross Check to Operating Cost Statement 2,482 4,799 7,281

Enc E

Item 11

Assurance Framework Report Quarter 4

and 2017/18 starting position

Meeting name Governing Body

Meeting date 20 April 2017

Title of paper

Governing Body Assurance Framework Quarter 4 Report 2016/17 and 2017/18 starting position

Executive / Clinical Lead(s)

Sarah Atkins Whatley, Chief of Corporate Services

Author(s) Sarah Atkins Whatley, Chief of Corporate Services Assurance Framework Risk Leads

Purpose of Paper - Executive Summary

Governing Body Assurance Framework Refresh 2017/18 Alongside the last Quarter’s Assurance Framework update, Members noted the formal feedback report from a Governing Body Assurance Framework Timeout session run by our Internal Auditors, which resulted in revised corporate objectives against which the Governing Body Assurance Framework is mapped, and a list of current and emerging strategic risks to the achievement of these objectives. A new template recommended by our Internal Auditors has been developed and is attached as Appendix A, populated with the risks identified at the Timeout. Existing risks being treated at year-end on our old Assurance Framework have been mapped across to the new Assurance Framework. In summary, the risks are: CO 1 - Ensure an effective, well led, and well governed organisation.

1.1 Organisational change: If we do we not have the right skill mix and resource within the organisation, supported by our Organisational Development Strategy, we may not achieve both our local commissioning strategy and our wider collaborative commissioning commitments.

CO 2- Commission high quality, continually improving, cost effective healthcare which meets the needs of the Doncaster population.

2.1 Quality impact: Financial resource reductions could potentially affect our ability to commission for continually improving quality.

2.2. Urgent Care: If we fail to commission effective, resilient and sustainable urgent & emergency care services, the quality of care delivered to patients and the achievement of associated quality and performance targets could be adversely affected.

2.3 Primary Care: If we fail to commission effective, resilient and sustainable primary medical care services, the quality of care delivered to patients and the achievement of associated quality and performance targets could be adversely affected, and the full vision contained within the Place Plan could potentially be adversely affected.

2.4 Provider Workforce: Providers in Doncaster may not have access to a sufficiently skilled workforce to meet the outcomes identified in our

commissioning intentions. CO 3 - Ensure that the healthcare system in Doncaster is sustainable.

3.1 Transformation: If our transformation delivery plans are not sufficiently ambitious to respond to the expected growth in activity and reduction in financial allocation, we could fail to deliver the efficiency savings required to maintain financial balance across the local health system.

3.2 Efficiencies: If we do not maximise efficiency opportunities presented by areas such as Prescribing and RightCare, we may be forced to consider decommissioning services from elsewhere in order to achieve the required savings.

3.3. System affordability: If the overall Doncaster healthcare system is not affordable given the impact of external controls on CCG allocations leading to increasingly limited financial resource, this may require the CCG to undertake greater prioritisation of resource to meet the identified needs of our population.

3.4. Control total: If we do not meet our CCG control total due to the impact of external controls on CCG allocations and/or the impact of unpredicted in-year cost pressures, then we will be in breach of our statutory duties to commission efficiently, effectively and to achieve value for money, and we may not be able to commission all the services which we have identified that our population needs.

CO 4 - Work collaboratively with partners to improve health and reduce inequalities in well governed and accountable partnerships.

4.1 Dual partnership focus: We have dual areas of partnership commissioning focus - our local focus on Doncaster as a place delivering the ambition described in the Doncaster Place Plan, and our collaborative commissioning commitments within areas such as the South Yorkshire & Bassetlaw Sustainability & Transformation Plan. If these dual areas of focus dilute our local system leadership as CCG as resource is aligned both locally and across a wider collaborative footprint, this could potentially impact upon our organisational independence of decision making.

4.2 Engagement & prevention: If, across the Doncaster Place Plan footprint, we do not achieve cultural change away from a more dependant medicalised model of healthcare towards greater self-care, prevention, patient engagement & empowerment, and building on the existing strengths within communities, we may not deliver the vision contained within the Place Plan, or the efficiencies.

4.3 STP non-delivery: If the South Yorkshire & Bassetlaw Sustainability & Transformation Plan does not deliver the expected savings, greater savings will need to be identified at a Place level, and we may not be able to commission all the services which we have identified that our population needs.

Assurance Framework closing position – Quarter 4 In light of the above fundamental refresh of the Assurance Framework during Quarter 4, the existing format of the Assurance Framework has been refreshed at a relatively high level during the last Quarter and the position is presented for Governing Body approval as at quarter-end.

Risks

2015/16 2016/17 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Total number of risks on the Assurance Framework

22 22 22 20 20 21 21 20

Number of risks in excess of the toleration threshold

3 3 3 2 2 3 3 3

Number of risks in excess of toleration threshold being treated

3 3 3 2 2 3 3 3

Number of risks below the toleration threshold being treated

3 1 1 1 1 3 1 0

Number of new risks added to the Assurance Framework during the Quarter

0 0 0 0 0 1 0 0

Number of risks removed from the Assurance Framework during the Quarter

0 0 0 2 0 0 0 1

Quarter-end position:

Score Rating Number

of risks Treatment Number

of risks

1-5 Low 0 Treat 3

6-11 Medium 17 Tolerate 17

12-15 High 2 Terminate 0

16-20 Very High 1 Transfer 0

25 Extreme 0

Risks being treated as at the end of the Quarter:

Risk 1.4 relating to the challenging financial position for 2017/18+ (score of 16).

Risk 2.4 relating to provider performance (score of 12).

Risk 4.4 relating to different commissioning footprints and collaborations emerging at a rapid pace (score of 12).

All changes since the last report are presented on the Assurance Framework using Track Changes. The key updates to which attention is particularly drawn are detailed below. Health inequalities (Risk 1.3): CHANGED FROM TREAT TO TOLERATE.

Status: This risk was at a score of 8 (below the risk toleration threshold) but was being treated to strengthen controls and assurances with an action to “work in partnership with the Health & Wellbeing Board to identify inequalities and address these in partnership in line with the Health & Wellbeing Board Strategy”.

Quarter 4 update: The Equality & Diversity Strategy has been refreshed and expanded to include wider health inequalities associated with wider determinants of health, and was approved by Governing Body in January 2017. The action has therefore been completed. The additional control has been added to the list of controls and the treatment of the risk changed from Treat to Tolerate.

Efficiency programme (Risk 1.4): CONTINUES TO BE TREATED.

Status: The risk is at a score of 16 (above the risk toleration threshold) and is being treated with an action plan to “develop and implement an efficiency

programme aligned to the Right Care analysis, impact assess this against our transformation plan, and monitor progress throughout the year”.

Quarter 4 update: Progress on developing Quality, Innovation, Productivity & Prevention initiatives in response to the 2017/18 financial position is progressing well, with initiatives being identified to close the gap. However many of the initiatives are ambitious and will be challenging to achieve. The Governing Body has noted a significant risk remaining in this area. At the Governing Body meeting in January 2017, the risk was re-scored to reflect the current 2017/18 forecast position, leaving the residual risk at a score of 16. The financial position is reported monthly to Governing Body, alongside any developments. In the last Quarter a Commissioning for Value Decision Making Framework has been approved by the Governing Body. The risk remains at a score of 16 at the end of the Quarter. A risk relating to the financial position is replicated on the new Governing Body Assurance Framework from 1 April 2017.

Performance management (Risk 2.4): CONTINUES TO BE TREATED.

Status: This is an ongoing risk which the Governing Body keeps sight of on the Assurance Framework. This risk remains at a score of 12 (above the risk toleration threshold) and it is being treated with an action to “continue to take all contractual and partnership measures available to the CCG to ensure provider performance is brought back on track for key performance targets”.

Quarter 4 update: No change. The Governing Body continues to receive monthly Quality & Performance reports which identify performance areas which are off trajectory and debates recovery plans. Risks on the Risk Register capture any performance areas which are significantly off track including Urgent Care performance (A&E 4 hour wait), Referral to Treatment times (RTT 18 week target) and Cancer waits (62 day target). A risk relating to performance is replicated on the new Governing Body Assurance Framework from 1 April 2017.

Commissioning collaborations (Risk 4.4): CONTINUES TO BE TREATED.

Status: There are many different commissioning footprints and collaborations emerging at a rapid pace to address the challenges in the 5 Year Forward View. NHS Doncaster CCG is strongly engaged in the development of the Doncaster Place Plan, the South Yorkshire & Bassetlaw Sustainability & Transformation Plan, the Working Together Joint Committee (8 local CCGs), the Transforming Care Partnership, and joint commissioning for Ambulance and urgent transport services across Yorkshire & Humber. All these collaborations are on a different footprint, and require to be resourced – whether with human resource or financial resource – and could impact on the priorities and pace which we have set locally to deliver the commitments in our Strategic Plan as a CCG. A new risk was therefore added to the Assurance Framework during the last year.

Quarter 4 update: As we end the 2016/17 financial year, we have a strategic partner working alongside partners within the Doncaster Place Plan to develop a State of Readiness Report, we have strong partnership working to develop an implementation plan for the South Yorkshire & Bassetlaw Sustainability & Transformation Plan which is aligned to the Five Year Forward View, we have CCG Commissioning & Contracting Intentions were have been enacted into 2-year contracts with Providers, and work is progressing through the Working Together Joint Commissioning Committee on collaborative commissioning

intentions for Hyper Acute Stroke Services and Children’s Surgery & Anaesthesia. Partnership commissioning remains an emerging area of risk, and a risk relating to the collaborative commissioning is replicated on the new Governing Body Assurance Framework from 1 April 2017.

NHS Number in commissioning (Risk 5.5): CLOSED.

The risk relating to the use of NHS Number in commissioning (Risk 5.5) has been closed at year-end, because this risk has now been addressed at a national level and mitigation is in place which is permitting us to fulfil our statutory functions without the use of NHS Number except in specifically permitted instances, and this is captured in a consolidated information sharing agreement with NHS Digital.

Recommendation(s)

CONSIDER and APPROVE the year-end position of the 2016/17 Governing Body Assurance Framework. CONSIDER and APPROVE the 2017/18 starting position of the new Assurance Framework following the Governing Body timeout in January 2017.

Impact analysis

Quality impact See Risks 2.1 and 2.2.

Equality impact

By treating Risk 1.3 on health inequalities, we aim to have a positive effect upon equalities in Doncaster

Sustainability impact

Nil

Financial implications

Nil

Legal implications

Nil

Management of Conflicts of

Interest None identified

Consultation / Engagement

(internal departments,

clinical, stakeholder & public/patient)

Consultation with Assurance Framework Lead Officers

Report previously

presented at None

Risk analysis

Captured throughout the Assurance Framework

Assurance Framework

5.1, 5.2

NHS Doncaster Clinical Commissioning Group Assurance Framework 2016/17

V1.4 as at 31st March 2017

Key notes:

The Assurance Framework has been developed in accordance with guidelines provided by the Department of Health, External Audit and Internal Audit and comprises risks which affect the achievement of the NHS Doncaster Clinical Commissioning Group’s (CCG’s) strategic objectives, vision and values.

Only those potential or current risks which affect the achievement of the NHS Doncaster CCG’s strategic objectives are eligible for entry to the Assurance Framework. All other risks are managed through the Risk Register, and each of the Risk Register risks is linked to an overarching Assurance Framework risk.

Risks can be a) treated (via an action plan), b) tolerated, c) terminated or d) transferred (e.g. to another organisation).

Leads named on the Assurance Framework review the controls, assurances, gaps in control / assurance and scores of the Assurance Framework risks on a regular basis. The Assurance Framework Risk Lead(s) for each area, in consultation with the Governance Lead, can add or remove risks from the Assurance Framework. This will be subsequently ratified by the Governing Body of the NHS Doncaster CCG.

The organisational risk appetite under which risks can be tolerated is a score of 11 or below.

Assurance Framework risks which are scored at or in excess of a score of 16 must be escalated to the next meeting of the NHS Doncaster CCG’s Governing Body.

The Strategic Objectives against which the Assurance Framework is currently mapped and risk scoring matrix are shown below.

Risk Matrix

Likelihood

(1) Rare

(2) Unlikely

(3) Possible

(4) Likely

(5) Almost certain

Co

nseq

uen

ce

(1) Negligible 1 2 3 4 5

(2) Minor 2 4 6 8 10

(3) Moderate 3 6 9 12 15

(4) Major 4 8 12 16 20

(5) Extreme 5 10 15 20 25

1-5 Low The risk appetite under which risks can be tolerated is a score of 11 or below.

Risks scored at or in excess of a score of 16 must be escalated to the Governing Body.

6-11 Medium 12-15 High 16-20 Very High

25 Extreme

Strategic Objectives (SOs)

SO 1 Commission innovative healthcare and pathways to improve patient experience, outcomes and cost effectiveness.

SO 2 Contract and performance manage for continuous quality improvement.

SO 3 Achieve economic efficiency and effectiveness within the allocated resource limit.

SO 4 Develop transparent and accountable relationships with stakeholders.

SO 5 Ensure all our Corporate Governance systems and processes are robust and transparent.

SO 6 Foster effective organisational development and leadership.

2

Assurance Framework Executive Summary – as at 31 March 2017

Ref Risk / threat to achievement of Strategic

Objective

Uncont-rolled risk

score

Risk score history Current risk

score

Gaps in control

Gaps in assurance

Outcome

Action Plan

Our organisational risk appetite is a score of 11 or below. We may choose to treat further gaps in control/assurance

which remain below the risk toleration threshold. Q1 Q2 Q3 Q4

Strategic Objective 1 – Commission innovative healthcare and pathways to improve patient experience, outcomes and cost effectiveness.

1.1 Failure to have a clear outcome-based Strategic Plan, potentially resulting in ambiguous priorities

and goals. 16 8 8 8 8 8 No No Tolerate N/A

1.2

Failure to deliver on the priorities and outcomes articulated in the organisational Strategic Plan, potentially resulting in non-achievement of the

organisational Strategy.

16 8 8 8 8 8 No No Tolerate N/A

1.3 Failure to effectively commission services to

reduce health inequalities, potentially resulting in a widening of the inequalities gap.

12 8 8 8 8 8 No No Tolerate

Work in partnership with the Health & Wellbeing Board to identify inequalities and address these in partnership in line with the

Health & Wellbeing Board Strategy.

1.4

A change to the national business rules for CCG allocations has resulted in an extremely

challenging financial position for CCGs in 2017/18+ which in Doncaster will require a

significant efficiency programme, could affect our local achievement of financial targets and our

system transformation plans.

20 12 12 12 16 16 No

Yes

Change in financial

allocations resulting in challenging

financial position for the CCG

Treat

Develop and implement an efficiency programme aligned to the Right Care analysis, impact assess this against our transformation

plan, and monitor progress throughout the year.

Strategic Objective 2 - Contract and performance manage for continuous quality improvement.

2.1

Failure to commission and performance manage for quality, patient safety and robust systems of

clinical governance, potentially resulting in increased harm to patients.

25 10 10 10 10 10 No No Tolerate N/A

2.2

Failure to commission services which adequately safeguard children and vulnerable adults, potentially resulting in increased harm to

vulnerable groups.

25 10 10 10 10 10 No No Tolerate N/A

2.3 Failure to specify contractual requirements, potentially resulting in a reduced ability to effectively performance manage contracts.

12 8 8 8 8 8 No No Tolerate N/A

2.4

Failure to performance manage contracts to ensure that Providers deliver against local and

national performance targets, potentially resulting in organisational non-achievement of required

targets.

16 12 12 12 12 12 No

Yes

Provider performance

issues, particularly in urgent care,

RTT & 62 day Cancer waits

Treat

Continue to take all contractual and partnership measures available to the CCG to ensure provider performance is brought back

on track for key performance targets.

Strategic Objective 3 - Achieve economic efficiency and effectiveness within the allocated resource limit.

3

Ref Risk / threat to achievement of Strategic

Objective

Uncont-rolled risk

score

Risk score history Current risk

score

Gaps in control

Gaps in assurance

Outcome

Action Plan

Our organisational risk appetite is a score of 11 or below. We may choose to treat further gaps in control/assurance

which remain below the risk toleration threshold. Q1 Q2 Q3 Q4

3.1

Failure to have a clear Financial Strategy matched to commissioning priorities in the Strategic Plan, potentially resulting in available funding not being

matched to prioritised commissioning areas.

16 8 8 8 8 8 No No Tolerate N/A

3.2 Failure to meet the organisation’s annual control

total, potentially resulting in organisational financial failure.

25 10 10 10 10 10 No No Tolerate N/A

Strategic Objective 4 – Develop transparent and accountable relationships with stakeholders.

4.1

Failure to effectively engage with patients, the public, stakeholders, partners and with seldom heard groups, potentially resulting in missed

opportunities to commission services that meet needs, missed opportunities achieve efficiency or quality gains in partnership, non-compliance with

the Health & Social Care Act 2012 and also potentially resulting in disengagement and

reputational impact.

12 8 8 8 8 8 No No Tolerate N/A

4.2 Failure of co-commissioners to work in

partnership, potentially resulting in conflicting strategies and priorities.

12 8 8 8 8 8 No No Tolerate N/A

4.3

Failure to hold partnerships to account for delivery of joint objectives, potentially resulting in partnership failures impacting upon the

organisation’s achievement of targets, patient satisfaction or achievement of control total.

12 8 8 8 8 8 No No Tolerate N/A

4.4

There are many different commissioning footprints and collaborations emerging at a rapid pace to address the challenges in the 5 Year Forward

View. NHS Doncaster CCG is strongly engaged in the development of the Doncaster Place Plan, the

South Yorkshire & Bassetlaw Sustainability & Transformation Plan, the Working Together Joint

Committee (8 local CCGs), the Transforming Care Partnership, and joint commissioning for

Ambulance and urgent transport services across Yorkshire & Humber. All these collaborations are

on a different footprint, and require to be resourced – whether with human resource,

financial resource, governance arrangements or public engagement – and could impact on the

priorities and pace which we have set locally to deliver the commitments in our Strategic Plan as a

CCG.

16 N/A 12 12 12 12

Yes

Externally driven fast

pace of change to

deliver 5 year forward view resulting in

lower levels of engagement across the

organisation than we would usually have for changes

Yes

Joint Committees

are at an early stage and

assurances are not yet

flowing through to Governing

Body

Treat

Engage the Governing Body fully on the rapidly evolving joint working with other organisations across the breadth of the collaboratives in which we are asked to

participate as they emerge, and agree the level of assurance, governance and

engagement which the Governing Body will require from each collaborative.

Strategic Objective 5 – Ensure all our Corporate Governance systems and processes are robust and transparent.

4

Ref Risk / threat to achievement of Strategic

Objective

Uncont-rolled risk

score

Risk score history Current risk

score

Gaps in control

Gaps in assurance

Outcome

Action Plan

Our organisational risk appetite is a score of 11 or below. We may choose to treat further gaps in control/assurance

which remain below the risk toleration threshold. Q1 Q2 Q3 Q4

5.1

Failure to meet statutory and legal obligations to authorisation and continued establishment as a

Clinical Commissioning Group, potentially resulting in local services being commissioned from outside

of Doncaster.

20 10 10 10 10 10 No No Tolerate N/A

5.2

Failure to ensure robust systems of Risk Management, potentially resulting in increased organisational risk, breaches of the Health &

Safety At Work Act 1974 and other associated legislation, fines imposed by external regulators

and loss of organisational reputation.

20 10 10 10 10 10 No No Tolerate N/A

5.3

Failure to ensure robust systems of Information Governance, potentially resulting in breaches of

the Data Protection Act and other associated legislation, fines imposed by the Information

Commissioner and loss of organisational reputation.

16 8 8 8 8 8 No No Tolerate N/A

5.4

Failure to ensure appropriate systems for emergency preparedness and business continuity,

potentially resulting in non-compliance with the Civil Contingencies Act and organisational impact

from business continuity issues.

16 8 8 8 8 8 No No Tolerate N/A

5.5

A change in national legislation prevents CCGs from using personal confidential data (including

postcode and NHS number) within commissioning. Exceptions are for direct care, with patient

consent, or through a statutory route. This means that CCGs cannot undertake certain

commissioning and contracting responsibilities seen as core (e.g. risk stratification, invoice

validation), potentially threatening achievement of our core statutory duties as a commissioner to achieve efficiency and effectiveness of spend.

16 8 8 8

CLOSED

8 No No Tolerate N/A

Strategic Objective 6 – Foster effective organisational development and leadership.

6.1

Failure to design and implement effective Organisational Development programmes,

potentially resulting in a decrease in leadership and effectiveness.

12 8 8 8 8 8 No No Tolerate N/A

6.2

Failure to effectively plan for the local impact of national changes such as changes in the political / economic / social climate, potentially resulting in

organisational strategies and responses not being able to rapidly respond to change.

12 8 8 8 8 8 No No Tolerate N/A

5

The Assurance Framework columns overleaf include:

Area Definition

Reference The risk reference, which links to the overarching strategic objective.

Principal Risks Those risks which affect the achievement of the Clinical Commissioning Group’s strategic objectives.

Lead Person / Delegated Committee

The lead responsible for reviewing the risk prior to presentation to Governing Body.

Uncontrolled Risk

The risk score (consequence x likelihood) if there were no controls in place. This helps the organisation to prioritise risks.

Current Risk The risk score (consequence x likelihood) as at the present time with the listed controls in place.

Key Controls

The controls which are already in place to control the risk and reduce its likelihood of occurring. Controls can be:

Preventative (stopping the risk occurring e.g. access controls)

Detective (If the risk is threatening to occur, how would we know? e.g. authorisation processes)

Directive (instructions or guidance in place to reduce the chance of the risk occurring e.g. policies)

Assurances The assurances which are in place to check that the key controls for the risk are operating effectively e.g. reports, audits. Assurances are broken down into internal assurances such as internal reports, and external assurances such as the independent Audit Reports.

Positive Assurances

The positive assurances which have been received that confirm the risk is being effectively managed, and that key controls are in place and working e.g. positive Internal or External Audit Reports.

Gaps in Control and Assurance

The gaps identified in control or assurance, which, if addressed, would reduce the risk score.

Outcome

The risk treatment which is appropriate for the risk based on the risk description, the scoring and any gaps in either control or assurance. There are 4 categories to choose from:

Treat – Where there are insufficient controls and/or assurances in place, risks must be treated. Any risk scored with a risk rating of 12 or above should be

treated. The risk treatment should be captured in an accompanying action plan.

Tolerate – Where the risk is deemed adequately controlled and there are sufficient assurances in place, risks can be tolerated providing that they are scored

with a risk rating of 11 or below.

Transfer – Risks can be transferred to another organisation, therefore removing the associated risk e.g. transfer of commissioning decisions, transferring

services or letting contracts with risk transfer clauses.

Terminate – It could be that the organisation wishes to avoid a particular risk altogether. This may involve ceasing the activity giving rise to the risk.

Review Date Risks should be reviewed at least Quarterly.

6

NHS Doncaster Clinical Commissioning Group Assurance Framework 2016/17

V1.4 as at 31st

March 2017

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

Strategic Objective 1 – Commission innovative healthcare and pathways to improve patient experience, outcomes and cost effectiveness.

1.1

Failure to have a clear outcome-based Strategic Plan, potentially

resulting in ambiguous

priorities and goals.

Chief of Strategy & Delivery

4 4 16 4 2 8

5-year Strategic Plan “Moving forwards, getting better”

Governing Body minutes detailing approval of Strategic Plan April 2014.

Governing Body approval of refresh and reaffirming of strategic plan November 2015.

Review of original Strategic Plan by Health & Wellbeing Board – Health & Wellbeing Board minutes / reports.

Publication of Strategic Plan April 2014. Refresh and reaffirming of priorities in November 2015.

Health & Wellbeing Board receipt of Strategic Plan.

CCG’s Area Team quarterly review assurance letter received by Governing Body.

CCG business planning cycle

None None TOLERATE

31 January

2017 New

Assurance

Framework

commences

from 1 April 2017

Priorities reiterated across the organisation’s strategies e.g. Delivery Plans.

Governing Body minutes detailing approval of relevant Strategies e.g. Communication, Engagement & Experience December 2014.

Refreshed Delivery Plans considered by Governing Body November 2015.

CCG Annual Report published May 2016.

None

Alignment with Health & Wellbeing Board priorities and submission of Strategic Plan to Health & Wellbeing Board.

CCG engagement in refresh of Health & Wellbeing Board Strategy.

Review of original Strategic Plan by Health & Wellbeing Board – Health & Wellbeing Board minutes / reports.

Engagement with wider clinical professionals, providers and co-commissioners through the planning cycle process to develop Strategic Priorities.

Reports emerging from partnership sessions held to support the planning cycle.

360 degree report feedback.

Strategic Plan is based on identified needs including those in the Joint Strategic Needs Assessment.

Governing Body receipt of JSNA July 2012 and presentation on JSNA in September 2013. No further changes to JSNA priorities since this point.

Review of original Strategic Plan by Shadow Health & Wellbeing Board – Health & Wellbeing Board minutes / reports.

7

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

Sustainability & Transformation Plan across a South Yorkshire & Bassetlaw footprint

Chief Officer engagement and leadership

Sustainability & Transformation Plan received and supported by Governing Body November 2016.

NHS England review of Sustainability & Transformation Plan

Place Plan.

Place Plan received and supported by Governing Body.

Strategic Partner appointed to support implementation of the Place Plan.

The Place Plan forms part of the Sustainability & Transformation Plan, which is reviewed by NHS England.

Annual Planning cycle.

Minutes of Strategy & Organisational Development Forum.

Chair and Chief Officer Reports to Governing Body.

None

1.2

Failure to deliver on the priorities and outcomes

articulated in the organisational Strategic Plan,

potentially resulting in non-

achievement of the organisational

Strategy.

Chief of Strategy & Delivery

4 4 16 4 2 8

Delivery Plans detailing how the Strategy will be delivered and the key milestones.

Quality & Performance Report provides exceptions - Governing Body minutes.

Delivery Plan areas refreshed and approved by Governing Body March 2017November 2016.

None

Quality & Performance monitoring reports received by Governing Body.

CCG’s Area Team quarterly review assurance letter received by Governing Body.

None None. TOLERATE

31 January

2017 New

Assurance

Framework

commences

from 1 April 2017

Business cases and pathway redesigns in the Delivery Plan are linked to the priorities articulated in the Strategic Plan.

Executive Committee minutes / reports.

Business Case template refreshed August 2016 and included in Standards of Business Conduct & Conflicts of Interest Policy.

None

Commissioning for Value Decision Making Framework

Framework approved by Governing Body February 2017

None.

8

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

Performance monitoring regime

Quality & Performance Reports monthly to Governing Body.

Governing Body minutes.

External monitoring of key targets which underpin delivery e.g. A&E, Ambulance.

Area Team performance reviews.

Executive Committee Executive Committee

minutes None

Strategy & Organisational Development Forum discussions on future plans to deliver agreed outcomes

Strategy & Organisational Development Forum minutes

None.

1.3

Failure to effectively

commission services to reduce health inequalities,

potentially resulting in a

widening of the inequalities gap.

Chief of Strategy & Delivery

&

Chief of Corporate Services

4 3 12 4 2 8

Joint Strategic Needs Assessment / Data Observatory with Local Authority / Health Needs Assessments.

Governing Body receipt of JSNA September 2013.

Use of population, inequality and Census data in service redesign.

Health & Wellbeing Board minutes / reports.

Joint Strategic Needs Assessment outcome data.

CCG’s Area Team quarterly review assurance letter received by Governing Body.

Publication of CCG Equality Objectives and annual equality reporting.

Joint Strategic Needs Assessment.

Patient & Public Engagement Internal Audit Report 1415DCCG01R – significant assurance.

Public Sector Equality Duty Internal Audit Report 1516/DCCG/09/R – significant assurance

None

None.

There are joint responsibilities for addressing health inequalities between local Councils and CCGs. This is a developing and very complex area because health inequalities are caused by multiple determinants, only one of which is health. It is felt that further work may be needed in this area to increase our assurance.

TOLERATE

TREAT

Action Plan:

Work in partnership with

the Health & Wellbeing Board

to identify inequalities and address these in

partnership in line with the Health & Wellbeing Board

Strategy.

Due date:

31 March 2017

31 January

2017 New

Assurance

Framework

commences

from 1 April 2017

Equality analysis activity to identify health inequalities.

Reporting of Equality Delivery System tool.

Equality analysis reports e.g. on Cancer and Dementia strategic priority areas.

None.

Membership of the Doncaster Inclusion & Fairness Forum.

Chief of Corporate Services representation.

Minutes of the Doncaster Inclusion & Fairness Forum.

Membership of Health Inequalities Working Group.

Membership by CCG Officers.

Minutes of meeting.

Equality & Diversity Strategy including health inequalities.

Governing Body receipt of Strategy January 2017December 2014.

Engagement & Experience Committee minutes.

Development of CCG Equality Objectives via Engagement & Experience Committee published in October 2013 and reported on annually.

Equality section within

User / carer feedback.

Patient & Public Engagement Internal Audit Report 1415DCCG01R – significant assurance.

Public Sector Equality Duty Internal Audit Report 1516/DCCG/09/R – significant assurance

9

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

Annual Report.

Engagement & Experience Committee.

Minutes of Engagement & Experience Committee.

Debate and resulting paper on health inequalities actions Q1 2015/16. Formalised into Strategy approved by Governing Body January 2017.

None.

Use of user/carer experience data in decision-making.

Experience data reported through the Engagement & Experience Committee (direct feedback) and through the Quality & Patient Safety Committee or underpinning Clinical Quality Review Groups (provider received feedback).

Engagement & Experience Committee minutes.

Quality & Patient Safety Committee / Clinical Quality Review Group minutes.

Patient Stories at Governing Body meetings.

Health Ambassador Scheme to engage with seldom heard groups – minutes of meetings.

User / carer feedback.

Patient & Public Engagement Internal Audit Report 1415DCCG01R – significant assurance.

Memorandum of Understanding with the Local Authority for Public Health support to identify and address health inequalities in partnership.

Public Health attendee at Governing Body.

Memorandum of Understanding in place.

Joint CCG / Public Health presentation to Strategy Development Forum on health inequalities – May 2016.

None.

Partnerships through Health & Wellbeing

Refreshed Health & Wellbeing Board

Health & Wellbeing Board minutes /

10

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

Board. Strategy co-produced in late 2015.

Well North project membership – minutes of meetings.

reports.

Health & Wellbeing Board performance reports.

Health & Wellbeing Board Workshop October 2016 on health inequalities.

1.4

A change to the national business

rules for CCG allocations has resulted in an

extremely challenging

financial position for CCGs in

2017/18+ which in Doncaster will

require a significant efficiency

programme, could affect our local achievement of financial targets and our system transformation

plans.

Chief Officer

&

Chief Finance Officer

4 45

1620

4 34

1216

Financial Plan.

Governing Body minutes / reports including efficiency reporting as part of Financial Reports.

Reporting on specific efficiency programmes through the relevant Committee e.g. Prescribing.

Indicative Financial Plan received and supported by Governing Body November 2016.

Quality, Innovation, Productivity and Prevention (QIPP) Review (1314DCCG11R)

CCG’s Area Team quarterly review assurance letter received by Governing Body.

Efficiency monitoring reports to Governing Body as part of Financial Reports.

Quality, Innovation, Productivity and Prevention (QIPP) Review (1314DCCG11R)

None

A change to the national business rules for CCG allocations has resulted in an extremely challenging financial position for CCGs in 2017/18+which in Doncaster could affect our local achievement of financial targets and our system transformation plans.

TREAT

Action Plan:

Develop and implement an

efficiency programme

aligned to the Right Care

analysis, impact assess this against our

transformation plan, and monitor

progress throughout the

year.

Due date:

31 March 2017

31 January

2017 New

Assurance

Framework

commences

from 1 April 2017

Efficiency programme performance management

Programme management approach adopted with meetings to report on delivery against plan put into place.

Reporting as part of Finance Report to Governing Body.

Presentations to Governing Body on financial climate and challenges.

None

Commissioning for Value Decision Making Framework

Framework approved by Governing Body February 2017

None.

Running cost target monitoring.

Reporting as part of Finance Reports to Governing Body.

External monitoring by NHS England through open ledger.

Right Care analysis.

Planned focus in 2016/17 on the areas of the national Right Care analysis where there is greatest potential impact for Doncaster.

None.

Prescribing analysis. Planned focus in

2016/17 on the areas of prescribing where

Prescription Pricing Authority data.

11

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

there is greatest potential impact for Doncaster.

Prescribing debate held at Strategy & Organisational Development Forum – September 2016.

Medicines Management Group.

Area Prescribing Committee

Sustainability & Transformation Plan across a South Yorkshire & Bassetlaw footprint

Chief Officer engagement and leadership

Sustainability & Transformation Plan received and supported by Governing Body November 2016.

NHS England review of Sustainability & Transformation Plan

Financial monitoring regime.

Monthly Finance Report received by Governing Body – minutes.

Non-ISFE returns to NHS England.

ISFE open ledger.

Key performance indicators and CQUINs embedded into Provider contracts.

Minutes of Contract Monitoring meetings with DBHFT and RDaSH.

Quality monitoring in Secondary Care Internal Audit Report 1314/DCCG/01/R – Significant assurance.

Strategic Objective 2 – Contract and performance manage for continuous quality improvement.

2.1

Failure to commission and

performance manage for

quality, patient safety and robust systems of clinical

governance, potentially resulting in

increased harm to patients.

Chief Nurse 5 5 25 5 2 10

Procurement Framework incorporates Quality requirements.

CQUINS and quality schedules within contracts.

Contracts.

Strategic Contracting Group minutes for DBHFT and RDaSH.

CQUIN monitoring and reporting to Quality & Patient Safety Committee.

Internal audits on certain contracts e.g. Domiciliary Care include quality reporting.

Monitor reports.

Provider Quality Accounts. Spotlight report presentation received by Governing Body in July 2015 on the CCG’s main Providers Quality Accounts.

Annual Care Quality Commission compliance statement from providers.

CCG’s Area Team quarterly review assurance letter received by Governing Body.

Quality monitoring in Secondary Care Internal Audit Report 1314/DCCG/01

None. None TOLERATE

31 January

2017 New

Assurance

Framework

commences

from 1 April 2017

Quality & Patient Safety Committee.

Quality & Patient Safety Committee minutes and reports.

Quality assurance mechanisms reported to Audit Committee.

Joint Quality meetings across the Area Team footprint – Quality Surveillance Group.

Quality & Patient Safety Committee benchmarking report by Internal Audit –

12

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

received by Audit Committee November 2015.

Quality and Patient Safety Committee Internal Audit Report 1516DCCG02R – significant assurance

/R – Significant assurance.

Joint Quality meetings across the Area Team footprint.

Serious Incident Reporting Internal Audit Report 1314/DCCG/10/R – positive conclusion

Governance Arrangements for Responding to National Quality Reports Internal Audit Report 1314/DCCG/13/R –significant assurance

Medicines Management Internal Audit Report 1415DCCG04R – Significant Assurance

Quality & Patient Safety Committee benchmarking report by Internal Audit – received by Audit Committee November 2015.

Quality and Patient Safety Committee Internal Audit Report 1516DCCG02

Clinical Quality Review Groups (CQRGs) with main providers.

Joint Monitoring Function with Doncaster Council in relation to Care Home quality and safety with weekly risk meetings.

CQRG minutes.

Minutes of joint monitoring meetings with Doncaster Council (co-chaired with monthly attendance by the Care Quality Commission).

Quality of Care in Care Homes Internal Audit Report 1617-DCCG-02-R.

Incident Management Group and associated Serious Incident monitoring processes.

Incident Management Group minutes.

Serious Incident themes reported to Quality & Patient Safety Committee and Governing Body.

Serious Incident Reporting Internal Audit Report 1314/DCCG/10/R – positive conclusion.

Infection rate monitoring.

District Infection Prevention & Control meeting.

Root Cause Analysis of infections.

Monitoring and reporting of infection rates to District Infection Prevention & Control Committee.

District Infection Prevention & Control minutes.

Quality & Patient Safety Committee minutes and reports.

Health-community wide monitoring of infection rates and joint Root Cause Analysis of infections.

Prescribing Sub Group.

Area Prescribing Committee.

Scheduled Drugs Monitoring Group (Accountable Officer function).

Prescribing Sub Group minutes.

Area Prescribing Committee minutes.

Scheduled Drugs Monitoring Group minutes.

Prescribing presentation to Strategy Development Forum September 2015.

External reporting on Controlled Drugs function.

Medicines Management Internal Audit Report 1415DCCG04R – Significant Assurance

Patient Safety Dashboard / Quality monitoring schedule.

Quality & Performance Report monthly to Governing Body –integrated with Performance Report.

Quality Surveillance Group with external regulators.

Quality monitoring in Secondary Care

13

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

Patient Safety Dashboard received by Quality & Patient Safety Committee – minutes.

Quality assurance mechanisms reported to Audit Committee via Internal Audit reports.

Internal Audit Report 1314/DCCG/01/R – Significant assurance.

R – significant assurance

Quality of Care in Care Homes Internal Audit Report 1617-DCCG-02-R.

Primary Care Co Commissioning Internal Audit Report 1617DCCG04R received by Audit Committee November 2016.

Response to national quality recommendations

CCG response to Francis Report received by Governing Body March 2013.

Winterbourne assurance to Governing Body January 2014 and December 2014.

Governance Arrangements for Responding to National Quality Reports Internal Audit Report 1314/DCCG/13/R –significant assurance.

Chief Nurse.

Quality Team.

Medicines Management Team.

Quality in Primary Care role.

Job descriptions.

Organisational structure.

Personal Development Reviews.

None.

Schedule of Quality Monitoring visits to Providers alongside Commissioning for Quality Assurance and Improvement using an Appreciative Enquiry Approach Policy

Reporting of Quality Monitoring visits to Quality & Patient Safety Committee.

Quality assurance mechanisms reported to Audit Committee.

PLACE scores.

Quality Accounts.

Patient Surveys.

Spotlight Reports to Governing Body detailing progress on specific quality / performance areas.

Governing Body minutes.

None.

Primary Care Quality Strategy & Dashboard.

Primary Care Commissioning Committee minutes.

TARGET.

Primary Care Strategic Framework received by November 2014 Governing Body.

NHS England attend Primary Care Commissioning Committee.

Primary Care Co Commissioning Internal Audit Report 1617DCCG04R received by Audit Committee November 2016.

2.2 Failure to

commission services which

Chief Nurse 5 5 25 5 2 10 Safeguarding Children

& Adult standards embedded in

Contracts.

Contract Monitoring

Minutes of partnership Doncaster Safeguarding Children

CCG’s Area Team quarterly review

None. None. TOLERATE 31

January 2017

14

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

adequately safeguard children

and vulnerable adults, potentially

resulting in increased harm to vulnerable groups.

contracts and supported by an Annual Declaration to the Care Quality Commission. Safeguarding CQUIN.

Group minutes for DBHFT and RDaSH.

CQUIN monitoring and reporting to Quality & Patient Safety Committee.

Board and Doncaster Safeguarding Adults Partnership Board.

Safeguarding Adults & Children Internal Audit Report 1314/DCCG/09/R – Significant assurance

Enhancing the Quality of Care for Vulnerable People in Care Homes Internal Audit Report 1415/DCCG/08/R – positive direction of progress.

assurance letter received by Governing Body.

Minutes of internal Safeguarding Assurance Forum.

Minutes of partnership Doncaster Safeguarding Children Board and Doncaster Safeguarding Adults Partnership Board.

Safeguarding Adults & Children Internal Audit Report 1314/DCCG/09/R – Significant assurance

Winterbourne assurance reports

Care Quality Commission health & social care community inspection – September 2014.

Enhancing the Quality of Care for Vulnerable People in Care Homes Internal Audit Report 1415/DCCG/08/R – positive direction of progress.

Quality and

New Assuran

ce Framew

ork comme

nces from 1 April 2017

Safeguarding meetings:

Safeguarding Assurance Forum.

Doncaster Safeguarding Children Board membership and financial contributions.

Doncaster Safeguarding Adults Board membership and financial contributions.

Multi-Agency Public Protection Arrangements (MAPPA) membership.

Multi-Agency Risk Assessment Conference (MARAC) for domestic violence membership.

Minutes of internal Safeguarding Assurance Forum.

Quality & Patient Safety Committee minutes and reports.

Transforming Care assurance reports

Child Sexual Exploitation assurance to Governing Body December 2014.

Minutes of Doncaster Safeguarding Children Board

Minutes of Doncaster Safeguarding Adults Board.

Minutes of MAPPA.

Minutes of MARAC.

Care Quality Commission health & social care community inspection – September 2014.

Safeguarding Reporting

CCG Safeguarding Annual Report

Doncaster Safeguarding Children Board Annual Report

Doncaster Safeguarding Adults Board Annual Report

Domestic Homicide Review process.

Domestic Homicide Review reports.

Quality & Patient Safety Committee minutes and reports.

Minutes of Doncaster Safeguarding Children Board

Minutes of Doncaster Safeguarding Adults Board.

Minutes of the Domestic Abuse Chief Officers Group and the Domestic Abuse

15

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

Theme Group. Patient Safety Committee Internal Audit Report 1516DCCG02R – significant assurance

Designated Nurse for Safeguarding Children and Looked After Children

Named Doctor for Safeguarding Children.

Designated Nurse for Safeguarding Adults including the lead for the Mental Capacity Act and the Designated Adult Safeguarding Manager role.

Deputy Designated Nurse for Safeguarding Children

Named Nurse for Safeguarding Adults and Quality

Primary Care Quality Lead

Job descriptions.

Organisational structure.

Personal Development Reviews.

None.

Mandatory safeguarding training.

Monitoring of mandatory training through the quarterly corporate assurance report reported to the Governing Body and Audit Committee.

Monitoring of multiagency safeguarding training through the Doncaster Safeguarding Children Board and Doncaster Safeguarding Adults Board – minutes.

Children’s Trust. Minutes of the

Children’s Trust.

Chief Officer is a Director on the Children’s Trust.

Safeguarding Policies – internal and multiagency.

Monitoring of mandatory training through the quarterly corporate assurance report reported to the Governing Body and Audit Committee.

Doncaster Safeguarding Children’s Board and Doncaster Safeguarding Adults Board minutes in relation to multiagency policies.

Quality & Patient Safety Committee and Quality Dashboard.

Quality & Patient Safety Committee minutes.

Quality & Performance Report monthly to Governing Body.

Patient Safety Dashboard received by Quality & Patient Safety Committee –

None.

16

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

minutes.

Quality assurance mechanisms reported to Audit Committee.

2.3

Failure to specify contractual

requirements, potentially

resulting in a reduced ability to

effectively performance

manage contracts.

Head of Contracting

4 3 12 4 2 8

Key Performance Indicators (KPIs) embedded within agreed NHS National Contract Framework (used for all providers).

Strategic Contracting Meeting minutes.

Use of national contract as standard which includes key clauses e.g. incident reporting, equality.

KPIs and CQUINs agreed and placed into contracts.

CCG’s Area Team quarterly review assurance letter received by Governing Body.

Collaboration with providers on strategic planning rounds to match objectives and strategy.

Collaborative Commissioning Internal Audit Report 1314/DCCG/05/R – Significant assurance

Deep dive report on this Assurance Framework risk received by Audit Committee July 2015 – positive outcome.

Commissioning & Contracting Intentions approved by Governing Body November 2016.

None

NHS England has brought forward the contracting cycle, requiring that 2-year contracts are signed by 23 December 2016 (previously this was the end of March each year). This increases the pace at which NHS Doncaster CCG is required to specify contractual requirements, negotiate these with providers, and sign contracts.

TREAT

Action Plan

Escalate the contracting

rounds to ensure contracts can be

signed by 23 December 2016

Due date

23 December 2016

31 January

2017 New

Assurance

Framework

commences

from 1 April 2017

National contracting guidance.

Contracting team using national guidance for 2016/17 contracting rounds.

Same guidance issued by NHS England to both commissioners and providers of NHS care - consistency.

Procurement Strategy.

Reporting on procurement progress via Governing Body reporting.

Procurement Strategy approved by Governing Body May 2014.

None.

Clear Contracting Intentions framework.

Annual contract negotiation cycle in place for contracts. Minutes of contracting meetings with DBHFT and RDaSH where contracting intentions are discussed.

Providers engaged in strategic planning rounds which lead to development of contracting intentions.

Commissioning & Contracting Intentions approved by Governing Body November 2016.

Collaborative Commissioning Internal Audit Report 1314/DCCG/05/R – Significant assurance

Workplan in place for prioritising development of clear service specifications within block contracts.

Specifications developed by a range of clinical and managerial leads.

Joint Strategic Needs Assessment used to support specifications.

None.

Procurement Team.

Contracting Team.

Job descriptions.

Organisational structure.

None.

17

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

Personal Development Reviews.

2.4

Failure to performance

manage contracts to ensure that

Providers deliver against local and

national performance

targets, potentially resulting in

organisational non-achievement

of required targets.

Head of Performance

4 4 16 4 3 12

Key Performance Indicators (KPIs) embedded within agreed NHS National Contract Framework (used for all providers).

Strategic Contracting Meeting minutes.

Use of national contract as standard which includes key clauses e.g. incident reporting, equality.

Performance Reports received from NHS North of England on a weekly basis at both Commissioner and Provider level.

Payment by Results (PbR) audits.

Monthly Quality & Performance Report to Governing Body.

CCG’s Area Team quarterly review assurance letter received by Governing Body.

Minutes of Strategic Contracting meetings with DBHFT and RDaSH.

Minutes of Clinical Quality Review Groups and Finance, Information & Performance Groups with DBHFT and RDaSH.

Collaborative Commissioning 2013/14 Contract Monitoring Process Internal Audit Report 1314/DCCG/12/R – indicative significant assurance

Mental Health Payment by Results Data Quality Internal Audit Report 1516DCCG05R – significant assurance

None.

The Quality & Performance Report details gaps in assurance where providers have failed to meet performance managed targets and trajectories. Operational risks are escalated to the Risk Register. Strategic risks will impact upon this Assurance Framework risk.

TREAT

Action Plan

Continue to take all contractual

and partnership measures

available to the CCG to ensure

provider performance is

brought back on track for key performance

targets.

Due date

31 March 2017

31 January

2017 New

Assurance

Framework

commences

from 1 April 2017

Clear Contracting Intentions framework.

Minutes of Strategic Contracting meetings with DBHFT and RDaSH where contracting intentions are discussed.

Contracting schedule.

None.

Strategic Contracting meeting highlighting themes and trends for formal contract query.

Clinical Quality Review Groups.

Finance, Performance & Information Groups.

Minutes of Strategic Contracting meetings with DBHFT and RDaSH.

Minutes of Clinical Quality Review Groups with DBHFT and RDaSH.

Minutes of Finance, Performance & Information Groups with DBHFT and RDaSH.

None.

Exception meetings with Providers for any areas going “off track” and/or targets are not being reached e.g. A&E, Ambulance.

Issue of contract queries (performance notices).

Minutes of any exception meetings with DBHFT and RDaSH.

Receipt of relevant actions plans following contract queries.

Reporting and management of Serious Incidents (SIs).

Reports on Providers by external auditors e.g. Care Quality Commission, Health & Safety Executive, Monitor.

Minutes of Quality Surveillance monitoring meetings with regulators.

Performance monitoring regime.

Governing Body minutes / reports including monthly Quality & Performance Report detailing exceptions

Audits conducted by Providers and reviewed by Commissioners.

Provider reports to their Boards /

18

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

with Spotlights on specific areas.

Finance & Performance Information Group minutes / reports.

Development of Mental Health Provider Quality Outcomes Framework

Governing Bodies and to Monitor.

Data Quality Internal Audit Report 1516DCCG08R – significant assurance

Strategic Objective 3 – Achieve economic efficiency and effectiveness within the allocated resource limit.

3.1

Failure to have a clear Financial

Strategy matched to commissioning

priorities in the Strategic Plan,

potentially resulting in

available funding not being matched

to prioritised commissioning

areas.

Chief Finance Officer

4 4 16 4 2 8

Financial Strategy.

Financial plan received by Governing Body in April each year. 2017/18 Indicative Financial Plan received and supported by Governing Body November 2016.

Non-ISFE returns to NHS England.

ISFE open ledger.

CCG’s Area Team quarterly review assurance letter received by Governing Body.

Financial Plan received by Governing Body.

None. None. TOLERATE

31 January

2017 New

Assurance

Framework

commences

from 1 April 2017

Financial section within Strategic Plan.

Receipt of Strategic Plan by Governing Body.

None.

Financial monitoring regime.

Monthly Finance Report received by Governing Body – minutes.

Non-ISFE returns to NHS England.

ISFE open ledger.

Chief Finance Officer.

Finance Team

Job descriptions.

Organisational structure.

Personal Development Reviews.

Chief Finance Officer Network minutes.

NHS England Director of Finance assurance.

3.2

Failure to meet the organisation’s annual control

total, potentially resulting in

organisational financial failure.

Chief Finance Officer

5 5 25 5 2 10

Standing Financial Instructions / Prime Financial Policies. Standing Orders. Scheme of Delegation and authorisation controls.

Year-end accounts process.

Governing Body Minutes / Reports.

Audit Committee minutes / reports.

Annual Accounts monitoring through Audit Committee.

Approval of Standing Orders, Standing Financial Instructions & Scheme of Delegation by Governing Body. Last reviewed February 2015.

Non-ISFE returns to NHS England.

ISFE open ledger.

Annual Governance Statement.

Submission of Annual Accounts.

External Audit review of annual accounts.

ISO 260 report to those charged with governance

Annual Audit Letter – July 2015

Internal Audit Reports.

Assurance received by Governing Body monthly of forecast of meeting control total.

Annual Accounts assurance received from External Audit in June 2014.

None. None. TOLERATE

31 January

2017 New

Assurance

Framework

commences

from 1 April 2017

Internal & External Audit programme.

Audit Committee monitoring of

Annual Accounts assurance received

19

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

programme progress.

External Audit Fees Letter noted by Audit Committee and Governing Body.

from External Audit in July 2015.

CCG’s Area Team quarterly review assurance letter received by Governing Body.

Budgetary Control & Financial Reporting Internal Audit Report 1516DCCG06R - significant assurance.

Key Financial Systems & Payroll Internal Audit Report 1314/DCCG/07/R– significant assurance.1617-DCCG-09-R – Budgetary Control & Key Financial Systems Internal Audit Report

Continuing Healthcare Payments Certification 1516DCCG04R Internal Audit Report – significant assurance

Shared Business Services Service Auditor Report.

Chief Finance Officer.

Finance Team.

Job descriptions.

Organisational structure.

Personal Development Reviews.

None.

Financial monitoring regime.

Monthly Finance Report received by Governing Body – minutes.

Presentation in November 2015 to Governing Body on financial climate and challenges.

Budgetary Control & Financial Reporting Internal Audit Report 1516DCCG06R - significant assurance.

Non-ISFE returns to NHS England.

ISFE open ledger.

Shared Business Services ledger.

Liaison with Shared Business Services.

Shared Business Services Service Auditor Report.

Contract with RDaSH for purchasing support.

Contract monitoring. None.

Strategic Objective 4 – Develop transparent and accountable relationships with stakeholders.

4.1

Failure to effectively engage with patients, the

public, stakeholders,

partners and with seldom heard

groups, potentially

Chief Officer

&

Chief of Corporate Services

4 3 12 4 2 8 Communication,

Engagement & Experience Strategy.

Engagement & Experience Committee minutes / reports.

Governing Body minutes / reports.

Equality Act compliance – Equality & Human Rights Commission assessments / feedback (ad hoc).

Provider Patient Experience data

Patient feedback.

CCG’s Area Team quarterly review assurance

None None. TOLERATE

31 January

2017 New

Assurance

Framework

20

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

resulting in missed opportunities to

commission services that meet

needs, missed opportunities

achieve efficiency or quality gains in partnership, non-compliance with

the Health & Social Care Act 2012 and also

potentially resulting in

disengagement and reputational

impact.

received through CQUINs, reviewed by Quality Team and themes raised in the Contracting meetings.

Health & Wellbeing Board minutes / reports.

Patient & Public Engagement Internal Audit Report 1415DCCG01R – significant assurance.

letter received by Governing Body.

Engagement & Experience Committee.

Patient & Public Engagement Internal Audit Report 1415DCCG01R – significant assurance.

Public Sector Equality Duty Internal Audit Report 1516/DCCG/09/R – significant assurance

commences

from 1 April 2017

Patient Experience collation

Engagement & Experience Committee minutes

We Asked, You Said, We Did feedback to contributors

Engagement pilots with specific communities of interest

Engagement & Experience Committee minutes

Health Ambassador scheme to engage with seldom heard groups – minutes of meetings.

PPG Network.

None.

Electronic patient experience data collation pilot across the Stroke care pathway

Outputs & notes from project.

None.

Use of Data Observatory to understand communities of interest / Community Profiles.

Publication of equality data – January each year

Data Observatory website.

Use of Equality Delivery System to produce and publish Equality Objectives.

Engagement & Experience Committee minutes / reports.

Reporting of Equality Delivery System tool.

Public Sector Equality Duty Internal Audit Report 1516/DCCG/09/R – significant assurance

Engagement & Experience Committee and associated Engagement programme and Experience data collation.

Engagement & Experience Committee minutes / reports.

Range of engagement opportunities via website.

User / Carer feedback.

Membership of the Doncaster Inclusion & Fairness Forum.

Chief of Corporate Services representation.

Minutes of the Doncaster Inclusion & Fairness Forum.

21

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

Complaints policy and management process.

Governing Body approval of Complaints Policy November 2012.

Complaints Guide for the public on website.

None.

Health & Wellbeing Board.

Public Health Memorandum of Understanding.

Approval of Public Health Memorandum of Understanding by Governing Body August 2012. Refreshed annually.

Health & Wellbeing Board minutes / reports.

Healthwatch Doncaster attendee at Governing Body.

Governing Body minutes.

360 degree feedback report.

Service specification with Doncaster CVS for third sector engagement to 31 March 2017.

Monitoring of specification with Doncaster CVS.

None.

4.2

Failure of co-commissioners to

work in partnership, potentially resulting in conflicting

strategies and priorities.

Chief of Strategy & Delivery

&

Chief of Partnership

Commissioning & Primary

Care

4 3 12 4 2 8

Health & Wellbeing Board.

Governing Body receipt of Health & Wellbeing Board draft Strategy for comment August 2012. Chair & Chief Officer involvement in strategy refresh in 2015.

Chair and Chief Officers sit on Health & Wellbeing Board.

Review of Strategic Plan by Shadow Health & Wellbeing Board – Health & Wellbeing Board minutes / reports.

Health & Wellbeing Board minutes.

CCG’s Area Team quarterly review assurance letter received by Governing Body.

Working Together Memorandum of Understanding.

CCG business planning cycle

Collaborative Commissioning Internal Audit Report 1314/DCCG/05/R – Significant assurance

Collaborative Commissioning 2013/14 Contract Monitoring Process Internal Audit

None.

Governing Body has identified a potential reputational risk for NHS Doncaster CCG in hosting the shared services for Continuing Healthcare. The existing controls and assurances within the service are considered to mitigate the gap to a tolerable level, but it is important that this gap is reflected on the Assurance Framework.

TOLERATE

31 January

2017 New

Assurance

Framework

commences

from 1 April 2017

Working Together Programme across local CCGs and Acute Trusts.

Joint Committee enacted from October 2016.

Progress updates received by Governing Body as part of Chair & Chief Officer report.

Working Together Memorandum of Understanding.

Proposals on joint Committee received by Governing Body June 2016

Minutes of Working Together Partnership Collaborative Board (chaired by CCG Chair)

Working Together Reports.

Collaborative Commissioning Internal Audit Report 1314/DCCG/05/R – Significant assurance

Commissioning 2013/14 Contract Monitoring Process Internal Audit Report 1314/DCCG/12/R –significant assurance

Informal Joint arrangements from October 2016 for joint commissioning of

Governing Body paper May 2016 and August 2016.

None.

22

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

999/111 services across Yorkshire & Humber, with a formal Joint Committee early in 2017.

Memorandums of Understanding signed December 2016.

Report 1314/DCCG/12/R –significant assurance

Sustainability & Transformation Plan.

Memorandum of Understanding for Continuing Healthcare hosted shared service.

Sustainability & Transformation Plan across a South Yorkshire & Bassetlaw footprint

Chief Officer engagement and leadership

Sustainability & Transformation Plan received and supported by Governing Body November 2016.

NHS England review of Sustainability & Transformation Plan

Development of a Doncaster Place Based Plan across statutory health and social care organisations in Doncaster

Chair and Chief Officer engagement and leadership

Chair & Chief Officer Reports to Governing Body updating on progress.

Discussion at Strategy & Organisational Development Forum September 2016.

Place Plan received and supported by Governing Body October 2016.

Presentation on the role and work of Team Doncaster received by Governing Body December 2016.

NHS England review of Sustainability & Transformation Plans, which are underpinned by Place Based Plans in each local area.

Memorandum of Understanding for Continuing Health hosting arrangements by NHS Doncaster CCG.

Internal leadership of the hosted service.

Governing Body decision regarding continued hosting post April 2017 made August 2016 – NHS Doncaster CCG will continue to host for 9 CCGs within the Yorkshire & Humber area with regular reviews.

Signed Memorandum of Understanding.

Continuing Healthcare Follow-up Review by Internal Audit received by Audit Committee September 2016 (1617-DCCG-01-R)

Clinical engagement through the planning cycle.

Notes from events during the planning cycle where wider clinicians, providers and co-commissioners are engaged in strategy discussions.

360 degree feedback report.

23

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

Local Authority, Public Health and Healthwatch Doncaster attendees on Governing Body.

Governing Body minutes.

None.

Joint working with NHS England.

Liaison led by SMT.

Quality assurance meeting across Area Team patch.

Area Team assurance review.

Executive Committee. Executive Committee

minutes / reports. None.

Chief of Partnership Commissioning & Primary Care.

Job description.

Organisational structure.

Personal Development Reviews.

None.

4.3

Failure to hold partnerships to

account for delivery of joint

objectives, potentially resulting in partnership

failures impacting upon the

organisation’s achievement of targets, patient satisfaction or

achievement of control total.

Chief of Strategy & Delivery

&

Chief of Partnership

Commissioning & Primary

Care

4 3 12 4 2 8

Health & Wellbeing Board.

CCG representatives at Health & Wellbeing Board.

Health & Wellbeing Board minutes / reports.

Working Together Memorandum of Understanding

Public Health Memorandum of Understanding signed

CCG’s Area Team quarterly review assurance letter received by Governing Body.

External review of Better Care Fund Plan and feedback.

Better Care Fund Governance Arrangements 1516/DCCG/01/R –significant assurance

None None. TOLERATE

31 January

2017 New

Assurance

Framework

commences

from 1 April 2017

Working Together programme

Joint Committee planned from October 2016.

Working Together Memorandum of Understanding

Hyper Acute Stroke Services joint proposals received by Governing Body during 2016

None.

Joint Committee planned from October 2016 for joint commissioning of 999/111 services across Yorkshire & Humber.

Governing Body paper May 2016.

None.

Place Plan meetings with all partners.

Minutes of Place Plan meetings.

Strategic Partner for Place Plan preparing a State of Readiness Report.

The Place Plan forms part of the Sustainability & Transformation Plan which is reviewed by NHS England.

Liaison with NHS England in respect of specialised commissioning.

Briefing to Governing Body November 2015.

Membership of Yorkshire & Humber Specialised Commissioning Oversight Group

None.

24

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

Public Health Memorandum of Understanding

Public Health Memorandum of Understanding approved by Governing Body August 2012 and refreshed annually.

None.

Section 75’s.

Internal monitoring reports.

Regular contracting meetings with the Local Authority – minutes.

None.

Executive Committee responsibility for integrated commissioning and partnerships.

Executive Committee minutes / reports including monthly Performance Report.

None.

Better Care Fund Plan.

Better Care Fund meetings with the Local Authority.

Section 75 agreement.

Reporting to Governing Body via the Finance Report.

External review of Better Care Fund Plan and feedback.

Better Care Fund Governance Arrangements 1516/DCCG/01/R –significant assurance

Chief of Partnership Commissioning & Primary Care.

Job description.

Organisational structure.

Personal Development Reviews.

None.

4.4

There are many different

commissioning footprints and collaborations emerging at a rapid pace to address the

challenges in the 5 Year Forward

View. NHS Doncaster CCG is strongly engaged

in the development of the Doncaster Place Plan, the

South Yorkshire & Bassetlaw

Sustainability & Transformation

Plan, the Working Together Joint

Chief Officer 4 4 16 4 3 12

Chair & Chief Officer working to tie these different commissioning plans together with our priorities.

Chair & Chief Officer Reports to Governing Body.

Locality Lead identified to support Planning.

None.

Engagement of Governing Body in changes.

The externally driven fast pace of change to collaborate with other organisations to commission services may potentially result in a lower level of engagement across the organisation on proposed changes than we usually endeavour to achieve as an organisation.

The plans and joint committees are all in draft or in early iterations, and therefore formal assurance is not yet following through the organisation in a routine manner.

TREAT

Action Plan

Engage the Governing Body

fully on the rapidly evolving joint

working with other organisations

across the breadth of the

collaboratives in which we are

asked to participate as

they emerge, and agree the level of

assurance, governance and

engagement which the

31 January

2017 New

Assurance

Framework

commences

from 1 April 2017

Governing Body approval for establishment of Joint Committees, and the level of delegation to joint Committees.

Governing Body minutes.

CCG Constitution – joint committees reflected in the Constitution.

Doncaster Place Plan which underpins the Sustainability & Transformation Plan.

Chair & Chief Officer leadership.

Chair & Chief Officer Reports to Governing Body.

Place Plan received and supported by

Partner engagement.

25

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

Committee (8 local CCGs), the

Transforming Care Partnership, and

joint commissioning for

Ambulance and urgent transport services across

Yorkshire & Humber. All these collaborations are

on a different footprint, and require to be resourced – whether with

human resource, financial resource,

governance arrangements or

public engagement – and could impact

on the priorities and pace which

we have set locally to deliver the

commitments in our Strategic Plan

as a CCG.

Governing Body October 2016.

Strategic Partner appointed to support implementation of the Place Plan.

Governing Body will require from

each collaborative.

Due date

31 March 2017

Sustainability & Transformation Plan.

South Yorkshire Sustainability & Transformation Plan received and supported by Governing Body November 2016.

External NHS England assurance of STP.

Focus on CCG Delivery Plans through Quality & Performance Report.

Governing Body minutes.

None.

Strategic Objective 5 – Ensure all our Corporate Governance systems and processes are robust and transparent.

5.1

Failure to meet statutory and legal

obligations to authorisation and

continued establishment as a

Clinical Commissioning

Group, potentially resulting in local services being commissioned from outside of

Doncaster.

Chief Officer 5 4 20 5 2 10

Governing Body and underpinning Governance meeting structure. Locality structure.

Governing Body minutes / reports including regular Authorisation update.

Locality meetings minutes / reports.

Terms of Reference for key meetings in the governance structure.

Governance Structure Review Internal Audit Report 1314/DCCG/08/R– significant assurance.

CCG’s Area Team quarterly review assurance letter received by Governing Body.

Governance Structure Review Internal Audit Report 1314/DCCG/08/R– significant assurance.

Interim Head of Internal Audit Opinion received by Audit Committee November 2016.

None. None. TOLERATE

31 January

2017 New

Assurance

Framework

commences

from 1 April 2017

Organisational structure including management and clinical leaders meeting authorisation requirements.

Personal Development Reviews.

None.

Area Team quarterly assurance process.

Team attendance at Area Team assurance reviews.

Quarterly Area Team assurance review meeting outcome.

Constitution.

Receipt of Constitution updates by Governing Body.

Governing Body consideration of amendments to

Member Practice support of Constitution.

26

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

Constitution then put to Members.

Annual Membership Meeting.

Annual reporting regime

Annual Report

Annual Governance Statement

Annual Accounts

Statement of Accountable Officer Responsibilities

External Audit review of annual reporting requirements

Head of Internal Audit Opinion

Interim Head of Internal Audit Opinion received by Audit Committee November 2016.

Procedural Document management

Ongoing progress tracked through Corporate Assurance Report.

None.

Corporate Assurance Report.

Receipt by Audit Committee and Governing Body on a regular basis.

None.

Strategic planning controls as per risk 1.1.

See 1.1. See 1.1.

Financial management controls as per risk 3.2.

See 3.2. See 3.2.

5.2

Failure to ensure robust systems of Risk Management,

potentially resulting in increased

organisational risk, breaches of the

Health & Safety At Work Act 1974

and other associated

legislation, fines imposed by

external regulators and loss of

organisational reputation.

Chief of Corporate Services

5 4 20 5 2 10

Integrated Risk Management Framework - Strategy, Policy & Procedure.

Policy approved by Governing Body.

Governing Body Assurance Framework Internal Audit Report 1314/DCCG/03/R – positive outcome.1617-DCCG-06-R – Governing Body Development Session Internal Audit Output

Head of Internal Audit Opinion.

Interim Head of Internal Audit Opinion received by Audit Committee November 2016.

Annual Governance Statement.

Annual Governance Statement

Audit reports e.g. Assurance Framework, Risk Register

External quality inspections by National Fraud Office

Corporate Assurance Report received Quarterly

Head of Internal Audit Opinion

Governing Body Assurance

None None. TOLERATE

31 January

2017 New

Assurance

Framework

commences

from 1 April 2017

Governance meeting structure including Governing Body and Audit Committee.

Minutes of meetings. None.

27

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

Health & Safety Strategy, Policy & Procedure.

Incident Monitoring.

Corporate Assurance Quarterly Report.

Mandatory & statutory training schedule.

Environment Agency visits.

Health & Safety Executive visits.

Framework Internal Audit Report 1314/DCCG/03/R – positive outcome.

CCG’s Area Team quarterly review assurance letter received by Governing Body.

Conflict of Interest Internal Audit Report 1415DCCG02R – significant assurance. 1617-DCCG-07-R - Conflicts of Interest Internal Audit Report

1617-DCCG-06-R – Governing Body Development Session Internal Audit Output

Counter Fraud Policy & Response Plan. Whistleblowing Policy, management process & Lead.

Counter Fraud Report to Audit Committee.

Fraud, Corruption & Bribery Policy received and approved by Audit Committee October 2013.

Whistleblowing Policy approved by Governing Body March 2014.

Annual Governance Statement.

Assurance Framework / Risk Register / Risk Assessments.

Assurance Framework & Risk Register reporting to Governing Body & Audit Committee.

Risk Register received by Audit Committee annually.

Corporate Assurance Quarterly Report.

1617-DCCG-06-R – Governing Body Development Session Internal Audit Output Governing Body Assurance Framework Internal Audit Report 1314/DCCG/03/R – positive outcome.

Head of Internal Audit Opinion.

Interim Head of Internal Audit Opinion received by Audit Committee November 2016.

Annual Governance Statement.

Standing Financial Instructions / Prime Financial Policies. Standing Orders. Scheme of Delegation and authorisation controls.

Governing Body Minutes / Reports.

Audit Committee minutes / reports.

Non-ISFE returns to NHS England.

ISFE open ledger.

Annual Governance Statement.

Corporate Governance Management Group which acts as the Health & Safety Committee for the organisation

Corporate Governance Management Group minutes.

None.

Governance Team.

Job descriptions.

Organisational structure.

None.

28

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

Personal Development Reviews.

Health, Safety & Security Service hosted by NHS Rotherham CCG on behalf of South Yorkshire & Bassetlaw CCGs – NHS Doncaster CCG purchases from this service.

Regular service review meetings.

Reports from the service.

Memorandum of Understanding and Information Sharing Agreement.

Standards of Business Conduct & Declarations of Interest Policy.

Policy approved by Governing Body August 2016.

Probity Register received by Audit Committee 6-monthly.

Declarations of Interest for Governing Body published on website.

Conflict of Interest Internal Audit Report 1415DCCG02R – significant assurance.1617-DCCG-07-R - Conflicts of Interest Internal Audit Report

5.3

Failure to ensure robust systems of

Information Governance,

potentially resulting in

breaches of the Data Protection Act and other

associated legislation, fines imposed by the

Information Commissioner and

loss of organisational

reputation.

Chief of Corporate Services

4 4 16 4 2 8

Information Governance Toolkit & Action plan.

Governing Body minutes.

Corporate Assurance Quarterly Report.

IG Toolkit compliance 2016/172015/16 submitted self-assessment at level 2 (required standard).

1617-DCCG-08-R - IGT Internal Audit Report Review of Information Governance Internal Audit Report 1516DCCG07R – Significant Assurance

External review of IG Toolkit submission by the Health & Social Care Information Centre – supported our self-assessment conclusion.

CCG’s Area Team quarterly review assurance letter received by Governing Body.

Accredited Safe Haven (ASH) accreditation

Review of Information Governance Internal Audit Report 1516DCCG07R – Significant Assurance1617-DCCG-08-R - IGT Internal Audit Report

Data Quality Internal Audit Report 1516DCCG08R – significant assurance

External review of IG Toolkit submission by

None. None TOLERATE

31 January

2017 New

Assurance

Framework

commences

from 1 April 2017

Information Governance Statement of Compliance (SOC) for the Information Commissioner.

None.

Information Commissioner reviews / website publication.

Information Governance Strategy, Policy & Procedure. Specific Information Governance policies

Staff Confidentiality Code of Conduct declaration on appointment.

Refreshed Information

None.

29

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

and procedures e.g. Data Protection, Confidentiality Code of Conduct, Records Management.

Governance Policy approved by Governing Body September 2013. Minor updates made in 2014/15.

Freedom of Information Policy received and approved by Audit Committee October 2013.

the Health & Social Care Information Centre – supported our self-assessment conclusion.

Information Technology Strategy.

Strategy approved by Governing Body August 2015.

Local Digital Roadmap

None.

Senior Information Risk Owner & Information Security Annual Plan.

SIRO & Incident reporting & monitoring.

Corporate Assurance Quarterly Report.

None.

Caldicott Guardian & Annual Plan.

Caldicott & Incident reporting & monitoring.

Minutes of Quality & Patient Safety Committee.

None.

Framework analysing uses of personal confidential data within the organisation.

Framework updated regularly by Chief of Corporate Services and reviewed by senior managers. Received by Corporate Governance Management Group December 2016.

Information Governance Toolkit audit.

Audit Committee and Corporate Governance Management Group

Audit Committee and Corporate Governance Management Group minutes

None.

Controlled Environment for Finance (CEfF) application/approval

Approval

Data sharing agreement with Health & Social Care Information Centre

Data Sharing Contract and Data Sharing Agreements with the Health & Social Care Information Centre

Contract and Data Sharing Agreements

Signed Contract and Data Sharing Agreements

30

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

5.4

Failure to ensure appropriate systems for emergency

preparedness and business

continuity, potentially

resulting in non-compliance with

the Civil Contingencies Act and organisational

impact from business continuity

issues.

Chief of Corporate Services

4 4 16 4 2 8

South Yorkshire Emergency Planning Fora.

South Yorkshire Local Health Resilience Partnership (LHRP) minutes / reports.

Doncaster Local Emergency Planning Forum minutes. De-brief reports from incidents and exercises.

None.

Tests run in-year “live” through real incidents e.g. snow, IT-loss.

CCG’s Area Team quarterly review assurance letter received by Governing Body.

Emergency Preparedness, Resilience and Response Plan received and approved by Governing Body November 2013.

EPRR Assurance received and approved by Local Health Resilience Partnership December 2014.

None. None. TOLERATE

31 January

2017 New

Assurance

Framework

commences

from 1 April 2017

Emergency Preparedness, Resilience and Response Plan.

Emergency Preparedness, Resilience and Response Plan received and approved by Governing Body December 2015.

EPRR Assurance received and approved by Governing Body September 2016.

Oversight of Plan by Area Team.

EPRR Assurance received and approved by Local Health Resilience Partnership January 2016.

Exercise Cygnus – pandemic flu preparedness exercise.

Business Continuity Policy. Business Continuity Plan with underpinning Team Business Continuity Plans. Business Continuity risks managed through Risk Register. Business Continuity meeting.

Minutes of Business Continuity Planning meeting.

Business Continuity Policy and Plan approved by Audit Committee September 2016.

None.

Sustainability Strategy.

Governing Body receipt of Sustainability Strategy December 2015.

Sustainability section in annual report: accountability to public.

Reporting via Corporate Assurance Report.

None.

5.5

A change in national legislation

prevents CCGs from using personal

confidential data (including

postcode and NHS number) within commissioning.

Chief of Corporate Services

4 4 16 4 2 8 Information

Governance Toolkit.

Quarterly Corporate Assurance report.

Governing Body minutes.

External review of Information Governance Toolkit self-assessed scores.

Review of Arrangements for Information Governance Internal Audit Report 1314/DCCG/06/R -

Risk assessment paper considered across organisation – risk identified and understood.

None None TOLERATE

31 January

2017 New

Assurance

Framework

commences

31

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

Exceptions are for direct care, with

patient consent, or through a statutory route. This means that CCGs cannot undertake certain commissioning and contracting responsibilities

seen as core (e.g. risk stratification,

invoice validation), potentially threatening

achievement of our core statutory

duties as a commissioner to

achieve efficiency and effectiveness

of spend.

Significant assurance.

Review of Information Governance Internal Audit Report 1516DCCG07R – Significant Assurance

Deep Dive Report on this risk received by Audit Committee November 2016.

from 1 April 2017

Contract for business intelligence data warehousing.

Performance monitoring.

None.

Data Sharing Agreements and Data Sharing Contract with NHS Digital (previously Health & Social Care Information Centre)

Signed agreement and contract.

None.

Framework analysing uses of personal confidential data within the organisation.

Risk assessment following national removal of Accredited Safe Havens from 12 October 2016.

Framework and associated risks updated regularly by Chief of Corporate Services and reviewed by senior managers. Received by Corporate Governance Management Group December 2016.

Information Governance Toolkit audit.

Controlled Environment for Finance (CEfF) approval

Review of requirements and compliance with these.

External approval of Controlled Environment for Finance status – approval extended to 30

th April 2017.

Risk Stratification contract.

Performance monitoring of contract.

None.

Audit Committee and Corporate Governance Management Group

Audit Committee and Corporate Governance Management Group minutes

None.

Strategic Objective 6 – Foster effective organisational development and leadership.

6.1

Failure to design and implement

effective Organisational Development programmes,

potentially resulting in a decrease in

leadership and effectiveness.

Chief Officer 4 3 12 4 2 8

Organisational Development Strategy.

OD action plan.

OD Strategy refresh received by Governing Body December 2016.

Governing Body minutes / reports.

360 degree stakeholder survey feedback report.

Implementation of previous OD action plan and development of replacement OD action plan.

CCG’s Area Team quarterly review assurance letter received by Governing Body.

It has been recognised within the organisation that the rapidly changing external commissioning environment will require different leadership skills, and will change relationships

None.

TREAT

Action Plan

Governing Body to consider the

outcome from the diagnostic

stocktake of Governing Body relationships and effectiveness, and

develop appropriate plans

to build on

31 January

2017 New

Assurance

Framework

commences

from 1 April 2017

OD Partner procured through tender to support implementation of the Strategy.

Reports to Governing Body.

360 feedback from partners.

Colleague Engagement Group

Feedback from Colleague Engagement Group

None

32

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

HR Policies e.g. Recruitment & Selection Policy, Management of Change & Redundancy Policy.

HR Manager monitoring of policy compliance.

Procedural document refresh reporting via Corporate Assurance Report.

Staff Side feedback on policies.

both within and external to the CCG. A diagnostic stocktake of Governing Body relationships and effectiveness is therefore required and has been commissioned during Quarter 2 of 2016/17.

positive conclusions from the diagnostic,

and address any identified gaps.

Due date

31 March 2017 1-1s & Personal

Development Reviews (PDRs).

Job descriptions

Personal Development Review themes arising.

None.

OD programmes commissioned based on needs analysis.

Procurement of coaching programmes and development programmes.

None.

Organisational Development / staff training budget.

Allocation managed by Head of HR based on needs assessments.

Expenditure monitored by Finance Team.

None.

Mandatory & Statutory training programme.

Mandatory & statutory training monitoring and reporting.

Training Needs Analyses.

None.

Member Practice Development Programme (TARGET).

TARGET evaluation. None.

Running costs monitoring.

Financial reports to Governing Body monthly – minutes.

Non-ISFE returns to NHS England.

ISFE open ledger.

6.2

Failure to effectively plan for the local impact of national changes such as changes in the political /

economic / social climate, potentially

resulting in organisational strategies and responses not being able to

rapidly respond to change.

Chief Officer 4 3 12 4 2 8

Governing Body and underpinning Governance meeting structure. Locality structure.

Governing Body minutes / reports including regular Authorisation update.

Locality meetings minutes / reports.

Terms of Reference for key meetings in the governance structure.

Governing Body and underpinning Governance meeting structure. Locality structure.

CCG’s Area Team quarterly review assurance letter received by Governing Body.

Chair & Chief Officer Reports.

Response to Effective Practice Papers Internal Audit Report

None. None. TOLERATE

31 January

2017 New

Assurance

Framework

commences

from 1 April 2017

Senior Management Team meetings, horizon scanning.

Attendance at national meetings and conferences.

Governing Body minutes / reports.

Chair & Chief Officer Reports.

5 Year Forward View presented to

Response to Effective Practice Papers Internal Audit Report 1415DCCG03R – positive conclusion

33

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

Participation in managerial and clinical networks.

Governing Body November 2014.

Changes to scope of specialised services commissioning presented to Governing Body November 2014.

PESTLE analysis.

1415DCCG03R – positive conclusion

Organisational response to national initiatives.

Chair & Chief Officer Reports to Governing Body

Area Team review meetings.

Sustainability & Transformation Plan across a South Yorkshire & Bassetlaw footprint

Chief Officer engagement and leadership

NHS England review of Sustainability & Transformation Plan

Doncaster Place Plan which underpins the Sustainability & Transformation Plan.

Chair & Chief Officer leadership.

Chair & Chief Officer Reports to Governing Body.

Place Plan received and supported by Governing Body October 2016.

Partner engagement.

Better Care Fund Plan.

Reporting to Governing Body on progress.

External review of Better Care Fund Plan.

Involvement in co-commissioning.

Reporting to Governing Body on progress.

Primary Care Strategic Framework received by November 2014 Governing Body.

Membership vote on applying for delegated responsibility for primary medical care commissioning – reporting of outcome to Governing Body October 2015. Delegation from 1 April 2016.

Primary Care Equitable Funding Review received by Governing Body October 2015.

Development of a Primary Care Risk

Primary Care Co Commissioning Internal Audit Report 1617DCCG04R received by Audit Committee November 2016.

34

Ref Principal Risk Lead Person / Delegated Committee

Risk scoring

Key Controls

Assurance Gaps

Outcome Next

Review Date

Uncontrolled Current

C L CxL C L CxL Internal Assurance External Assurance Positive

Assurance Gaps in Control

Gaps in Assurance

Register.

Running costs monitoring via Finance Reports to Governing Body

Governing Body minutes

Use of running costs non-recurrently for short-term pieces of work

None

Chief Officer Staff Briefings.

Staff feedback. None.

Organisational Development Strategy & Action Plan.

Outcomes from organisational development plan.

None.

Management of Change & Redundancy Policy.

HR Manager monitoring of policy compliance.

None.

35

Assurance Framework Action Plan

Ref Principal Risk Lead Person /

Delegated Committee

Uncontrolled risk Current Risk Action Plan Progress Due Date

C L CxL C L CxL

1.3

Failure to effectively commission services to

reduce health inequalities, potentially resulting in a

widening of the inequalities gap.

Chief of Strategy & Delivery

&

Chief of Corporate Services

4 3 12 4 2 8

Work in partnership with the Health & Wellbeing Board to identify inequalities and address these in partnership in line with the Health & Wellbeing Board Strategy.

31 December 2015 – action opened.

31 March 2016 – Work has been ongoing in the last Quarter in partnership with the Public Health Team in the Local Authority to develop a workshop session for Governing Body members on health inequalities. This workshop is planned to be run in Quarter 1 of 2016/17 and should result in the development of a health inequalities plan.

30 June 2016 – An engagement session with Governing Body members on health inequalities was developed and run at the May meeting of the Strategy & Organisational Development Forum. It was agreed that a health inequalities plan would be developed focussing on performance data, reducing unwarranted variation in primary care, and seeking to better understand the health needs of our black, asian and minority ethnic population in Doncaster. Work is taking place jointly with public health team members from Doncaster Council over the summer to develop these workstreams into an action plan, which will then be combined with our existing Equality Strategy.

30 September 2016 – The Health & Wellbeing Board is developing a workshop on health inequalities to take place during October 2016, which the CCG is co-leading. It is envisaged that a partnership health inequalities action plan will be developed from this workshop. The CCG’s role within this will be captured within the refresh of the Equality & Diversity Strategy planned for December 2016. The action plan therefore remains on track.

30 December 2016 – The Health & Wellbeing Board workshop on health inequalities took place during October 2016 and a partnership action plan is being developed from this workshop. The review of the Equality Delivery System (EDS) took place at an Engagement & Experience Committee workshop in December 2016 and will be approved by the Engagement & Experience Committee at its next meeting in January 2017. The Equality & Diversity Strategy has been refreshed to align to the latest EDS self-assessment and will be taken through for approval during Quarter 4 of 2016/17. The action remains on track.

31 January 2017 – The Equality & Diversity Strategy has been refreshed and expanded to include wider health inequalities associated with wider determinants of health, and was approved by Governing Body in January 2017. The action has therefore been completed. The additional control has been added to the list of controls and the treatment of the risk changed from Treat to Tolerate.

31 March 2017

CLOSED

1.4

A change to the national business rules for CCG

allocations has resulted in an extremely challenging

financial position for CCGs in 2017/18+ which in Doncaster will require a

significant efficiency programme, could affect our local achievement of financial targets and our system transformation

plans.

Chief Officer

&

Chief Finance Officer

4 5 20 4 4 16

Develop and implement an efficiency programme aligned to the Right Care analysis, impact assess this against our transformation plan, and monitor progress throughout the year.

17 March 2016 – A change to the national business rules for CCG allocations has resulted in an extremely challenging financial position for CCGs in 2016/17 which in Doncaster could affect our local achievement of financial targets and our system transformation plans. The descriptor for Risk 1.4 which focusses on achievement of efficiency savings has therefore been refreshed to capture the current position. The financial position requires a significant efficiency programme as reported to Governing Body in March 2016. The risk identified is the impact which this significant efficiency programme could potentially have upon our local achievement of financial targets and our system transformation plans. New controls have been added to the risk comprising Right Care analysis, prescribing analysis and our financial monitoring regime. The likelihood of the risk has increased from a score of 2 “unlikely” where we do not expect it to happen/recur but it is possible it may do so to a score of 3 “possible” where the risk might happen or recur occasionally or a percentage likelihood of 21-50%. The likelihood risk score will be under regular review throughout the year in line with the reported financial position. The risk treatment has been changed from “tolerate” to “treat” and an action plan has been developed to “develop and implement an efficiency programme aligned to the Right Care analysis, impact assess this against our transformation plan, and monitor progress throughout the year”. This action was opened on 17 March 2016 after the financial position was reported to the March Governing Body meeting. Since this point, the Right Care analysis received from NHS England has been reviewed by CCG team members and an efficiency programme will be developed aligned to this analysis. Prescribing has been identified as a key priority and initial meetings have taken place to begin planning.

30 June 2016 – Based on the national Commissioning for Value packs and tools, four local workstreams have been initiated in the areas of a) Respiratory, b) Endocrine, c) Neurology, and d) Musculoskeletal, and clinical leaders have been identified to these workstreams. We are also focussing on quality and value in prescribing, and July has seen the launch to General Practice of a prescribing gain-share scheme approved by the Primary Care Commissioning Committee. These areas form the basis of our efficiency programme in 2016/17. Progress will be reported to the Governing Body as the workstreams develop.

30 September 2016 – Progress on the RightCare Workstreams (respiratory, endocrine, neurology,

31 March 2017

Carried forward to new Governing

Body Assurance Framework from 1

April 2017

36

Ref Principal Risk Lead Person /

Delegated Committee

Uncontrolled risk Current Risk Action Plan Progress Due Date

C L CxL C L CxL

musculoskeletal and prescribing) continues. The Finance Report has, however, identified potential overspends in other areas such as the acute contract, prescribing, funded nursing care and individual placements which could require further efficiencies to be identified in order to achieve the CCG’s year-end control total. The Governing Body has debated this as part of the Finance Report, and has also received a presentation on the financial control environment in 2016/17. Whilst the action to develop and impact assess an efficiency programme remains on track, the issue of financial stability remains a significant risk for the CCG.

30 December 2016 – Progress on the RightCare Workstreams (respiratory, endocrine, neurology, musculoskeletal and prescribing) continues. The monthly Finance Report received by the Governing Body continues to identify potential overspends in other areas such as the acute contract, prescribing, funded nursing care and individual placements. We are still forecasting to achieve the CCG’s year-end control total in 2016/17, however the financial position remains challenging if there are unexpected cost pressures. The action to develop and impact assess an efficiency programme remains on track, however the issue of financial stability remains a significant risk for the CCG as reported in the Indicative Financial Plan for 2017/18 received by the Governing Body in November 2016 and the risk description has been refreshed to mirror the 2017/18+ risks.

14 March 2017 – Progress on developing Quality, Innovation, Productivity & Prevention initiatives in response to the 2017/18 financial position is progressing well, with initiatives being identified to close the gap. However many of the initiatives are ambitious and will be challenging to achieve. The Governing Body has noted a significant risk remaining in this area. At the Governing Body meeting in January 2017, the risk was re-scored to reflect the current 2017/18 forecast position, leaving the residual risk at a score of 16. The financial position is reported monthly to Governing Body, alongside any developments. In the last Quarter a Commissioning for Value Decision Making Framework has been approved by the Governing Body. The risk remains at a score of 16 at the end of the Quarter. A risk relating to the financial position is replicated on the new Governing Body Assurance Framework from 1 April 2017.

2.4

Failure to performance manage contracts to ensure that Providers

deliver against local and national performance

targets, potentially resulting in organisational

non-achievement of required targets.

Head of Performance

4 4 16 4 3 12

Continue to take all contractual and partnership measures available to the CCG to ensure provider performance is brought back on track for key performance targets.

30 June 2016 – No change. The Governing Body receives monthly Quality & Performance reports which identify performance areas which are off trajectory. The transformation programmes approved by the Governing Body aim to address the underpinning system issues and support care closer to home. Additional remedial action on performance issues is reported to the Governing Body e.g. in response to the pressures on the NHS system associated with Junior Doctor industrial action and ongoing performance issues nationally in urgent care systems and Ambulance Services. The risk is being maintained at its existing score and progress will continue to be reported to Governing Body through the Quality & Performance Report.

30 September 2016 – No change. The Governing Body receives monthly Quality & Performance reports which identify performance areas which are off trajectory. The transformation programmes approved by the Governing Body aim to address the underpinning system issues and support care closer to home. Additional remedial action on performance issues is reported to the Governing Body e.g. in response to the pressures on the NHS system associated with Junior Doctor industrial action and ongoing performance issues nationally in urgent care systems and Ambulance Services. The risk is being maintained at its existing score and progress will continue to be reported to Governing Body through the Quality & Performance Report.

30 December 2016 – No change. The Governing Body continues to receive monthly Quality & Performance reports which identify performance areas which are off trajectory and debates recovery plans.

31 March 2017 – No change. The Governing Body continues to receive monthly Quality & Performance reports which identify performance areas which are off trajectory and debates recovery plans. Risks on the Risk Register capture any performance areas which are significantly off track including Urgent Care performance (A&E 4 hour wait), Referral to Treatment times (RTT 18 week target) and Cancer waits (62 day target). A risk relating to performance is replicated on the new Governing Body Assurance Framework from 1 April 2017.

31 March 2017

Carried forward to new Governing

Body Assurance Framework from 1

April 2017

4.4

There are many different commissioning footprints

and collaborations emerging at a rapid pace to address the challenges

in the 5 Year Forward View. NHS Doncaster

Chief Officer 4 4 16 4 3 12

Engage the Governing Body fully on the rapidly evolving joint working with other organisations across the breadth of the collaboratives in which we are asked to participate as they emerge, and agree the level of assurance, governance and engagement which the Governing Body will

6 September 2016 - The externally driven fast pace of change to collaborate with other organisations to commission services may potentially result in a lower level of engagement across the organisation on proposed changes than we usually endeavour to achieve as an organisation. The plans and joint committees are all in draft or in early iterations, and therefore formal assurance is not yet following through the organisation in a routine manner. New risk added. Action added: Engage the Governing Body fully on the rapidly evolving joint working with other organisations across the breadth of the collaboratives in which we are asked to participate as they emerge, and agree the level of assurance which the Governing Body

31 March 2017

Carried forward to new Governing

Body Assurance Framework from 1

April 2017

37

Ref Principal Risk Lead Person /

Delegated Committee

Uncontrolled risk Current Risk Action Plan Progress Due Date

C L CxL C L CxL

CCG is strongly engaged in the development of the Doncaster Place Plan, the

South Yorkshire & Bassetlaw Sustainability & Transformation Plan, the Working Together Joint

Committee (8 local CCGs), the Transforming

Care Partnership, and joint commissioning for Ambulance and urgent

transport services across Yorkshire & Humber. All these collaborations are on a different footprint,

and require to be resourced – whether with human resource, financial

resource, governance arrangements or public

engagement – and could impact on the priorities

and pace which we have set locally to deliver the

commitments in our Strategic Plan as a CCG.

require from each collaborative.

will require from each collaborative.

30 September 2016 – Papers on the Doncaster Place Plan and Sustainability & Transformation Plan are expected to be available by the end of October 2016. Governing Body considered proposals for joint Committees for Working Together and 999/111 over the past few months. These joint committees are not yet in place; when established, the minutes will be received by the Governing Body. A Locality Lead for Planning has been identified to support improved clinical involvement in planning. Through the Place Plan development, a neighbourhood approach has been agreed which is co-terminus across primary care, social care and community care boundaries. Development of the Place Plan has been communicated at joint committees, individual organisations and primary care forums.

30 December 2016 – During the last Quarter we have seen significant progress in this area. Governing Body supported the Doncaster Place Plan in October 2016, and supported the South Yorkshire & Bassetlaw Sustainability & Transformation Plan in November 2016. Our Commissioning & Contracting Intentions were agreed in November 2016 and triggered the contracting rounds with our providers. We have also seen the first meeting of the Working Together Joint Commissioning Committee which is focussing on Hyper Acute Stroke Services and Children’s Surgery & Anaesthesia. Finally we have signed a Memorandum of Understanding for the collaborative commissioning arrangements across Yorkshire & Humber CCGs for 999 and 111 services commissioned from the Yorkshire Ambulance Service. Partnership commissioning remains an emerging area of risk, and therefore the risk continues to be treated as the partnership commissioning governance and reporting structures start to embed into the organisation.

17 March 2017 – As we end the 2016/17 financial year, we have a strategic partner working alongside partners within the Doncaster Place Plan to develop a State of Readiness Report, we have strong partnership working to develop an implementation plan for the South Yorkshire & Bassetlaw Sustainability & Transformation Plan which is aligned to the Five Year Forward View, we have CCG Commissioning & Contracting Intentions were have been enacted into 2-year contracts with Providers, and work is progressing through the Working Together Joint Commissioning Committee on collaborative commissioning intentions for Hyper Acute Stroke Services and Children’s Surgery & Anaesthesia. Partnership commissioning remains an emerging area of risk, and a risk relating to the collaborative commissioning is replicated on the new Governing Body Assurance Framework from 1 April 2017.

38

NHS Doncaster CCG Governing Body Assurance Framework

Last updated: 1 April 2017

CO 1

CO 2

CO 3

CO 4

1 2 3 4 5

Rare Unlikely Possible LikelyAlmost

certain

(1) Negligible 1 2 3 4 5

(2) Minor 2 4 6 8 10

(3) Moderate 3 6 9 12 15

(4) Major 4 8 12 16 20

(5) Extreme 5 10 15 20 25

1-5 Low

6-10 Medium

12-15 High

16-20 Very High

25 Extreme

Ensure that the healthcare system in Doncaster is sustainable.

Work collaboratively with partners to improve health and reduce inequalities in well

governed and accountable partnerships.

Corporate Objectives (COs)

The risk appetite under which risks can be tolerated is a score

of 11 or below.

Risks scored at or in excess of a score of 16 must be escalated

to the Governing Body.

Risk Matrix

Likelihood

Co

ns

eq

uen

ce

Ensure an effective, well led, and well governed organisation.

Commission high quality, continually improving, cost effective healthcare which meets

the needs of the Doncaster population.

Last updated: 1 April 2017

Clinical / Lay Lead:

Start

of year

End of

Q1

End of

Q2

End of

Q3

End of

Q4

3

2

6 0 0 0 0

Internal External Positive Rec'd?

X X Yes

X Yes

X Yes

X No

X X Yes

X X Yes

X Yes

X X Yes

X Yes

Objective 1: Ensure an effective, well led, and well governed organisation.

Principal risk(s)/threat(s) to delivery of the objective

N/ANone.

Date reviewed:

Next review due:

01 April 2017

30 June 2017

Gaps in control: Actions being taken to address gaps:

Gaps in assurance:

None.

N/A

360 Stakeholder Survey

Executive Committee - responsibility for deploying organisational resource

Colleague Engagement Group (CEG) & Staff Briefs - involving staff in readiness for the future

Organisational Development / Learning & Development budget

Personal Development Reviews (PDRs)

Organisational Development (OD) Strategy

External partner for OD support

2

Key controls to mitigate risk/threat:

TOLERATE

Sponsors for each of the 6 domains within the OD Strategy

Organisational change: If we do we not have the right skill mix and resource within the

organisation, supported by our Organisational Development Strategy, we may not

achieve both our local commissioning strategy and our wider collaborative commissioning

commitments.1.1

Total

12

6

6

Consequence

3

3

3

Likelihood

4

2

Actions being taken to address gaps: Due date

Score history:

Consequence

Likelihood

Governing Body approval of OD Strategy - December 2016 (minutes)

Tender documentation / Partner appointment

Governing Body approval of OD Strategy - December 2016 (minutes)

360 Stakeholder Survey Report 2017

Executive Committee minutes (also reported to Governing Body)

Sources of Assurance:

Total

Colleague Engagement Group minutes; Staff Brief presentations

Budget monitoring reports

PDR Training Needs Analysis

NHS Doncaster CCG Governing Body Assurance Framework

Robust governance infrastructure as a basis for future developments - Constitution, Standing

Orders, Governance Meeting Structure, Risk Management, Information Governance, Health &

Safety, Emergency Preparedness and Mandatory & Statutory training

Corporate Assurance Report received by Governing Body on a quarterly basis

(Governing Body minutes);

1617-DCCG-08-R - Information Governance Toolkit Internal Audit Report -

significant assurance;

1617-DCCG-07-R - Conflicts of Interest Internal Audit Report - full compliance;

Head of Internal Audit Report

Due date

N/A N/A

Executive Committee

Chief of Corporate Services

Chair

Risk Rating

Uncontrolled risk:

Current risk:

Target risk:

Outcome:

Committee:

Executive Lead:

Last updated: 1 April 2017

Clinical / Lay Lead:

Start

of year

End of

Q1

End of

Q2

End of

Q3

End of

Q4

5

2

10 0 0 0 0

Internal External Positive Rec'd?

X X X Yes

X Yes

X Yes

X Yes

X X Yes

X Yes

X Yes

X Yes

Yes

X X Yes

16

Current risk: 5 2

Objective 2: Commission high quality, continually improving, cost effective healthcare

which meets the needs of the Doncaster population.

Committee:

Executive Lead:

2.1

Quality impact: Financial resource reductions could potentially affect our ability to

commission for continually improving quality.

Uncontrolled risk: 4 4

Target risk: 5

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total

10

Outcome: TOLERATE

Score history:

Consequence

2 10

Date reviewed: 01 April 2017 Likelihood

Next review due: 30 June 2017 Total

Key controls to mitigate risk/threat: Sources of Assurance:

Quality & Patient Safety Committee minutes;

Quality and Patient Safety Committee Internal Audit Report 1516DCCG02R –

significant assurance

Quality & Performance Reports monthly to Governing Body Governing Body minutes

National oversight and benchmarking of key quality performance targets NHS England Quarterly Review meetings; benchmarking data

None. N/A N/A

Quality Surveillance Group across South Yorkshire & Bassetlaw area Quality Survelliance Group minutes

Prescribing Sub Group; Area Prescribing Committee Prescribing Sub Group & Area Prescribing Committee minutes

Quality & Safety Team Quality & Safety Directorate structure

None. N/A N/A

Gaps in assurance: Actions being taken to address gaps: Due date

NHS Doncaster CCG Governing Body Assurance Framework

Quality & Patient Safety Committee

Chief Nurse

Locality Lead with Quality lead role

Actions being taken to address gaps: Due date

Safeguarding Boards - Children's and Vulnerable Adults Safeguarding Board minutes

Gaps in control:

Contractual provider quality monitoring reportsClinical Quality Review Group minutes;

Quality of Care in Care Homes Internal Audit Report 1617-DCCG-02-R

Provider Care Quality Commission (CQC) ratings CQC website

Incident Management Group oversees Serious Incident Reporting Incident Management Group minutes

Quality & Patient Safety Committee

Last updated: 1 April 2017

Clinical / Lay Lead:

Start

of year

End of

Q1

End of

Q2

End of

Q3

End of

Q4

4

3

12 0 0 0 0

Internal External Positive Rec'd?

X X Yes

X Yes

X X Yes

X Yes

X Yes

X No

X Yes

16

Current risk: 4 3

Objective 2: Commission high quality, continually improving, cost effective healthcare

which meets the needs of the Doncaster population.

Committee:

Executive Lead:

2.2

Urgent Care: If we fail to commission effective, resilient and sustainable urgent &

emergency care services, the quality of care delivered to patients and the achievement of

associated quality and performance targets could be adversely affected.

Uncontrolled risk: 4 4

Target risk: 4

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total

12

Outcome: TREAT

Score history:

Consequence

2 8

Date reviewed: 01 April 2017 Likelihood

Next review due: 30 June 2017 Total

Key controls to mitigate risk/threat: Sources of Assurance:

Delivery Plan received by Governing Body March 2017 (minutes)

A&E Delivery Board jointly with NHS Bassetlaw CCG Minutes of A&E Delivery Board

Contracts with providers for the delivery of urgent care services Signed contracts

Remediation plan developed and monitored through A&E Delivery Board. National expectation

that the target will be back on track by April 2017.30/04/2017

Actions being taken to address gaps:

A&E 4-hour wait performance

None. N/A N/A

Gaps in assurance: Due date

NHS Doncaster CCG Governing Body Assurance Framework

Executive Committee

Chief of Strategy & Delivery

Locality Lead with Urgent Care lead role

Actions being taken to address gaps: Due dateGaps in control:

Patient experience analysis in A&EPatient experience report to Engagement & Experience Committee January

2017

Quality & Performance monitoring reporting Quality & Performance Reports monthly at Governing Body (minutes)

System Resilience Group and underpinning weekly operational surge group Minutes of System Resilience Group

Urgent Care system e.g. Same Day Health Centre, Urgent Care Centre, A&E front-door triage Quality assurance visits to services

Urgent Care Delivery Plan

Last updated: 1 April 2017

Clinical / Lay Lead:

Start

of year

End of

Q1

End of

Q2

End of

Q3

End of

Q4

4

3

12 0 0 0 0

Internal External Positive Rec'd?

X X Yes

X X X Yes

X Yes

X X Yes

X Yes

X Yes

2.3

Primary Care: If we fail to commission effective, resilient and sustainable primary

medical care services, the quality of care delivered to patients and the achievement of

associated quality and performance targets could be adversely affected, and the full

vision contained within the Place Plan could potentially be adversely affected.

Uncontrolled risk:

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood

Objective 2: Commission high quality, continually improving, cost effective healthcare

which meets the needs of the Doncaster population.

Committee:

Executive Lead:

Total

Likelihood

16

Current risk: 4 3 12

Target risk: 4 2 8

Score history:

Consequence

4 4

None. N/A N/A

Development of Federations in Doncaster are at an early stage and may not be fully set up to

respond to and take their place within the Doncaster Place Plan

Gaps in assurance: Due dateActions being taken to address gaps:

NHS Doncaster CCG Governing Body Assurance Framework

GP 5 Year Forward View Plan Submitted to NHS England as part of annual planning submission

Executive Committee

Chief of Partnership Commissioning & Primary Care

Lay Member - Primary Care Commissioning

Primary Care Delivery Plan Delivery Plan received by Governing Body March 2017 (minutes)

Primary Care Commissioning CommitteeMinutes of Primary Care Commissioning Committee;

Primary Care Co Commissioning Internal Audit Report 1617DCCG04R

Outcome: TREAT

Gaps in control:

Quarterly reporting from Primary Care Commissioning Committee to Governing Body Governing Body minutes

Date reviewed: 01 April 2017

Due date

Support from commissioned Strategic Partner - EY. Action ongoing. State of Readiness Report

being developed.30/06/2017

National oversight and benchmarking of key quality performance targets NHS England Quarterly Review meetings; benchmarking data

Actions being taken to address gaps:

Delegation from NHS England for commissioning primary medical care services - supports better

integration of primary medical care commissioning with the wider CCG commissioning strategyDelegation Agreement

Next review due: 30 June 2017 Total

Key controls to mitigate risk/threat: Sources of Assurance:

Last updated: 1 April 2017

Clinical / Lay Lead:

Start

of year

End of

Q1

End of

Q2

End of

Q3

End of

Q4

4

3

12 0 0 0 0

Internal External Positive Rec'd?

X X Yes

X X Yes

X Yes

X Yes

X Yes

X Yes

X Yes

4 16

Current risk:

Objective 2: Commission high quality, continually improving, cost effective healthcare

which meets the needs of the Doncaster population.

Committee:

Executive Lead:

Executive Committee

Chief of Strategy & Delivery

Locality Lead with Planning lead role

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total

4 3 12

Outcome: TREAT

Target risk: 4 2 8

Score history:

Consequence

Date reviewed: 01 April 2017 Likelihood

2.4

Provider Workforce: Providers in Doncaster may not have access to a sufficiently skilled

workforce to meet the outcomes identified in our commissioning intentions.

Uncontrolled risk: 4

Minutes of Team Doncaster - Chief Officer & Chair representation

Next review due: 30 June 2017 Total

Key controls to mitigate risk/threat: Sources of Assurance:

NHS Doncaster CCG Governing Body Assurance Framework

Local Digital Roadmap describing a vision of paperfree at the point of care by 2020 and

interoperability to support better provider integration and cross-workingMinutes of Doncaster Interoperability Group

An understanding of the partnerships' state of readiness for implementing the Place Plan. EY developing a State of Readiness Report. Expected to be ready by the middle of Quarter 1.

Partnership engagement with Health Education England and Doncaster College on provider

workforce needs

Chief Officer engagement within Team Doncaster;

Chief of Partnership Commissioning & Primary Care engagement with South

Yorkshire & Bassetlaw Primary Care Workforce Group supporting the GP 5

Year Forward View within the Sustainability & Transformation Plan

Joint Commissioning Partnership with Doncaster Council - including the Better Care Fund Minutes of Joint Commissioning Partnership

2-year outcome based contracts - giving providers greater flexibility to innovate Contracts with Providers

Doncaster Place Plan - a vision of an Accountable Care System with providers working in

partnership togetherAll statutory organisations have supported the vision in the Place plan

Strategic Partner appointed to support implementation of the Place Plan Contract for Strategic Partner - EY

Team Doncaster - working together to improve the economic climate in Doncaster, attract and

retain new workforces, and train our own staff from within Doncaster

30/06/2017

Gaps in assurance: Actions being taken to address gaps: Due date

Gaps in control:

None.

Actions being taken to address gaps: Due date

N/A N/A

Last updated: 1 April 2017

Clinical / Lay Lead:

Start

of year

End of

Q1

End of

Q2

End of

Q3

End of

Q4

5

4

20 0 0 0 0

Internal External Positive Rec'd?

X Yes

X Yes

X Yes

X Yes

X X X Yes

X Yes

X X Yes

X Yes

X X Yes

X Yes

X Yes

25

Current risk: 5

NHS Doncaster CCG Governing Body Assurance Framework

Objective 3: Ensure that the healthcare system in Doncaster is sustainable. Committee:

Executive Lead:

3.1

Transformation: If our transformation delivery plans are not sufficiently ambitious to

respond to the expected growth in activity and reduction in financial allocation, we could

fail to deliver the efficiency savings required to maintain financial balance across the

local health system.

Uncontrolled risk: 5 5

Target risk:

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total

4 20

Outcome: TREAT

Score history:

5 2 10

Consequence

Date reviewed: 01 April 2017 Likelihood

Next review due: 30 June 2017 Total

Key controls to mitigate risk/threat: Sources of Assurance:

Doncaster Place Plan Governing Body support of Doncaster Place Plan - October 2016

South Yorkshire & Bassetlaw Sustainability & Transformation PlanGoverning Body support of Sustainability & Transformation Plan - November

2016

CCG Commissioning & Contracting IntentionsGoverning Body approval of CCG Commissioning & Contracting Intentions -

November 2016

Collaborative Partnership Board for the South Yorkshire & Bassetlaw Sustainability &

Transformation Plan - Chief Officer representationCollaborative Partnership Board minutes

Governing Body approval of CCG Delivery Plans - March 2017;

Mental Health Payment by Results Data Quality Internal Audit Report

1516DCCG05R – significant assurance

Delivery Plans for each of the 12 areas in the Commissioning & Contracting Intentions

Our Plans includes ambitious targets and trajectories reflecting the priorities of the Membership,

Governing Body, service users, and other stakeholders. The Plan was subject to review &

challenge by NHS England at key stages in its development.

NHS England Quarterly Review meetings

Commissioning for Value Decision Making Framework Governing Body approval of Framework - February 2017 (minutes)

Assurance that our transformation plans are sufficiently ambitious to achieve the necessary

savings

Gaps in assurance:

Gaps in control:

None.

Actions being taken to address gaps:

N/A

Regular reporting to Governing Body on delivery of our CCG Delivery Plans.

Operational planning templates 2017-2019 submitted to NHS England alongside a planning

narrative setting out plans to deliver agreed activity reductions, standards and targets.NHS England submission

Governing Body

Chief Officer

Chair

Actions being taken to address gaps: Due date

N/A

NHS England Improvement & Assessment Framework - a continuous risk-based process, with

meetings as required, informed by performance indicators and a wide range of other sources of

insight, leading to a formal assessment against the 4 domains of assurance at the year end.

NHS England Improvement & Assessment Framework Reports

Internal assessment of national potential Right Care opportunities and tracking of progress

against theseRight Care tracker document

Health & Wellbeing Board - local collaborative work to improve health outcomes and address

health inequalities; Health & Wellbeing Board challenge of CCG plansHealth & Wellbeing Board minutes - Chair & Chief Officer representation

Due date

Developing a template for reporting to Governing Body - tested in March 2017. 30/06/2017

Regular Governing Body challenge of the ambition described in our transformation plans -

action is ongoing.Ongoing

Last updated: 1 April 2017

Clinical / Lay Lead:

Start

of year

End of

Q1

End of

Q2

End of

Q3

End of

Q4

4

3

12 0 0 0 0

Internal External Positive Rec'd?

X X Yes

X Yes

X Yes

X Yes

X X X Yes

X Yes

X Yes

X Yes

X Yes

X Yes

X Yes

X X Yes

X X Yes

X Yes

4 16

Current risk:

NHS Doncaster CCG Governing Body Assurance Framework

Objective 3: Ensure that the healthcare system in Doncaster is sustainable. Committee: Governing Body

Executive Lead: Chief Officer

Chair

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total

4 3 12

Outcome: TREAT

Target risk: 4 2 10

Score history:

Consequence

Date reviewed: 01 April 2017 Likelihood

3.2

Efficiencies: If we do not maximise efficiency opportunities presented by areas such as

Prescribing and RightCare, we may be forced to consider decommissioning services

from elsewhere in order to achieve the required savings.

Uncontrolled risk: 4

Next review due: 30 June 2017 Total

Key controls to mitigate risk/threat: Sources of Assurance:

Governing Body support of Doncaster Place Plan - October 2016

CCG Commissioning & Contracting Intentions Governing Body approval of CCG Commissioning & Contracting Intentions -

Collaborative Partnership Board minutes

Commissioning for Value Decision Making Framework Governing Body approval of Framework - February 2017 (minutes)

Internal assessment of national potential Right Care opportunities and tracking of progress Right Care tracker document

Prescribing analysis

Prescribing Reports to Prescribing Sub Group (minutes);

Medicines Management Internal Audit Report 1415DCCG04R – Significant

Assurance

Standards of Business Conduct & Conflicts of Interest Policy - including business case and

procurement requirements

Policy - on website;

1617-DCCG-07-R - Conflicts of Interest Internal Audit Report - full compliance

Gaps in control: Actions being taken to address gaps: Due date

Prescribing costs - at a primary care level and at a secondary care level.Monitoring of prescribing; prescribing incentive scheme; Commissioning for Value Framework

limiting to NICE guiedance. Action ongoingOngoing

Gaps in assurance: Actions being taken to address gaps: Due date

None. N/A N/A

Financial Strategy Governing Body approval of Strategy - November 2016 (minutes)

NHS England Improvement & Assessment Framework - a continuous risk-based process, with

meetings as required, informed by performance indicators and a wide range of other sources of

insight, leading to a formal assessment against the 4 domains of assurance at the year end.

NHS England Improvement & Assessment Framework Reports

Procurement Strategy Governing Body approval of Strategy - May 2014 (minutes)

Collaborative Partnership Board for the South Yorkshire & Bassetlaw Sustainability &

Transformation Plan - Chief Officer representation

Delivery Plans for each of the 12 areas in the Commissioning & Contracting Intentions Governing Body approval of CCG Delivery Plans - March 2017

Operational planning templates 2017-2019 submitted to NHS England alongside a planning

narrative setting out plans to deliver agreed activity reductions, standards and targets.NHS England submission

Our Plans includes ambitious targets and trajectories reflecting the priorities of the Membership,

Governing Body, service users, and other stakeholders. The Plan was subject to review &

challenge by NHS England at key stages in its development.

NHS England Quarterly Review meetings

South Yorkshire & Bassetlaw Sustainability & Transformation PlanGoverning Body support of Sustainability & Transformation Plan - November

2016

Doncaster Place Plan

Last updated: 1 April 2017

Clinical / Lay Lead:

Start

of year

End of

Q1

End of

Q2

End of

Q3

End of

Q4

5

3

15 0 0 0 0

Internal External Positive Rec'd?

X Yes

X Yes

X Yes

X Yes

X Yes

X Yes

X X Yes

X Yes

X Yes

X Yes

4 20

Current risk:

NHS Doncaster CCG Governing Body Assurance Framework

Objective 3: Ensure that the healthcare system in Doncaster is sustainable. Committee: Governing Body

Executive Lead: Chief Officer

Chair

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total

5 3 15

Outcome: TREAT

Target risk: 5 2 10

Score history:

Consequence

Date reviewed: 01 April 2017 Likelihood

3.3

System affordability: If the overall Doncaster healthcare system is not affordable given

the impact of external controls on CCG allocations leading to increasingly limited

financial resource, this may require the CCG to undertake greater prioritisation of

resource to meet the identified needs of our population.

Uncontrolled risk: 5

Next review due: 30 June 2017 Total

Key controls to mitigate risk/threat: Sources of Assurance:

South Yorkshire & Bassetlaw Sustainability & Transformation Plan Governing Body support of Sustainability & Transformation Plan - November

Doncaster Place Plan Governing Body support of Doncaster Place Plan - October 2016

CCG Commissioning & Contracting Intentions Governing Body approval of CCG Commissioning & Contracting Intentions -

Collaborative Partnership Board for the South Yorkshire & Bassetlaw Sustainability &

Transformation Plan - Chief Officer representationCollaborative Partnership Board minutes

Delivery Plans for each of the 12 areas in the Commissioning & Contracting Intentions Governing Body approval of CCG Delivery Plans - March 2017

Operational planning templates 2017-2019 submitted to NHS England alongside a planning

narrative setting out plans to deliver agreed activity reductions, standards and targets.NHS England submission

Our Plans includes ambitious targets and trajectories reflecting the priorities of the Membership,

Governing Body, service users, and other stakeholders. The Plan was subject to review &

challenge by NHS England at key stages in its development.

NHS England Quarterly Review meetings

Commissioning for Value Decision Making Framework Governing Body approval of Framework - February 2017 (minutes)

Partnership working across Team Doncaster. Team Doncaster minutes

Working Together Partnership Board - collaborative decision making on Hyper Acute Stroke

Unit services and Children's Surgery & AnaesthesiaWorking Together Partnership Board minutes - received by Governing Body

If local providers arae unable to develop an effective Accountable Care Partnership to respond

to Integrated Commissioning (CCG and Doncaster Council) commissioning (starting with testing

the model with Intermediate Care services), then there is a risk that we not achieve the vision

set out in the Doncaster Place Plan, which may adversely affect system susta#inability.

Support from commissioned Strategic Partner - EY. Action ongoing. State of Readiness

Report being developed.30/06/2017

Gaps in control: Actions being taken to address gaps: Due date

NHS Doncaster CCG does not have any control over financial allocations from NHS England /

the Department of Health, which have been reducing over the past few years. A move from

deprivation-based allocations to age-based allocations adversely affected NHS Doncaster

CCG's allocations, and these have continued to decrease year-on-year. The CCG allocations

affect the resources which we have available to commission local healthcare services, and

pump-prime transformation work.

Limited controls - national allocations. Ongoing dialogue with NHS England. Ongoing

CCG additional funding is contingent upon the delivery of organisational control totals by

providers across the Sustainability & Transformation Plan footprint.Limited controls - national allocations. Ongoing dialogue with NHS England. Ongoing

Gaps in assurance: Actions being taken to address gaps: Due date

There is national funding available for first wave Sustainability & Transformation Plan areas, but

this has not yet been allocated.

Governance arrangements are being developed collaboratively across the Sustainability &

Transformation Plan footprint, but are at an early stage.Ongoing

Last updated: 1 April 2017

Clinical / Lay Lead:

Start

of year

End of

Q1

End of

Q2

End of

Q3

End of

Q4

5

2

10 0 0 0 0

Internal External Positive Rec'd?

X X Yes

X Yes

X Yes

X Yes

X Yes

X X Yes

X X Yes

5 25

Current risk:

NHS Doncaster CCG Governing Body Assurance Framework

Objective 3: Ensure that the healthcare system in Doncaster is sustainable. Committee: Audit Committee

Executive Lead: Chief Finance Officer

Locality Lead with Finance lead role

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total

5 2 10

Outcome: TOLERATE

Target risk: 5 2 10

Score history:

Consequence

Date reviewed: 01 April 2017 Likelihood

3.4

Control total: If we do not meet our CCG control total due to the impact of external

controls on CCG allocations and/or the impact of unpredicted in-year cost pressures, then

we will be in breach of our statutory duties to commission efficiently, effectively and to

achieve value for money, and we may not be able to commission all the services which

we have identified that our population needs.

Uncontrolled risk: 5

Next review due: 30 June 2017 Total

Key controls to mitigate risk/threat: Sources of Assurance:

Financial Strategy Governing Body approval of Strategy - November 2016 (minutes)

Commissioning for Value Decision Making Framework Governing Body approval of Framework - February 2017 (minutes)

Finance Report to Governing Body on a monthly basis Governing Body minutes

External Audit Annual Audit Letter 2015-16;

ISA260 Report to those charged with Governance

Standing Financial Instructions, Standing Orders, & Scheme of Delegation On website. Last approved by Governing Body in March 2017

Finance, Performance & Information Group (FPIG) meetings with ProvidersMinutes of FPIG meetings;

Data Quality Internal Audit Report 1516DCCG08R – significant assurance

Internal Audits

Internal Audit Plan 2017/18;

Counter Fraud Workplan 2017/18;

Head of Internal Audit Opinion;

1617-DCCG-09-R – Budgetary Control & Key Financial Systems Internal Audit

Report - significant assurance

Gaps in control: Actions being taken to address gaps: Due date

None. N/A N/A

Gaps in assurance: Actions being taken to address gaps: Due date

None. N/A N/A

Last updated: 1 April 2017

Clinical / Lay Lead:

Start

of year

End of

Q1

End of

Q2

End of

Q3

End of

Q4

4

2

8 0 0 0 0

Internal External Positive Rec'd?

X Yes

X Yes

X Yes

X Yes

X X Yes

X Yes

X Yes

X X Yes

X Yes

X Yes

X Yes

3 12

Current risk:

NHS Doncaster CCG Governing Body Assurance Framework

Objective 4: Work collaboratively with partners to improve health and reduce inequalities

in well governed and accountable partnerships.

Committee: Executive Committee

Executive Lead: Chief of Strategy & Delivery

Locality Lead with Planning lead role

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total

4 2 8

Outcome: TOLERATE

Target risk: 4 2 8

Score history:

Consequence

Date reviewed: 01 April 2017 Likelihood

4.1

Dual partnership focus: We have dual areas of partnership commissioning focus - our

local focus on Doncaster as a place delivering the ambition described in the Doncaster

Place Plan, and our collaborative commissioning commitments within areas such as the

South Yorkshire & Bassetlaw Sustainability & Transformation Plan. If these dual areas of

focus dilute our local system leadership as CCG as resource is aligned both locally and

across a wider collaborative footprint, this could potentially impact upon our organisational

independence of decision making.

Uncontrolled risk: 4

Next review due: 30 June 2017 Total

Key controls to mitigate risk/threat: Sources of Assurance:

None. N/A N/A

Colleague Engagement Group (CEG) & Staff Briefs - involving staff in readiness for the future Colleague Engagement Group minutes; Staff Brief presentations

External partner for OD support - ensuring organisational readiness for change Tender documentation / Partner appointment

Standards of Business Conduct & Conflicts of Interest Policy - including business case and

procurement requirements

Policy - on website;

1617-DCCG-07-R - Conflicts of Interest Internal Audit Report - full compliance

Gaps in control: Actions being taken to address gaps: Due date

Memorandum of Understanding (MOU) for Continuing Health hosting arrangements by NHS

Doncaster CCG.

Signed MOU;

Continuing Healthcare Payments Certification 1516DCCG04R Internal Audit

Report – significant assurance

Gaps in assurance: Actions being taken to address gaps: Due date

None. N/A N/A

Section 75 agreement with Doncaster Council Signed Section 75 agreement

Governing Body approval for establishment of Joint Committees, and the level of delegation to

joint Committees.Governing Body minutes

Working Together Partnership Board - collaborative decision making on Hyper Acute Stroke Unit

services and Children's Surgery & Anaesthesia. Represented by Chief Officer.Working Together Partnership Board minutes - received by Governing Body

South Yorkshire & Bassetlaw Sustainability & Transformation Plan - Collaborative Partnership

Board for the South Yorkshire & Bassetlaw Sustainability & Transformation Plan - Chief Officer

representation.

Governing Body support of Sustainability & Transformation Plan - November

2016; Collaborative Partnership Board minutes

Doncaster Place Plan - represented on collaborative partnership by Chair & Chief OfficerGoverning Body support of Doncaster Place Plan - October 2016;

Collaborative Partnership minutes received by Executive Committee

Partnership working across Team Doncaster. Team Doncaster minutes

Strategic Partner appointed to support implementation of the Place Plan Contract for Strategic Partner - EY

Last updated: 1 April 2017

Clinical / Lay Lead:

Start

of year

End of

Q1

End of

Q2

End of

Q3

End of

Q4

4

2

8 0 0 0 0

Internal External Positive Rec'd?

X Yes

X X X Yes

X Yes

X Yes

X Yes

X Yes

X Yes

X No

3 12

Current risk:

NHS Doncaster CCG Governing Body Assurance Framework

Objective 4: Work collaboratively with partners to improve health and reduce inequalities

in well governed and accountable partnerships.

Committee: Engagement & Experience Committee

Executive Lead: Chief of Corporate Services & Chief of Strategy & Delivery

Locality Leads with lead for engagement

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total

4 2 8

Outcome: TOLERATE

Target risk: 4 2 8

Score history:

Consequence

Date reviewed: 01 April 2017 Likelihood

4.2

Engagement & prevention: If, across the Doncaster Place Plan footprint, we do not

achieve cultural change away from a more dependant medicalised model of healthcare

towards greater self-care, prevention, patient engagement & empowerment, and building

on the existing strengths within communities, we may not deliver the vision contained

within the Place Plan, or the efficiencies.

Uncontrolled risk: 4

Next review due: 30 June 2017 Total

Key controls to mitigate risk/threat: Sources of Assurance:

Communication, Engagement & Experience Strategy Governring Body approval of Strategy - December 2014

Equality & Diversity Strategy - incorporating our approach to health inequalities and our equality

objectives

Governring Body approval of Strategy - January 2017;

Public Sector Equality Duty Internal Audit Report 1516/DCCG/09/R –

significant assurance

Engagement & Experience Committee Minutes of Engagement & Experience Committee

Cross-Doncaster Communication & Engagement Group, chaired by NHS Doncaster CCG,

supporting public engagement in the Place PlanNotes from meeting

Commissioning of Healthwatch Doncaster to lead public engagement on the Sustainability &

Transformation PlanReport from engagement

Doncaster Inclusion & Fairness Forum - CCG membership Notes from Inclusion & Fairness Forum

Strong relationship with Healthwatch Doncaster, who also sit on our Governing Body Governing Body minutes, written agreement for co-working

Health & Wellbeing Board - local collaborative work to improve health outcomes and address

health inequalities; Health & Wellbeing Board challenge of CCG plansHealth & Wellbeing Board minutes - Chair & Chief Officer representation

Gaps in control: Actions being taken to address gaps: Due date

None. N/A N/A

Gaps in assurance: Actions being taken to address gaps: Due date

None. N/A N/A

Last updated: 1 April 2017

Clinical / Lay Lead:

Start

of year

End of

Q1

End of

Q2

End of

Q3

End of

Q4

4

2

8 0 0 0 0

Internal External Positive Rec'd?

X Yes

X Yes

X Yes

X Yes

3 12

Current risk:

NHS Doncaster CCG Governing Body Assurance Framework

Objective 4: Work collaboratively with partners to improve health and reduce inequalities

in well governed and accountable partnerships.

Committee:

Executive Lead:

Principal risk(s)/threat(s) to delivery of the objective Risk Rating Consequence Likelihood Total

4 2 8

Outcome: TOLERATE

Target risk: 4 2 8

Score history:

Consequence

Date reviewed: 01 April 2017 Likelihood

4.3

STP non-delivery: If the South Yorkshire & Bassetlaw Sustainability & Transformation

Plan does not deliver the expected savings, greater savings will need to be identified at a

Place level, and we may not be able to commission all the services which we have

identified that our population needs.

Uncontrolled risk: 4

South Yorkshire & Bassetlaw Sustainability & Transformation Plan Governing Body support of Sustainability & Transformation Plan - November

Next review due: 30 June 2017 Total

Key controls to mitigate risk/threat: Sources of Assurance:

As above. As above. As above

Gaps in control: Actions being taken to address gaps: Due date

The Sustainability & Transformation Plan is at an early stage, and only high-level indicative

savings have been identified.

Chief Officer represents NHS Doncaster CCG on the STP Collaborate Partnership Board and

engages the Governing Body in the direction of travel and any expected commissioning and

financial impact.

Ongoing

Collaborative Partnership Board for the South Yorkshire & Bassetlaw Sustainability &

Transformation Plan - Chief Officer representation

Governing Body support of Sustainability & Transformation Plan - November

2016; Collaborative Partnership Board minutes

Gaps in assurance: Actions being taken to address gaps: Due date

Commissioning for Value Decision Making Framework Governing Body approval of Framework - February 2017 (minutes)

Working Together Partnership Board - collaborative decision making on Hyper Acute Stroke Unit

services and Children's Surgery & AnaesthesiaWorking Together Partnership Board minutes - received by Governing Body

Enc F

Item 12

Chair & Chief Officer Report

1

Meeting name Governing Body

Meeting date 20 April 2017

Title of paper

Chair and Chief Officer Report

Executive / Clinical Lead(s)

Dr David Crichton, Clinical Chair Mrs Jackie Pederson, Chief Officer

Author(s) Mrs Sarah Atkins Whatley, Chief of Corporate Services

Purpose of Paper - Executive Summary

The purpose of this report is to update the Governing Body on issues relating to the activity of the CCG of which the Governing Body needs to be aware, but which do not themselves warrant a full Governing Body paper. This month the paper includes updates on the following areas:

Next steps on the NHS Five Year Forward View

360 Stakeholder Survey

NHS England Annual Assurance Review

Constitutional change proposal – The Phoenix Practice

National CCG changes – April 2017

NHS Security Management

Information Governance Toolkit

Recommendation(s)

The Governing Body is asked to:

Note the report.

Consider the Constitutional change request to move The Phoenix Practice from the South East to the Central Locality, and recommend the change to our Member Practices.

2

Impact analysis

Quality impact Neutral Equality impact

Neutral

Sustainability impact

Nil

Financial implications

Nil

Legal implications

Nil

Management of Conflicts of

Interest Paper is for information. No relevant interests.

Consultation / Engagement

(internal departments,

clinical, stakeholder & public/patient)

N/A

Report previously

presented at None

Risk analysis

Nil

Assurance Framework

3.2, 5.1, 6.2

3

Chair and Chief Officer Report

April 2017 1. Next steps on the NHS Five Year Forward View On 31 March 2017 the NHS published the Next steps on the NHS Five Year Forward View, outlining further support for strengthening and transforming GP practices, as it continues to improve and care for more patients. The report also highlights other practical improvements in areas of particular concern to patients including cancer and mental health, while transforming the way that care is delivered to ease pressure on hospitals. It also includes the mechanisms by which the NHS aims to deliver this change, taking the lessons learned from the vanguards and making them integral to how Sustainability and Transformation Plans develop from proposals to plans. 2. 360 Stakeholder Survey As a system leader we need to have strong relationships with a range of health and care partners. Our relationships provide us with ongoing information, advice and knowledge to help us make the best possible commissioning decisions. The CCG 360 Stakeholder Survey is a key part of ensuring these strong relationships are in place. NHS England commissioned Ipsos Moro to conduct the 2017 CCG 360 Stakeholder Survey which has allowed stakeholders to provide feedback on their working relationships with us. Our overall response rate to the survey in 2017 was 57%, which is a 10% improvement in our response rate from 2016. The average response rate across all CCGs within the survey was 62%. An internal analysis of our Stakeholder Survey outcomes, including the full report from Ipsos Mori, is attached as Appendix A. We would like to take this opportunity to thank our stakeholders for the time and thought which they put into their responses. Only with an open relationship in which we can tell each other what is going well and what could be better, can we improve our partnership effectiveness as an organisation. 3. NHS England Annual Assurance Review On 12 April 2017 we had our Annual Assurance Review with NHS England. With representation from our Senior Management Team and Chair, key areas discussed were:

CCG key achievements and issues from 2016/17

Operational and financial plans for 2017/18: formal sign-off / identification of key issues

CCG Place Based Strategy

4

Wider Sustainability & Transformation Plan implementation The outcome letter from NHS England will be presented to the Governing Body when received. 4. Constitutional change proposal – The Phoenix Practice The Phoenix Practice has made a formal request to NHS Doncaster CCG for them as a Member Practice to move from the South East Locality to the Central Locality. The rationale given is due to the geographic patient base (for the purposes of commissioning) and also with a view to the future emerging local NHS landscape in Doncaster. The process for consideration of this change is detailed below:

a) Consult the Locality which the Practice is wishing to leave to ascertain if they have any objections to the Practice leaving the Locality (via Practice Representatives at the Locality meeting).

b) Consult the Locality which the Practice is wishing to join to ascertain if they have any objections to the Practice joining the Locality (via Practice Representatives at the Locality meeting).

c) Present the change to the Governing Body for approval (within the April 2017 Chair & Chief Officer Report).

d) Consult the Membership to ascertain if they have any objections to the change (via the established process as this will require a Constitutional change).

e) Submit the Constitutional change request to NHS England. The South East and Central Localities have been consulted during early April 2017 on the proposed change, and have supported the change. Governing Body members are asked to consider this Constitutional change request and recommend the change to our Member Practices. The changes to our Constitution in order to reflect the Joint Committee of CCGs for Working Together from April 2017 was formally approved by NHS England on 30 March 2017, and the refreshed Constitution has been placed on our website. http://www.doncasterccg.nhs.uk/about-us/who-are-we/ 5. National CCG changes – April 2017 From 1 April 2017 there are 207 CCGs operating in England – Central Manchester CCG, North Manchester CCG and South Manchester CCG have merged to form Manchester CCG. A further 62 CCGs took forward delegated commissioning arrangements for primary medical services on 1 April 2017. This brings the total number of CCGs with full delegation to 176, representing 84% of CCGs.

5

6. NHS Security Management Our Security Management Director, the Chief of Corporate Services, has received a letter from the Managing Director of NHS Protect to thank NHS organisations for the support and assistance given to the NHS security management and tackling violence agenda. There are national plans for the creation of a new Special Health Authority dedicated to counter fraud work. The new organisation will be called the NHS Counter Fraud Authority (NHSCFA) and exists in shadow form from 1 April 2017. The transfer of staff and the creation of the NHSCFA will take place during the first quarter of 2017/18, with the new organisation being launched on 3 July 2017. At this point NHS Protect will cease to exist. Services provided by NHS Protect’s Local Support and Development and Training teams will cease on 31 March 2017. The remaining NHS Protect security management functions will also be decommissioned at this time as part of the transition leading to the establishment of the NHSCFA. NHS Doncaster CCG is part of a partnership arrangement with the South Yorkshire & Bassetlaw CCGs for Health, Safety & Security hosted by NHS Rotherham CCG. As part of this service we have access to advice and support from an experienced and accredited NHS security management professional. 7. Information Governance Toolkit On 27 March 2017 we published our 2016/17 Information Governance (IG) Toolkit. We attained an overall IG Toolkit score of 77%, improving on the score achieved for 2015/16 by 1%. The IG Toolkit scores result in one of 2 outcomes – “satisfactory” or “unsatisfactory”. Our score of 77% with a minimum score of 2 across all the standards means that our Toolkit outcome is “satisfactory”. The Toolkit was also subject to Internal Audit review in the last Quarter, which resulted in an outcome of significant assurance. 8. Recommendations The Governing Body is asked to:

Note the report.

Consider the Constitutional change request to move The Phoenix Practice from the South East to the Central Locality, and recommend the change to our Member Practices.

6

1

NHS Doncaster CCG Stakeholder Survey Report 2017 – Analysis 1. Introduction

NHS Doncaster Clinical Commissioning Group (CCG) needs to have strong relationships with a range of health and care partners in order to be successful as commissioners within the local system. Our relationships provide us with ongoing information, advice and knowledge to help us make the best possible commissioning decisions. The CCG 360o Stakeholder Survey is a key part of ensuring these strong relationships are in place. NHS England commissioned Ipsos Moro to conduct the 2017 CCG 360o Stakeholder Survey. The survey allows stakeholders to provide feedback on working relationships with CCGs. The results from the survey are intended to serve two purposes:

1. To provide a wealth of data for CCGs to help with their ongoing organisational development, enabling them to continue to build strong and productive relationships with stakeholders. The findings can provide a valuable tool for all CCGs to be able to evaluate their progress and inform their organisational decisions.

2. To feed into improvement and assessment conversations between NHS England and CCGs. The survey will form part of the evidence used to assess whether the stakeholder relationships continue to be central to the effective commissioning of services by CCGs, and in doing so, improve quality and outcomes for patients.

Within the survey, stakeholders were asked a series of questions about their working relationship with the CCG. In addition, to reflect each core stakeholder group’s different area of expertise and knowledge, they were presented with a short section of questions specific to the stakeholder group they represented. The 360o Stakeholder Survey ran from Monday 16 January 2017 to Tuesday 28 February 2017. 2. Response rate Our overall response rate to the survey in 2017 was 57%, which is a 10% improvement in our response rate from 2016. The average response rate across all CCGs within the survey was 62%. We had a better than national average response rate from all stakeholders with the exception of our Member Practices and wider stakeholders, although a significant improvement in response rate from our Member Practices compared to 2016.

2

2017

Overall response

rate

GP member practices

Health and

Wellbeing Board

Local Health Watch

NHS providers

Other CCGs Local

Authority Wider

Stakeholders

Doncaster

57% 49% 100% 100% 75% 100% 50% 50%

National average 62% 63% 61% 73% 48% 74% 56% 60%

2016 Overall

response rate

GP member practices

Health and

Wellbeing Board

Local Health Watch

Other patient groups

NHS providers

Other CCGs Local

Authority Wider

Stakeholders

Doncaster

47% 36% 100% 0% 100% 100% 75% 75% N/A

National average 61% 59% 60% 76% 72% 57% 75% 56% 56%

3. Outcome report The full nationally-produced outcome report from the survey is available on our website www.doncasterccg.nhs.uk. The report covers the domains:

Overall engagement

Commissioning services

Leadership of the CCG

Monitoring and reviewing services

Plans and priorities A 2-page summary is shown at Appendix A. 4. Analysis The following themes have emerged from the analysis of the report.

Theme Result Analysis

Working relationships and overall

engagement

76% of respondents rate their overall working relationship with us as very good or fairly good. 74% of respondents are very or fairly satisfied with the way that the CCG has engaged with them over the last 12 months. This is in line with national and cluster comparisons and has not changed significantly since last year. There was a general upwards trend of improvement across all questions when compared to previous years.

This is a positive outcome and reflects the open, transparent and engaging CCG leadership culture which we are trying to foster.

3

Theme Result Analysis

Commissioning services

61% of respondents feel we engage the right people when making commissioning decisions, with the exceptions being a minority of Member Practices and Healthwatch. This result is an improvement on previous years, and in line with national and cluster comparisons. 64% of respondents have confidence in the CCG to commission high quality services for the local population, with a further 24% neither agreeing nor disagreeing. This is an improvement on previous years, and in line with national and cluster comparisons. We score higher than our 2 previous years, and higher than the national average and higher than our CCG Cluster average for respondents understanding the reasons for commissioning decisions and for our plans delivering continuous improvement. At 39%, we score lower than that national comparator (58%) and our CCG Cluster (59%) for satisfaction with engagement with patients and the public, and lower for acting on patient/public views when making commissioning decision and feeding back to those who have shared their views.

This is a significant improvement on previous years’ results, and testament to the time which we have dedicated to working in partnership with our stakeholders and striving to involve our stakeholders more in our commissioning priorities. We recognise that not all our stakeholders feel fully involved in all aspects of commissioning. As the statutory voice for patients and citizens in Doncaster, we want to work more closely with Healthwatch Doncaster, and we have developed a more collaborative programme of engagement for 2017/18 through a partnership grant agreement and the secondment of the CCG team member to Healthwatch Doncaster. This is also in response to a commissioned Diagnostic piece of work on Stakeholder communication and engagement, which has recently led to refreshed engagement principles for the CCG, and plans to use the NHS Ladder of Engagement in all our work. The outcome of the survey matches the developmental areas which our Diagnostic had already identified.

Leadership of the CCG

In all the Leadership domain questions, our 2017 position is significantly improved when compared to the survey results in 2015 and 2016, and our score is consistently higher than or in line with national and cluster comparisons. Of particular note is:

the increase in those reflecting that the CCG has the necessary blend of skills and experience – which has increased from 44% in 2016 to 79% in 2017

the increase in those reflecting

NHS Doncaster CCG started the year in April 2016 with significant changes in leadership - a new Chair and Chief Officer. Subsequently we had changes to both the Chief Nurse and Chief of Strategy & Delivery roles alongside a change in Locality Lead for the Central Locality. We now have a stable senior clinical and managerial leadership team and this team has held a robust period of engagement with our Member Practices on how they wished to be better engaged in their role as clinical commissioners.

4

Theme Result Analysis

that the CCG has clear and visible leadership – which has increased from 44% in 2016 to 85% in 2017

confidence in the leadership of the CCG to deliver its plans and priorities – which has increased from 37% in 2016 to 67% in 2017

76% of respondents felt that we were effective as a system leader. This is higher than the national and CCG Cluster comparisons.

The senior leadership team has also been engaging with our breadth of stakeholders, particularly in respect the Doncaster Place Plan and the South Yorkshire & Bassetlaw Sustainability & Transformation Plan. In December 2016, following externally facilitated self-assessment and stakeholder engagement, we approved a refreshed Organisational Development Strategy to support us to build upon this sound basis and evolve our leadership role within the new integrated commissioning environment. Our successful enactment of the action plan associated with this Strategy will be crucial to building on the improvements in leadership visibility to our stakeholders which have been achieved in the last year.

Monitoring and reviewing services

We are broadly in line with national and cluster comparisons for confidence in the CCG to monitor the quality of commissioned services and confidence in raising concerns. There is lower comparative confidence in our acting upon feedback received (from a majority Member Practices and Healthwatch Doncaster) however our score shows an increase from 2016.

We have robust quality and patient safety mechanisms in place which have been tested by Internal Audit during the year and our reflected in our Annual Governance Statement. It would be beneficial to spend some time with our Member Practice and Healthwatch stakeholders providing further assurance on and seeking feedback on these mechanisms.

Plans and priorities

We have improved our score in every question within this domain compared to 2016. We are broadly in line with national and cluster comparisons for the opportunity for stakeholders to influence plans/priorities, for taking on board comments on plans/priorities, and for having the right plans/priorities. We score slightly higher than national and cluster comparisons for what stakeholders know of our plans/priorities, and how the CCG has effectively communicated

It is very positive to see the time we have invested in working in partnership with our stakeholders to agree plans/priorities within the Doncaster Place Plan and the South Yorkshire & Bassetlaw Sustainability & Transformation Plan have been reflected in significant increases in scores across this domain. We want to continue to engage with our stakeholders as the fast-paced work evolves over the next tear.

5

Theme Result Analysis

plans/priorities. 91% of stakeholders feel that improving patient outcomes is a core focus for the CCG.

Stakeholder groups

Generally, we received very positive feedback from:

Our Local Authority on integrated commissioning and safeguarding.

From the Health & Wellbeing Board on active membership of the Board and delivering shared plans for integrated commissioning.

Healthwatch / Patient Groups on engaging with seldom heard groups and listening to / acting on concerns/complaints/issues.

Providers on working together on long term strategies and quality of services, with good understanding of the challenges facing providers and good clinical involvement in service redesign.

Member Practices had a more mixed view, with the majority feeling that they have a low level of influence on decision making. However the majority felt that they did have confidence in the clinical leadership of the CCG to deliver plans/priorities. At least half of Member Practices agreed that the clinical leadership of the CCG was delivering quality improvements, addressing health inequalities, and sustaining 2-way accountability. At least half also understood both financial and service improvement implications of CCG plans. A very low level of understanding and involvement in the financial position of the CCG was reflected.

Last year, other CCGs did not feel fully engaged with the work of our CCG. We are pleased to see a significant shift, which we ascribe to the partnership development of the Sustainability & Transformation Plan, in which NHS Doncaster CCG has been an active partner. There are a minority of Member Practices who reflect that they do not feel engaged (6 out of 20) with their CCG. Discussions have taken place in the last year with our Member Practices to understand their preferred clinical commissioning involvement and communication mechanisms. We feel that we have made progress in engaging Member Practices as commissioners with the additional of whole-Doncaster regular meetings alongside Locality meetings. There has been a rapid evolution of Federations from a GP provider perspective, which may have impacted Member Practice views, and this theme comes through the verbatim comments from the survey. We will continue to work with Member Practices on what they want from engagement with their CCG, and this forms a key part of the Organisational Development Strategy approved in December 2016. We have 43 Member Practices in Doncaster, and so we do not have the views of all Member Practices represented in the survey; we will engage with all Member Practices via the Locality engagement model to ensure that we hear all voices.

6

5. Conclusion The Stakeholder Survey is one element of the feedback which we receive as an organisation to support us in evaluating and improving our relationships with stakeholders and to ensure that our stakeholders’ views continue to be central to the effective commissioning of healthcare services. The key themes emerging are:

General improvement: There was a general upwards trend of improvement across all questions when compared to previous years. Generally, we received positive feedback from our Local Authority on integrated commissioning and safeguarding, from the Health & Wellbeing Board on active membership of the Board and delivering shared plans for integrated commissioning, and from Providers on working together on long term strategies and quality of services, with good understanding of the challenges facing providers and good clinical involvement in service redesign.

Integration – plans & priorities: We were pleased to see our investment in partnership integration reflected in generally improved scores across the plans and priorities domain, and in our overall working relationships with stakeholders.

Quality monitoring: It would be beneficial for us to to spend some time with our Member Practice and Healthwatch stakeholders providing further assurance on and seeking feedback on our existing mechanisms for responding to quality concerns.

Patient engagement: The area of patient engagement in commissioning, in which we scored lower than the national average, was an area which we had already identified internally as an area for further development, and we have now completed a Diagnostic and resulting action planning. With the enactment of the actions emerging from the Diagnostic, we hope to see this indicator improve in the next survey.

Member engagement: There are a number of Member Practices who reflect that they do not feel engaged (6 out of 20) with their CCG. We will continue to work with Member Practices on what they want from engagement with their CCG, and this forms a key part of our refreshed Organisational Development Strategy approved in December 2016.

Leadership: In December 2016, following externally facilitated self-assessment and stakeholder engagement, we approved a refreshed Organisational Development Strategy to support us to build upon and evolve our leadership role within the new integrated commissioning environment. This is reflected in a significantly improved 2017 position in all the Leadership domain questions when compared to the survey results in 2015 and 2016, and a score consistently higher than or in line with national and cluster comparisons. Our successful enactment of the action plan associated with our Organisational Development Strategy will be crucial to building on the improvements in leadership visibility to our stakeholders which have been achieved in the last year. We have 43 Member Practices in Doncaster, and so we do not have the views of all Member Practices represented in the survey; we will engage with all Member Practices via the Locality engagement model to ensure that we hear all voices.

7

We would like to take this opportunity to thank our stakeholders for the time and thought which they put into their responses. Only with an open relationship in which we can tell each other what is going well and what could be better, can we improve our partnership effectiveness as an organisation. Analysis prepared by: Chief of Corporate Services NHS Doncaster CCG 3 April 2017

8

Base = all stakeholders except CQC (2017; 33, 2016; 27, 2015; 27) unless otherwise stated

Fieldwork: 16 January - 28 February 2017

Summary This report presents the results from Doncaster CCG 360 Stakeholder Survey 2017. The annual CCG 360 Stakeholder Survey, which has been

conducted online and by telephone since 2014, allows a range of key stakeholders to provide feedback on working relationships with their CCG.

The results are used to support CCGs’ ongoing development and feed into improvement and assessment conversations with NHS England.

The following chart presents the summary findings across the CCG for the questions asked of all stakeholders. This provides the percentage of

stakeholders responding positively to the key questions, including year-on-year comparisons where the question was also asked in 2016 and 2015.

*Base = all who feel they have some level of engagement with CCG (2017; 31, 2016; 25, 2015; 25)

Overall Engagement

Commissioning services

2017 2016 2015

2017 2016 2015

% a great deal/ a fair amount

% very/ fairly satisfied

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% very/ fairly good

% a great deal/ a fair amount

% very/ fairly satisfied

9

% very/fairly effective

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

Leadership of the CCG

Monitoring and reviewing services

Plans and priorities

2017 2016 2015

2017 2016 2015

2017 2016 2015

Summary cont.

Fieldwork: 16 January - 28 February 2017

% a great deal/fair amount

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

*Base = all stakeholders (2017; 33, 2016; 27, 2015; 27)

10

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CCG 360 stakeholder survey 2017 - Report | April 2017 | Public 1

Doncaster CCG

CCG 360o stakeholder survey 2017

Main report

2 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

Table of contents

Slide 3 Summary

Slide 6 Overall report

Slide 7 Background and objectives

Slide 8 Methodology and technical details

Slide 10 Interpreting the results

Slide 11 Using the results

Slide 13 Overall views of relationships

Slide 41 Upper tier and unitary local authorities

Slide 45 Health and wellbeing board members

Slide 48 Healthwatch and patient groups

Slide 51 Member practices

Slide 69 NHS providers

Slide 76 Appendix – CCG cluster

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Summary

4 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

Overall, to what extent, if at all, do you feel you have been engaged by the CCG over the past 12

months? 79% 78% 74%

And how satisfied or dissatisfied are you with the way in which the CCG has engaged with you

over the past 12 months?* 74% 64% 72%

Overall, how would you rate your working relationship with the CCG? 76% 74% 78%

To what extent, if at all, would you say your CCG/CCG has contributed to wider discussions

through local groups? 61% 63% 48%

How satisfied or dissatisfied are you with the steps taken by your CCG to engage with patients

and the public? 39% - -

The CCG involves and engages with the right individuals and organisations when making

commissioning decisions 61% 37% 41%

I have confidence in the CCG to commission high quality services for the local population

64% 52% 59%

I understand the reasons for the decisions that the CCG makes when commissioning services

67% 41% 48%

The CCG’s plans will deliver continuous improvement in quality within the available resources

61% 48% 56%

My CCG acts on the views of patients and the public when making commissioning decisions

33% - -

My CCG effectively communicates about how it has acted on what it is told by patients and the

public

30% - -

Base = all stakeholders except CQC (2017; 33, 2016; 27, 2015; 27) unless otherwise stated

Fieldwork: 16 January - 28 February 2017

Summary This report presents the results from Doncaster CCG 360 Stakeholder Survey 2017. The annual CCG 360 Stakeholder Survey, which has been

conducted online and by telephone since 2014, allows a range of key stakeholders to provide feedback on working relationships with their CCG.

The results are used to support CCGs’ ongoing development and feed into improvement and assessment conversations with NHS England.

The following chart presents the summary findings across the CCG for the questions asked of all stakeholders. This provides the percentage of

stakeholders responding positively to the key questions, including year-on-year comparisons where the question was also asked in 2016 and 2015.

*Base = all who feel they have some level of engagement with CCG (2017; 31, 2016; 25, 2015; 25)

Overall Engagement

Commissioning services

2017 2016 2015

2017 2016 2015

Doncaster CCG

% a great deal/ a fair amount

% very/ fairly satisfied

% very/ fairly good

% a great deal/ a fair amount

% very/ fairly satisfied

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

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I have confidence that the CCG effectively monitors the quality of the services it commissions 61% 41% 59%

If I had concerns about the quality of local services I would feel able to raise my concerns with the

CCG 76% 74% 81%

I have confidence in the CCG to act on feedback it receives about the quality of services 45% 41% 63%

How effective, if at all, do you feel your CCG is as a local system leader? 76% 63% -

The leadership of the CCG has the necessary blend of skills and experience* 79% 44% 67%

There is clear and visible leadership of the CCG* 85% 44% 74%

There is clear and visible clinical leadership of the CCG* 79% 63% 63%

I have confidence in the leadership of the CCG to deliver its plans and priorities* 67% 37% 63%

The leadership of the CCG is delivering continued quality improvements 58% 30% 44%

I have confidence in the leadership of the CCG to deliver improved outcomes for patients* 61% 37% 59%

How much would you say you know about the CCG’s plans and priorities? 82% 59% 70%

I have been given the opportunity to influence the CCG’s plans and priorities 52% 41% 52%

When I have commented on the CCG’s plans and priorities I feel that my comments have been taken

on board 48% 30% 37%

The CCG has effectively communicated its plans and priorities to me 70% 44% 59%

The CCG’s plans and priorities are the right ones 48% 26% 37%

Improving patient outcomes is a core focus for my CCG 91% 81% 81%

% very/fairly effective

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

Leadership of the CCG

Monitoring and reviewing services

Plans and priorities

2017 2016 2015

2017 2016 2015

2017 2016 2015

Summary cont.

Fieldwork: 16 January - 28 February 2017

Doncaster CCG

% a great deal/fair amount

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

% strongly/ tend to agree

*Base = all stakeholders (2017; 33, 2016; 27, 2015; 27)

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Overall report

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Background and objectives

Doncaster CCG

Clinical Commissioning Groups (CCGs) need to have strong relationships with a range of health and care

partners in order to be successful commissioners within the local system. These relationships provide CCGs

with on-going information, advice and knowledge to help them make the best possible commissioning

decisions.

The CCG 360o stakeholder survey is a key part of ensuring these strong relationships are in place. The

survey allows stakeholders to provide feedback on working relationships with CCGs. The results from the

survey will serve two purposes:

1. To provide a wealth of data for CCGs to help with their ongoing organisational development, enabling

them to continue to build strong and productive relationships with stakeholders. The findings can

provide a valuable tool for all CCGs to be able to evaluate their progress and inform their

organisational decisions.

2. To feed into improvement and assessment conversations between NHS England and CCGs. The survey

will form part of the evidence used to assess whether the stakeholder relationships continue to be

central to the effective commissioning of services by CCGs, and in doing so, improve quality and

outcomes for patients.

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Methodology and technical details

Doncaster CCG

• It was the responsibility of each CCG to provide the list of

stakeholders to invite to take part in the CCG 360o stakeholder

survey.

• CCGs were provided with a specification of core stakeholder

organisations (outlined in the table opposite) to be included in their

stakeholder list. Beyond this however, CCGs had the flexibility to

determine which individual within each organisation was the most

appropriate to nominate.

• CCGs were also given the opportunity to add up to ten additional

stakeholders they wanted to include locally (they are referred to in

this report as ‘Wider stakeholders’). These included: Commissioning

Support Units, Health Education England, lower tier local authorities,

MPs, private providers, Public Health England, social care /

community organisations, Voluntary Sector Council/Leader,

voluntary / third sector organisations, local care homes, GP out-of-

hours providers and other stakeholders and clinicians.

• Stakeholders were sent an email inviting them to complete the

survey online. Stakeholders who did not respond to the email

invitation, and stakeholders for whom an email address was not

provided, were telephoned by an Ipsos MORI interviewer who

encouraged response and offered the opportunity to complete the

survey by telephone.

Core stakeholder framework

GP member practices One from every member practice

Health and wellbeing boards Up to two per HWB

Local Healthwatch Up to three per local Healthwatch

Other patient groups Up to five

NHS providers – Acute Up to two from each provider

NHS providers – Mental

health trusts

Up to two from each provider

NHS providers – Community

health trusts

Up to two from each provider

Other CCGs Up to five

Upper tier or unitary local

authorities Up to five per LA

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Methodology and technical details • Within the survey,

stakeholders were asked a

series of questions about

their working relationship

with the CCG. In addition, to

reflect each core stakeholder

group’s different area of

expertise and knowledge,

they were presented with a

short section of questions

specific to the stakeholder

group they represented.

• Fieldwork was conducted

between 16th January 2017

and 28th February 2017.

• 33 of the CCG’s stakeholders

completed the survey. The

overall response rate was

57% which varied across the

stakeholder groups as

shown in the table opposite.

Survey response rates for Doncaster CCG

Stakeholder group Invited to take

part in survey

Completed

survey Response rate

GP member practices 41 20 49%

Health and wellbeing boards 1 1 100%

Local Healthwatch/patient

groups 2 2 100%

NHS providers 4 3 75%

Other CCGs 4 4 100%

Upper tier or unitary local

authorities 4 2 50%

Wider stakeholders 2 1 50%

Doncaster CCG

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Interpreting the results

• For each question, the response to each answer is presented as both a percentage (%) and as a

number (n).

• The total number of stakeholders who answered each question (the base size) is also stated at the

bottom of each chart and in every table.

• For questions with fewer than 30 stakeholders answering, we strongly recommend that you look at the

number of stakeholders giving each response rather than the percentage, as the percentage can be

misleading when based on so few stakeholders.

• This report presents the results from Doncaster CCG's stakeholder survey. Throughout the report, ‘the

CCG / your CCG’ refers to Doncaster CCG.

• Where a result for the ‘cluster’ is presented, this refers to the overall score across the 20 CCGs that are

most similar to the CCG. For more information on the cluster and how this has been defined, please

see the Appendix.

• Where results do not sum to 100%, or where individual responses (e.g. tend to agree; strongly agree)

do not sum to combined responses (e.g. strongly/tend to agree) this is due to rounding.

Doncaster CCG

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Using the results – the reports

Doncaster CCG

• This report contains a summary section, a section on overall views of relationships and a section for

each of the main stakeholder groups who were invited to complete the survey.

• The overall summary slides show the results at CCG level for the questions asked of all stakeholders

(i.e. only those in section 1 of the questionnaire).

• This provides CCGs with an ‘at a glance’ visual summary of the results for the key questions,

including direction of travel comparisons where appropriate.

• The stakeholder specific sections of the report contain those questions which were targeted at

individual groups of stakeholders only.

• These questions were often around specific issues which were only relevant to the specific group

of stakeholders.

• The remainder of the report shows the results for all questions in the survey including any local

questions where CCGs included them. The results for each question are provided at CCG level with a

breakdown also shown for each of the core stakeholder groups where relevant.

• This allows CCGs to interrogate the data in more detail.

12 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

Using the results – comparisons

Doncaster CCG

• For some questions, data has been included in the reports to compare the results for the CCG with:

• The CCG’s result in 2015

• The CCG’s result in 2016

• The 2017 average across all CCGs in the CCG’s cluster

• The 2017 average across all CCGs in the CCG’s regional (DCO) teams

• National CCG average in 2017

• The comparisons are included to provide an indication of differences only and should be treated with

caution due to the low numbers of respondents and differences in stakeholder lists.

• Any differences are not necessarily statistically significant differences; a higher score than the

cluster average does not always equate to ‘better ’ performance, and a higher score than in 2016

does not necessarily mean the CCG has improved.

• The comparisons offer a starting point to inform wider discussions about the CCG’s ongoing

organisational development and its relationships with stakeholders. For example, they may

indicate areas in which stakeholders think the CCG is performing relatively less well, for the CCG

to discuss internally and externally to identify what improvements can be made in this area, if any.

13 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public 13 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

Overall views of relationships

14 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

Overall, to what extent, if at all, do you feel you have been engaged by the CCG

over the past 12 months?

Stakeholder group Base Great deal / Fair

amount

Not very much /

Not at all

GP member practices 20 70% (14) 30% (6)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 100% (2) -

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) 25% (1)

Upper tier/unitary local

authorities 2 100% (2) -

Wider stakeholders 1 100% (1) -

All stakeholders By stakeholder group

Percentage of stakeholders saying a great deal / a fair amount

2017: 79% 2016: 78% 2015: 74% National: 79% CCG cluster: 81% CCG DCO: 80%

CCG comparisons

30%

48%

15%

6% 10

16

5

2

A great deal A fair amount Not very much

Not at all Don't know

Fieldwork: 16 January - 28 February 2017

Doncaster CCG Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8512),

Base CCG cluster: All stakeholders (760), Base CCG DCO: All stakeholders (898)

0 10 20 30 40 50 60 70 80 90 100

15 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

32%

42%

16%

10% 10

13

5

3

Very satisfied Fairly satisfied

Neither satisfied nor dissatisfied Fairly dissatisfied

Very dissatisfied Don't know

How satisfied or dissatisfied are you with the way in which the CCG has engaged

with you over the past 12 months?

All stakeholders who have been engaged by the CCG

Stakeholder group Base Very / Fairly

satisfied

Very / Fairly

dissatisfied

GP member practices 18 61% (11) 17% (3)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 100% (2) -

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) -

Upper tier/unitary local

authorities 2 100% (2) -

Wider stakeholders 1 100% (1) -

Percentage of stakeholders saying very / fairly satisfied CCG comparisons

By stakeholder group

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

Doncaster CCG

2017: 74% 2016: 64% 2015: 72% National: 70% CCG cluster: 69% CCG DCO: 71%

Base: All those who feel they have had some level of engagement (2017: 31; 2016: 25; 2015: 25; National average: 8297; CCG cluster: 748; DCO: 876)

16 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

42%

33%

12%

6% 3% 3%

14

11

4

2 1 1

Very good Fairly good

Neither good nor poor Fairly poor

Very poor Don't know

I/we do not have a working relationship

Overall, how would you rate your working relationship with the CCG?

Stakeholder group Base Very good /

Fairly good

Very poor /

Fairly poor

GP member practices 20 65% (13) 10% (2)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 100% (2) -

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) 25% (1)

Upper tier/unitary local

authorities 2 100% (2) -

Wider stakeholders 1 100% (1) -

Percentage of stakeholders saying very good / fairly good CCG comparisons

By stakeholder group All stakeholders

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

Doncaster CCG

2017: 76% 2016: 74% 2015: 78% National: 75% CCG cluster: 75% CCG DCO: 74%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8512),

Base CCG cluster: All stakeholders (760), Base CCG DCO: All stakeholders (898)

17 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

To what extent do you agree or disagree with the following statements about the

way in which the CCG commissions services…? The CCG involves and engages with the right individuals and organisations when making commissioning decisions

By stakeholder group

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 55% (11) 10% (2)

Health and wellbeing boards 1 - -

Local Healthwatch/patient

groups 2 - 100% (2)

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) -

Upper tier/unitary local

authorities 2 100% (2) -

Wider stakeholders 1 100% (1) -

12%

48%

24%

9% 3% 3%

4

16

8

3

1 1

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

Percentage of stakeholders saying strongly agree / tend to agree CCG comparisons

All stakeholders

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

Doncaster CCG

2017: 61% 2016: 37% 2015: 41% National: 58% CCG cluster: 57% CCG DCO: 63%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8512),

Base CCG cluster: All stakeholders (760), Base CCG DCO: All stakeholders (898)

18 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

To what extent do you agree or disagree with the following statements about the

way in which the CCG commissions services…?

9%

55%

24%

6% 6%

3

18

8

2

2

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

Percentage of stakeholders saying strongly agree / tend to agree CCG comparisons

I have confidence in the CCG to commission high quality services for the local population

By stakeholder group All stakeholders

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

Doncaster CCG

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 45% (9) 20% (4)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 100% (2) -

NHS providers 3 67% (2) -

Other CCGs 4 100% (4) -

Upper tier/unitary local

authorities 2 100% (2) -

Wider stakeholders 1 100% (1) -

2017: 64% 2016: 52% 2015: 59% National: 63% CCG cluster: 63% CCG DCO: 67%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8512),

Base CCG cluster: All stakeholders (760), Base CCG DCO: All stakeholders (898)

19 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

15%

52%

21%

6% 6%

5

17

7

2

2

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

To what extent do you agree or disagree with the following statements about the

way in which the CCG commissions services…? I understand the reasons for the decisions that the CCG makes when commissioning services

Percentage of stakeholders saying strongly agree / tend to agree CCG comparisons

By stakeholder group All stakeholders

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

Doncaster CCG

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 60% (12) 15% (3)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 50% (1) 50% (1)

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) -

Upper tier/unitary local

authorities 2 50% (1) -

Wider stakeholders 1 100% (1) -

2017: 67% 2016: 41% 2015: 48% National: 63% CCG cluster: 61% CCG DCO: 65%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8512),

Base CCG cluster: All stakeholders (760), Base CCG DCO: All stakeholders (898)

20 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

To what extent do you agree or disagree with the following statements about the

way in which the CCG commissions services…?

6%

55%

30%

3% 6%

2

18

10

1 2

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 45% (9) 15% (3)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 100% (2) -

NHS providers 3 67% (2) -

Other CCGs 4 100% (4) -

Upper tier/unitary local

authorities 2 50% (1) -

Wider stakeholders 1 100% (1) -

The CCG’s plans will deliver continuous improvement in quality within the available resources

Percentage of stakeholders saying strongly agree / tend to agree CCG comparisons

By stakeholder group All stakeholders

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

Doncaster CCG

2017: 61% 2016: 48% 2015: 56% National: 53% CCG cluster: 54% CCG DCO: 53%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8512),

Base CCG cluster: All stakeholders (760), Base CCG DCO: All stakeholders (898)

21 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

To what extent do you agree or disagree with the following statements about the

leadership of the CCG…?

30%

48%

12%

3% 3% 3% 10

16

4

1 1 1

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

The leadership of the CCG has the necessary blend of skills and experience

Percentage of stakeholders saying strongly agree / tend to agree CCG comparisons

By stakeholder group All stakeholders

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

Doncaster CCG

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 70% (14) 10% (2)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 100% (2) -

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) -

Upper tier/unitary local

authorities 2 100% (2) -

Wider stakeholders 1 100% (1) -

2017: 79% 2016: 44% 2015: 67% National: 65% CCG cluster: 63% CCG DCO: 65%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8516),

Base CCG cluster: All stakeholders (761), Base CCG DCO: All stakeholders (898)

22 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

39%

45%

6% 6% 3%

13

15

2

2 1

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

To what extent do you agree or disagree with the following statements about the

overall leadership of the CCG…?

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 80% (16) 10% (2)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 100% (2) -

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) 25% (1)

Upper tier/unitary local

authorities 2 100% (2) -

Wider stakeholders 1 100% (1) -

There is clear and visible leadership of the CCG

Percentage of stakeholders saying strongly agree / tend to agree CCG comparisons

By stakeholder group All stakeholders

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

Doncaster CCG Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8516),

Base CCG cluster: All stakeholders (761), Base CCG DCO: All stakeholders (898)

2017: 85% 2016: 44% 2015: 74% National: 71% CCG cluster: 70% CCG DCO: 75%

23 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

To what extent do you agree or disagree with the following statements about the

clinical leadership of the CCG…?

30%

48%

12%

3% 3% 3% 10

16

4

1 1 1

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 75% (15) 10% (2)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 100% (2) -

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) -

Upper tier/unitary local

authorities 2 50% (1) -

Wider stakeholders 1 100% (1) -

There is clear and visible clinical leadership of the CCG

Percentage of stakeholders saying strongly agree / tend to agree CCG comparisons

By stakeholder group All stakeholders

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

Doncaster CCG

2017: 79% 2016: 63% 2015: 63% National: 70% CCG cluster: 71% CCG DCO: 72%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8516),

Base CCG cluster: All stakeholders (761), Base CCG DCO: All stakeholders (898)

24 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

To what extent do you agree or disagree with the following statements about the

leadership of the CCG…?

24%

42%

24%

3% 6%

8

14

8

1 2

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 50% (10) 5% (1)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 100% (2) -

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) -

Upper tier/unitary local

authorities 2 100% (2) -

Wider stakeholders 1 100% (1) -

I have confidence in the leadership of my CCG/CCG to deliver its plans and priorities

Percentage of stakeholders saying strongly agree / tend to agree CCG comparisons

By stakeholder group All stakeholders

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

Doncaster CCG

2017: 67% 2016: 37% 2015: 63% National: 60% CCG cluster: 62% CCG DCO: 65%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8516),

Base CCG cluster: All stakeholders (761), Base CCG DCO: All stakeholders (898)

25 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

To what extent do you agree or disagree with the following statements about the

leadership of the CCG…?

6%

52%

30%

6% 6%

2

17

10

2

2

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 45% (9) 10% (2)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 100% (2) -

NHS providers 3 67% (2) -

Other CCGs 4 75% (3) -

Upper tier/unitary local

authorities 2 50% (1) -

Wider stakeholders 1 100% (1) -

The leadership of my CCG/ CCG is delivering continued quality improvements

Percentage of stakeholders saying strongly agree / tend to agree CCG comparisons

By stakeholder group All stakeholders

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

Doncaster CCG

2017: 58% 2016: 30% 2015: 44% National: 55% CCG cluster: 58% CCG DCO: 57%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8512),

Base CCG cluster: All stakeholders (760), Base CCG DCO: All stakeholders (898)

26 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

To what extent do you agree or disagree with the following statements about the

leadership of the CCG…?

24%

36%

24%

6%

9% 8

12

8

2

3

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 45% (9) 10% (2)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 100% (2) -

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) -

Upper tier/unitary local

authorities 2 50% (1) -

Wider stakeholders 1 100% (1) -

I have confidence in the leadership of the CCG to deliver improved outcomes for patients

Percentage of stakeholders saying strongly agree / tend to agree CCG comparisons

By stakeholder group All stakeholders

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

Doncaster CCG

2017: 61% 2016: 37% 2015: 59% National: 56% CCG cluster: 58% CCG DCO: 58%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8516),

Base CCG cluster: All stakeholders (761), Base CCG DCO: All stakeholders (898)

27 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

To what extent do you agree or disagree with the following statements about the

way in which the CCG monitors and reviews the quality of commissioned services…?

18%

42%

18%

9%

3% 9%

6

14

6

3

1

3

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 40% (8) 20% (4)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 100% (2) -

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) -

Upper tier/unitary local

authorities 2 100% (2) -

Wider stakeholders 1 100% (1) -

I have confidence that my CCG/CCG effectively monitors the quality of the services it commissions

Percentage of stakeholders saying strongly agree / tend to agree CCG comparisons

By stakeholder group All stakeholders

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

Doncaster CCG

2017: 61% 2016: 41% 2015: 59% National: 61% CCG cluster: 59% CCG DCO: 62%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8512),

Base CCG cluster: All stakeholders (760), Base CCG DCO: All stakeholders (898)

28 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

To what extent do you agree or disagree with the following statements about the

way in which the CCG monitors and reviews the quality of commissioned services…?

30%

45%

12%

6% 3% 3% 10

15

4

2 1 1

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 65% (13) 15% (3)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 100% (2) -

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) -

Upper tier/unitary local

authorities 2 100% (2) -

Wider stakeholders 1 100% (1) -

If I had concerns about the quality of local services I would feel able to raise my concerns with the CCG

Percentage of stakeholders saying strongly agree / tend to agree CCG comparisons

By stakeholder group All stakeholders

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

Doncaster CCG

2017: 76% 2016: 74% 2015: 81% National: 84% CCG cluster: 81% CCG DCO: 85%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8512),

Base CCG cluster: All stakeholders (760), Base CCG DCO: All stakeholders (898)

29 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

To what extent do you agree or disagree with the following statements about the

way in which the CCG monitors and reviews the quality of commissioned services…?

15%

30%

24%

18%

6% 6%

5

10

8

6

2

2

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 20% (4) 35% (7)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 50% (1) 50% (1)

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) -

Upper tier/unitary local

authorities 2 100% (2) -

Wider stakeholders 1 100% (1) -

I have confidence in the CCG to act on feedback it receives about the quality of services

Percentage of stakeholders saying strongly agree / tend to agree CCG comparisons

By stakeholder group All stakeholders

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

Doncaster CCG

2017: 45% 2016: 41% 2015: 63% National: 65% CCG cluster: 66% CCG DCO: 67%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8512),

Base CCG cluster: All stakeholders (760), Base CCG DCO: All stakeholders (898)

30 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

21%

61%

15% 3%

7

20

5

1

A great deal A fair amount

Not very much Nothing at all

How much would you say you know about the CCG’s plans and priorities?

Doncaster CCG

All stakeholders

Stakeholder group Base Great deal / Fair

amount

Not very much /

Nothing at all

GP member practices 20 75% (15) 25% (5)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 100% (2) -

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) 25% (1)

Upper tier/unitary local

authorities 2 100% (2) -

Wider stakeholders 1 100% (1) -

Percentage of stakeholders saying a great deal / a fair amount CCG comparisons

By stakeholder group

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

2017: 82% 2016: 59% 2015: 70% National: 77% CCG cluster: 79% CCG DCO: 80%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8512),

Base CCG cluster: All stakeholders (760), Base CCG DCO: All stakeholders (898)

31 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

To what extent do you agree or disagree with each of the following statements about the

CCG’s plans and priorities, including operational and sustainability plans?

Doncaster CCG

15%

36% 24%

15%

9%

5

12

8

5

3

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 40% (8) 30% (6)

Health and wellbeing boards 1 - -

Local Healthwatch/patient

groups 2 - 50% (1)

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) 25% (1)

Upper tier/unitary local

authorities 2 100% (2) -

Wider stakeholders 1 100% (1) -

I have been given the opportunity to influence the CCG’s plans and priorities

All stakeholders

Percentage of stakeholders saying strongly agree / tend to agree CCG comparisons

By stakeholder group

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

2017: 52% 2016: 41% 2015: 52% National: 54% CCG cluster: 57% CCG DCO: 58%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8512),

Base CCG cluster: All stakeholders (760), Base CCG DCO: All stakeholders (898)

32 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

9%

39%

30%

12%

9%

3

13

10

4

3

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

To what extent do you agree or disagree with each of the following statements

about the CCG’s plans and priorities…?

Doncaster CCG

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 25% (5) 25% (5)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 50% (1) 50% (1)

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) 25% (1)

Upper tier/unitary local

authorities 2 100% (2) -

Wider stakeholders 1 100% (1) -

When I have commented on the CCG’s plans and priorities I feel that my comments have been taken on board

All stakeholders

Percentage of stakeholders saying strongly agree / tend to agree CCG comparisons

By stakeholder group

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

2017: 48% 2016: 30% 2015: 37% National: 48% CCG cluster: 52% CCG DCO: 51%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8512),

Base CCG cluster: All stakeholders (760), Base CCG DCO: All stakeholders (898)

33 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

12%

58%

12%

12%

6%

4

19

4

4

2

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Not applicable

Don't know

To what extent do you agree or disagree with each of the following statements

about the CCG’s plans and priorities…?

Doncaster CCG

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 60% (12) 25% (5)

Health and wellbeing boards 1 - -

Local Healthwatch/patient

groups 2 100% (2) -

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) 25% (1)

Upper tier/unitary local

authorities 2 100% (2) -

Wider stakeholders 1 100% (1) -

The CCG has effectively communicated its plans and priorities to me

All stakeholders

Percentage of stakeholders saying strongly agree / tend to agree CCG comparisons

By stakeholder group

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

2017: 70% 2016: 44% 2015: 59% National: 63% CCG cluster: 64% CCG DCO: 66%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8512),

Base CCG cluster: All stakeholders (760), Base CCG DCO: All stakeholders (898)

34 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

9%

39% 45%

3% 3%

3

13 15

1 1

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

To what extent do you agree or disagree with each of the following statements

about the CCG’s plans and priorities…?

Doncaster CCG

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 30% (6) 5% (1)

Health and wellbeing boards 1 - -

Local Healthwatch/patient

groups 2 100% (2) -

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) -

Upper tier/unitary local

authorities 2 50% (1) -

Wider stakeholders 1 100% (1) -

The CCG’s plans and priorities are the right ones

All stakeholders

Percentage of stakeholders saying strongly agree / tend to agree CCG comparisons

By stakeholder group

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

2017: 48% 2016: 26% 2015: 37% National: 50% CCG cluster: 53% CCG DCO: 53%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8512),

Base CCG cluster: All stakeholders (760), Base CCG DCO: All stakeholders (898)

35 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

0 10 20 30 40 50 60 70 80 90 100

24%

52%

12%

6% 6%

8

17

4

2

2

Very effective Fairly effective

Not very effective Not at all effective

Don't know

How effective, if at all, do you feel the CCG is as a local system leader?

Stakeholder group Base Very / Fairly

effective

Not very / Not

at all effective

GP member practices 20 65% (13) 25% (5)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 100% (2) -

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) 25% (1)

Upper tier/unitary local

authorities 2 100% (2) -

Wider stakeholders 1 100% (1) -

By ‘local system leader‘ we mean that the CCG works proactively and constructively with the other partners in its local economy,

prioritising tasks-in-common over formal organisational boundaries, for example sustainability and transformation plans, to seek

the best health and wellbeing outcomes for its population.

All stakeholders

Percentage of stakeholders saying very effective/ fairly effective CCG comparisons

By stakeholder group

Fieldwork: 16 January - 28 February 2017

Doncaster CCG

2017: 76% 2016: 63% National: 73% CCG cluster: 74% CCG DCO: 76%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base national average: All stakeholders (8512), Base CCG cluster: All stakeholders

(760), Base CCG DCO: All stakeholders (898)

36 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

0 10 20 30 40 50 60 70 80 90 100

15%

45%

12%

6%

21%

5

15

4

2

7

A great deal A fair amount Not very much

Not at all Don't know

Stakeholder group Base Great deal /

Fair amount

Not very much /

Not at all

GP member practices 20 45% (9) 25% (5)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 50% (1) 50% (1)

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) -

Upper tier/unitary local

authorities 2 100% (2) -

Wider stakeholders 1 100% (1) -

Percentage of stakeholders saying a great deal / fair amount CCG comparisons

By stakeholder group All stakeholders

Fieldwork: 16 January - 28 February 2017

Doncaster CCG

Please now think about discussions that take place about the wider health economy in your area, through local groups. This

may include groups such as the Quality Surveillance Group, Urgent Care Working Group, Council for Voluntary Services,

Strategic Clinical Networks, Clinical Senate Assemblies, clinical or non-clinical networks, forums and any other relevant local

groups. To what extent, if at all, would you say the CCG has contributed to wider discussions through these groups?

2017: 61% 2016: 63% 2015: 48% National: 61% CCG cluster: 64% CCG DCO: 64%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8512),

Base CCG cluster: All stakeholders (760), Base CCG DCO: All stakeholders (898)

37 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

How satisfied or dissatisfied are you with the steps taken by CCG to engage with

patients and the public?

9%

30%

24%

9%

3%

24%

3

10

8

3

1

[VALUE]

Very satisfied Fairly satisfied

Neither satisfied nor dissatisfied Fairly dissatisfied

Very dissatisfied Don't know

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

Stakeholder group Base Very / Fair

Satisfied

Very / Fair

dissatisfied

GP member practices 20 30% (6) 15% (3)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 - 50% (1)

NHS providers 3 33% (1) -

Other CCGs 4 75% (3) -

Upper tier/unitary local

authorities 2 50% (1) -

Wider stakeholders 1 100% (1) -

By stakeholder group All stakeholders

0 10 20 30 40 50 60 70 80 90 100

CCG comparisons Percentage of stakeholders saying a great deal / fair amount

2017: 39% National: 58% CCG cluster: 59% CCG DCO: 60%

Base 2017: All stakeholders (33), Base national average: All stakeholders (8512), Base CCG cluster: All stakeholders (760), Base CCG DCO: All

stakeholders (898)

38 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

To what extent do you agree or disagree that each of the following statements

apply to your CCG? The CCG acts on the views of patients and the public when making commissioning decisions

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 20% (4) 25% (5)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 - 100% (2)

NHS providers 3 33% (1) -

Other CCGs 4 75% (3) -

Upper tier/unitary local

authorities 2 50% (1) -

Wider stakeholders 1 100% (1) -

Percentage of stakeholders saying a great deal / fair amount CCG comparisons

By stakeholder group All stakeholders

2017: 33% National: 50% CCG cluster: 53% CCG DCO: 53%

Base 2017: All stakeholders (33), Base national average: All stakeholders (8512), Base CCG cluster: All stakeholders (760), Base CCG DCO: All

stakeholders (898)

33%

30%

21%

15% 11

10

7

5

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

Not applicable

0 10 20 30 40 50 60 70 80 90 100

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To what extent do you agree or disagree with each of the following statements…?

The CCG effectively communicates about how it has acted on what it is told by patients and the public

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 15% (3) 25% (5)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 - 100% (2)

NHS providers 3 33% (1) -

Other CCGs 4 75% (3) -

Upper tier/unitary local

authorities 2 50% (1) -

Wider stakeholders 1 100% (1) -

Percentage of stakeholders saying a great deal / fair amount CCG comparisons

By stakeholder group All stakeholders

2017: 30% National: 49% CCG cluster: 51% CCG DCO: 53%

Base 2017: All stakeholders (33), Base national average: All stakeholders (8512), Base CCG cluster: All stakeholders (760), Base CCG DCO: All

stakeholders (898)

3%

27%

30%

18%

3%

18%

1

9

10

6

1

6

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

Not applicable

0 10 20 30 40 50 60 70 80 90 100

40 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

42%

48%

3% 6%

14

16

1 2

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

To what extent do you agree or disagree with the following statement…?

Doncaster CCG

Stakeholder group Base Strongly / Tend

to agree

Strongly / Tend

to disagree

GP member practices 20 85% (17) 15% (3)

Health and wellbeing boards 1 100% (1) -

Local Healthwatch/patient

groups 2 100% (2) -

NHS providers 3 100% (3) -

Other CCGs 4 100% (4) -

Upper tier/unitary local

authorities 2 100% (2) -

Wider stakeholders 1 100% (1) -

Improving patient outcomes is a core focus of the CCG

All stakeholders

CCG comparisons

By stakeholder group

0 10 20 30 40 50 60 70 80 90 100

Fieldwork: 16 January - 28 February 2017

Percentage of stakeholders saying strongly agree / tend to agree

2017: 91% 2016: 81% 2015: 81% National: 79% CCG cluster: 77% CCG DCO: 81%

Base 2017: All stakeholders (33), Base 2016: All stakeholders (27), Base 2015: All stakeholders (27), Base national average: All stakeholders (8512),

Base CCG cluster: All stakeholders (760), Base CCG DCO: All stakeholders (898)

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Upper tier and unitary local authorities

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How well, if at all, would you say the CCG and your local authority are working

together to deliver shared plans for integrated commissioning?

50% 50% 1 1

Very well Fairly well Not very well Not at all well Don't know

All upper tier / unitary local authority stakeholders

Total responses : All upper tier / unitary local authority stakeholders (2)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

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How effective, if at all, has the CCG been as part of the Local Safeguarding

Children Board?

100%

2

Very effective Fairly effective Not very effective Not at all effective Don't know

All upper tier / unitary local authority stakeholders

Total responses : All upper tier / unitary local authority stakeholders (2)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

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How effective, if at all, has the CCG been as part of the Safeguarding Adults

Board?

50% 50% 1 1

Very effective Fairly effective Not very effective Not at all effective Don't know

All upper tier / unitary local authority stakeholders

Total responses : All upper tier / unitary local authority stakeholders (2)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

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Health and wellbeing board members

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How active, if at all, would you say the CCG is as a member of the health and

wellbeing board?

100%

1

Very active Fairly active Not very active Not at all active Don't know

All Health and wellbeing board stakeholders

Total responses : All health and wellbeing board stakeholders (1)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

47 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

And how well, if at all, would you say the CCG and the local authority are working

together to deliver shared plans for integrated commissioning?

100%

1

Very well Fairly well Not very well Not at all well Don't know

All Health and wellbeing board stakeholders

Total responses : All health and wellbeing board stakeholders (1)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

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Healthwatch and patient groups

49 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

50% 50% 1 1

A great deal A fair amount Just a little Not at all Don't know

To what extent, if at all, do you feel that the CCG has engaged with seldom heard

groups?

All Healthwatch and patient group stakeholders

Total responses : All Healthwatch and patient group stakeholders (2)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

50 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

50% 50% 1 1

Strongly agree Tend to agree Neither agree nor disagree Tend to disagree Strongly disagree Don't know

To what extent do you agree or disagree that the CCG listens to and acts on any

concerns, complaints or issues that are raised?

All Healthwatch and patient group stakeholders

Total responses : All Healthwatch and patient group stakeholders (2)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

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Member practices

52 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

5%

45%

25%

20%

5%

1

9

5

4

1

Very effective Fairly effective Not very effective Not at all effective Don't know

How effective, if at all, would you say the arrangements are for member

participation in decision-making in your CCG?

50%

(10) Very / Fairly

effective 2017

33% (5) Very / Fairly

effective 2016

All member practices

37% (7) Very / Fairly

effective 2015

Total responses : All member practices (2017: 20); (2016: 15); (2015: 19)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

Please note, in 2014 and 2015 the question read: ‘How effective, it at all, would you say the arrangements are for member participation and decision making?’

53 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

25%

30%

45%

5

6

9

A great deal A fair amount Just a little Not at all Don't know

To what extent, if at all, do you feel able to influence the CCG’s decision-making

process?

All member practices

Total responses : All member practices (2017: 20); (2016: 15)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

25% (5) A great deal /

Fair amount

2017

7% (1) A great deal /

Fair amount

2016

54 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

To what extent do you agree or disagree with the following statements about the

clinical leadership of your CCG/CCG…?

15%

50%

15%

20%

3

10

3

4

Strongly agree Tend to agree Neither agree nor disagree Tend to disagree Strongly disagree Don't know

I have confidence in the clinical leadership of my CCG/CCG to deliver its plans and priorities

Total responses : All member practices (2017: 20); (2016: 15); (2015: 19)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

65%

(13)

Strongly /

Tend to agree

2017

33% (5) Strongly /

Tend to agree

2016

42% (8) Strongly /

Tend to agree

2015

All member practices

55 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

10%

40%

30%

10%

10%

2

8

6

2

2

Strongly agree Tend to agree Neither agree nor disagree Tend to disagree Strongly disagree Don't know

To what extent do you agree or disagree with the following statements about the

clinical leadership of your CCG/CCG…?

Total responses : All member practices (2017: 20); (2016: 15); (2015: 19)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

The clinical leadership of my CCG/CCG is delivering continued quality improvements

50%

(10)

Strongly /

Tend to agree

2017

33% (5) Strongly /

Tend to agree

2016

32% (6) Strongly /

Tend to agree

2015

All member practices

56 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

10%

40%

20%

5%

5%

20%

2

8

4

1

1

4

Strongly agree Tend to agree Neither agree nor disagree Tend to disagree Strongly disagree Don’t know

To what extent do you agree or disagree that your contracts with the CCG place

enough emphasis on delivering positive patient outcomes? All NHS providers

Total responses : All member practices (2017: 20); (2016: 15); (2015: 19)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

To what extent do you agree or disagree with the following statements about the

clinical leadership of your CCG/CCG…? The clinical leadership of my CCG/CCG is delivering continued improvements to reduce local health inequalities

50%

(10)

Strongly /

Tend to agree

2017

33% (5) Strongly /

Tend to agree

2016

32% (6) Strongly /

Tend to agree

2015

All member practices

57 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

5%

55% 20%

10%

10%

1

11

4

2

2

Very confident Fairly confident Not very confident Not at all confident Don't know

How confident are you, if at all, in the systems to sustain two-way accountability

between your CCG and its member practices in the CCG?

60%

(12) Very / Fairly

confident 2017

40%

(6) Very / Fairly

confident 2016

47%

(9) Very / Fairly

confident 2015

All member practices

Total responses : All member practices (2017: 20); (2016: 15); (2015: 19)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

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How well, if at all, would you say that you understand…?

10%

50% 15%

25%

2

10

3

5

Very well Fairly well Not very well Not at all well Don't know

60%

(12) Very / Fairly

well 2017

33% (5) Very / Fairly

well 2016

All member practices

The financial implications of the CCG’s plans

11% (2) Very / Fairly

well 2015

Total responses : All member practices (2017: 20); (2016: 15); (2015: 19)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

59 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

How well, if at all, would you say that you understand…?

5%

55% 15%

20%

5%

1

11 3

4

1

Very well Fairly well Not very well Not at all well Don't know

60% (12) Very / Fairly

well 2017

27% (4) Very / Fairly

well 2016

All member practices

The implications of the CCG’s plans for service improvement

32% (6) Very / Fairly

well 2015

Total responses : All member practices (2017: 20); (2016: 15); (2015: 19)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

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How well, if at all, would you say that you understand…?

5%

45%

30%

20%

1

9

6

4

Very well Fairly well Not very well Not at all well Don't know

50% (10) Very / Fairly

well 2017

33% (5) Very / Fairly

well 2016

All member practices

The referral and activity implications of the CCG’s plans

26% (5) Very / Fairly

well 2015

Total responses : All member practices (2017: 20); (2016: 15); (2015: 19)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

61 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

5%

30%

40%

20%

5%

1

6

8

4

1

Very well Fairly well Not very well Not at all well Don't know

How well, if at all, would you say that you understand…?

All member practices

The CCG’s plans to reduce health inequalities

20% (3) Very / Fairly

well 2016

35% (7) Very / Fairly

well 2017

Total responses : All member practices (2017: 20); (2016: 15); (2015: 19)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

32% (6) Very / Fairly

well 2015

62 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

10%

45% 25%

20%

2

9 5

4

Very well Fairly well Not very well Not at all well Don't know

How well, if at all, would you say that you understand…?

All member practices

The CCG’s plans to improve the health of the local population

47% (7) Very / Fairly

well 2016

55%

(11) Very / Fairly

well 2017

Total responses : All member practices (2017: 20); (2016: 15); (2015: 19)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

47% (9) Very / Fairly

well 2015

63 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

30%

30%

25%

5%

5% 5% 6

6

5

1

1 1

Strongly agree Tend to agree Neither agree nor disagree Tend to disagree Strongly disagree Don’t know

To what extent do you agree or disagree that value for money is a key factor in

decision making when formulating my CCG’s plans and priorities? All member practices

80%

(12)

Strongly /

Tend to agree

2016

60%

(12)

Strongly /

Tend to agree

2017

Total responses : All member practices (2017: 20); (2016: 15); (2015: 19)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

58%

(11)

Strongly /

Tend to agree

2015

64 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

10%

20%

30%

40%

2

4

6

8

Strongly agree Tend to agree Neither agree nor disagree Tend to disagree Strongly disagree Don’t know

To what extent do you agree or disagree with the following statement…?

All member practices

I am regularly involved in discussions regarding the management of my CCG’s finances

13% (2) Strongly /

Tend to agree

2016

10% (2) Strongly /

Tend to agree

2017

Total responses : All member practices (2017: 20); (2016: 15); (2015: 19)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

5% (1) Strongly /

Tend to agree

2015

65 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

5%

35%

40%

20%

1

7

8

4

Very familiar Fairly familiar Not very familiar Not at all familiar Don’t know

How familiar are you, if at all, with the financial position of your CCG?

All member practices

33% (5) Very / Fairly

familiar 2016

40% (8) Very / Fairly

familiar 2017

Total responses : All member practices (2017: 20); (2016: 15); (2015: 19)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

21% (4) Very / Fairly

familiar 2015

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2017

Number

1

1

8

5

2

1

1

1

5%

5%

40%

25%

10%

5%

5%

5%

73%

7%

7%

7%

7%

63%

5%

5%

16%

11%

Weekly

Twice a month

Once a month

Quarterly

Twice a year

Once a year

Less than once a year

Don't know

2017 2016 2015

2016

Number

0

0

11

1

1

1

1

0

Approximately how often, if at all, do you have the opportunity for direct

discussions with your CCG’s leaders?

2015

Number

0

0

12

1

1

3

2

0

All member practices

Total responses : All member practices (2017: 20); (2016: 15); (2015: 19)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

67 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

15%

25%

30%

25%

5%

3

5

6

5

1

Strongly agree Tend to agree Neither agree nor disagree Tend to disagree Strongly disagree Don't know

To what extent do you agree or disagree that representatives from member

practices are able to take a leadership role within the CCG if they want to?

All member practices

Total responses : All member practices (2017: 20); (2016: 15); (2015: 19)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

40%

(8)

Strongly /

Tend to agree

2017

47%

(7)

Strongly /

Tend to agree

2016

37%

(7)

Strongly /

Tend to agree

2015

68 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

5%

30%

45%

20%

1

6

9

4

Very involved Fairly involved Not very involved Not at all involved Not applicable – CCG is not pursuing a co-commissioning role

Overall, how involved, if at all, do you feel you have been in discussions about

CCG’s plans for primary care co-commissioning? All member practices

53% (8) Very / Fairly

involved 2016

35% (7) Very / Fairly

involved 2017

Total responses : All member practices (2017: 20); (2016: 15); (2015: 19)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

Please note, in 2015 the question included the response: ‘Not applicable - CCG is not pursuing a

co-commissioning role’

37% (7) Very / Fairly

involved 2015

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NHS providers

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33%

67%

1

2

Very well Fairly well Not very well Not at all well Don't know

How well, if at all, would you say the CCG and your organisation are working

together to develop long-term strategies and plans? All NHS providers

Total responses : All NHS providers (3)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

71 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

100%

3

Too much About right Too little Don't know

Would you say that the amount of monitoring the CCG carries out on the quality

of your services is too much, too little or about right? All NHS providers

Total responses : All NHS providers (3)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

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To what extent do you agree or disagree with the following statement…?

33%

67%

1

2

Strongly agree Tend to agree

Neither agree nor disagree Tend to disagree

Strongly disagree Don't know

There has never been an issue with the quality of services

All NHS providers

When there is an issue with the quality of services, the response of the CCG is proportionate and fair

Total responses : All NHS providers (3)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

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How involved, if at all, would you say clinicians from the CCG are in discussions

about…?

33%

67%

1

2

Very involved Fairly involved Not very involved Not at all involved Don't know

All NHS providers

Quality

Total responses : All NHS providers (3)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

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How involved, if at all, would you say clinicians from the CCG are in discussions

about…?

100%

3

Very involved Fairly involved Not very involved Not at all involved Don't know

All NHS providers

Service Redesign

Total responses : All NHS providers (3)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

75 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

33%

67%

1

2

Very well Fairly well Not very well Not at all well Don't know

How well, if at all, would you say the CCG understands the challenges facing your

provider organisation? All NHS providers

Total responses : All NHS providers (3)

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

76 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public 76 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

Appendix

77 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

Appendix A – cluster information

Doncaster CCG

Fieldwork: 16 January - 28 February 2017

Each CCG is compared to a cluster of the 20 other CCGs to which they are most similar. The clusters are based on

the following variables:

Hartlepool and Stockton-on-Tees CCG Wirral CCG

Barnsley CCG Warrington CCG

Durham Dales, Easington and Sedgefield CCG St Helens CCG

Wigan Borough CCG Darlington CCG

Rotherham CCG Chorley and South Ribble CCG

Wakefield CCG Warwickshire North CCG

Mansfield and Ashfield CCG Bassetlaw CCG

North East Lincolnshire CCG Greater Huddersfield CCG

Tameside and Glossop CCG Hardwick CCG

North Lincolnshire CCG Stoke on Trent CCG

• Index of Multiple Deprivation averages

(overall and health domain)

• Population registered with practices

• Age of population • Population density

• Ethnicity

• Ratio of registered population to overall population

Based on these variables, the following 20 CCGs form the CCG cluster for Doncaster CCG

CCG clusters

78 CCG 360 stakeholder survey 2017 - Report | April 2017 | Public

Version 1 | Internal Use Only

For more information

ccg360stakeholder@ipsos-mori.com

CCG 360 stakeholder survey 2017 - Report | April 2017 | Public © Ipsos MORI This work was carried out in accordance with the requirements of the international quality standard for market research, ISO 20252:2006 and with the Ipsos MORI Terms and Conditions which can be found here

Verbal

Item 13

Locality Feedback

Enc G

Item 14

Receipt of Minutes

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Minutes of the Engagement and Experience Committee Held on Thursday 2nd February 2017 at 10:00am -12:00

In Boardroom, Sovereign House

Present: Mrs Sarah Whittle Lay representative-Patient &

Public Involvement (Chair) Mrs Sarah Atkins Whatley Chief of Corporate Services Mrs Kayleigh Wastnage Primary Care Team

Representative Mr Curtis Henry Engagement & Equalities Officer Mr Mike Young

Performance & Intelligence Team Representative

Mr Tom McKnight Doncaster CVS Mrs Debbie Hilditch HealthWatch Doncaster Mr Wayne Goddard Strategy & Delivery Team

Representative Mrs Norma Carr Chair of Patient Participation

Group Network Dr Victor Joseph Public Health Representative Ms Rachel Mather Engagement Officer Mr Ian Carpenter Head of Communications and

Engagement Mr Dennis Atkin

Chair of the Health Ambassador Network

Mrs Claire Larner Finance & Contracting Team Representative

Mrs Christina Quinn Patient Experience Manager Mrs Michelle Ross

In attendance: Miss Lindsay Moore Senior Corporate Services

Support Officer (taking notes) Mrs Rachel Webster Attain (Item 6) Mrs Ailsa Leighton Head of Strategy & Delivery

(Unplanned Care) (Item 8)

Action 1. Welcome and Introductions

Mrs Whittle welcomed all to the meeting and introductions were made.

2. Apologies for Absence Apologies for absence were received from:

Dr Khaimraj Singh - Locality Lead

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Mrs Susan Hampshaw – Doncaster MBC

Mrs Maria Wilson - Quality & Patient Safety Support Officer

3. Declarations of Interest The Chair 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 NHS Doncaster Clinical Commissioning Group (CCG). Declarations declared by members of the committee are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk The meeting was noted as quorate. Declarations of interest from today’s meeting: None declared.

4. Minutes of the meeting held on 5 January 2017 The minutes of the meeting held on 5 January 2017 were approved as a correct record.

5. Action Tracker The actions within the action tracker were noted as complete or in progress.

6. Communication and Engagement Stakeholder Review Mrs Webster explained that the report has been produced by ‘Attain’ who work with the Healthcare Sector in relation to commissioning. The report presents the findings and recommendations of the review of stakeholder engagement undertaken during September-December 2016 as per the request from NHS Doncaster Clinical Commissioning Group. The research around this was both qualitative and quantitative and included structured interviews, review of existing policies and procedures, and direct engagement with patients, the public and key stakeholders and partners including the third sector and community representatives if necessary / required. Four phases of work were agreed on to develop this piece of work;

Diagnostic – understanding context, current activities,

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resources and ambition

Research – evaluating new models for engagement which match the ambition

Evaluation – evaluating how the ambition meets the needs of stakeholders and what will be needed to enable this

Implementation – Outlining the recommendations for change The research carried out has highlighted a shared vision, internally and with local partner organisations, to do the right thing for Doncaster. There is greater outward focus from the CCG in the last 6-9 months and a strong commitment to tackling the health and care needs in partnership and in being open and more responsive to the needs of local people. The general findings are positive; the CCG has a good basis from which to grow its engagement and communication programme and is already 70% of the way there. The research has also highlighted the desire of local people to engage with the work of the CCG as much as possible. There is also the will to increase the enablement of communities to develop their own solutions, within the parameters available. The Committee agreed that the research and subsequent report was really useful and we, as a CCG need to look at how to develop and build on this in terms of our engagement and the elements within it, particularly the ‘so what’. It would be useful to look at the ‘better not bigger’ element to build on what we already have in place. The systematic approach to engagement is less well developed throughout the organisation, and should be our priority area of focus. The group also acknowledged that this work can be aligned with our revised Organisational Development (OD) Strategy to drive forward engagement for improved health outcomes (rather than engagement for engagement’s sake). It was noted that an approach to communication and engagement across Doncaster is now in place, driven by the Doncaster Place Plan. Mrs Whittle summarised the consensus of the discussions as:

Building on a strong existing base within the organisation to develop a more systematic engagement programme

Learning from elsewhere

Sharing communication and engagement resources across the Place Plan footprint

Voluntary Sector engagement

Alignment with the OD Strategy

The Committee agreed to use the next Engagement & Experience Committee as a workshop to start to take this work forward. Mrs Whittle and Mrs Atkins Whatley will discuss how best to do this and welcomed views of other Committee Members prior to the next

Mrs Whittle/

Mrs Atkins

Whatley

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meeting.

7. Dementia Strategy Update Mr Goddard informed the Committee that the Dementia Strategy is due to complete at the end of March 2017. The Doncaster Dementia Strategic Partnerships (DDSP) workshop took place on Monday the 12th December on The Hub. 50 invites were extended to members, partners and associates. There were 43 attendees including people with dementia and carers. The main purpose of the event was to:

Review progress against the 2015-17 Doncaster Dementia Strategy – have we done what we said and if not what are the next steps.

Identify and consider the dementia challenges for Doncaster post 2017

Identify possible solutions to those challenges.

A recommendation paper will be presented to Senior Managers for approval once ratified at the Dementia Strategic Partnership meeting. The Committee thanked Mr Goddard for his work around this as it shows excellent cross partnership working and allows us to look at what we have done differently in this piece of work and if this can be adapted to other areas to allow a change in outcomes. Mr Goddard agreed to send the Independent Evaluation data to Miss Moore to be circulated with the Minutes and to provide a progress update at the next Engagement and Experience Committee.

Mr Goddard

8. Patient Experience Engagement and Experience Tracker The Committee noted the tracker and agreed that it is a useful and informative document to highlight the CCG’s level of engagement. Ms Mather informed the Committee that the 2 consultations around Hyper Acute Stroke Units and Children’s Surgery & Anaesthesia remain open until 28th February to allow for further engagement opportunities. Ms Mather also informed the Committee that the BME Focus Group is taking place on Wednesday 15 February from 6pm - 8pm at the Trades & Labour Club, Frenchgate, Doncaster as part of the Children’s Surgery and Stroke Consultations. Ms Mather will send the information for the Focus Group to the Committee.

Ms Mather

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Doncaster Place Plan & Sustainability & Transformation Plan (STP) Engagement Update More engagement around this has been requested as 80% of the changes being planned will come from the Place Plan rather than the STP. Cllr Pat Knight at Doncaster Council as Chair of the Health & Wellbeing Board has acknowledged receipt of and noted the Place Plan and has confirmed that comments will be made after more local engagement has taken place. Wider input and contributions are being looked at via the wider communications group and Ms Mather has visited Practice Participation Group (PPGs) and the wider PPG Network. It was noted that the pace of change is very rapid on the Place Plan engagement planning, and the involvement and role of a new Strategic Partner to the Doncaster Place Plan will need to be factored in. The Committee agreed that a bulletin such as the CCG ‘In Touch’ bulletin being circulated to the PPGs would be a good way of developing and enhancing engagement. Mr Carpenter agreed to discuss this further with Mr Henry and Mrs Carr. CCG representatives, HWD, and the PPG chair are to meet to agree how the Place Plan would involve wider partners in the development of the engagement strategy. Mrs Hilditch confirmed that a meeting had already been established for the 17th February and that she would reissue the invitation. Co:Create Report and Next Steps Mrs Leighton informed the Committee that Co: Create were commissioned to review the attendance at Doncaster Royal Infirmary’s A&E Department and obtain the patients’ experience of the queuing system. The report also highlights the reasons for patients choosing to attend A&E and shows any common themes. The report identifies that patients seem to be happy with the queuing system at the front door and their overall the experience of Doncaster A&E is positive with the majority of patients being triaged within 10 minutes of arrival. Patients also made some suggestions to improve their general experience of arriving at and waiting in Doncaster A&E, the main one being to change the direction of the queue so that it leads away from the doors.

Co Create have highlighted potential next steps for the work around this which are:

Explore ways to engage more patients, hospital staff and other health professionals to gain a deeper understanding of why and how patients are referred to the A&E Department. Other health professionals to include could be; local GPs,

Mr Carpenter

/ Mr Henry/

Mrs Carr

Mrs Hilditch

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Practice Nurses, Receptionists, staff at walk-in centres and pharmacies.

Prototype solutions using Design Thinking Methods and ask patients, staff and health professionals for their feedback

Feed back to patients the commitment to improving services. For example “what we will do” and “what you could do” notices in the department.

Arrange for Over2You to complete a 6 month review of the same patient journey

The Committee welcomed and supported these proposed next steps. Mrs Leighton was invited to provide an update and proposal to the Committee once this has been agreed. We asked, you said, we did – Quarter 3 The Committee noted the report and thanked all involved for their work in pulling this together Complaints Quarter 3 Report Mrs Quinn informed the Committee that there has been a reduction in the amount of complaints received but the ones received have been more complex. Mrs Quinn advised that of the 14 complaints received;

3 complaints related to the Continuing Health Care (CHC) Appeals - the time taken, and the process,

3 complaints related to current CHC – the decision-making process, delays in achieving outcomes following assessments, and a change in provider for complex care packages

1 complaint related to non-eligibility regarding Individual Funding Requests.

1 related to the lack of recycling of prescribed medical equipment.

1 related to Children’s CHC provider

1 related to the CHC Fast track process

1 related to a Personal Health Budget

1 related to a CHC retrospective review

2 related to claims for Previously Unassessed Periods of Care (PUPoC)

Mrs Quinn and Mrs Ross are currently attending CHC team meetings and details of the complaints received are fed back to the Senior Teams. 8 MP enquiries were received in quarter 3 and were dealt with as highlighted below;

3 related to a new or existing complaints (included above)

3 were signposted to other providers for a response

1 related to Diabetes Type 1 glucose monitoring

1 related to policy relating to the treatment of Lymphedema

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23 concerns and enquiries were dealt with in Quarter 3 most of which required signposting to other services / areas.

9. Key Engagement Themes and Trends identified by Partners since the last meeting Health Ambassadors

The Committee noted the minutes provided

The overseeing of the Health Ambassador Scheme will be transferring to NHS Doncaster CCG from 1st April 2017 due to the closure of Doncaster CVS on 31st March 2017.

PPG Network

The minutes of the last meeting are unavailable as they have not yet been approved.

Mrs Hilditch attended the last Network meeting to discuss the Healthwatch Engagement Pilot.

The Network will now be meeting monthly or bi-monthly

Mrs Wastnage will be attending Network meetings to discuss the Primary Care Strategy.

A strategy has been devised to look at how to take the Network forward and Mrs Carr will discuss this at the next Engagement and Experience Committee.

Doncaster CVS

Mr McKnight has attended 2 events – the Doncaster Carers Forum and Doncaster Adult Social Care Forum. The Doncaster Place Plan and the consultations around Hyper Acute Stroke Unit Services (HASU) and Children’s Surgery & Anaesthesia were raised at both meetings. Meeting attendees completed both Surveys after the meetings had finished.

Public Health

The BME Health Needs Assessment is being finalised for final agreement at the Health & Wellbeing Board.

Healthwatch Doncaster

The specification for the £10,000 allocation to Doncaster and South Yorkshire areas has been agreed by Helen Stevens; ways of taking this work forward are being looked at. Healthwatch Doncaster have been commissioned to produce the South Yorkshire Feedback report and have been allocated £1,500 to complete this by the end of April 2017.

A North West Locality Advocate is being piloted in Carcroft and Petersgate Practices.

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A Crowd Funding website has been developed and Healthwatch Doncaster are providing funding for a photographer to spend time with families in or going into poverty and video / photograph their Health and Social care needs. This work will help to highlight people’s perceptions of how they look when accessing Health Care Services. This programme will run for 6 weeks and the findings will be published and discussed with Health Care partners. Mrs Hilditch will keep Mrs Atkins Whatley informed of the progress of this work.

Follow up of Patient Questions/ Stories from Governing Body and forward Planning

Mr Carpenter informed the Committee that the Patient Story scheduled for February Governing Body is from two teenage girls and will focus on their experiences of going into care and also after leaving care.

10. Any Other Business There were no items of other business raised.

11. Date and Time of Next Meeting The next meeting is scheduled for Thursday 2 March at 10:00am -12 noon in Meeting Room 1, Sovereign House The meeting will be run as a workshop to discuss the Communication and Engagement Stakeholder Review

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Minutes of the Engagement & Experience Committee Held on Thursday 2 March 2017 at 10am to 12noon

In the Boardroom, White Rose House, Ten Pound Walk, Doncaster, DN4 5DJ Present: Mrs Sarah Whittle Lay Representative – Patient and

Public Involvement (Chair) Mrs Sarah Atkins Whatley Chief of Corporate Services Mrs Kayleigh Wastnage Primary Care Team

Representative Mr Mike Young Performance & Intelligence Team

Representative Mr Tom McKnight Doncaster CVS Mrs Debbie Hilditch Healthwatch Doncaster Mrs Norma Carr Chair of Patient Participation

Group Network Ms Rachel Mather Engagement Officer Mr Ian Carpenter Head of Communications and

Engagement Mr Dennis Atkin Chair of Health Ambassador

Network Mrs Michele Clarke Strategy and Delivery Manager Dr Khaimraj Singh Locality Lead

In attendance: Mr Gareth Jones Corporate Governance Manager

Action 1. Welcome and Introductions

Mrs Whittle welcomed everyone to the meeting.

2. Apologies for Absence Apologies for absence were received from:

Dr Nick Tupper, Locality Lead

Mr Wayne Goddard, Strategy and Delivery Team Representative

3. Declarations of Interest The Chair 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 NHS Doncaster Clinical Commissioning Group (CCG). Declarations declared by members of the committee are listed in

2

the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk The meeting was noted as quorate. Declarations of interest from today’s meeting: None declared.

4. Introduction to Workshop session Mrs Whittle welcomed everyone to the Workshop session, which was planned to lead on from the Communication & Engagement “diagnostic” received from Attain at the last meeting. The key points from the diagnostic were summarised – Attain felt that we are 70% of the way there already and should be pleased with this solid foundation on which to build. Assets on which to build:

A leadership team committed to engagement.

A strong sense of local identity and a shared vision across partner organisations to work strategically towards common goals.

A vibrant, active voluntary & third sector community.

Access to experienced, knowledgeable and committed communications and engagement professionals internally and across the health and public sectors locally.

A recognition amongst partner organisations that NHS Doncaster CCG is changing and that relationships are improving as a result of these changes.

Areas of focus:

Developing and implementing a systematic approach to stakeholder engagement across the CCG, directly linked to our decision-making processes.

Using the information and analysis from this systematic approach to prioritise activities and target resources more effectively to increase engagement with patients and the public

Working with partner organisations to coordinate. communications and engagement activities to provide a more joined-up approach to working with local people, as well as ensure that resources are used efficiently and to their maximum effect .

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Workshop 1 – Developing the Principles In this workshop, the group split into tables for group discussions about what NHS Doncaster CCG’s principles for engagement with our population should be. The group considered the Ladder of Engagement and the Gunning Principles: Ladder of Engagement:

Devolving Placing decision-making in the hands of the community and individuals. E.g. Personal Health Budgets, Community Development approach.

Collaborating Working in partnership with communities and patients in each aspect of the decision, including the development of alternatives, and the identification of the preferred solution.

Involving Working directly with communities and patients to ensure that concerns and aspirations are consistently understood and considered. E.g. partnership boards, reference groups, workshops.

Consulting Obtaining community and individual feedback on analysis, alternatives and / or decisions. E.g. patient surveys, citizens’ panels, focus groups, 1:1 interviews.

Informing Providing communities and individuals with balanced and objective information to assist them in understanding problems, alternatives, opportunities, solutions. E.g. websites, newsletters and press releases.

Gunning Principles:

Consultation must take place when the proposal is still at a formative stage;

Sufficient reasons must be put forward for the proposal to allow for intelligent consideration and response;

Adequate time must be given for consideration and response;

The product of consultation must be conscientiously taken into account.

The group agreed the following engagement principles:

1. Lived experience is vital in commissioning healthcare services

effectively.

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2. Engage together in partnership across Doncaster health and social care services wherever possible, avoiding duplication of engagement activity.

3. Centralise feedback wherever possible through the local statutory voice of the users of health and social care services – Healthwatch Doncaster.

4. Focus CCG engagement activity on the priority areas of the CCG, identifying the best engagement option for each priority area using the Ladder of Engagement.

5. Engagement should be: o Planned (with a clear purpose, scope, limitations and outcomes) o Productive (with a focus on improving health outcomes) o Undertaken early (before decisions are made) o Open, transparent & empowering (clear on what can be

influenced) o Ongoing (proactive conversations rather than reactive to changes) o Inclusive (including targeting more seldom heard groups) o Accessible (times, places, methodologies) o Sustainable (with adequate time and resources)

6. Take the time to feed back to contributors on the outcome of engagement activity, and celebrate engagement successes.

Workshop 2 – Testing the Principles: Dementia Case Study In this workshop, Mrs Clarke, Strategy & Delivery Manager for Dementia, gave a presentation to the group on work in the Dementia commissioning area. Mrs Clarke described:

The rationale for involvement;

Links to the commissioning cycle;

The flow of the patient voice right though the dementia meeting governance structure;

Examples of engagement and listening events;

The patient voice across the dementia commissioning pathway;

The lived experience of people, although anecdotal, is vital for planning the right services in Doncaster.

The group then tested the principles developed in Workshop 1 against the Dementia engagement work to check for “fit” and identify any changes. The group commended Mrs Clarke on the engagement work in the Dementia area, and recommended that this was a presentation which it may be beneficial for the Governing Body to hear, co-presented with patients/carers.

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Workshop 3 – Prioritising engagement to improve health

outcomes In this workshop, the group started to identify priorities for engagement in 2017/18 and beyond. Our current CCG commissioning priorities were noted as:

Sustainability & Transformation Plan (STP)

Place Plan

Our 12 CCG Delivery Plan areas:

Urgent Care

Intermediate Care

Cancer

Mental Health and Learning Disabilities

Primary Care

Community Services

End of Life Care

Children’s and Maternity

Dementia

Care Homes

Medicines Management

Planned Care As a result of the discussions it was agreed that perhaps our CCG engagement priorities would be better evolving to be Doncaster health engagement priorities to align to our principle around partnership in engagement. It was noted that each of these areas may need a different level of engagement from the Ladder of Engagement. As a starting point, it was agreed that the Communication & Engagement Team could start to engage with the Commissioning Managers for each of the 12 CCG priority areas to introduce the Ladder of Engagement and support assessment of which “step” on the “ladder” each area has both climbed to and aspires to. Following these discussions, we could pilot Engagement & Experience Committee members attending Delivery Boards for the 12 CCG priority areas to co-present the Ladder of Engagement with the Commissioning Managers and engage all participants across the partnership area in the discussions.

5. Summary and next steps Mrs Whittle summarised the outcomes from the Workshop:

We have agreed principles of engagement which we can start

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to embed into our day-to-day work and throughout the CCG.

We have tested the principles against a good practice case study.

We have agreed the pilot the Ladder of Engagement approach with Commissioning Managers and Delivery Boards.

It was agreed that a summary of the workshop, via some notes, will be presented to the next formal Committee meeting in April.

6. Date and Time of Next Meeting Thursday 6th April 2017 -10am -12noon, Sovereign House Meeting Room 3 Future Meetings

Thursday 4th May 2017 from 10am -12noon, Sovereign House Meeting

Room 3

Thursday 1st June 2017 from 10am -12noon, Sovereign House Boardroom

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Executive Committee Held on Wednesday 1st March 2017 commencing at 9am

In Dr David Crichton’s Office, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ

Formal Members Mrs Jackie Pederson – Chief Officer (Chair) Present: Dr David Crichton – Chairman Mrs Sarah Atkins Whatley – Chief of Corporate Services

Mr Anthony Fitzgerald – Chief of Strategy & Delivery Mrs Hayley Tingle – Chief Finance Officer

Formal Attendees Present: Mr Ian Carpenter – Communications and Engagement

Manager In attendance: Miss Lindsay Moore – Senior Corporate Services Support

Officer (taking minutes) Mr Chris Empson, information Technology & Systems

Programme Manager (item 5) Mr Karl Roberts (item 6)

Mr Mark Randerson (item 7 & 8) Mrs Ailsa Leighton (item 10) Mrs Katie Rhodie (Item 10)

ACTION 1. Apologies

Apologies were received from: Mr Andrew Russell, Chief Nurse Mrs Lisa Devanney, Head of HR Mrs Laura Sherburn – Chief of Partnerships Commissioning & Primary Care

2. Declarations of Interest The Chair reminded committee members of their obligations to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group. Declarations declared by members of the committee are listed in the CCG’s register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link www.doncasterccg.nhs.uk The meeting was noted as quorate. Declarations of interest from sub-committee/working groups:

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None declared. Declarations of interest from today’s meeting: Dr Crichton Declared an Interest in items 6,7,& 8 however as this is a professional interest not a financial one Dr Crichton may remain in the room but will be unable to take part in discussions.

3. Minutes from the Meeting held on 4 January 2017 The minutes from the Executive Committee meeting held on was agreed as a correct record.

4. Matters Arising Not on the Agenda Fleet Solutions A briefing paper is to be brought to a future informal Senior Management Team Meeting. Market Place Session Mr Fitzgerald informed the committee that the QIPP session planned for 29th March is not going ahead due to availability issues for the staff involved. Governing Body have been updated in relation to the work around this and are happy with the position at the moment. A stocktake exercise is planned for 6 months’ time and monthly updates will be provided to Governing Body. National Diabetes Prevention Programme Wave 2 Mr Fitzgerald advised that no communications have been received in relation to funding as yet. Planned Care Update Mr Carpenter advised that as plans around this are not yet finalised the release of information to the public is scheduled for approximately 2 weeks’ time pending the confirmation and finalisation of the referral process. The Committee agreed that a decision needs to be made as to how much detail we need to share with the general public and how we can make this information easy to understand and that producing an easy read document highlighting the key information may be the best way to take this forward alongside updating the CCG website once information is finalised.

Mrs Atkins Whatley / Mrs Devanney

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5. Apple Equipment Evaluation

Mr Empson advised the committee that in 2013/14 NHS Doncaster Clinical Commissioning Group (NHS Doncaster CCG) commissioned an information technology project to understand the benefits and limitations of utilising Apple devices on their computer networks. This project has now finished and NHS Doncaster CCG needs to decide on the future of utilising Apple equipment on its infrastructure. Due to the current financial pressures on the CCG and the unavoidable increase in IT support which would be required, it is recommended that this area of work is ceased for the present time but is revisited in 3-4 years’ time. The Executive Committee agreed and approved this recommendation and requested that all existing equipment remains in place and the spare equipment is allocated to SMT and appropriate deputies for contingency purposes.

6. Dermatology Options Paper Mr Roberts advised that following on from the Clinical Reference Group meeting on the 24th November 2016 when the group widely agreed that changes needed to be made to the current Dermatology pathways in Doncaster and that some of the non-symptomatic/Non disfiguring benign skin lesions would now not be treated under any tariff in primary or secondary care. The outcome of these discussions were that the CCG in conjunction with primary and secondary care providers would work in conjunction and provide an options paper re the potential model for Dermatology in Doncaster. The options and recommendations paper has been drawn up based up on best guidance and utilisation of new and existing technology, it also takes into account treatment options with low or no clinical value. The committee reviewed and discussed the options contained within the paper and advised that before a decision can be made work needs to be done around costing’s and the options need to be re- presented to Clinical Reference Group to enable a recommendation to be made to Executive Committee via a business case.

Mr Roberts / Mr Fitzgerald

7. Pregabalin Mr Randerson advised that a new license for neuropathic pain for Alzain (pregabalin) has recently been granted. Compared to the current brand leader, Lyrica (pregabalin) Alzain offers significant in year savings of approximately £750k per annum if patients in Doncaster are swapped to Alzain, for the neuropathic

4

pain indication. Mr Randerson informed the committee that some neighbouring CCGs have already carried out the switch and several other CCG’s are also considering this. There are several residual risks to take into account if the switch is made however these are deemed to be low risks;

Supply/availability - should all CCGs switch across to Alzain the supply chain from a single manufacturer may fail? This would cause significant disruption and reputational damage.

Market development. The likely emergence of generics and Drug Tariff price changes will necessitate a later switch to generic prescribing to maximise medium/long term savings

Challenge from the brand leader manufacturer, Pfizer, which is currently in legal proceedings over breach of patent by generic manufacturers. This risk is likely small but material.

Challenge by NHS England based on current guidance to prescribe Lyrica for neuropathic pain. The guidance is technically extant however NHS England has indicated a revision will be required given entry to the market of competitor products and on completion of current legal proceedings.

Mr Randerson asked the committee to consider the following options and advise which one is to be taken forward;

1. Switch across to generically prescribed pregabalin.

2. Do nothing until generics are readily available (July 2017

at earliest) and reflected in Drug Tariff pricing

3. Work through the risks and benefits of switching across to Alzain with individual practices and offer the medicines management team as a resource to switch patients, should the practice choose this option

The committee agreed that option 1 is not recommended as this would increase the risk of a challenge by NHSE or Pfizer in relation to drug tariff prices. Option two would still impact on finances until implementation. The committee agreed that Option 3 is the preferred option to take forward based on reasonable evidence and information. The operational detail around this option is being worked up and there will be an initial focus on the practices with the highest spends on Pregabalin. This option could be implemented in approximately one months’ time. The committee approved option 3 and also the recommendation to approve the reimbursements of practice postage costs necessarily incurred in the switch over of patients (estimated at around £2k) The Committee also noted that this

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could be added to Optimise Rx as the ‘drug of choice.’

8. Sore Throat Pharmacy Pilot Mr Randerson explained that a recent pilot was run by Boots pharmacies in London and Leicester around the Sore Throat Test and Treat (STTT) Service. This was a private service which held a charge for the test and also any antibiotics prescribed as a result of the test. A subsequent meeting was held to discuss the findings of this and it was felt that whilst commissioning this service may have the potential to give a significant reduction in the prescribing of antibiotics and also release some GP capacity, there would be difficulties in estimating how effective it would be in Doncaster. If a pilot were to take place, there are 2 broad options: 1/ A Doncaster wide pilot open to any interested pharmacy that could meet the requirements set out, including the appropriate staff training, willingness to work with neighbouring practices and collecting and submitting audit data 2/ A pilot targeted as specific pharmacies chosen based on, in addition to the above factors, proximity to practices with high antibiotic prescribing, late/weekend opening and potentially in a variety of areas with different demographics The committee agreed that there is no capacity to take this work forward at present however wider work with pharmacists, the APC and medicines management team would be beneficial to explore the possibility of carrying out the testing in GP Practices.

9. Consultant Connect Business Case Doncaster Clinical Commissioning Group (DCCG) GP referral demand into planned care services within secondary care providers has grown significantly over the course of the last 3 years. Commissioning for Value and Right Care intelligence indicates that DCCG refer 12% more patients than the national average and 6% more patients than peer group average (attached supporting data). This has inevitably led to demand and capacity pressures within secondary care services, an increase in waiting times for patients and a reduction in quality of patient experience. Increased demand has resulted in a significant increase in spend of £2.5 million over the last 3 years. Research with Primary and Secondary Care Professionals has indicated a clear wish for a simple method for increased communication and patient discussion. Consultant Connect is a UK based telephone solution that allows GPs to contact hospital specialty consultants directly and

6

immediately for advice and guidance. The GP dials a local number and the call is answered by a local specialty consultant, typically in under a minute, pick up rate is 80-90% and calls last between 3-5 minutes. Timely advice can be sought during a patient appointment in the GP consulting room. The calls are recorded for medico-legal purposes and are saved as digitally encrypted files, making the service secure and paperless. Consultant Connect has level 2 information governance toolkits and is secure. A full complement of activity and outcome data is available including referrals avoided, activity volumes, connection speed, and call duration, source of call and source of advice. The Executive Committee agreed that this is a useful piece of work to take forward in 8 speciality areas and also that we need to encourage practice utilisation. The Business Case and proposal was approved by Executive Committee.

10. FDASS Review Mrs Rhodie, Mrs Leighton and Mrs Tingle informed the committee that the Front Door Assessment and Signposting Service (FDASS) was commissioned by NHS Doncaster Clinical Commissioning Group as part of the changes to the Doncaster urgent care system in 2015. The service was commissioned through a full procurement and the tender was won by DBHFT. A review has taken place and the Trust are largely meeting the specifications however more work is being carried out around streaming consistencies. Co Create have carried out a piece of work around FDASS and the actions they have recommended have been implemented and the additional actions have been identified. The committee were advised that the current FDASS service has not seen streaming rates consistently at the level anticipated at the contract outset. As a result DBHFT were asked to consider, as part of the FDASS review, the options available to secure an increase in streaming rates. These options are presented within the FDASS review report and can be summarised as:

Option 1: No Change; no cost implication

Option 2: Increase band 6 lead role to 24/7

Option 3: Change all nurse posts from band 5 to band 6

Option 4: Change model to consultant led.

The committee agreed option 3 and requested that the timings, risk management and system impact costing’s are worked up and outlined in an update to a future Executive Committee

Mrs Tingle / Mrs Rhodie

7

11. Bring Forward Agenda

The Committee agreed the following: Strategy & Organisational Development Forum April 2017

An Extraordinary governing body to be held prior to Strategy to discuss PTS

Place Plan update from EY Governing Body

March 2017

Future Child Health Service Model

Continuing Heath care Service Model April 2017

Children & Young People Plan (Lee Golze)

12. Items to Note/Receipt of Minutes The Executive Committee noted the receipt of the following minutes: DBHFT Strategic Contracting Group – Minutes from the meeting

held on 13 December 2016

RDaSH Strategic Contracting Group - Minutes from the meeting

held on 19 December 2016

System Resilience Group – Draft minutes from the meeting held on

26 January 2017

Joint Commissioning Co-ordination Committee – Draft minutes

from the meeting held on 16 January 2017

13. Any Other Business Mr Fitzgerald will be holding a QIPP workshop at DCCG Managers on 6th March

14. Date and Time of Next Meeting Wednesday 5th April 2017 at 9am, Dr Crichton’s Office, Sovereign House

8

1

Paper A

Joint Committee of Clinical Commissioning Groups

Meeting held 21 February 2017, 9:30 – 11:30 am, Barnsley CCG

Decision Summary for CCG Boards

1 Minutes of the Joint Committee of Clinical Commissioning Group (JCCC) meeting held 6 December 2017

01/17 (a) that the minutes were ratified to be circulated to all, subject to two amendments

KATE WOODS

2 Children’s Services Acutely Ill Child (AIC) – Final case for change

02/17 (a) that revisions be made to the documentation to include Chesterfield Royal NHS Foundation Trust as part of the project (b) that an analysis of nursing workforce be included as part of this project (c) that the document be circulated with the above changes, and taken through all public meetings.

RACHEL GILLOTT RACHEL GILLOTT ALL

3 Hyper Acute Services Review update

03/17 (a) that an interim report would be brought to the JCCC in March, around public consultation

RACHEL GILLOTT

4 Transformation Programme Timeline

04/17 (a) that an interim position on the Stroke and Children's Services business cases would be discussed at the March meeting and full business cases would be submitted for the April session.

RACHEL GILLOTT

5 Public Consultation update – Stroke and Children’s Surgery and Anesthesia

05/17 (a) that the final analysis of the consultation be broken down by locality (b) that the final report be circulated when complete.

HELEN STEVENS HELEN STEVENS

6 Joint Committee of Clinical Commissioning Groups (CCG) Governance manual and terms of reference

06/17 (a) that a discussion would take place with NHS England regarding NHS Hardwick CCG’s decision not to be part of the JCCC and picked up with Hardwick CCG to agree the way forward.

EMMA WILSON

2

(b) that a proposal regarding system wide commissioning and the infrastructure required for this would be developed for March JCCC for further discussion to then be taken to GBs.

ACCOUNTABLE OFFICERS

7 Lay member representation

07/17 (a) that remuneration and time commitment for the lay members be readdressed to align with the other CCGs (HT to advise on current rate) (b) that as part of the above, a discussion was also required for clarity around resource commitment for WTP and the STP and JN would be preparing a full paper on this for AOs to consider (c) that the requirement for demonstrable experience be made clear (d) that the lay members would remain non-voting attendees for JCCCs for the current time, however this should be reviewed in 6 month’s time (e) that the posts would be open to current lay members and wider, noting that any successful applicant must relinquish current CCG role if applicable (f) that current recruitment of CCG Governing Body lay members would be used to inform the document. (g) that the number of lay members would remain at 2 to be reviewed in 6 months time (h) that an email would be circulated for volunteers to join the recruitment panel. (i) that a status report would be given in at March JCCC.

HELEN STEVENS, HAYLEY TINGLE JULIA NEWTON HELEN STEVENS HELEN STEVENS HELEN STEVENS HELEN STEVENS HELEN STEVENS HELEN STEVENS HELEN STEVENS

8 SYB STP update

08/17 (a) that BM would share the overview of Derbyshire STP to inform thinking within SYB.

BEN MILTON

9 Sustainable Hospital Services Review (SHSR)

09/17 (a) that the slide deck presented to JCCC would be used to facilitate discussions at local level

ALL

10 Any other business – future meeting dates

11/17 (a) that proposed revision to meeting dates to ensure greater clinical representation be confirmed, rotating the venue for meetings across the patch.

KATE WOODS

3

Minutes of the meeting of Joint Committee of the Clinical Commissioning Group, held 21 February 2017, 9:30 – 11:30, Barnsley CCG

Present: Dr Andrew Perkins, Clinical Chair, NHS Bassetlaw CCG (Chair) Esther Ashman, Head of Strategic Planning, NHS Wakefield CCG

John Boyington, Lay Member

Andrew Cash, Chief Executive, Sheffield Teaching Hospitals NHS Foundation Trust/South Yorkshire

and Bassetlaw Sustainability and Transformation Plan Lead

Will Cleary-Gray, Director of Sustainability and Transformation, South Yorkshire and Bassetlaw

Sustainability and Transformation Plan

Chris Edwards, Accountable Officer, NHS Rotherham CCG

Debbie Hilditch, Healthwatch Representative

Rachel Gillott, Deputy Director of Transformation, South Yorkshire and Bassetlaw Sustainability and

Transformation Plan Victoria Mcgregor-Riley, Executive Lead for Primary Care, NHS Bassetlaw CCG Dr Ben Milton, Clinical Chair, NHS North Derbyshire CCG Jackie Pederson, Accountable Officer, NHS Doncaster CCG

Maddy Ruff, Accountable Officer, NHS Sheffield CCG

Lesley Smith, Accountable Officer, NHS Barnsley CCG

Helen Stevens, Associate Director of Communications and Engagement, Working Together

Programme

Hayley Tingle, Chief Finance Officer, NHS Doncaster CCG

Emma Wilson, Head of Co-Commissioning, NHS England

Kate Woods, Programme Office Manager, Working Together Programme

Apologies: Steve Allinson, Accountable Officer, NHS North Derbyshire CCG

Dr David Crichton, Clinical Chair NHS Doncaster CCG

Andy Gregory, Accountable Officer, NHS Hardwick CCG

Idris Griffiths, Interim Accountable Officer, NHS Bassetlaw CCG

Steve Hardy, Lay Member Dr Julie Kitlowski, Clinical Chair, NHS Rotherham CCG Dr Steve Lloyd, Clinical Chair, NHS Hardwick CCG

Dr Tim Moorhead, Clinical Chair, NHS Sheffield CCG (Chair)

Julia Newton, Director of Finance, NHS Sheffield CCG

Jo Webster, Chief Officer, NHS Wakefield CCG

Minute reference

Item

ACTION

It was noted that the JCCC meeting was not quorate as Hardwick CCG was not represented. This would be discussed as part of the agenda.

01/17 Minutes of the Joint Committee of Clinical Commissioning Group meeting held 6 December 2017

4

The minutes were accepted as a true and accurate record subject to the following amendments: Pat Keane to be removed from attendees list. Typo noted under item 28/16: amend to “taken through private Trust Boards.” All matters arising would be picked up on the agenda.

02/17 Children’s Services Acutely Ill Child (AIC) – Final case for change The Children’s Services AIC case for change had been taken through Governing Body and Trust Board meetings. A request was made to the group to take this through public sessions. BM highlighted that North Derbyshire CCG had not taken this document through governing body. This had been on account of debate around Chesterfield Royal NHS Foundation Trust who had now agreed to join the project. The current paperwork did not reflect this and revisions to include Chesterfield to pick up impact were requested. This would be actioned before taking this paper through public. The final document would be circulated virtually when amended. AP highlighted the current situation at Bassetlaw Hospital and the closure of the paediatric wing at night due to nursing workforce shortage. A request was made to include nursing workforce as part of this work. Upskilling GPs in paediatrics was crucial for this work to be picked up as part of the work programme being developed. The JCCC agreed to circulation of the paper in public governing bodies, subject to the changes noted above.

RACHEL GILLOTT RACHEL GILLOTT

03/17 Hyper Acute Services Review update An update was given on the programme of change noting that a key development was a refresh on the risks and mitigations implemented. Cross boundary flows had previously been noted however some further risks were highlighted; particularly the need to actively engage with commissioners to ensure all information pulled together for final business case. An interim report would be brought to the JCCC in March around public consultation.

RACHEL GILLOTT

04/17 Transformation Programme Timeline A timeline was shared with JCCC and noted that a final business case would be brought to the April 2017 meeting. Some challenges and risks around capacity to pull this together on the team and CCGs to ensure all CCGS own final business case were noted. A comment was made that the implications for commissioning must be considered as part of this. At the point that decision was made around change to services, consideration must be given to how commissioning would be mobilised to respond.

5

It was recognised by JCCC that the programme must ensure that feedback was clear within the evaluation report around messages heard from the public consultation. JCCC noted that an interim position on the business case would be discussed at the March meeting and a full business case would be submitted for the April session.

RACHEL GILLOTT

05/17 Public Consultation update – Stroke and Children’s Surgery and Anaethesia JCCC were updated on the position of the public consultation, the independent analysis report for which was still being drafted. It was noted that more than 2,000 responses for both consultations had been received. 11 formal public events had taken place as well as many face to face conversations and focus groups. 19 media articles had been noted and 62,000 websites views. Included in the themes emerging were concerns around travel. Each hospital in the region had submitted a formal response to the consultation with the exception of Sheffield Children’s Hospital NHS Foundation Trust. Key themes noted were around a possible inability to maintain skills for some services where the impact would be greatest, that there was an enthusiasm to collaborate with a clinical network approach and that there needed to be a consideration of budgets around relocating services. JCCC were advised that Barnsley Save Our NHS had submitted a petition. It was noted that the process had been robust and thorough. A request was made that the final analysis of the consultation be broken down by locality and this was agreed. JCCC noted that the final report would be circulated when complete.

HELEN STEVENS HELEN STEVENS

06/17 Joint Committee of Clinical Commissioning Groups Governance manual and terms of reference It had recently come to light that Hardwick CCG had resolved at their Governing Body not to delegate to the JCCC for Children’s Surgery and Anaethesia and the Hyper Acute Stroke Unit Review back in September 2016 but unfortunately this had not been communicated to the Commissioners Working Together Team or JCCC (the North Derbyshire position was that the CCG was a formal member of the committee for the items currently delegated). It was not known at this stage what impact or risk this would pose to the Joint Committee or on the assurance process with NHS E. This would be raised formally with NHS England by EW and picked up with Hardwick CCG to agree the way forward. The first public meeting of the JCCC would take place in April and must therefore be a formally constituted committee by this point. NHS Hardwick CCG had committed to resolving its membership by this point.

EMMA WILSON

6

An update was given on the NHS Sheffield CCG position further to issues raised at previous JCCC meetings which were now resolved, noting that it had been confirmed that there would be no liability on the part of individual CCG members around a decision that a particular CCG could not support. A discussion took place around assurance for all members, as the JCCC would be a statutory committee from April when it met in public. A considered process and approach would be required for core business. This would be discussed further by AOs and at the next meeting in March. JCCC discussed decision making and governance for the South Yorkshire and Bassetlaw Sustainability and Transformation Plan (SYB STP). BM updated the group on the Derbyshire Sustainability and Transformation Plan, noting that there was a wish to move towards a single commissioner by April 2018. A discussion took place around the current governance arrangements for JCCC, noting that consideration would be required quickly for collective decision making in other areas such as cancer. It was noted that discussions were taking place around system wide commissioning for South Yorkshire and the infrastructure required to support this. A proposal would be developed for March JCCC for further discussion to then be taken to GBs.

ACCOUNTABLE OFFICERS

07/17 Lay member representation A paper was circulated setting out an approach for lay membership recruitment. This had been developed using NHS England and NICE guidance. Comments on this were welcomed around content and how to advertise the role. The positions needed to be in place by the first public meeting in April and support was required on recruitment panel for this. Comments were noted from NHS Sheffield CCG as:

- Time commitment should be re-evaluated to reflect networking with other CCGs and organisations

- Number of lay members being recruited to be considered (whether two was sufficient given breadth and geography of work)

- Possible re-evaluation of lay members being non-voting members of JCCC

- Remuneration was possibly too low and not aligned with other CCGs.

JCCC discussed this and agreed: That remuneration and time commitment for the lay members be readdressed to align with the other CCGs (HT to advise on current rate). That as part of the above, a discussion was also required for clarity around resource commitment for WTP and the STP and JN would be preparing a full paper on this for AOs to consider. That the requirement for demonstrable experience be made clear.

HELEN STEVENS, HAYLEY TINGLE JULIA NEWTON HELEN STEVENS

7

That the lay members would remain non-voting attendees for JCCCs for the current time, however this could be reviewed in 6 months time. That the posts would be open to current lay members and wider, noting that any successful applicant must relinquish current CCG role if applicable. Current recruitment of CCG Governing Body lay members would be used to inform the document. That the number of lay members would remain at 2 to be reviewed in 6 months time. That an email would be circulated for volunteers to join the recruitment panel. A status report would be given in at March JCCC.

HELEN STEVENS HELEN STEVENS HELEN STEVENS HELEN STEVENS HELEN STEVENS HELEN STEVENS

08/17 SYB STP update JCCC were updated on the South Yorkshire and Bassetlaw Sustainability and Transformation Plan (SYB STP) around progress to date and key next steps. It was noted that an excercise was taking place around the work streams to ensure all work was adding value and not being duplicated at local level. Work was taking place to align the collaborative teams. The Terms of Reference for the CPB were being reviewed to ensure governance arrangements were correctly in place to realise the ambitions outlined within the Plan. The commissioning and hospital services reviews were taking place. It was noted that nationally progress had been made around the STP to develop a set of proposals to enable SYB to accelerate plans. The group was invited to comment. BM updated on the STP in Derbyshire highlighting that the STP should to be the major vehicle to transformation and morph all work under this. It was agreed that BM would share, when publically available, the overview of Derbyshire STP to inform thinking within SYB. LS updated the group on the review of commissioning noting that the strategic planning and transformation function across the footprint had moved to the STP, and providers and commissioners were aligned and moving at pace on the key elements of the commissioning cycle. The review was ongoing. The national landscape was changing while SYB was working through internal local review. Workshops with AOs had taken place and proposals would be taken to CPB, JCCCs and governing bodies on the

BEN MILTON

8

commissioning reform. Further national direction was anticipated.

09/17 Sustainable Hospital Services Review (SHSR) WCG updated the JCCC on progress with the SHSR work noting that the Steering Group had met for its inaugural meeting in February. Context to this work was outlined for JCCC, noting the viability of quality and access and sustainability and acute services across the region. This work had specific reliance on new models of care for acute services and commissioner place plans. Terms of reference had been discussed at the STP Collaborative Partnership Board and the Provider Federation, however remained draft until the secretariat was established; the work would be independently led by Jonathan Michael. The purpose of the work and intended benefits were reiterated to the JCCC. The methodology of the previous Provider Working Together approach would be retained, with a tiered approach to services. Objectives and scope were highlighted to the group. A discussion took place around governance. It was noted that the SHSR Steering Group would have close links to the SYB Directors of Commissioning Group to ensure there was a mechanism in place to take recommendations to full business case from a commissioning perspective. JCCC were encouraged to use the slide deck to facilitate discussions at local level. The slides would be circulated to all. A discussion took place regarding the STP Oversight and Assurance Group and approaches to ensure full engagement from all across the patch from the outset with the reviews. The group considered a joint Health and Wellbeing Board approach. It was agreed that the group must provide oversight and assurance of the processes to enact change. This group would not hold decision making power and the statutory function of Health and Wellbeing Boards was to encourage integration and partnership working. Consideration was also given around including a representative Overview and Scrutiny Chair to join the group. After further discussion on this, the JCCC agreed that the Oversight and Assurance Group was the preferred approach initially and could be reviewed at a later date. It was noted that the STP brand would continue nationally however locally it was being revisited as part of the current conversations with the public and staff..

10/17 Commissioning Review update This item was covered under 09/17.

11/17 Any Other Business Future meeting dates Further to discussions at previous JCCC meetings, it was noted that work had taken place to try and ensure there was increased clinical

KATE WOODS

9

representation at future meetings. A proposal was put forward to the group and the dates would be confirmed as soon as possible. The JCCC were asked to ensure primary care was represented on the Committee. The venue for the revised dates would rotate across the patch.

Manual/Agreement for JC CCG

32

Appendix 2 – JC CCGs Terms of Reference

1. Introduction

1.1 The NHS Act 2006 (as amended) (‘the NHS Act’), was amended through the

introduction of a Legislative Reform Order (“LRO”) to allow CCGs to form joint

committees. This means that two or more CCGs exercising commissioning functions

jointly may form a joint committee as a result of the LRO amendment to s.14Z3

(CCGs working together) of the NHS Act.

1.2 Joint committees are a statutory mechanism which gives CCGs an additional option

for undertaking collective strategic decision making and this can include NHS

England too, who may also make decisions collaboratively with CCGs.

1.3 Individual CCGs and NHS England will still always remain accountable for meeting

their statutory duties. The aim of creating a joint committee is to encourage the

development of strong collaborative and integrated relationships and decision-making

between partners.

1.4 The Joint Committee of Clinical Commissioning Groups (‘JC CCGs’) is a joint

committee of:

(1) NHS Barnsley Clinical Commissioning Group;

(2) NHS Bassetlaw Clinical Commissioning Group;

(3) NHS Doncaster Clinical Commissioning Group;

(4) NHS Rotherham Clinical Commissioning Group;

(5) NHS Sheffield Clinical Commissioning Group;

(6) NHS North Derbyshire Clinical Commissioning Group; and

(7) NHS Wakefield Clinical Commissioning Group.

It has the primary purpose of enabling the CCG members to work effectively together, to

collaborate and take joint decisions in the areas of work that they agree.

1.5 In addition the JC CCGs will meet collaboratively with NHS England to make

integrated decisions in respect of those services which are directly commissioned by

NHS England.

1.6 Guiding principles:

Manual/Agreement for JC CCG

33

· Collaborate and co-operate. Do it once rather than repeating or duplicating

actions and increasing cost across the CCGs. Establish and adhere to the

governance structure set out in these Terms of Reference and in the JC

CCGs Manual (as updated from time to time), to ensure that activities are

delivered and actions taken as required;

· Be accountable. Take on, manage and account to each other for performance

of the respective roles and responsibilities set out in these Terms of

Reference and in the JC CCGs Manual (as updated from time to time);

· Be open. Communicate openly about major concerns, issues or opportunities

relating to the functions delegated to the JC CCGs, as set out in Schedule 1;

ensuring our collective decisions are based on the best available evidence,

that these are fully articulated, heard, and understood.

· Learn, develop and seek to achieve full potential. Share information,

experience, materials and skills to learn from each other and develop effective

working practices, work collaboratively to identify solutions, eliminate

duplication of effort, mitigate risk and reduce cost whilst ensuring quality is

maintained or improved across all the CCGs;

· Adopt a positive outlook. Behave in a positive, proactive manner;

· Adhere to statutory requirements and best practice. Comply with applicable

laws and standards including EU procurement rules, data protection and

freedom of information legislation.

· Act in a timely manner. Recognise the time-critical nature of the functions

delegated to the JC CCGs as set out in Schedule 1, and respond accordingly

to requests for support;

· Manage stakeholders effectively;

· Deploy appropriate resources. Ensure sufficient and appropriately qualified

resources are available and authorised to fulfil the responsibilities set out in

these Terms of Reference and in the JC CCGs Manual (as updated from time

to time);

· Act in good faith to support achievement of the Key Objectives as set out in

the JC CCGs Manual and compliance with these Principles.

1.7 The JC CCG has a commitment to ensuring that in pursuing its Key Objectives it

does not increase inequalities or worsen health outcomes for any local populations.

1.8 From time to time programmes boards may be established to oversee individual

programmes of work. Where these are established under the direction of the JC

CCG these will be accountable to the JC CCG.

2. Statutory Framework

Manual/Agreement for JC CCG

34

2.1 The NHS Act which has been amended by LRO 2014/2436, provides at s.14Z3 that

where two or more clinical commissioning groups are exercising their commissioning

functions jointly, those functions may be exercised by a joint committee of the groups.

2.2 The CCGs named in paragraph 1.5 above have delegated the functions set out in

Schedule 1 to the JC CCGs.

3. Role of the JC CCGs

3.1 The role of the JC CCGs shall be:

• Development of collective strategy and commissioning intentions;

• Development of co-commissioning arrangements with NHS England;

• Joint contracting with Foundation Trusts and other service providers;

• System transformation, including the development and adoption of service redesign and best clinical practice across the area – which may include the continuation or establishment of clinical networks in addition to those nationally established;

• Representation and contribution to Alliances and Networks including clinical networks nationally prescribed;

• Work with NHS England on the outcome and implication of national or regional service reviews;

• Work with the NHS England Area on system management and resilience;

• Collaboration and sharing best practice on Quality Innovation Productivity and Prevention initiatives; and

• Mutual support and aid in organisational development.

3.2 At all times, the JC CCGs, through undertaking decision making functions of each of

the member CCGs, will act in accordance with the terms of their constitutions. No

decision outcome shall impede any organisation in the fulfilment of its statutory

duties.

4. Geographical coverage

4.1 The JC CCGs will comprise those CCGs listed above in paragraph 1.5 and cover the

South Yorkshire and Bassetlaw, North Derbyshire and Wakefield areas.

4.2 NHS England Specialised Commissioning will also be involved through a

collaborative commissioning arrangement.

5. Membership

5.1 Membership of the committee will combine both Voting and Non-voting members and

will comprise of: -

5.2 Voting members:

Manual/Agreement for JC CCG

35

• Two decision makers from each of the member CCGs, who will be the Clinical

Chair and Accountable Officer;

5.3 Non-voting attendees:

• Two Lay Members

• One Director of Finance chosen from the member CCGs.

• A representative from NHS England;

• A Healthwatch representative nominated by the local Healthwatch groups

• STP Lead or deputy

5.4 The JC CCG may invite additional non-voting members to join the JC CCG to enable

it to carry out its duties for example Local Authority Chief Executive

5.4 Committee members may nominate a suitable deputy when necessary and subject to

the approval of the Chair of the JC CCGs. All deputies should be fully briefed and the

secretariat informed of any agreement to deputise so that quoracy can be

maintained.

5.5 No person can act in more than one role on the JC CCGs, meaning that each deputy

needs to be an additional person from outside the JC CCGs membership.

5.6 Commissioners Working Together will act as secretariat to the Committee to ensure

the day to day work of the JC CCGs is proceeding satisfactorily. The membership will

meet the requirements of the constitutions of the CCGs named above at paragraph

1.5.

5.7 The JC CCG will be Chaired by a respective CCG Clinical Chair and vice Chair

6. Meetings

6.1 The JC CCGs shall adopt the standing orders of NHS Sheffield Clinical

Commissioning Group insofar as they relate to the:

a) notice of meetings;

b) handling of meetings;

c) agendas;

d) circulation of papers; and

e) conflicts of interest.

7. Voting

Manual/Agreement for JC CCG

36

7.1 The JC CCGs will aim to make decisions by consensus wherever possible. Where

this is not achieved, a voting method will be used. The JC CCG has seven CCG

members and fourteen voting members. The voting power of each individual present

will be weighted so that each party (CCG) possesses 14.29% of total voting power.

7.2 It is proposed that recommendations can only be approved if there is approval by

more than 75%.

8. Quorum

At least one full voting member from each CCG must be present for the meeting to

be quorate. The Healthwatch representative must also be present.

9. Frequency of meetings

Frequency of meetings will usually monthly, but the Chair has the power to call

meetings of the JC CCGs as and when they are required.

10 Meetings of the JC CCGs

10.1 Meetings of the JC CCGs shall be held in public unless the JC CCGs considers that

it would not be in the public interest to permit members of the public to attend a

meeting or part of a meeting. Therefore, the JC CCGs may resolve to exclude the

public from a meeting that is open to the public (whether during the whole or part of

the proceedings) whenever publicity would be prejudicial to the public interest by

reason of the confidential nature of the business to be transacted or for other special

reasons stated in the resolution and arising from the nature of that business or of the

proceedings or for any other reason permitted by the Public Bodies (Admission to

Meetings) Act 1960 as amended or succeeded from time to time.

10.2 Members of the JC CCGs have a collective responsibility for the operation of the JC

CCGs. They will participate in discussion, review evidence and provide objective

expert input to the best of the knowledge and ability, and endeavor to reach a

collective view.

10.3 The JC CCGs may call additional experts to attend meetings on an ad hoc basis to

inform discussions.

10.4 The JC CCGs has the power to establish sub groups and working groups and any

such groups will be accountable directly to the JC CCGs.

10.5 Members of the JC CCGs shall respect confidentiality requirements as set out in the

Standing Orders referred to above unless separate confidentiality requirements are

set out for the JC CCGs, in which event these shall be observed

Manual/Agreement for JC CCG

37

11. Secretariat provisions

The secretariat to the JC CCGs will:

a) Circulate the minutes and action notes of the committee within five working days

of the meeting to all members; and

b) Present the minutes, decisions and action notes to the governing bodies of the

CCGs set out in paragraph 1.5 above.

12. Reporting to CCGs and NHS England

The JC CCGs will make a quarterly written report to the CCG member governing

bodies and NHS England and hold at least annual engagement events to review

aims, objectives, strategy and progress and publish an annual report on progress

made against objectives.

13. Decisions

13.1 The JC CCGs will make decisions within the bounds of the scope of the functions

delegated.

13.2 The decisions of the JC CCGs shall be binding on all member CCGs.

13.3 All decisions undertaken by the JC CCGs will be published by the Clinical

Commissioning Groups set out in paragraph 1.5, above.

14. Review of Terms of Reference

These terms of reference will be formally reviewed annually by Clinical

Commissioning Groups set out in paragraph 1.5 and may be amended by mutual

agreement between the CCGs at any time to reflect changes in circumstances as

they may arise.

15. Withdrawal from the JC CCG

15.1 Should this joint commissioning arrangement prove to be unsatisfactory, the

governing body of any of the member CCGs can decide to withdraw from the

arrangement, but has to give a minimum six months’ notice to partners, with

consideration by the JC CCG of the impact of a leaving partner - a maximum of 12

notice could apply.

Manual/Agreement for JC CCG

38

16. Signatures

Manual/Agreement for JC CCG

39

Schedule 1 - Delegation by CCGs to JC CCGs

A. The CCG functions at B will be delegated to the JC CCGs by the member CCGs in

accordance with their statutory powers under s.14Z3 of the NHS Act 2006 (as amended)

(“the NHS Act”). Section 14Z3 allows CCGs to make arrangements in respect of the

exercise of their commissioning functions and includes the ability for two or more CCGs

to create a Joint Committee to exercise functions.

B The delegated functions relate to the health services provided to the member CCGs by

all providers they commission services from in the exercise of their functions. The CCGs

delegate their commissioning functions so far as such functions are required for the

Joint Committee to carry out its role, as set out in the Terms of Reference (appendix 2).

The CCGs delegate the above functions to enable the Joint Committee to take decisions

around future transformation projects, specifically and limited to transformation and

redesign of Hyper Acute Stroke Services and Children’s Surgery and Anaethesia

services.

C Each member CCG shall also delegate the following functions to the JC CCGs so that it

can achieve the purpose set out in (B) above:

1. Acting with a view to securing continuous improvement to the quality of

commissioned services. This will include outcomes for patients with regard to clinical

effectiveness, safety and patient experience to contribute to improved patient

outcomes across the NHS Outcomes Framework

2. Promoting innovation, seeking out and adopting best practice, by supporting

research and adopting and diffusing transformative, innovative ideas, products,

services and clinical practice within its commissioned services, which add value in

relation to quality and productivity.

3. The requirement to comply with various statutory obligations, including making

arrangements for public involvement and consultation throughout the process. That

includes any determination on the viability of models of care pre-consultation and

during formal consultation processes, as set out in s.13Q, s.14Z2 and s.242 of the

NHS Act.

4. The requirement to ensure process and decisions comply with the four key tests for

service change introduced by the last Secretary of State for Health, which are:

Support from GP commissioners;

Strengthened public and patient engagement;

Clarity on the clinical evidence base; and

Consistency with current and prospective patient choice.

5. The requirement to comply with the statutory duty under s.149 of the Equality Act

2010 i.e. the public sector equality duty.

Manual/Agreement for JC CCG

40

6. The requirement to have regard to the other statutory obligations set out in the new

sections 13 and 14 of the NHS Act. The following are relevant but this is not an

exhaustive list:

ss.13C and 14P - Duty to promote the NHS Constitution

ss.13D and 14Q - Duty to exercise functions effectively, efficiently and economically

ss.13E and 14R – Duty as to improvement in quality of services

ss.13G and 14T - Duty as to reducing inequalities

ss.13H and 14U – Duty to promote involvement of each patient

ss.13I and 14V - Duty as to patient choice

ss.13J and 14W – Duty to obtain appropriate advice

ss.13K and 14X – Duty to promote innovation

ss.13L and 14Y – Duty in respect of research

ss.13M and 14Z - Duty as to promoting education and training

ss.13N and 14Z1- Duty as to promoting integration

ss.13Q and 14Z2 - Public involvement and consultation by NHS England/CCGs

s.13O - Duty to have regard to impact in certain areas

s.13P - Duty as respects variations in provision of health services

s.14O – Registers of Interests and management of conflicts of interest

s.14S – Duty in relation to quality of primary medical services

7. The JC CCGs must also have regard to the financial duties imposed on CCGs under

the NHS Act and as set out in:

· s.223G – Means of meeting expenditure of CCGs out of public funds

· s.223H – Financial duties of CCGs: expenditure

· s.223I - Financial duties of CCGs: use of resources

· s.223J - Financial duties of CCGs: additional controls of resource use

8. Further, the JC CCGs must have regard to the Information Standards as set out in

ss.250, 251, 251A, 251B and 251C of the Health & Social Care Act 2012 (as

amended).

9. The expectation is that CCGs will ensure that clear governance arrangements are put

in place so that they can assure themselves that the exercise by the JC CCGs of

their functions is compliant with statute.

10. The JC CCGs will meet the requirement for CCGs to comply with the obligation to

consult the relevant local authorities under s.244 of the NHS Act and the associated

Regulations.

11. To continue to work in partnership with key partners e.g. the local authority and other

commissioners and providers to take forward plans so that pathways of care are

seamless and integrated within and across organisations.

Manual/Agreement for JC CCG

41

12. The JC CCGs will be delegated the capacity to propose, consult on and agree future

service configurations that will shape the medium and long terms financial plans of

the constituent organisations. The JC CCGs will have no contract negotiation powers

meaning that it will not be the body for formal annual contract negotiation between

commissioners and providers. These processes will continue to be the responsibility

of Clinical Commissioning Groups (and NHS England) under national guidance,

tariffs and contracts during the pre-consultation and consultation periods.

1

Paper A

South Yorkshire and Bassetlaw Sustainability and Transformation Plan

Collaborative Partnership Board

13 January 2017, The Birch and Elm Room, Oak House, Rotherham

Decision Summary

Ref Item Lead

1 Minutes of the meetings held 11 November and 16 December 2016

02/17 (a) that the minutes of the previous meeting held 11 November 2016 and 16 December 2016 were ratified to be made publicly available subject to amendments recorded

ALL

(b) that a query around the Sustainable Hospital Services Review terms of reference and research raised at the previous meeting would be discussed outside the session

WILL CLEARY-GRAY, MIKE PINKERTON

(c) that discussions by the local authorities were still taking place around a proposal for focused support in each area.

LOCAL AUTHORITY LEADS

2 Summary update to the Collaborative Partnership Board (CPB)/ Transformation funding to support clinical priority areas

04/17 (a) that the Mental Health and Learning Disabilities and Cancer transformation funding bids would cross reference one another

KATHRYN SINGH, JACKIE PEDERSON, LESLEY SMITH

(b) that the summary update on next steps, when fully developed, would be shared with all for use when updating organsiations

WILL CLEARY-GRAY

(c) that CPB supported the proposal that work would take place on the workstreams and priorities to ensure clarity on deliverables, enabling the STP to track back what the ask was of the financial gap, working with place and having focus on the SYB outputs

WILL CLEARY-GRAY

3 Communications and engagement approach to public consultation

05/17 (a) that an agreed approach on discussions with stakeholders and the public on the STP would be taken forward at place level and be consistent across the patch

ALL

(b) that a draft report on the public consultations for Hyper Acute Stroke Services and Children’s Surgery and Anaesthesia would be given to the STP CPB in March 2017

HELEN STEVENS

4 Health, disability and employment

2

06/17 (a) that the STP CPB approved the work in principle and further detail including baseline metrics would be presented to the STP CPB in due course

GREG FELL (CHRIS SHAW)

5 Healthy lives

07/17 (a) that the STP CPB committed to aspirations outlined in principle requesting that constituent organisations be consulted and a considered approach be delivered back to the STP CPB for final approval in April/May

GREG FELL

6 STP governance Terms of Reference (ToR)

08/17 (a) that the STP CPB supported the ToR presented

ALL

7 Workforce Terms of Reference

09/17 (a) that the STP CPB supported the ToR and agreed to contribute to this work where required.

ALL

8 Social Kinetic 3De proposal

12/07 (a) that the STP CPB supported the proposal and would work with Social Kinetic 3De on leadership and development at the meeting on 3 February 2017

ALL

3

South Yorkshire and Bassetlaw Sustainability and Transformation Plan

Collaborative Partnership Board

Minutes of the meeting of 13 January 2017, The Boardroom, 722 Prince of Wales Road, Sheffield

Present: Andrew Cash, South Yorkshire and Bassetlaw STP Lead/Chief Executive, Sheffield Teaching Hospitals NHS Foundation Trust (CHAIR) Adrian Berry, Medical Director, South West Yorkshire Partnership NHS Foundation Trust (Deputy for Rob Webster, Chief Executive) Dominic Blaydon, Associate Director of Transformation, The Rotherham NHS Foundation Trust (Deputy for Louise Barnett, Chief Executive) Catherine Burn, Director, Voluntary Action Bassetlaw Julia Burrows, Director of Public Health, Barnsley Metropolitan Borough Council (Deputy for Diana Terris, Barnsley Metropolitan Borough Council) Will Cleary-Gray, Director of Sustainability and Transformation, South Yorkshire and Bassetlaw STP Jeremy Cook, Interim Director of Finance, South Yorkshire and Bassetlaw STP Mike Curtis, Local Director, Health Education England Chris Edwards, Accountable Officer, NHS Rotherham Clinical Commissioning Group Adrian England, Chair, Healthwatch Barnsley Idris Griffiths, Interim Accountable Officer, NHS Bassetlaw Clinical Commissioning Group Richard Jenkins, Medical Director, Barnsley Hospital NHS Foundation Trust Alison Knowles, Locality Director North of England, NHS England Ainsley Macdonnell, Service Director – North Nottinghamshire and Direct Services, Adult Social Care, Health and Public Protection, Nottinghamshire County Council (Deputy for Anthony May, Chief Executive) Richard Parker, Interim Chief Executive, Doncaster and Bassetlaw Hospitals NHS Foundation Trust Jackie Pederson, Accountable Officer, NHS Doncaster Clinical Commissioning Group Matthew Powls, Interim Director of Commissioning, NHS Sheffield Clinical Commissioning Group (Deputy for Maddy Ruff, Accountable Officer) Mathew Sandford, Associate Director of Planning and Development, Yorkshire Ambulance Service NHS Trust (Deputy for Rod Barnes, Chief Executive) Steve Shore, Chair, Healthwatch Doncaster Kathryn Singh, Chief Executive, Rotherham, Doncaster and South Humber NHS Foundation Trust Paul Smeeton, Chief Operating Executive, Nottinghamshire Healthcare NHS Foundation Trust (Deputy for Ruth Hawkins, Chief Executive) Lesley Smith, Accountable Officer, NHS Barnsley Clinical Commissioning Group John Somers, Chief Executive, Sheffield Children’s Hospital NHS Foundation Trust Richard Stubbs, Acting Chief Executive, The Yorkshire and Humber Academic Health Science Network Kevan Taylor, Chief Executive, Sheffield Health and Social Care NHS Foundation Trust Neil Taylor, Chief Executive, Bassetlaw District Council Jon Tomlinson, Assistant Director of Commissioning, Doncaster Metropolitan Borough Council (Deputy for Jo Miller, Chief Executive) Mark Tuckett, Assistant Director of Public Service Reform, Sheffield City Council (Deputy for John Mothersole, Chief Executive) Apologies: Louise Barnett, Chief Executive, The Rotherham NHS Foundation Trust Des Breen, Medical Director, Provider Working Together Programme Frances Cunning, Deputy Director of Health and Wellbeing, Public Health England Greg Fell, Director of Public Health, Sheffield City Council Ruth Hawkins, Chief Executive, Nottinghamshire Healthcare NHS Foundation Trust Richard Henderson, Chief Executive, East Midlands Ambulance Service

4

Sharon Kemp, Chief Executive, Rotherham Metropolitan Borough Council Jo Miller, Chief Executive, Doncaster Metropolitan Borough Council Leaf Mobbs, Director of Planning and Development, Yorkshire Ambulance Service NHS Trust Paul Moffatt, Chief Executive, Doncaster Children’s Services Trust Tim Moorhead, Clinical Chair, NHS Sheffield Clinical Commissioning Group Simon Morritt, Chief Executive, Chesterfield Royal Hospital NHS Foundation Trust John Mothersole, Chief Executive, Sheffield City Council Mike Pinkerton, Chief Executive, Doncaster and Bassetlaw Hospitals NHS Foundation Trust Maddy Ruff, Accountable Officer, NHS Sheffield Clinical Commissioning Group Diane Wake, Chief Executive, Barnsley Hospital NHS Foundation Trust Rob Webster, Chief Executive, South West Yorkshire Partnership NHS Foundation Trust Janet Wheatley, Chief Executive, Voluntary Action Rotherham In Attendance: Chris Shaw, Director of Health Improvement, Sheffield City Council Susan Hird, Consultant in Public Health, Sheffield City Council Lynsey Hamilton, Transformation Board Manager, Health Education England Helen Stevens, Associate Director of Communications and Engagement, Commissioners Working Together Janette Watkins, Programme Director, Providers Working Together Programme Kate Woods, Programme Office Manager, South Yorkshire and Bassetlaw STP

Minute reference

Item Action

01/17 Welcome and introductions The Chair welcomed members.

02/17 Minutes of the meetings held 11 November 2016 and 16 December 2016 The minutes of the meetings held 11 November and 16 December were accepted as a true and accurate record subject to the comments below and were ratified by the STP CPB. The minutes will be published. Amendments were recorded as: 11 November 2016 minutes: John Somers to be removed from apologies list and organisation for Neil Priestley to be amended to Sheffield Teaching Hospitals NHS Foundation Trust. The STP CPB noted that all actions arising from 11 November 2016 were complete. Actions outstanding from 16 December 2016 were noted as: Sustainable Hospital Services Review (Item 24/16 refers) A query about research raised previously would be discussed outside the meeting. SYB STP resources (Item 26/16 refers) It was confirmed that discussions by the local authorities were still taking place on a proposal for focused support in each area.

WILL CLEARY-GRAY, MIKE PINKERTON LOCAL AUTHORITY LEADS

5

03/17 National update from the STP Lead The STP CPB were updated on a time-out for the STP leads taking place in January 2017 and it was anticipated that a further national update would be available at this session. LS updated the group on an STP summit, highlighting a case study presented to this group by Simon Stevens. There was also reference at the session to ensuring fragmentation between organisations was proactively resolved. Discussions had taken place on the challenges to come together for the planning of the STP and therefore consideration was required around ensuring there was capacity to deliver the plans. Discussions had taken place around leading at an organisational level as well as leading across the wider footprint to underpin the STP and that engaging Councilors as part of the process was crucial. There had been a focus at the session on ensuring systems were not “stifled by regulation.” The group noted that local contracts were signed off, highlighting a shift in behaviours between systems and organisations to achieve this at such an early stage. It was anticipated that the direction of travel for the STP would emerge shortly and would move from plan to implementation. A delivery timetable would be developed collaboratively. An electronic update would be circulated weekly sharing work and best practice within the STP.

04/17 Summary update to the Collaborative Partnership Board/ Transformation funding to support clinical priority areas The STP CPB was updated on work within the Mental Health and Learning Disabilities and Cancer work streams. Mental Health and Learning Disabilities The group noted that a Mental Health and Learning Disabilities Steering Group had been established and would review the Case for Change and agree next steps for four priority focus areas. An initial meeting of the Mental Health Provider Alliance between RDaSH and SHSCT would be held in January. It was noted that capacity had been identified as the main risk. An update on the transformation bid was given: Integrated IAPT The purpose was outlined: to expand the IAPT workforce to offer psychological therapies to long term conditions pathways and for people with medically unexplained symptoms, evidence for highest savings from Diabetes, Cardiovascular and Respiratory Disease. This supported the five year forward view (FYFV) access target that by 2020/21, at least 25% of people with common mental health conditions could access services each year. The total national funding available was highlighted as £20m in 2017/18. Urgent and Emergency Mental Health Services

6

The purpose was outlined: to pump prime and accelerate existing plans to expand acute hospital liaison mental health services so that they operate at the required standard within one year of receiving the funding. This supported the FYFV target that by 2020/21, all acute hospitals would have all-age mental health liaison teams in place, and at least 50% of these would meet the required standard service standard as a minimum. The total national funding available was highlighted as £19m in 2017/18 and 2018/19 and the approach taken was outlined to the group. Learning Disabilities – Reducing reliance on specialist inpatient care The purpose was outlined: supporting the implementation of the Transforming Care Partnerships three year plans for reforming services, in line with Building the Right Support, October 2015. This had included strengthening support in the community and reviewing specialist inpatient services . The total national funding available was highlighted as £15m in 2017/18 and £15m in 2018/19. Reduction in children placed away from their home and local community The purpose was outlined: providing Positive Behavioural Support based services for children to improve support for children and young people that display behaviour that challenges and prevents escalation and the need to be looked after away from home. The total national funding available was highlighted as £1m in 2017/18 and 2018/19. Cancer The STP CPB was asked to note that the current process covered 2017/18 and 2018/19 only. Colleagues from the South Yorkshire, Bassetlaw and North Derbyshire Cancer Alliance member organisations had supported the development of the Delivery Plan and Transformation Fund Bid. A draft Delivery Plan and bid was supported in principle by the Cancer Alliance Board. The Delivery Plan added to the next level of detail onto the work undertaken by the STP Cancer work stream. Includes funding to support the Cancer Alliance in 2017/18 & 2018/19. An update on the transformation bid was given: Cancer Transformation fund bids Early Diagnosis The purpose of the bid was outlined: the funding would be to support the interventions on early diagnosis in the Cancer Alliance delivery plan. The bid proposed a package of interventions. Recovery package The purpose of the bid was outlined: existing funded Living With And Beyond Cancer programme with Macmillan and all localities within our Cancer Alliance footprint and therefore the bid focused on integrating

7

‘electronic holistic needs assessments’ into existing Trust systems. In response to a query, it was confirmed that the early diagnosis bid would be focused on reducing inequalities and to move the Cancer Alliance agenda forward. It was agreed that the Mental Health and Learning Disabilities and Cancer bids would cross reference one another, acknowledging the work to be done. Diabetes The STP CPB noted that the bids were being developed locally. The bids being submitted were structured into four components; education, NICE treatment targets, multi-disciplinary foot care teams, and inpatient specialist nursing services. There were links between places for some elements of the bids. All transformation bids would be submitted on behalf of SYB by the STP PMO by 18 January 2017 (IAPT bid due 25 January 2017). As part of a general update, the STP CPB noted key next steps for the coming months. The group was reminded of the approach taken to develop the STP, and how this had been worked through in terms of the STP process. The themes and priorities of the STP were highlighted, using place plans and the submission of the STP. An outline on establishing the workstreams was delivered. Collaborative programmes, projects and the task and finish groups were outlined, showing where there was a clearly defined project and programme to deliver and where this was under development that would change and evolve. The group was invited to comment. In response to a query around demonstrating place on the diagram, it was confirmed that place colleagues had been asked to overlay workstream information with local work taking place alongside the work of across SYB. Strategic direction and coordination would take place at SYB level for those workstreams for those workstreams that SYB coordinate for whole system delivery. The presentation would be developed further to reflect this. In response to a query around community integration, it was confirmed that the programmes outlined in the presentation to STP CPB were collaborative, connecting with place. Discussions would be required around what was taking place at South Yorkshire and Bassetlaw level and local. Key outputs over the past year were highlighted to the STP CPB, including the STP, Commissioning Intentions, the cases for change, the implementation plan, and place plans. System wide objectives were noted by the STP CPB. An update was given on the financial strategy noting triangulation between the financial plans submitted in December and the STP submitted in October 2016. Changes in assumptions were outlined to

KATHRYN SINGH, JACKIE PEDERSON, LESLEY SMITH

8

the group which may reflect increased financial risk, noting deterioration in the underlying position, Clinical Commissioning Group (CCG) allocation adjustments to reflect changes in national tariff and identification rules, non-recurrent income not reflected in control totals, that clinical negligence scheme for trusts premium increases may not be cost neutral as assumed in the STP plan, that financial plans between commissioners and providers may not be aligned, and the delivery risks on provider Cost Improvement Programme plans and commissioner Quality, Innovation, Productivity and Prevention plans. It was proposed that work would take place on the workstreams and priorities to ensure clarity on deliverables, enabling the STP to track back what the ask was of the financial gap, working with place and having focus on the SYB outputs. This was supported. Work was also taking place around how the STP would develop as a whole system. Workshops had taken place around how this would happen. There existed already cross-working between collaboratives. A proposal would be taken to both programme boards to set out how to best align the delivery teams to support the STP. The STP CPB noted that the current meeting schedules would be readdressed. Work would take place around this and a proposal given to the group. It was agreed that the narrative presented was helpful and would be used to update organisations across the patch. This would be further developed and circulated. The presentation would also be circulated in its current format for information.

WILL CLEARY-GRAY WILL CLEARY-GRAY KATE WOODS

05/17 Communications and engagement approach to public consultation HS updated the STP CPB on work undertaken with communication and engagement colleagues across the partnership. The group had been developing the shape of discussions with the public. An approach and principles had been agreed. The STP CPB noted these:

• That this must be an open conversation

• That the difficult issues faced should be outlined and ask for

views and what is important

• That public conversations would be led by Healthwatch and the

voluntary sector, with commissioner support

• That staff conversations would be led by provider teams, with

STP support

• That political conversations would be led by STP partners, with

STP support

• That these discussions would happen at place level.

The governance approach for this was outlined; a task and finish group to be established made of representatives from all areas, co-

9

creating the plan and timelines. A report would be delivered to the STP CPB in April 2017. It was agreed that actions at local level must be cohesive and consistent. In response to a query, it was confirmed that discussions and engagement with members would take place in February 2017. An update was given on the HASU and Children’s Services consultation. A piece of work had been undertaken at the midpoint of the consultation, and as a result of the outcomes of this review, the deadline had been extended to 14 February. At the end of this process, an independent analysis would take place to show key themes and feedback. The draft report would be given to the STP CPB and Joint Healthy Overview and Scrutiny Committee before being taken to the Joint Committee of Clinical Commissioning Groups.

HELEN STEVENS

06/17 Health, disability and employment The STP CPB noted the data presented around the numbers of unemployment across the patch and the landscape across the city region and that initiatives were taking place across the city region/city. Money was available across the city region and what was required now was coordination and potentially to collaborate. The STP CPB was invited to comment. It was noted that two elements that would impact on health were employment and cessation of smoking. A request was made to ensure links were made to the workforce workstream, particularly around possibilities with apprentices. It was highlighted that discussions and engagement with employers was crucial to ensure occupational health services were utilised appropriately in organisations. It was noted that access to support must be simplified and links to IAPT for this was important. The STP CPB approved this work in principle. Further detail including baseline metrics would be brought back to the STP CPB.

GREG FELL (CHRIS SHAW)

07/17 Healthy Lives The STP CPB noted the Healthy Lives workstream related to three elements; scaling up primary care, workforce and healthy lifestyles. A key recommendation for this was employment and smoking. The STP was asked to sign up to a 10% prevalence for smoking in SYB. Detail around work that all could collaborate on was also highlighted. The group was invited to comment. It was highlighted that the 10% prevalence target felt ambitious. The timescale was confirmed as 5 years. In response to a query it was confirmed that the resource

10

requirements for this work had been included in the STP plan. It was commented that there was work that acute providers could do to support this. A discussion took place around smoking and mental health and that the work needed to align with the MH workstream to change the prevalence trend. The STP CPB committed to aspirations outlined in principle requesting that constituent organisations be consulted and a considered approach be delivered back to the STP CPB for final approval in April/May.

GREG FELL

08/17 STP governance terms of reference The STP CPB was sighted on detail of the establishment of the Governance Group. Two initial pieces of work were agreed at the first meeting; to draft out the terms of reference (ToR) and to produce a summary of the governance as it currently existed and to work with boards and members to consider what future governance could look like. Two gaps were noted in membership for Local Authority and Medical Director representation which would be considered further. A discussion took place, noting that Neil Riley was linked to this work with experience in his previous role of board secretary. The STP CPB supported the ToR.

09/17 Workforce terms of reference The STP CPB were updated on the Local Workforce Action Board which had a programme of work established. A briefing would be developed, giving a comprehensive overview of the workforce landscape. A briefing would then be delivered to the board in 3-4 months time. A workstream lead was required. HEE would fund this. Business intelligence would be provided by HEE but links would be required locally. The STP CPB supported the ToR and agreed to contribute to this piece of work where required.

10/17 Independent review of hospital services The STP CPB were updated on the progress around the Sustainable Hospital Review, noting the draft ToR had been agreed, steering group membership was being established and that the first meeting was taking place 7 February 2017. A project plan was being developed as well as a business case to engage support from NHS England and NHS Improvement. In response to a query, it was noted that an initial task of the steering group would be to define what sustainable services would mean. It was confirmed that the amendments to the TOR in light of discussions at the previous meeting around researched were accepted.

11

An update would be given at the next meeting.

11/17 Review of commissioning The STP CPB were updated on the review of commissioning, noting that an external consultancy would be engaged to work with CCGs and that a fuller scope would be developed. A senior commissioning operations group would be established, the first meeting of which was taking place 13 January. The ambition outlined was for shadow commissioning arrangements to be in place by April 2017, aligning with the pace of the hospital services review.

12/07 Social Kinetic 3De proposal The group was updated on a meeting that had taken place around the leadership work with Social Kinetic and the proposal was that the STP CPB would engage with this group and utilise a future meeting to start this work. The STP CPB supported taking this work forward.

1

Paper A

South Yorkshire and Bassetlaw Sustainability and Transformation Partnership

Collaborative Partnership Board

17 March 2017, 722 Prince of Wales Road, Sheffield, S9 4EU

Decision Summary

Ref Item Lead

1 Minutes of the meetings held 13 January 2017 – matters arising

13/17 (a) that AJC would be invited to attend a meeting of the South Yorkshire and Bassetlaw (SYB) Local Authority (LA) Leaders to discuss a further proposal. This action would be followed up outside the meeting

LOCAL AUTHORITY CEOS

2 National update

14/17 (a) that the summary paper circulated on local and national Sustainability and Transformation Plans (STPs) would be used by the Collaborative Partnership Board (CPB) to support local discussion and share in private Board sessions

ALL

(b) to continue to support the direction of travel for SYB to become an exemplar and development of a memorandum of understanding

ALL

(c) that CPB confirmed support for SYB to be named in the National Delivery Plan as an exemplar STP

ALL

3 Finance update

17/17 (a) that a revised indicative budget for 17/18 would be shared with CPB in April/May

JEREMY COOK

(b) that the Directors of Finance group would work up a proposal on how transformation funding could be used and whether a collaborative approach could be taken to jointly commission work to leverage cost improvements and whether that could be supported by transformation funding

JEREMY COOK

4 STP communications and engagement approach to public consultation

19/17 (a) that CPB would receive the full STP engagement analysis when complete.

HELEN STEVENS

5 Public consultation – Hyper Acute Stroke Services and Children’s Services

20/17 (a) that a discussion would take place around a freedom of information request on the impact of the proposed changes on the Yorkshire Ambulance Service outside the meeting

HELEN STEVENS, MATT SANDFORD

2

(b) that the Joint Committee of Clinical Commissioning Groups would discuss the clinical case for change and a full analysis of the public consultation in April and review a decision making business case in May

HELEN STEVENS

(c) that the analysis would be widely shared with all stakeholders, people who completed the consultations and would be made publicly available via the website

HELEN STEVENS

6 Independent review of Hospital Services

21/17 (a) that a full update on the Sustainable Hospitals Services Review work on Invitation to Tender, recruitment of a lead director and senior project support would be shared virtually to enable a full update for all private Boards

WILL CLEARY-GRAY

7 Review of Commissioning

22/17 (a) that guidance anticipated around links between specialised commissioning and place plans would be shared when available

MATTHEW GROOM

8 Healthy Lives work stream update

23/17 (a) that the possible national support for social prescribing be considered as part of the development of the Memorandum of Understanding

ALL

(b) that the Chief Executive of the Sheffield City Region (SCR) would be contacted to propose joint infrastructure to share across the SCR/STP patch and clarify how this would be taken forward.

KEVAN TAYLOR

(c) that the update paper would be discussed at local Health and Wellbeing Boards

GREG FELL

9 Social Kinetic 3D proposal for leadership analysis

24/17 (a) that a request would be circulated requesting nomination of 3-4 people per organisation to complete the next stage of survey and a date to convene all in may for a second workshop would be established.

HELEN STEVENS

10 Action to get A&E back on track

26/17 (a) that a discussion would take place around the principles to utilise money made available for social care to, in part, free up acute hospital beds with a LA CEO, MR and LB

MADDY RUFF, LOUISE BARNETT, AN LA CEO

3

South Yorkshire and Bassetlaw Sustainability and Transformation Partnership

Collaborative Partnership Board

Minutes of the meeting of 17 March 2017, The Boardroom, 722 Prince of Wales Road, Sheffield

Present: Andrew Cash, South Yorkshire and Bassetlaw STP Lead/Chief Executive, Sheffield Teaching Hospitals NHS Foundation Trust (CHAIR) Adrian Berry, Deputy Chief Executive, South West Yorkshire Partnership NHS Foundation Trust (Deputy for Rob Webster, Chief Executive) Des Breen, Medical Director, Working Together Partnership Vanguard Julia Burrows, Director of Public Health, Barnsley Metropolitan Borough Council (Deputy for Diana Terris, Barnsley Metropolitan Borough Council) Catherine Burn, Director, Voluntary Action Bassetlaw

Tracey Clarke, Associate Director of Strategy and Commercial Development, RotherhamDoncaster and South Humber NHS Foundation Trust (Deputy for Kathryn Singh, Chief

Executive) Will Cleary-Gray, Director of Sustainability and Transformation, South Yorkshire and Bassetlaw STP Jeremy Cook, Interim Director of Finance, South Yorkshire and Bassetlaw STP Frances Cunning, Deputy Director of Health and Wellbeing, Public Health England Chris Edwards, Accountable Officer, NHS Rotherham Clinical Commissioning Group Adrian England, Chair, Healthwatch Barnsley Greg Fell, Director of Public Health, Sheffield City Council (Deputy for John Mothersole, Chief Executive Matthew Groom, Assistant Director of Specialised Commissioning, NHS England Specialised Commissioning Chris Holt, Chief Operating Officer, The Rotherham NHS Foundation Trust (Deputy for Louise Barnett) Ben Jackson, Senior Clinical Teacher, Academic Unit of Primary Medical Care, Sheffield University Richard Jenkins, Medical Director, Barnsley Hospital NHS Foundation Trust Sharon Kemp, Chief Executive, Rotherham Metropolitan Borough Council Alison Knowles, Locality Director North of England, NHS England Ainsley Macdonnell, Service Director, North Nottinghamshire and Direct Services, Adult Social Care, Health and Public Protection, Nottinghamshire County Council (Deputy for Anthony May, Chief Executive) Simon Morritt, Chief Executive, Chesterfield Royal Hospital NHS Foundation Trust Jackie Pederson, Accountable Officer, NHS Doncaster Clinical Commissioning Group Maddy Ruff, Accountable Officer, NHS Sheffield Clinical Commissioning Group Mathew Sandford, Associate Director of Planning and Development, Yorkshire Ambulance Service NHS Trust (Deputy for Rod Barnes, Chief Executive) Sewa Singh, Medical Director, Doncaster and Bassetlaw Teaching Hospitals NHS FoundationTrust (Deputy for Richard Parker, Chief Executive) Lesley Smith, Accountable Officer, NHS Barnsley Clinical Commissioning Group John Somers, Chief Executive, Sheffield Children’s Hospital NHS Foundation Trust Richard Stubbs, Acting Chief Executive, The Yorkshire and Humber Academic Health Science Network Rupert Suckling, Director of Public Health, Doncaster Metropolitan Borough Council (Deputy for Jo Miller, Chief Executive) Kevan Taylor, Chief Executive, Sheffield Health and Social Care NHS Foundation Trust Neil Taylor, Chief Executive, Bassetlaw District Council Apologies: Louise Barnett, Chief Executive, The Rotherham NHS Foundation Trust

4

Mike Curtis, Local Director, Health Education England Idris Griffiths, Interim Accountable Officer, NHS Bassetlaw Clinical Commissioning Group Ruth Hawkins, Chief Executive, Nottinghamshire Healthcare NHS Foundation Trust Richard Henderson, Chief Executive, East Midlands Ambulance Service Anthony May, Chief Executive, Nottinghamshire Healthcare NHS Foundation Trust Jo Miller, Chief Executive, Doncaster Metropolitan Borough Council Leaf Mobbs, Director of Planning and Development, Yorkshire Ambulance Service NHS Trust Tim Moorhead, Clinical Chair, NHS Sheffield Clinical Commissioning Group John Mothersole, Chief Executive, Sheffield City Council Richard Parker, Chief Executive, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust Kathryn Singh, Chief Executive, Rotherham, Doncaster and South Humber NHS Foundation Trust Steve Shore, Chair, Healthwatch Doncaster Paul Smeeton, Chief Operating Executive, Nottinghamshire Healthcare NHS Foundation Trust Diane Wake, Chief Executive, Barnsley Hospital NHS Foundation Trust Rob Webster, Chief Executive, South West Yorkshire Partnership NHS Foundation Trust Janet Wheatley, Chief Executive, Voluntary Action Rotherham In Attendance: Helen Stevens, Associate Director of Communications and Engagement, South Yorkshire and Bassetlaw STP Kate Woods, Programme Office Manager, South Yorkshire and Bassetlaw STP

Minute reference

Item Action

13/17 Welcome and introductions The Chair welcomed members, outlining the content of the meeting, and noted apologies for absence.

14/17 Minutes of the previous meeting held 13 January 2017 The minutes of the meeting were accepted as a true and accurate record.

15/17 Matters arising All matters arising would be picked up as part of the agenda. An update was given on the following actions: 02/17 – Minutes of the meetings held 11 November and 16 December It was confirmed that AJC would be invited to attend a meeting of the South Yorkshire and Bassetlaw Local Authority Leaders to discuss a further proposal. This action would be followed up outside the meeting. 04/17 Summary update to the Collaborative Partnership Board (CPB)/ Transformation funding to support clinical priority areas It was confirmed that the bids had been cross referenced as agreed and awaiting final outcome.

LOCAL AUTHORITY CEOS

16/17 National update A summary paper was circulated on local and national STP developments.

5

The Chair gave an update on the STP Executive Time Out of 2/3 March 2017 noting that a national Delivery Plan would be published on 28 March naming SYB as one of the leading STPs of the 44. This had been agreed at the time out by SYB STP Executives. The SYB STP would move from a transactional way of working to a transformational one through integrated pathway redesign. How business was currently conducted would continue for 17/18, and over the coming months, partners would work together with NHS England to develop a Memorandum of Understanding (MOU). The SYB STP would move to a managed system of accountable care and the plan would be recast with refreshed additional national priorities with transformational funding around:

- Urgent and emergency care (UEC) (e.g. redesign of 111, single point of access, urgent care centres, social care etc)

- Demand management elective and diagnostic (e.g. referral management services, alternative care outside hospitals etc).

- Primary care (e.g. risk stratification, long term condition management, extended access etc.).

- Discharge management (e.g. enablement, intermediate care social care etc).

Agreement had been reached at the time out that UEC would be a major focus for year one, to resolve local issues and align nationally. The draft MOU would be considered at a further STP Executive Team time out on 28 April 2017. The Chair updated the STP CPB on a meeting with the Secretary of State. It was noted that, as an exemplar STP, SYB would receive a package of funding, still to be determined. It was confirmed that this would be embedded within the MOU as money for transformation funding. This money would also be received in the knowledge that bids had been submitted in some areas. It was confirmed that guidance from the Department for Communities and Local Government was anticipated. In response to a query raised around risk stratification in Primary Care, the Chair confirmed that this was in reference to populations that utilise 70% of resource, and within this, addressing the parts of this population that were the most complicated to ensure this tranche were as independent as possible. In response to a query raised, it was confirmed that Mental Health remained a key STP work stream, and that the reset around UEC included general and mental health. A comment was made that a specialised Mental Health and Learning Disabilities work stream would be required with representative interest in various other work streams. The CPB were asked to note that principles would need to be

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developed as part of the MOU around how the system would work with regulators around assurance and accountability. This would be considered as part of the 17/18 work. The CPB agreed to use the local and national STP update paper to support local discussion and share in private Board sessions, to continue to support the direction of travel for SYB to become an exemplar and development of an MOU, and confirmed support for SYB to be named in the National Delivery Plan as an exemplar STP.

ALL

17/17 Finance update

JC updated the CPB, noting: Work to compare STP with operational plans for 17/18 and 18/19

Work was complete and had been shared with the Directors of

Finance (DoFs). All organisations had signed up to the control totals

for 17/18 with the exception of The Rotherham NHS Foundation

Trust, which had submitted a draft revised plan and would have further

discussion with NHS Improvement (NHSI) around agreeing a revised

control total.

The CPB were asked to note identified risks in 17/18 with delivering

Cost Improvement Programmes (CIP) and Quality Innovation

Productivity and Prevention (QIPP) plans and the differences between

commissioner and provider plans reflecting an assessment by

providers on the likely success of QIPP plans

It was agreed that the CPB would receive a monthly update financial

performance across the STP in the new financial year.

Financial modelling

An exercise had taken place to understand how the solutions built into

the STP were calculated and was nearing completion. This would be

shared with finance and other colleagues as appropriate. This would

give greater visibility to the assumptions and calculations used in the

financial model.

Options were being looked at with regards future financial modelling in

the short and medium term and a proposal would be taken to the

DoFs meeting in April.

A meeting with Jon Swift, NHS England (NHSE) had identified that a

Band 8c finance post should shortly be available to the STP either as

a person or funding as there was currently a vacant post.

STP budget

The DoFs had agreed the forecast outturn for 16/17 which showed an

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underspend primarily due to slippage on the Sustainable Hospital

Services Review which would impact on the 17/18 budget.

A revised indicative budget for 17/18 would be shared with DoFs but

was unlikely to be finalised until April when clarity around funding from

NHSE/NHSI was received. This would be brought back to the April or

May CPB.

STP DoF

The DoF group had met twice and comprised 21 members from

providers, commissioners, local authorities and NHSE and NHSI.

The group would report to the Finance Oversight Committee and had

developed terms of reference which would be approved at the March

meeting.

The DoFs group would consider the Stroke and Children’s business

cases at a future meeting.

The risks outlined were noted by CPB and it was highlighted that the STP must consider moving work on quickly around back office functions as part of the recast of the plan and development of the MOU. The CPB discussed the importance of undertaking a review of commissioning back office functions on an STP footprint. A discussion took place around commissioning integrating at place level. It was noted that detail around the Accountable Care System needed to be worked through. It was noted that health providers and commissioners working together more closely and in an integrated way was taking place, with a redefining of health commissioning that needed to take place in the context of a managed system. It was agreed that the Directors of Finance group would work up a proposal on how transformation funding could be used and whether a collaborative approach could be taken to jointly commission work to leverage cost improvements and whether that could be supported by transformation funding.

JEREMY COOK JEREMY COOK

18/17 Summary update to collaborative partnership board The report was circulated for all to use to locally update teams. The CPB were updated on discussions from January that a stock take would take place around deliverables from each work stream noting that this was underway and in light of the Delivery Plan and development of the MOU, this was being reconsidered.

19/17 STP communications and engagement approach to public consultation The CPB were informed that a public engagement exercise was taking place and was currently half was through the process. Early data received indicated that there was a clear mandate from staff and the

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public for change. The data would be fully analysed on completion and recommendations likely to include a new narrative while continuing to continue to engage staff and the public. CB confirmed positive local discussions with a general acceptance that change within the system was required. AE confirmed strong input from Barnsley Save Our NHS that was useful and comments were welcomed. It was commented that the questionnaire had been received by General Practitioners and that this was a positive step to engage and public and staff. The CPB noted the early report and would receive the full analysis when complete.

HELEN STEVENS

20/17 Public consultation – Hyper Acute Stroke Services and Children’s Surgery and Anaesthesia Services The CPB were updated on the results of the public consultation for the Hyper Acute Stroke Services and Children’s Surgery and Anaesthesia Services reviews. The methodology of the process was outlined to the CPB and the activity undertaken was outlined, noting connections had been made to seldom heard groups, and to those organisations and groups that would be directly affected by change. The numbers of responses received was outlined and broken down by locality and the themes that emerged were highlighted to CPB. HS advised the consistent picture was that there was mixed support for the proposals and the main concerns highlighted were around the impact on families. It was confirmed that themes raised previously by the Joint Overview and Scrutiny Committee (JOSC) were embedded within the analysis. The JOSC had a duty to carry out on behalf of local people and these would be addressed in the presentation delivered to the JOSC on 3 April. It was confirmed that a decision at the Joint Committee of Clinical Commissioning Groups (JCCC) would be taken based on the views of the local people as well as the clinical and financial case for change. A comment was made that an interesting result of the analysis was around access to services and patient safety, and that communications for the STP should make clear that place plans and local treatment for local people were fundamental to the STP and a small proportion of patients would need to move for specialist care. It was highlighted that a freedom of information act request had been received by the Yorkshire Ambulance Service around the impact on the ambulance service as a result of the consultations. This would be

MATT

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discussed further outside the meeting. It was highlighted that this work was a test bed for the whole of the STP and lessons had been learned from the process. Connections would be required from this work to the STP when funding was clarified. The CPB noted that the full analysis would be taken to:

• Joint Overview and Scrutiny Committee (3 April) • Joint Committee Clinical Commissioning Groups (for

discussion in April and decision in May) • Widely share with all stakeholders, people who completed the

consultations and made publicly available via the website

SANDFORD, HELEN STEVENS HELEN STEVENS

21/17 Independent review of hospital services The CPB were informed that the second Sustainable Hospitals Services Review (SHSR) Steering Group had taken place and was well supported by all partners. Final sign off for the Invitation to Tender (ITT) had been received andwould be used to tender for secretariat support to this extensive programme of work. This was out to tender. The first moderation including partners from the steering group would be taking place on 5 April. A robust process was taking place to ensure the right engagement was in place on the core steering group. Discussion took place at the SHSR Steering Group around the independent review director and it had been agreed to progress the recruitment of a review director. This would not result in a delay in process. How the review would move forward was being discussed. Key roles and approaches to take forward had been previously outlined. Senior project support was required to steer and support the group. Detail of this was being worked through. This would all be in place by the beginning of May. A full update would be written and shared virtually to enable a full update for all private Boards and Governing Bodiess within the next two weeks.

WILL CLEARY-GRAY

22/17 Review of commissioning An outline of the process to date was given to CPB, noting the review of commissioning had reflected the need for a collective transformation plan, and likely to move to the collective delivery of this plan. This process had highlighted that commissioning needed to happen at system and at place level. It was noted that it was likely to continue as currently established during 17/18 with the Joint Committee of Clinical Commissioning Groups making decisions for the system. Within the last two weeks, it had become clear that removing the commissioner and provider split would be the direction of travel

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with a view to moving to system reform by 18/19 rather than commissioning reform. A typo was noted and corrected on page 4 of the document. The next steps were highlighted; that a programme director would be recruited, to work on the immediate asks and to shape the future direction of travel, at system and at place level. It was highlighted that local authorities should be part of this work early on. It was noted that work was taking place in Sheffield to create a platform for a partnership approach with different models being explored around this. The shift in thinking was a positive development. It was noted that guidance was anticipated around links between specialised commissioning and place plans and this would be shared when available with LS. CPB was reminded that the paper had been produced by Chief Officers with a focus on system as the direction of travel. The messages and challenges were the same for system as for place; integration of provision and commissioning. CPB noted the next phases of development for the commissioning reform.

MATTHEW GROOM

23/17 Healthy Lives work stream update A paper was circulated to CPB following an update given in January and the subsequent request for further detail on the Healthy Lives work stream. An update was given on the three components of the work stream, cardiovascular disease and lifestyle risk, social prescribing and work and health. CPB were asked to note the ongoing work, the ambition of the programme and the recommendation that implementation of the Healthy Lives work was principally local within place based plans, with an undertaking of some activity consistently in each area and that there were elements that should be embedded in each of the work streams. CPB were asked to note the current infrastructure gap across the patch for work and health and employment support. It was agreed that the Chief Executive of Sheffield Health and Social Care would write to the Chief Executive of the Sheffield City Region (SCR) to propose joint infrastructure to share across the SCR/STP patch and clarify how this would be taken forward. It was noted that the national team for social prescribing was working with Rotherham. It was anticipated that three STPs would be selected for national roll out of social prescribing and that SYB could be one and therefore might be funding available. This would be considered as part of the MOU. CPB noted an overlap around a care navigation role that was developing, noting that CCGs had funded online training for primary care staff within Wakefield. As part of this, some evaluation from social

KEVAN TAYLOR ALL

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prescribing was being done should be fed into the development of care navigation. A comment was made that social prescribing was currently dependent upon an effective voluntary service system and the risks around the lack of guarantee that these services would exist in the future were noted. A discussion took place around the risks noted around implementation and delivery. Further work would be done on future iterations of the detail and more clearly linking to resource need that had been identified in the original submission. It was commented that the ambition of the work stream would be tailored to the resources available. Detail outlined with financial calculations were a work in progress in terms of linking back to overall STP funding. This paper would be discussed at local Health and Wellbeing Boards.

GREG FELL

24/17 Social Kinetic 3De proposal for leadership analysis CPB noted the next steps from the workshop held on 3 February to develop a narrative with public conversations. A request would be circulated requesting nominations of 3-4 people per organisation to complete the next stage of the survey and a date to convene all in may for a second workshop would be established.

25/17 Working Together Partnership Vanguard 17-18 Correspondence was circulated to confirm funding for the Vanguard programme and this was likely to be part of the total funding package SYB. As part of the plan refresh, funding for the Vanguard would be considered to ensure alignment to the Delivery Plan including exploring possibilities around managed clinical networks.

26/17 Action to get A&E back on track An update was given on the regional A&E Delivery Board, noting that A&E performance was top of list of priorities. Richard Barker (NHSI) would be overseeing the SYB STP A&E Delivery and would be meeting with the UEC team. Current A&E delivery plans had been reviewed against the national 10 point plan to ensure all requirements were being met and work was taking place to understand what could be done at SYB level and what was an issue at place level. A strong support team was required to undertake this work. A discussion took place around the principles to utilise money made available for social care to in part free up acute hospital beds. A meeting would be established to discuss further with an LA CEO, MR and LB.

MADDY RUFF, LOUISE BARNETT

27/17 Minutes of the STP Finance Oversight Committee on 7 February 2017 The minutes were ratified by the CPB.

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28/18 Any other business Local elections The CPB noted that the SYB MOU would be published in May 2017 and the group discussed the potential impact of this, noting that county council elections would be taking place however would be campaigning on election matter. CPB members agreed that governance and engaging leaders was crucial as part of this work. Public Health Workshop CPB noted a workshop taking place on health inequalities on 5 April with 10 places available for each STP for Y&H. 3 filled for SYB however representatives were welcomed.

Verbal

Item 15

Any Other Business

Verbal

Item 16

Date & Time of Next Meeting

Thursday 18 May 2016 at 1pm in the Boardroom, Sovereign House, Heavens

Walk, Doncaster, DN4 5HZ