ncl joint commissioning committee thursday, 1 august 2019 … · ncl joint commissioning committee...
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NCL Joint Commissioning Committee Thursday, 1 August 2019 2.30pm – 4.05pm Council Chamber Crowndale Centre 218 Eversholt St London NW1 1BD
Voting Members
Ms Karen Trew (Chair) Governing Body Vice Chair and Lay Member, Enfield CCG
Dr Mo Abedi Governing Body Chair, Enfield CCG Mr Matt Backler Director of Finance, Barnet CCG Dr Charlotte Benjamin Governing Body Chair, Barnet CCG Ms Sorrel Brookes Governing Body Lay Member, Islington CCG Ms Kathy Elliott Governing Body Lay Member, Camden CCG Dr Neel Gupta Governing Body Chair, Camden CCG Ms Catherine Herman Governing Body Lay Member, Haringey CCG Dr Fawad Hussain Governing Body Secondary Care Clinician, Enfield CCG Ms Helen Pettersen NCL Accountable Officer, Barnet, Camden, Enfield,
Haringey and Islington CCGs Dr John Rohan Governing Body Deputy Clinical Chair, Haringey CCG Dr Jo Sauvage Governing Body Chair, Islington CCG Mr Dominic Tkaczyk Governing Body Lay Member, Barnet CCG
Non-Voting Members Ms Parin Bahl Healthwatch Enfield Ms Janet Burgess Councillor, Islington London Borough Council Ms Pat Callaghan Councillor, Camden London Borough Council Ms Sharon Grant Healthwatch Haringey Ms Sarah James Councillor, Haringey London Borough Council Mr Daniel Thomas Councillor, Barnet London Borough Council Attendees Ms Aimee Fairbairns Director of Quality and Clinical Services, Enfield CCG Mr Will Huxter NCL Director of Strategy Mr Ed Nkrumah NCL Director of Performance Mr Ian Porter Director of Corporate Services, NCL CCGs Ms Sarah Rothenberg NCL PoD Director, North East London Commissioning
Support Unit Mr Paul Sinden NCL Director of Performance, Planning and Primary
Care Apologies Ms Alev Cazimoglu Councillor, Enfield London Borough Council Dr Peter Christian Governing Body Chair, Haringey CCG Dr Tamara Djuretic Director of Public Health, Public Health Barnet Ms Eileen Fiori NCL Director of Acute Commissioning Mr Simon Goodwin NCL Chief Finance Officer, Barnet, Camden, Enfield,
Haringey and Islington CCGs Ms Sharon Seber Nurse Representative, Haringey CCG Mr Adam Sharples Governing Body Lay Member, Haringey CCG Minutes Mr Steve Beeho Board Secretary, Haringey CCG
1
AGENDA
Lead Action Paper Time Page
1. Introduction
1.1 Apologies for Absence Chair Note Verbal 2.30 1.2 Declaration of Interests Chair Note 1.2 2.32 3 1.3 Gifts and Hospitality Register Chair Note Verbal 2.33 1.4 Opening Remarks Chair Note Verbal 2.34 1.5 Questions from Public Chair Note Verbal 2.35
2. Governance
2.1
Minutes from the Committee meetings held on 6 June 2019
Chair Approve 2.1 2.50 10
2.2 Matters Arising Chair Approve 2.2 2.55 20
3. Contracts and Planning
3.1 Acute Contracts Report Paul Sinden Approve
3.1 3:05 22
3.2 Acute Quality and Performance Report
Paul Sinden Approve 3.2 3:25 48
4. Risk
4.1 NCL Joint Commissioning Committee Risk Register
Paul Sinden Note 4.1 3:45 58
6. Items for Information
5.1 Glossary of Acronyms Paul Sinden Note 5.1 4:00 66
6. Any Other Business
6.1 Forward Planner 2019/20 Chair Discuss 6.1 4:01 69
6.2 Deadline for submission of reports for the next meeting – 19 September 2019
Chair Note Verbal
8. Date of next meeting:
Thursday, 3 October 2019, 2.30pm - 5pm. Claremont Room, Ground Floor, The Laycock Centre, Laycock Street, London, N1 1TH
2
From To
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Pro
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sio
na
l
Inte
res
ts
No
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ina
nc
ial
Pe
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na
l In
tere
sts
East Enfield Medical
Practice - GP PracticeYes Yes Direct GP Principal Nov-02 current 30.8.18
Evergreen Surgery
Limited - GP PracticeYes Yes Direct Director/Shareholder 2004 current 30.8.18
Brick Lane Surgery Yes Yes Direct Partner 2013 current 30.8.18
Brick Lane Surgery Yes Indirect Wife is a GP / Principal Jul-17 current 30.8.18
Medicare Medical
services LLP - Runs walk
in centre at Evergreen
Yes Yes Direct Director/Shareholder 2003 current 30.8.18
DM786 Limited
Property management
company
Yes Yes Direct Director 2002 current 30.8.18
DM786 Limited
Property management
company
Yes Yes Indirect Wife is a director, mother and
children are shareholders 2002 current 30.8.18
DM786 Health Ltd -
Health Consultancy (not
actively trading)
Yes Yes Direct Director 2012 current 30.8.18
DM786 Health Ltd -
Health Consultancy (not
actively trading)
Yes Yes Indirect Wife is a director, mother and
children are shareholders 2012 current 30.8.18
Prime Point Limited
Primary care medical
services provider
Yes Yes Direct Director / Shareholder 2012 current 30.8.18
Nature of Interest
Declared Interest-
(Name of the
organisation and
nature of business)
Chair of Enfield CCG Governing Body
Chair of Enfield CCG Clinical Commissioning Group
Voting Members
Mo
First NameCurrent position (s) held- i.e. Governing Body,
Member practice, Employee or other
Date of InterestType of Interest
Is the interest
direct or
indirect?
Second Name
Abedi
Update Date
declared
3
Enfield Health
Partnership Limited,
Provider of community
gynaecology service
Yes Yes Direct Shareholder 2010 current 30.8.18
Enfield Healthcare
Alliance Ltd – runs
Chalfont Rd and
Boundary Court GP
Practices
Yes Yes Direct Shareholder 2014 current 30.8.18
South East Locality
Access hub Yes Indirect Wife is a locum GP 2016 current 30.8.18
Enfield Locum GPs
Yes Indirect Wife works in Enfield as a locum GP 2016 current 30.8.18
St George's Medical
Centre Yes Yes Direct GP Partner 1.3.17 30.10.17
JFS, Brent Yes Direct School Governor 1.3.17 30.10.17
Chelsea and
Westminster NHS FT Yes Indirect Husband is clinical lead for ENT 1.3.17 30.10.17
Sorrel Brookes
Lay Vice Chair, Islington CCG
Member of Governing Body, Islington CCG
Strategy & Finance Committee, Islington CCG
PPP Committee, Islington CCG
Audit Committee, Islington CCG
Remuneration Committee, Islington CCG
NCL Primary Care Committee in Common
Trustee of Help on Your
Doorstep.Direct
Help on Your Doorstep is a
contractor for Islington CCG.
I take no part in contracting
decisions.
15/03/2016 present 23.8.18
Muswell Hill Practice Yes Direct Practice Partner 15.3.18 7.11.18
Muswell Hill Practice is
a member of
Federated4Health, the
pan-Haringey
federation of GP
practices.
Yes Direct Practice Partner 15.3.18 7.11.18
Muswell Hill Practice is
a member of WISH -
Urgent Care Centre
provider at Whittington
Hospital.
Yes Direct Practice Partner 15.3.18 7.11.18
Muswell Hill Practice
provides anticoagulant
care to Haringey
residents under a
contract with the CCG.
Yes Direct Practice Partner 15.3.18 7.11.18
Chair of Enfield CCG Governing Body
Chair of Enfield CCG Clinical Commissioning Group
Elected GP Representative and Governing Body Chair-Elect, Barnet CCG
Haringey CCG Chair, West GP Lead
GP Partner, Muswell Hill Practice
Member, Clinical Cabinet, Haringey CCG
Member, Health and Wellbeing Board
Member, Collaboration Board
Member, Remuneration Committee, Haringey CCG
Member, STP Clinical Cabinet and Transformation Board
Mo Abedi
Charlotte Benjamin
Peter Christian
4
The Hospital Saturday
Fund - a charity which
gives money to health
related issues.
Yes Direct Member 15.3.18 7.11.18
The Hospital Saturday
Fund - a charity which
gives money to health
related issues.
Yes Indirect (wife) Patron 15.3.18 7.11.18
The Lost Chord Charity -
organises interactive
musical sessions for
people with dementia
in residential homes.
Yes Indirect (wife) Patron 15.3.18 7.11.18
Haringey Health
Connected, the
federation of west
Haringey GP practices
Yes Indirect Practice Manager is Finance
Manager. 15.3.18 7.11.18
Salmons Brook
residents EdmontonYes Yes Direct
Non-Executive Director (flat owned
within the complex)2013 current 2.11.18
RSM UK Consulting -
RSM act as the CCGs
internal auditors
Yes Direct Associate Director Jun-14 current 2.11.18
Trustee Lyndsey Leg
Foundation Yes Direct Trustee May-17 current 2.11.18
Caversham Group
Practice Yes Direct
Member of the Patient Participation
Groupcurrent 12.12.16
21.8.18UK Public Health
Register (UKPHR) Yes Direct
Assessor and Chair of the
Registration Panelcurrent 12.12.16
21.8.18
Faculty of Public Health Yes Direct Member current 12.12.16
21.8.18
Simon Goodwin
Chief Finance Officer, NCL CCGs
Member, NCL CCG Governing Bodies
Member of all five CCG Finance Committees
Attendee, CCG Audit Committees and NCL Audit Committee in Common
Attendee, NCL Joint Commissioning Committee
Attendee, NCL Primary Care Co Commissioning in Common
East London
Foundation Trust Yes Indirect Wife is Senior Manager at the Trust 14.6.17 29/09/2017
15/10/2018
Neel Gupta Elected GP and GB Chair, Camden CCG The Keats Group
PracticeYes Yes Direct Salaried Employee 15/11/2016 current 09/11/18
8/10/18
Lay Member, Governing Body
Chair, NCL Primary Care Committee in Common
Member, Health and Well Being Board
Chair, Investment Committee
Member, Audit Committee
Member, Quality and Performance Committee
Member, Primary Care Transformation Group and Organisational
Development
Catherine Herman No interests to declare.
Kathy Elliott Lay Member, Camden CCG
Angela Dempsey Nurse Representative, Enfield CCG Governing Body
Chair, Quality and Safety Committee, Enfield CCG
Member, Clinical Commissioning Committee
Haringey CCG Chair, West GP Lead
GP Partner, Muswell Hill Practice
Member, Clinical Cabinet, Haringey CCG
Member, Health and Wellbeing Board
Member, Collaboration Board
Member, Remuneration Committee, Haringey CCG
Member, STP Clinical Cabinet and Transformation Board
left the
Committee ad
stood down
from Enfield
CCG March
2019
Peter Christian
5
Barking, Havering and
Redbridge NHS trustYes Yes Direct
Associate Medical Director and
Responsible Officer 04/03/2019
BUPA clinics in central
London Yes Yes Direct Consultant 04/03/2019
Holly Hospital, Redbridge Yes Yes Direct Consultant 04/03/2019
Redbridge practice (name
TBC) Yes Yes Indirect Wife is a GP partner. 04/03/2019
London-wide LMC Yes Yes Indirect Associate Medical Director 04/03/2019
Helen Pettersen
Accountable Officer, NCL CCGs and STP Convener
Member of all five NCL CCG Governing Bodies
Member of all five NCL CCGs' Finance Committees
Attend CCG Audit Committee meetings and NCL Audit Committee in Common
meetings as required
Royal Borough of
Kensington and Chelsea
Local Authority
Yes Indirect
Husband is Programme Manager for
Partners in Practice, a social work
training programme.
01/05/2018 `5/10/2018
Josephine Sauvage
Chair Islington CCG - GP
Partner City Road Medical Centre
Chair of Islington CCG Governing Body
Co-Chair of A&E Delivery Board-Member of Islington Strategy and Finance
Committee
- Member of NCL Urgent and Emergency Care Delivery Board
- Member of Islington HWBB
- Member of Joint Haringey & Islington HWBB
- Chair of Haringey & Islington Community Education Provider Network
- Co-Chair NCL STP Clinical Cabinet
- NCL CCG Chair representative on STP Programme Delivery Board
- Member of NCL Local Workforce Advisory Board
SRO Primary Care workforce / new models of care
London Regional representative board member NHSCC Chair of Wellbeing
Partnership
Transparency:
1. The Federation has been established with full support of Islington Clinical
Commissioning Group (CCG), and any business conducted between
commissioners and the federation is subject to normal scrutiny and probity.
External auditors have advised the CCG of appropriate process
2. I am absent from any discussions or decisions within my role as CCG Chair
that might overlap with my role as a member of this organisation. I also am
not privy to any information that may create a conflict in my role. The CCG
has standard systematic processes in place to ensure that this process if
1. I am a partner at
City Road Medical
Centre.
City Road Medical
Centre is a member of
the Islington
GP Federation. The
share is formally held
in the name of Dr Philly
O 'Riordan
one of my partners
2. The practice holds
a single share in the
Islington GP Group
Ltd trading as
Islington GP Federation.
Board Member of
London Region NHS
Clinical Commisioners.
City Road Medical Centre is
a member of the Islington GP
Federation06/11/2018
JS Medical Practice Yes Direct Advanced Nurse Practitioner 19.3.18 6.11.18
JS Medical Practice is a
member of
Federated4Health, the
pan-Haringey
federation of GP
practices.
Yes Direct Advanced Nurse Practitioner 19.3.18 6.11.18
Fawad Hussain Secondary Care Member, Enfield CCG Governing Body
Sharon Seber
South East Governing Body Membe, Haringey CCG
Increasing Healthy Life Expectancy/Long Term Condition Clinical Lead inc
Stroke lead, Haringey CCG
Member, Quality and Performance Committee, Haringey CCG
Member, Primary Care Steering Group, Haringey CCG
Member, NCL Joint Commissioning Committee
Member, Clinical Cabinet, Haringey CCG
Member, Camden, Haringey and Islington Responsible Respiratory Prescribing
Group
6
Freshney Consulting YesIndirect
(Partner)
Freshney Consulting may seek to do
business with the NHS but is not
currently doing so.
6.11.18 6.11.18
Islington COPD Steering
Group Yes Direct Attending Member 5.3.18 6.11.18
Money Advice Trust
(a national debt advice
charity)
Yes Direct Chair 01.07.16 8.10.18
Enfield CCG Yes Direct Member, Audit Committee 10.1.14 8.10.18
Headway East London (HEL)
Yes Direct
Treasurer to HEL, which provides
services to people with acquired
brain injury
1.6.18 17.10.18
Healthcare People
Management
Association Yes Direct Honorary Treasurer 1.10.18 17.10.18
Haringey CCG Yes Yes Direct Member of Haringey CCG Audit
CommitteeApr-13 current 31.10.18
TkaczykDominic
Lay Member for Audit and Governance, Barnet CCG
Chair of Barnet CCG Audit Committee
Chair of Camden CCG Audit Committee (with effect from 1.6.19)
Lay Member of NCL Audit Committee in Common
Lay Member of Commissioning Finance and QIPP Committee
Lay Member of Primary Care Procurement Committee Barnet CCG
Sharon Seber
South East Governing Body Membe, Haringey CCG
Increasing Healthy Life Expectancy/Long Term Condition Clinical Lead inc
Stroke lead, Haringey CCG
Member, Quality and Performance Committee, Haringey CCG
Member, Primary Care Steering Group, Haringey CCG
Member, NCL Joint Commissioning Committee
Member, Clinical Cabinet, Haringey CCG
Member, Camden, Haringey and Islington Responsible Respiratory Prescribing
Group
Adam Sharples
Member, Governing Body, Haringey CCG
Chair, Audit Committee, Haringey CCG
Chair, NCL Audit Committee in Common
Chair, Remuneration Committee, Haringey CCG
Member, Strategy and Finance Committee, Haringey CCG
Member, Finance and Performance Partnership Board, Haringey CCG
Chair, IFR Panel, Haringey CCG
Member, NCL Joint Commissioning Committee
Member, Community Services Improvement Group
Member, CSU In-Housing Sub Group
Member, Employment and Health Working Group (run by Haringey Council)
Conflicts of interest Guardian, Haringey CCG
Lay Vice Chair, Enfield CCG Governing Body
Lead for Governance and Audit, Enfield CCG
Member, Finance and Performance Committee, Enfield CCG
Member, Clinical Commissioning Committee, Enfield CCG
Member, Procurement Committee, Enfield CCG
TrewKaren 7
NHS England Performer
List Decision Panel
(outside of North
Central London)
Yes Direct Chair of Panels Apr-13 current 31.10.18
Broxbourne School
HertfordshireYes Direct
Chair of the Governing Body
(previously Governing Body
members since Nov. 2004)
Jun-15 current 31.10.18
Wormley C of E Primary
School, HertfordshireYes Direct Chair of the Governing Body 2006 current 31.10.18
Lloyds Pharmacy
Clinical HomecareYes Indirect Son employed in operational role Apr-17 current 31.10.18
Parin Bahl Healthwatch representative, Enfield CCG Governing Body Enfield Healthwatch Yes Yes Direct
Chair: Healthwatch Enfield is run by a
Community Interest Company, called
Combining Opinions to Generate
Solutions CIC (COGS). COGS is
commissioned by the London
Borough of Enfield to provide the
statutory Healthwatch service for
Enfield. COGS also undertakes
commissioned work e.g. training or
engagement work.
2017 current 20.11.18 16.1.19
Islington Council Direct
Executive Member for Health &
Social Care & Deputy Leader of the
Council
26.10.17
The Advisory Group For
The Friendship
Network, Manor
Garden Welfare Trust
Direct Member 26.10.17
Unite Direct Member 26.10.17
Whittington Health NHS
TrustDirect Attendee at Board Meetings 1.3.18 28.3.18
Whittington Park
Community CentreDirect Trustee 26.10.17
Camden Council Direct
Cabinet member for Tackling Health
Inequality and Promoting
Independence
5.10.17 13/11/2018
Health and Well Being
Board Direct Member 5.10.17 13/11/2018
Wolfe and Company Direct Director 28.9.18
Barnet Holdings Ltd Direct TBC 28.9.18
Barnet Council Yes Direct DPH has a statutory duty to provide
‘core offer’ to Barnet CCG 3.5.18
Ravenscroft Medical
CentreYes Direct Patient 3.5.18
Public Voice CIC (a
Community Interest Yes Direct Chair of the Board 19.2.18 8.11.18
Healthwatch Haringey Yes Direct Chair, Steering Committee 19.2.18 8.11.18
Bernie Grant Arts
Centre Partnership Yes Direct Director 19.2.18 8.11.18
Bernie Grant Trust Yes Direct Director 8.11.18Independent Advisory
Group, Metropolitan
Police Haringey
Yes Direct Member 19.2.18 8.11.18
Sharon Grant
Chair, Healthwatch Haringey
Haringey CCG Governing Body Observer (With Speaking Rights)
Non-Voting Members
Richard Cornelius Councillor, Barnet Council
Lay Vice Chair, Enfield CCG Governing Body
Lead for Governance and Audit, Enfield CCG
Member, Finance and Performance Committee, Enfield CCG
Member, Clinical Commissioning Committee, Enfield CCG
Member, Procurement Committee, Enfield CCG
TrewKaren
Councillor, Islington Council Burgess Janet
Tamara Djuretic Director of Public Health, Barnet Council
Councillor, Camden CouncilCallaghan Patricia
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Parliamentary
researcher Yes Direct
Part-time-employment as a
Parliamentary Researcher on Health
issues for backbench Labour MP
19.2.18 8.11.18
London Borough of
Haringey Fairness
Commission
Yes Direct Member 8.11.18
Haringey Joint
Partnership Board Yes Direct Co-Chair 8.11.18
Consumers Association
(Which?)Yes Direct
Trustee and Director
(Unremunerated)19.2.18 8.11.18
Mary Ward Centre Direct Dyslexia Assessor 24.10.18 University and College
Union Direct Member 24.10.18
Eileen Fiori
Director of Acute Commissioning, NCL
Member, Senior Management Team
Attendee, Joint Commissioning Committee
No interests to declare. 6.10.18
Will Huxter Director of Strategy, NCL NCL CCGs N/A N/A N/A N/A
Attends all 5 CCGs Governing Body
meetings, NCL Primary Care
Commissioning in Common.
N/A N/A 23.4.18
NCL CCGs N/A N/A N/A N/AAcute Performance Management
Lead N/A N/A 12.10.18
NCL CCGs N/A N/A N/A N/A Cancer Commissioning Lead N/A N/A 12.10.18
NCL CCGs N/A N/A N/A N/A Assurance Lead N/A N/A 12.10.18
City and Hackney and
Waltham Forest MIND Yes Yes Direct
Trustee - the Charity has no interests
in NCL CCGs26.1.17 current 12.10.18
Ian Porter Director of Corporate Services, NCL NONE N/A N/A N/A N/A
Attends all 5 CCGs Governing Body
meetings, NCL Audit Committee in
Common and other meetings as and
when required.
N/A N/A 14.6.17 23.7.18
Sarah Rothenberg Acting PoD Director and Director of Finance, NELCSUAssociation of Jewish
Refugees Yes Direct
Finance Committee member (no
social care overlap in NHS role )29.11.18
Paul Sinden Director of Performance and Acute Commissioning, NCL NCL CCGs N/A N/A N/A N/A
Attends all 5 CCGs Governing Body
meetings, NCL Primary Care
Commissioning in Common.
N/A N/A 30.4.18
Ed Nkrumah Director of Performance, NCL
Sharon Grant
Chair, Healthwatch Haringey
Haringey CCG Governing Body Observer (With Speaking Rights)
Sarah James Councillor, Haringey Council
Attendees
9
1
NORTH CENTRAL LONDON (‘NCL’) JOINT COMMISSIONING COMMITEE Draft minutes of the meeting held in public on Thursday, 6 June 2019, 2.30pm – 5pm
Council Chamber, Crowndale Centre, 218 Eversholt St, London NW1 1BD
Voting Members Present:
Ms Karen Trew (Chair) Governing Body Vice Chair and Lay Member, Enfield CCG
Dr Mo Abedi Governing Body Chair, Enfield CCG
Ms Sorrel Brookes Governing Body Lay Member, Islington CCG
Dr Peter Christian Governing Body Chair, Haringey CCG
Ms Kathy Elliott (Vice Chair) Governing Body Lay Member, Camden CCG
Dr Neel Gupta Governing Body, Chair, Camden CCG
Ms Catherine Herman Governing Body Lay Member, Haringey CCG
Dr Fawad Hussain Governing Body Secondary Care Clinician, Enfield CCG
Ms Helen Pettersen Accountable Officer, Barnet, Camden, Enfield, Haringey and Islington CCGs
Dr Jo Sauvage Governing Body Chair, Islington CCG
Mr Dominic Tkaczyk Governing Body Lay Member, Barnet CCG
Non-Voting Members Present:
Ms Sharon Grant Healthwatch Haringey
Ms Parin Bahl Healthwatch Enfield
Attendees:
Ms Pat Callaghan Councillor, Camden Council
Ms Eileen Fiori NCL Director of Acute Commissioning
Ms Jenny Goodridge Director of Quality and Clinical Services, Barnet CCG
Ms Kath McClinton Senior Responsible Officer, Transforming Care Programme
Mr Ian Porter Director of Corporate Services, Barnet, Camden, Enfield, Haringey and Islington CCGs
Ms Sarah Rothenberg NCL POD Director, NELCSU
Mr Paul Sinden NCL Director of Planning, Performance and Primary Care
Apologies:
Dr Charlotte Benjamin Governing Body Chair, Barnet CCG
Ms Janet Burgess Councillor, Islington Council
Ms Alev Cazimoglu Councillor, Enfield Council
Ms Tamara Djuretic Director of Public Health, Barnet Council
Mr Simon Goodwin NCL Chief Finance Officer, Barnet, Camden, Enfield, Haringey and Islington CCGs
Ms Sarah James Councillor, Haringey Council
Mr Ed Nkrumah NCL Director of Performance
Mr Adam Sharples Governing Body Lay Member, Haringey CCG
Mr Daniel Thomas Councillor, Barnet Council
Minutes
Mr Steve Beeho Board Secretary, Haringey CCG
1 Introduction
1.1 Apologies for absence
1.1.1
Apologies were received from Charlotte Benjamin, Janet Burgess, Alev Cazimoglu, Tamara Djuretic, Simon Goodwin, Sarah James, Ed Nkrumah, Sharon Seber, Adam Sharples and Daniel Thomas.
10
2
1.2 Declarations of Interests
1.2.1
There were no additional declarations of interests.
1.3 Declarations of gifts and hospitality
1.3.1
There were no gifts or hospitality offered or received.
1.4 Opening Remarks
1.4.1
The Chair welcomed everybody to the meeting.
1.5 Questions from the public
1.5.1 1.5.2
The Committee noted the responses to the written questions submitted in advance of the Committee. Terms of reference for the Committee would be updated to allow flexibility for the timing of accepting deputations in the event of meeting papers being published the week before a Bank Holiday or being published late. ACTION: Ian Porter to arrange for the wording relating to deputations to be amended in the next review of the Standing Orders to allow for greater flexibility in the event of Bank Holidays.
2. Governance
2.1 Minutes of Committee Meetings on 4 April and 2 May 2019
2.1.1 2.1.2
The Committee APPROVED the minutes of the meeting on 4 April 2019 as an accurate record, subject to the reference to JCC meetings in section 7.3.2 being amended to Directors of Quality Meetings. The Committee APPROVED the minutes of the meeting on 2 May 2019 as an accurate record, subject to Dominic Tkaczyk’s name being added to the list of individuals who had given their apologies.
2.2 Action Log
2.2.1 2.2.2 2.2.3 2.2.4
The Committee reviewed the action log. The majority of the actions had been discharged. It was agreed that action 69 could be closed, as this would be picked up under item 4.3 on the meeting agenda. Paul Sinden provided a verbal update for action 73, noting that the Enfield CCG 2019-20 acute contracts include new investment in the rapid response pathway, the community ophthalmology service and the clinical service for cardiac triage. It was agreed that this action could also now be closed. The Committee NOTED the action log.
2.3 Minutes of Committees in Common meeting
2.3.1
The Committee NOTED the minutes of the Committees in Common meeting held on 24 April 2019 for Project Oriel.
11
3
2.3.2 2.3.3
It was confirmed that Healthwatch representatives would be invited to future Committee in Common for Project Oriel. ACTION: Will Huxter to confirm Healthwatch invites to future Committees in Common.
3. Contracts and Planning
3.1 Finance and Activity Report
3.1.1
Sarah Rothenberg provided an overview of the report:
For 2018/19 over-performance on all acute contracts was £72m (5.9%), predominantly relating to the four main acute contracts in NCL. The deterioration from Month 11 (£10m), was primarily caused by £8m of provision changes and year-end adjustments by CCGs rather than from activity changes;
The reported position included year-end settlements with Royal Free London (RFL), NMUH and Barts. The RFL settlement included all prior year legacy issues;
Acute QIPP delivery across the 4 main acute contracts was £29m (45% of plan), with delivery particularly challenging for Enfield CCG where financial recovery plans were longer standing, and quick QIPP wins had been gained from prior year programmes;
Accepted claims and challenges up to Month 11 totalled £20.3m, with the highest value accruing from the major non-elective counting and coding challenge at Royal Free London;
All in-sector acute contracts for 2019/20 had been agreed following settlement of the UCLH contract, and signed except for the Royal Free and UCLH, which had been agreed but not signed. The signing of both contracts was planned to take place by the end of June 2019;
Acute contract forms varied for 2019/20 with ULCH on a block contract (and for 2020/21), Whittington Health on a Payment by Results contract, and Royal Free London and NMUH on a ‘Cap and Collar’ contract setting out maximum and minimum amounts that would be paid in-year. In addition the NMUH contract allowed for a marginal rate recovery from QIPP schemes below the collar amount if activity fell sufficiently;
The nature of the agreed acute contracts (especially the block ones) would impact on financial QIPP delivery in 2019-20, but full effects would be built into contract baselines for 2020/21. To support this QIPP delivery reports would now focus on both activity and cost reductions, and report by Trust as well as by workstream;
A more collaborative approach for claims and challenges had been agreed with providers for 2019/20. Technical/automated challenges would remain unchanged but manual challenges were expected to decrease due to changes in behaviour that both providers and commissioners had agreed to. This would be supported by the agreement of all prior-year issues with Royal Free London providing the contact with a clean-slate for 2019/20;
The materiality of any challenges would be jointly assessed and monitored with providers, and rapid close-down supported by early escalation to the Director of Acute Commissioning where required;
Reported activity trends were for March 2019. Month 1 data for 2019/20 was not yet usable due to quality issues, but a report on activity trends would be provided for the Committee Seminar in July 2019;
Activity trends for elective pathways showed a year-on-year reduction for GP referrals, but an increase in outpatient first attendances. This was being addressed by the planned care workstream including the continued expansion of Clinical Advice
12
4
3.1.2
and Guidance. Outpatient follow-ups were stable year-on-year with work underway with providers to reduce the number of follow-ups in 2019/20 as part of the NHS Long Term Plan ambition to reduce outpatient face-to-face attendances by 30% over the next five years;
Electives saw year-on-year increases of 4%, largely driven by the specialities with higher outpatient attendances, including ophthalmology, dermatology and gastroenterology. Part of the increased activity at Whittington Health was attributable to the reintroduction of capacity which had been lower in previous years as a result of staff vacancies;
For non-elective pathways growth accrued from A&E attendances (3.1%) and zero length of stay (0LOS) emergency admissions (particularly ay NMUH and Royal Free London), with the latter not accompanied by a corresponding drop in admissions of 1 day or more;
The increase in zero length of stay (0LOS) emergency admissions at NMUH and the Royal Free London had resulted in joint clinical audits with the Trusts being undertaken. A summary of the audit outcomes would be shared with the Committee following sign-off by both parties;
Activity trends, including the impact of QIPP delivery, would be monitored in 2019/20 through Local Delivery Groups and contract meetings. In addition, Outpatient Transformation Boards were being introduced to optimise the targeted reduction in outpatient attendances supported by benchmark data and dashboards that would be shared with the Committee;
The Committee then discussed the report:
Confirming that acute QIPP delivery in 2018/19 was 3% in line with QIPP targeted for 2019/20. Slippage in 2018/19 was in the context of a high 6% planning assumption;
It was hoped that the alignment of the regulatory framework following the coming together of NHS England and NHS Improvement would support a more collaborative approach with providers, as indicated by recent joint system-wide meetings rather than the separate CCG and provider meetings held in previous years;
Assurance was given that all contractual/legacy issues with Royal Free London had been closed at the year-end, unlike in previous years;
Development of Integrated Care Systems would support system-wide working and providers and commissioners moving to a collaborative “single version of the truth” approach;
To support working collaboratively with Trusts it was important to agree a single process for checking counting and coding against a defined set of principles with providers;
Confirmation was sought on whether there was a process in place for monitoring PoLCE (Procedures of Limited Clinical Effectiveness) in light of the recent changes. (This point would be picked up again under Item 4.3);
Assurance was given that the 2019-20 QIPP plans had been developed collaboratively by CCGs and STP workstreams. Establishing the NCL QIPP Directors meeting, chaired by Simon Goodwin, would support delivery and coherent planning assumptions;
Depending on the outcome the joint clinical audits with provides on zero length of stay (0LOS) emergency admissions could be a template for future ways of working with providers;
Confirmation would be provided outside the meeting on the purpose and dates of the forthcoming Engagement Advisory Board and Residents Panel meetings;
It was confirmed that updates on the work of the Outpatients Advisory Board would include details of patient and public engagement and how this will inform the next steps.
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3.1.3 3.1.4
The Committee:
APPROVED the Acute Commissioning Report and
ENDORSED the new approach to QIPP reporting.
ACTION: Will Huxter to circulate the purposes and dates of the forthcoming Engagement Advisory Board and Residents Panel meetings.
3.2 Acute Performance and Quality Report
3.2.1 3.2.2
Paul Sinden introduced the report, highlighting the following key points:
Following the reporting of six Never Events by UCLH in March 2019, the Trust had been invited to attend the seminar in July 2019. Camden CCG were working with the Trust and regulators to ensure on the investigation and lessons learned;
The recent Care Quality Commission (CQC) inspection of the Royal Free London FT resulted in an overall rating of ‘requires improvement’ compared to a “good” rating from the previous inspection. The Trust had already submitted an action plan to the CQC for the immediate actions requested, and the full plan would be submitted by 9 June 2019. Areas of concern from the inspection included theatre utilisation, timely discharge from critical care at Barnet Hospital and cultural issues at the Royal Free relating to theatre and medical teams. Barnet CCG had been working closely with the Trust in many of these areas;
There was concern nationally on the dip in A&E performance in 2019/20 to date compared to the corresponding period in 2018/19, with most concern locally focused on UCLH. CCGs were working with the Trust to improve performance through the Camden A&E Delivery Board. The national drive to improve performance focused on reducing extended lengths of stay in hospital beds, reducing ambulance handover times at emergency departments, and redirection of patients into primary care access hubs where appropriate;
Work on harmonising London Ambulance Service (LAS) capacity and performance across Boroughs included alternatives to conveyance to emergency departments, working with care homes to reduce calls, and the introduction of an additional vehicle to work across Barnet, Enfield and Haringey;
Call handling response times by the NHS 111 and GP Out-of-Hours service met the contract standard in April 2019, improving from the previous month;
The Referral to Treatment (RTT) data presented in the report excluded Royal Free London, following the Trust’s decision to cease national reporting from February 2019 due to a number of data quality issues identified during a review of reporting systems and processes. Local reporting had been developed by the Trust in lieu of this, and a steering group has been established, including NCL CCGs, NHS England and NHS Improvement, to ensure visibility of overall performance and the introduction of the new validation tool;
Since the publication of the report, Whittington Health, the Royal Free and NMUH had all achieved the 85% 62-day cancer waiting time operational standard in April 2019, bringing NCL’s aggregate performance up to 80%. UCLH performance in April 2019 was 70%.
In response to the report the Committee:
Noted that the poor performance at NMUH against the 2-week breast cancer symptomatic target was caused by a mammography capacity problem now resolved, but requested further assurance on access to the service;
Welcomed the positive impact on performance from investment in 2018/19 into the NHS 111 and Out of Hours service;
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3.2.3 3.2.4
Received assurance on the action being taken to address the previously-reported cultural issues in the Operating Theatres at Royal Free Hampstead, and that progress on this was monitored as a standing item by the Clinical Quality Review Group. It was agreed that progress updates would be included in a future Acute Performance and Quality Report;
Requested further information on the work to improve Friends and Family Test (FFT) scores at NMUH give the concern at performance being below NCL averages;
Noted concern at the lack of significant progress made in LAS performance, especially in outer London, give the recovery actions undertaken.
The Committee APPROVED the Acute Performance and Quality Report. ACTION: Paul Sinden to include the following in the next Acute Performance and Quality Report:
Assurance on NMUH recovery of position for 2-week wait breast appointments;
Update on the Royal Free London progress against the milestones to improve their working culture, with site-specific data;
Update on NMUH work to improve patient experience ratings in A&E;
Update on actions taken by London Ambulance Service to improve response times.
3.3 Transforming Care Programme Update
3.3.1 3.3.2
Kath McClinton provided a summary of the report, highlighting the following points:
At 31 March 2019, the NCL Transforming Care Programme (TCP) had 55 inpatients, against a target of 48. This represented a 33% reduction in the use of inpatient beds for this cohort across NCL from the April 2019 baseline, and compared favourably to a London-wide reduction of 19%;
NHS England had confirmed the programme would be extended until March 2021, with a further reduction in the use of inpatient beds agreed with NHS England;
NHS England had yet to confirm funding to CCGs to support the continuation of the programme into 2019/20. However, there is also likely to be an expectation of match-funding from CCGs and local authorities;
Further to the recent Panorama programme highlighting concerns about a facility in Durham run by Cygnet Healthcare, it was confirmed that there were no NCL patients at this facility. However, as Cygnet was a large provider of services for people with learning disabilities and had hospitals in the south east region, NCL currently had five patients in Cygnet-run facilities, four of whom were Haringey residents. Treatment reviews of these placements had been undertaken with no concerns identified;
Patients had treatment reviews every six months, and in the event of quality concerns being identified, local teams carried out unannounced visits;
Patients were increasingly being moved closer to London allowing the further development of treatment reviews and good working relationships with providers.
In response to the report the Committee:
Welcomed the clarity of the report and the ‘lessons learned’ to date;
Commended the treatment review process, supported by unannounced visits, to provide assurance on the quality of care received by NCL patients;
Noted the need to understand the recent ‘spike’ in admissions of children across London. Linked to this there had been a number of instances of children being diagnosed late with autism which had increased admissions locally and Children’s Services were investigating this;
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3.3.3 3.3.4
In the absence of clarity on funding from NHS England for 2019/20 it was agreed that a letter from NCL CCGs, and ideally also from the five local authorities, should be sent to NHS England requesting final clarification on the 2019/20 funding arrangements. It was suggested that the pressures caused by the increasing prevalence of autism and the transition to adulthood should also be referenced in this letter.
The Committee:
NOTED the report and
AGREED the recommendation to write to NHSE to request final clarification on the 2019/20 funding arrangements.
ACTION: Kath McClinton to co-ordinate a letter to NHS England on funding for 2019/20 Transforming Care Programme, ideally with local authorities.
4. Commissioning
4.1 NCL Adult Elective Orthopaedic Services Update
4.1.1 4.1.2
Will Huxter presented the drafting changes to the financial assessment of the options appraisal process verbally reported to the committee at the 2 May 2019 meeting. The Committee NOTED the drafting changes to the Clinical Delivery Model and Options Appraisal Process which had been approved by the Committee Chair under the authority agreed to be delegated at the 2 May 2019 meeting.
4.2 NCL Cancer Commissioning Update
4.2.1 4.2.2
Paul Sinden presented the overview of three key initiatives underway in NCL to improve services for patients diagnosed with, or suspected of being at risk of, cancer, and address priorities in the NHS Long Term Plan to deliver 75% of cancer diagnoses at an early stage and implement the 28-day Faster Diagnosis Standard from April 2020. The service developments included:
The roll-out of the Faecal Immunochemical Test (FIT) for low-risk patients across primary care in NCL from April 2019. Provisional data indicated an uptake in the use of the test in primary care, with less than 15% of patients requiring onward referral
The cancer Alliance had launched the largest lung cancer screening project in the UK, across north central and north east London, to improve early detection. The 15-month pilot was expected to yield earlier detection of over 200 lung cancer cases in NCL. Approximately 50% of practices across NCL had signed up to the study to date;
The Faster Diagnosis Standard would be introduced in April 2020. Under this, most patients would receive a definitive diagnosis or ruling out of cancer within 28 days of referral. Shadow running was currently taking place in preparation.
The Committee then discussed the report, making the following comments:
Clarification was requested on when the FIT pathway would be mobilised for patients with a higher-risk of cancer diagnosis;
It was agreed that an equalities assessment would be undertaken on access to the lung cancer screening project;
A communications campaign should be developed to encourage practice and patient take-up of the lung cancer screening programme;
It would be helpful to involve patients in the design of communication materials for the introduction of the Faster Diagnosis Standard;
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4.2.3 4.2.4 4.2.5 4.2.6 4.2.7
An update on readiness for the implementation of the Faster Diagnosis Standard by April 2020 would be brought to the Committee later in the year.
The Committee NOTED the service developments for cancer pathways in support of delivering priorities for cancer services the NHS Long Term Plan. ACTION: Ed Nkrumah to clarify when the second higher risk cancer pathway will be mobilised for qFIT. ACTION: Ed Nkrumah to arrange for an equalities assessment to be undertaken for the uptake of the lung cancer screening project. ACTION: Ed Nkrumah to consider the development of communications to encourage take-up of the lung cancer screening programme. ACTION: Ed Nkrumah to provide an update later in 2019/20 on NCL readiness to implement and measure the 28-day Faster Diagnosis Standard by April 2020.
4.3 Procedures of Limited Clinical Effectiveness (POLCE) update
4.3.1 4.3.2 4.3.3 4.3.4 4.3.5 4.3.6
Will Huxter introduced the report, recommending the PoLCE policy be renamed as ‘Evidence Based Interventions and Clinical Standards’ following feedback from stakeholders on the imprecise nature of the current term ‘procedures of limited clinical effectiveness (generally abbreviated to ‘PoLCE’). The recommended name change followed an engagement process with stakeholders. In the interests of accessibility, this name would be used in full, rather than reduced to an acronym. Communications for the policy had also been made more patient-focused by replacing the Frequently Asked Questions on the website with the answers to specific questions which have been asked. Subject to the committee’s approval of the proposed name change it was hoped that draft leaflets could be shared with Healthwatch at a meeting the following day and then with other community groups, to allow publication by the end of June 2019. The Committee then discussed the recommended name change and report:
Work to make the policy more patient focused and understandable to the general public needed to continue alongside the proposed name change;
The name change would support the need to align with the relevant national programme “Evidence Based Interventions” and London programme called Choosing Wisely. The second element of the proposed name (“Clinical Standards”) reflected the drive to achieve standardised approach to what were often complex decisions;
Application of the policy would need to be monitored to ensure it was applied equitably across population groups. This would be emphasised in the patient leaflet.
The Committee:
AGREED to adopt the new name of ‘Evidence Based Interventions and Clinical Standards’ and restructure the supporting document to clarify why different procedures had been included in the policy.
ACTION: Will Huxter to ensure that patient leaflets for Evidence Based Interventions and Clinical Standards explain clearly the appeals/complaints process.
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4.3.7 4.3.8
ACTION: Will Huxter to clarify how Healthwatch/patients can input into any Evidence Based Interventions and Clinical Standards-related communications. ACTION: Will Huxter to clarify how the Evidence Based Interventions and Clinical Standards process will be monitored.
5. Risk
5.1 NCL Joint Commissioning Committee Risk Register
5.1.1 5.1.2 5.1.3
Paul Sinden introduced the JCC Risk Register, highlighting the following:
More detail relating to QIPP delivery would be added to Risk JCC26 in the next review, as agreed in the teleconference;
It will also be made clearer in the next update that the development of the Medium Term Financial Strategy will mitigate Risk JCC28.
In response to queries from the Committee, the following clarifications were provided:
The learning from the after action reviews for winter 2018/19 were in the process of being carried out by each A&E Delivery Board. These meetings would be followed by a pan-NCL meeting to discuss mutual aid across NCL. Once completed an update would be included in the next Acute Performance and Quality Report
An update report on the Medium Term Financial Strategy (Risk JCC28) would be brought to the Committee Seminar in September 2019.
The Committee NOTED the report and updates to the Committee risk register.
6. Items for Information
6.1 Glossary of Acronyms
6.1.1
The Committee NOTED the Glossary of Acronyms.
7. Any Other Business
7.1 Forward Planner 2018/19
7.1.1
The Committee NOTED the Forward Planner.
7.2 Deadline for Submission of Reports
7.2.1
The Committee NOTED that reports for the JCC meeting on 1 August 2019 should be sent to Paul Sinden by 22 July 2019.
8. Date of Next Meeting
8.1
The next Committee meeting would be on 1 August 2019.
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NORTH CENTRAL LONDON (‘NCL’) JOINT COMMISSIONING COMMITEE Draft minutes of the Part II meeting held in public on Thursday, 6 June 2019, 4.45pm – 5pm
Council Chamber, Crowndale Centre, 218 Eversholt St, London NW1 1BD
Voting Members Present:
Ms Karen Trew (Chair) Governing Body Vice Chair and Lay Member, Enfield CCG
Dr Mo Abedi Governing Body Chair, Enfield CCG
Ms Sorrel Brookes Governing Body Lay Member, Islington CCG
Dr Peter Christian Governing Body Chair, Haringey CCG
Ms Kathy Elliott (Vice Chair) Governing Body Lay Member, Camden CCG
Dr Neel Gupta Governing Body, Chair, Camden CCG
Ms Catherine Herman Governing Body Lay Member, Haringey CCG
Dr Fawad Hussain Governing Body Secondary Care Clinician, Enfield CCG
Ms Helen Pettersen Accountable Officer, Barnet, Camden, Enfield, Haringey and Islington CCGs
Dr Jo Sauvage Governing Body Chair, Islington CCG
Mr Dominic Tkaczyk Governing Body Lay Member, Barnet CCG
Apologies:
Dr Charlotte Benjamin Governing Body Chair, Barnet CCG
Mr Simon Goodwin NCL Chief Finance Officer, Barnet, Camden, Enfield, Haringey and Islington CCGs
Mr Adam Sharples Governing Body Lay Member, Haringey CCG
Minutes
Mr Steve Beeho Board Secretary, Haringey CCG
1 Introduction
1.1 Apologies for absence
1.1.1
Apologies were received from Charlotte Benjamin, Simon Goodwin and Adam Sharples.
1.2 Declarations of Interests
1.2.1
There were no additional declarations of interests.
1.3 Declarations of gifts and hospitality
1.3.1
There were no gifts or hospitality offered or received.
1.4 Minutes of Part II Meeting on 4 April 2019
1.4.1
The Committee APPROVED the minutes of the Part II meeting on 4 April 2019 as an accurate record.
1.5 Any Other Business
1.5.1
There was no other business.
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Agenda Item: 2.2
JOINT COMMISSIONING COMMITTEE
ACTION LOG
Meeting Date
Action No. Action Lead Deadline Update
6 June 2019 79 To arrange for the wording relating to deputations to be amended in the next review of the Standing Orders to allow for greater flexibility in the event of Bank Holidays.
Ian Porter July 2019 An additional one-day allowance will be applied with immediate effect and this change will then be formally incorporated as part of the next review of the Standing Orders.
6 June 2019 80 To confirm Healthwatch invites to future Committees in Common.
Will Huxter June 2019 We will ensure that invitations are sent to Healthwatch representatives in advance of the next meeting of the Committees in Common.
6 June 2019 81 To circulate the purposes and dates of the forthcoming Engagement Advisory Board and Residents Panel meetings.
Will Huxter June 2019 An email was sent to all Committee members immediately after the meeting on 6 June 2019.
6 June 2019 82 To include the following in the next Acute Performance and Quality Report:
Assurance on NMUH recovery of position for 2-week wait breast appointments;
Update on the Royal Free London progress against the milestones to improve their working culture, with site-specific data;
Update on NMUH work to improve patient experience ratings in A&E;
Update on actions taken by London Ambulance Service to improve response times.
Paul Sinden July 2019 These points have been addressed in the Acute Services Quality and Performance Report which the Committee is receiving on 1 August 2019 (item 3.2).
6 June 2019 83 To co-ordinate a letter to NHS England on funding for 2019/20 Transforming Care Programme, ideally with local authorities.
Kath McClinton
July 2019 A letter was sent to NHS England in June but no reply has been received to date. This is being followed up and a verbal update will be provided at the meeting. 20
Agenda Item: 2.2
6 June 2019 84 To clarify when the second higher risk cancer pathway will be mobilised for qFIT.
Ed Nkrumah July 2019 These actions have all been addressed in the Acute Services Quality and Performance Report (item 3.2).
6 June 2019 85 To arrange for an equalities assessment to be undertaken for the uptake of the lung cancer screening project.
Ed Nkrumah July 2019
6 June 2019 86 To consider the development of communications to encourage take-up of the lung cancer screening programme.
Ed Nkrumah July 2019
6 June 2019 87 To provide an update later in 2019/20 on NCL readiness to implement and measure the 28-day Faster Diagnosis Standard by April 2020.
Ed Nkrumah July 2019
6 June 2019 88 To ensure that patient leaflets for Evidence Based Interventions and Clinical Standards explain clearly the appeals/complaints process.
Will Huxter July 2019 The leaflets have been drafted and include information on this.
6 June 2019 89 To clarify how Healthwatch/patients can input into any Evidence Based Interventions and Clinical Standards-related communications.
Will Huxter July 2019 Healthwatch colleagues were involved in the review and development of these leaflets, as well as resident groups across different CCGs. We will continue to work with Healthwatch on future communications about this policy and work with residents to ensure clear communications.
6 June 2019 90 To clarify how the Evidence Based Interventions and Clinical Standards process will be monitored.
Will Huxter July 2019 As part of the monitoring of the policy, there will be clinical audits undertaken and reviews based on this. Work is also underway to ensure consistent coding and reporting in line with national guidance on evidence based interventions.
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NCL Joint Commissioning Committee Thursday, 1 August 2019
Report Title Finance report for the month of June 2019 (Month 3) and Activity report for the month of May 2019 (Month 2)
Date of report 1 August 2019
Agenda Item 3.1
Lead Director /
Manager
Eileen Fiori Director of Acute Commissioning for NCL CCGs
Tel/Email [email protected]
GB Member Sponsor
Ms Karen Trew (Chair) Governing Body Vice Chair and Lay Member, Enfield CCG
Report Author
Eileen Fiori & Sarah Rothenberg Director of Finance NELCSU
Tel/Email [email protected]
Name of Authorising
Finance Lead
Simon Goodwin, Chief Finance Officer
Summary of Financial Implications
There is a reported forecast outturn over performance of £3.5m on all acute contracts for NCL CCGs. This is made up of:
£4.6m over performance at the four main acute;
£1.8m over performance on the other acute provider contracts;
£2.9m underperformance on ‘other contracts’ that include oversees visitors, LAS.
QIPP has been reported on plan at 100% delivery.
Report Summary
This report sets out the Financial and Activity performance for NCL Commissioners at our Acute Hospital Providers for the reporting Month 3 (June) 2019. Actions being taken are included in the main body of the report as detailed below.
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Recommendation The NCL Joint Commissioning Committee is asked to:
APPROVE the report and
ADVISE on areas where further action could be taken by CCGs to mitigate key risks.
Identified Risks and
Risk Management
Actions
The 2019/20 contract with UCLH has not yet been signed. The contract Value for NCL has been agreed but not all CCGs associate to the contract have agreed their block values. The Trust is currently describing an anticipated income shortfall of £6m. Associates to the UCLH contract are being pursued to secure the maximum block values to enable the Trust to meets its control total. Over performance at Whittington Health cannot be mitigated through contract form as this is a standard ‘Payment by Results’ contract. Each of the other 3 contracts will be able to partially mitigate through the contract form. QIPP delivery has been reported at 100% for Month 3. QIPP monitoring will reflect a more realistic position as the year progresses. These risks are monitored by the CCG Finance and Performance Committees. The system needs to maximise the use of its Urgent Treatment Centres and Clinical Advice and Guidance services in order to mitigate the risks of over financial over performance on acute contracts.
Conflicts of Interest Not applicable.
Resource
Implications
Annual budgets held by each CCG.
Engagement
The report is presented to the NCL Joint Commissioning Committee which includes elected GP representatives, lay members, Healthwatch, Public Health and representatives from each NCL London borough.
Equality Impact
Analysis
This report was written in accordance with the provisions of the Equality Act 2010.
Report History and
Key Decisions
This is a standard report provided for the Joint Commissioning
Committee.
Next Steps Ongoing monitoring of performance against QIPP delivery and actions as detailed in the main report. Agree outstanding 2019/20 Contracts, agree indicative activity plans and finalise contract documentation.
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Appendices
Full Finance and Activity pack is circulated with this summary report. See Appendix 1 - Full Finance and Activity pack
What CCG does this relate to
Barnet CCG, Camden CCG, Enfield CCG, Haringey CCG, Islington CCG
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1. Finance
1.1 Four Main NCL Acute Contracts
When monitoring against CCG financial plans, at the four main NCL acute providers are
reporting a forecast over performance for the year of £4.6m (0.5%) at Month 3. This over
performance assumes QIPP delivery of 100%.
Data submitted by providers for month 3 was of variable quality, which is not unusual early
on in the financial year. There are known data issues (omitted data fields) with UCLH
following the implementation of their EPIC system; ECDS (A&E) data set at RFL needs
further interrogation on accuracy; Whittington data is being further investigated as there are
unrecognised increases in acuity.
1.2 Other NCL Acute and Non NCL Acute Provider Contracts
Commissioners forecast a full year over performance of £1.8m on acute contracts outside of
NCL. At this early stage of the year, some providers were unable to submit data on time, or
submissions contained known errors and so were reported on plan.
Highest over performers included Moorfields (£0.8m), Guys and St Thomas’s (£1.4m) and
Homerton (£0.6m). This was partially offset by underperformance at Chelsea and
Westminster (£0.3m), West Hertfordshire Hospitals (£0.3m) and St George’s (£0.3m).
To date, there is a reported under performance of £2.9m on ‘Other Acute’ contracts. These
include Private Provider contracts, non-commissioned activity at providers elsewhere and
services commissioned at our providers that sit outside of the main contract value.
1.3 2019/20 NCL Contract Agreement
With the exception of UCLH, all acute and non-acute contracts have been agreed and signed within NCL CCGs. The constructs are as follows: Whittington Health: A payment by results (PbR) contract has been agreed. This includes an agreement on QIPP schemes and the Provider to support joint working on delivering outpatient transformation as an additional cost reduction opportunity throughout the year. North Middlesex Hospital: A PbR contract with Cap and Collar arrangement has been agreed. This agreement includes a condition that if any of our QIPP schemes takes the contract to below the value of the collar, this will have a 70% tariff benefit to ourselves and a 30% tariff contribution will be made to the Trust to cover off unplanned stranded costs. Royal Free London: A block contract with a Cap and Collar arrangement has been agreed. The Cap and Collar has a variable element of £5m related to activity, whether it is under or over performance. Of the £5m element, £3m relates to emergency care & £2m to planned care activity. University College London Hospital: A two year block arrangement was agreed 24th May 2019. The value for year one has been agreed and year two will take into consideration shifts, up or down, in activity throughout 2019/20 and will be aligned to the NCL Medium Term Financial Strategy (MTFS). There are a number of CCGs associated to this contract that have yet to agree their block value and this is now, due to a shortfall in planned income by the Trust, causing delay to signature.
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1.4 Claims and Challenges in 2019/20
We have agreed with providers that our approach to Claims and Challenges need to change in 19/20.
The approach in the past has become adversarial at times and has consumed resources that could
be used to better effect on service transformation. The key change from the past approach is that
apparent ‘step changes’ in coding or recording will be jointly investigated for future understanding.
Neither CCGs nor Providers are expected to proactively look for opportunities to challenge or code.
Instead the Trust and the CCG will work together to identify and remediate challenges where
appropriate to reduce the volume of queries.
As part of the contractual meetings, we will continue to monitor claims and challenges. In the event
that there is a material activity increase against the 19/20 activity plan, the activity delivered in
2019/20 or if a new query is raised, this will be flagged to the Trust for discussion. Materiality
thresholds will be discussed and agreed in the Contract Technical Group (CTG) and reported to the
Contract Management Group. Contractual notice periods and processes will still apply.
1.4.1 Claims and Challenges (open and not accepted by Providers) The largest open queries at Month 1 2019/20 for the NCL CCGs at all providers are:
• Maternity Pathway Casemix Complexity not Evidenced - £855k • Diagnostic Imaging Variances SUS and Non-SUS Datasets - £853k • Single record queries – Financial - £574k • Aggregate Record Queries – Financial - £426k • Non-E-Referred Outpatient First Attendance - £309k
Aggregate and Single record queries are manual challenges where there appear to have been
systematic problems affecting a group of charges. Closedown of these claims is part of year end
agreements or part of quarterly reconciliation escalations.
1.4.2 Claims and Challenges (accepted) At Month 1, £223k of claims have been accepted by Providers. A breakdown of accepted claims by
CCG is shown below:
• Barnet - £ 14k
• Camden - £ 15k
• Enfield - £ 52k
• Haringey - £106k
• Islington - £ 36k
Accepted claims will change once the final year end position for each Provider is agreed.
1.5 Quality, Innovation, Productivity and Prevention (QIPP) workstreams by Provider
1.5.1 North Middlesex University Hospital (NMUH)
Headlines for the Trust:
NMUH, Haringey CCG and Enfield CCG are working together to more closely align work on
QIPP (Quality, Innovation, Productivity and Prevention) and CIP (Cost Improvement Plans).
As part of this, a Local Delivery Board made of up of Executive Team members has been
meeting monthly since February 2019 to unblock delivery challenges on existing plans and
strengthen emerging schemes.
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Progress on schemes:
During Quarter one, NMUH, Haringey and Enfield CCGs have:
Agreed improvement plans to both increase the number of Clinical Advice and
Guidance (CAG) referrals from primary care and responsiveness to queries from
hospital specialists. The impact of these will be monitored through the Local Delivery
Board during Q2 – for example, in May 2019, Haringey and Enfield primary care
clinicians doubled their volume of CAG requests;
Established a Joint Outpatients Programme Transformation Board, chaired by
NMUH’s Medical Director, to progress the vision outlined within the NHS plan. A joint
piece of work is underway to scope initial areas for focus between NMUH, Haringey
and Enfield CCG operational and planned care leads. This was presented at the first
joint meeting on 16th July;
Mobilised operational pathways between community services and ED ahead of the
July launch of Enfield’s enhanced frailty scheme, which focuses on improved
admissions avoidance and care outside of hospital settings;
Held a number of clinically led system-wide workshops with operational leads to
agree actions to improve the interface between acute, community, social care and
primary care services in relation to joint work on frailty (a shared QIPP/CIP priority).
As a result of this a joint system wide project implementation group is being
established;
Agreed that NMUH’s Medical Director will join the NCL Planned Care Steering
Group; and
Launched improved pain management pathways in Enfield and agreed funding for
the full role out of the MSK Single Point of Access in Haringey from July.
Actions:
During July and August 2019, NMUH, Haringey and Enfield CCGs are:
Working to understand the impact that a number of QIPP schemes are having so far
(MSK, Rapid Response and Paediatric Admission Avoidance);
Jointly reviewing indicative data on QIPP achievement during 2019/20 which is due
to be available for M2 from early August. This will allow partners to work together to
mitigate any risks to delivery in addition to those that are already being taken via
monthly highlight reporting;
Assessing progress against expected outcomes in relation to new Pain Management
(in Enfield), MSK pathways (in Haringey) and the CAG improvement plan across all
partners; and
Bringing together clinicians to jointly review findings from the recent non-elective care
audit in order to agree pathway improvements both internally at the Trust and in the
community.
1.5.2 Whittington Health (WH)
Headlines for the Trust:
WH, Islington CCG and Haringey CCG are working together to more closely align work on
QIPP and CIPs. As part of this, a Local Delivery Board made of up of Executive Team
members has been meeting monthly since January 2019 to unblock delivery challenges on
existing plans and strengthen emerging schemes. It has agreed to focus on two main
programmes of work which encompass a number of QIPP and CIP schemes:
27
7
(i) Transforming Outpatients to avoid unnecessary planned care activity and (ii) Improving
Bed Usage to reduce unnecessary admissions and excess bed days.
Progress on schemes:
During Quarter one, WH, Islington and Haringey CCGs have:
Agreed improvement plans to both increase the number of CAG referrals from
primary care and responsiveness to queries from hospital specialists. The impact of
these will be monitored through the Local Delivery Board during the coming quarter;
Established a Joint Outpatients Programme Transformation Board, chaired by WH’s
Chief Operating Officer, to progress the vision outlined within the NHS plan. A piece
of scoping work was undertaken collaboratively by commissioning leads and WH’s
project manager for outpatient transformation to agree initial areas of focus including
the redesign of the gastro service; group consultations and exploration of e-
consultations;
Made progress on reducing escalation beds through joint work to improve bed
usage. This joint collaborative plan focuses on the achievement of QIPP schemes
including admission avoidance, Last Phase of Life and Simplified Discharge as well
as CIP scheme enablers such as MADE (Multi-Agency Discharge Events) and a
specific focus on specialisms with higher than benchmarked lengths of stay. A key
benefit of this has been a marked reduction in excess bed days; and
Agreed funding for the full role out of the MSK Single Point of Access in Haringey
and Islington from July.
Actions:
During July and August 2019, WH, Islington and Haringey CCGs will be:
Jointly reviewing indicative data on QIPP achievement during 2019/20 which is due
to be available for M2 from early August. This will allow partners to work together to
mitigate any risks to delivery in addition to those that are already being taken via
monthly highlight reporting;
Assessing progress against expected outcomes in relation to the MSK roll out; and
Assessing progress against the expected outcomes in relation to CAG improvement
plans between all partners.
1.5.3 University College London Hospitals (UCLH)
Headlines for the Trust:
Work continues to progress to set up a joint transformation team between UCLH and
Camden CCG. Discussions on the governance structures took place in early July and a Joint
Transformation Board with senior representatives will be put in place.
The team will work across the Trust and CCG to deliver a joint programme of work that will
focus on delivering some key objectives from the Long Term Plan e.g. reducing Length Of
Stay (LOS) and face to face outpatient appointments as well as some other joint priorities
e.g. Evergreen ward and improving the arrangements for transitioning mental health patients
into the community.
Progress on schemes:
Whilst the UCLH QIPP is financially delivered through the block contract, there is still
a key requirement to ensure QIPP schemes deliver the expected activity reductions
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8
to deliver transformation and inform the baseline for 2020/21. At Month 3 the acute
data was not available to report in terms of QIPP impact as a result of data quality
issues in the Month 1 dataset. The Trust reported that these data issues relate to the
implementation of EPIC. Data quality issues have also been flagged as part of the
Month 2 dataset. These continue to be managed as part of the UCLH data assurance
arrangements.
There are proposed areas of work for the joint transformation team that expand on
existing schemes in:
Gastroenterology
Teledermatology
Sleep Apnoea
Integrated Paediatric Service
Decommissioning Evergreen Ward
Evidence based interventions and clinical standards (EBICS) policy went live at
UCLH from the 1st July;
CAG action plans will be shared between CCG and UCLH which are focused on
increasing usage of CAG between primary care and trust; and
UCLH have started to develop a High Intensity User Forum. An ED consultant is
currently being sourced to be the clinical lead at the monthly meetings. During the
summer the terms of reference and processes will be agreed.
Actions:
Camden CCG and UCLH will continue to work together over the summer to define
the governance structures associated with the joint transformation team including
refocusing the Local Delivery Group (LDG); and
Monthly UCLH LDG meetings, attended by Camden and Islington, will drive the pace
of change. The intention in future is to also discuss
Incorporate CIP plans into LDG discussions.
1.5.4 Royal Free London NHS Foundation Trust (RFL)
Headlines for the Trust:
RFL, Barnet, Enfield and Camden CCGs continue to work together to deliver system
transformation plans. Key risks and issues for QIPP programmes are escalated through the
regular meetings of the LDG which has recently extended membership to operational and
transformation leads at RFL as well as CCG QIPP leads to support delivery and align
priorities.
Progress on schemes:
During the first four months of 2019/20 RFL, Barnet, Enfield and Camden CCGs made the
following progress on QIPP programmes:
Established an outpatients transformation programme at RFL to progress the vision
outlined within the NHS Long Term Plan, including focussing on increased non face
to face appointments and reduction in follow-ups via patient initiated follow-ups;
Launched a new community based anticoagulation service in Barnet to follow up
lower risk patients;
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9
Mobilised the NCL tele-dermatology service for Camden and extended the existing
Barnet and Enfield tele-dermatology to skin rashes as well as lesions;
Launched the new Evidence Based Intervention and Clinical Standards policy in
April 2019 for all providers and commissioners in NCL;
Launched a new test administered in primary care to detect bowel cancer (Faecal
Immunotherapy Test – FIT), this is intended to reduce the number of unnecessary
colonoscopies required in secondary care;
Agreed improvement plans to both increase the number of CAG referrals from
primary care and responsive times to queries from RFL specialists; and
Launched improved pain management pathways in Enfield. This will help alleviate
some of the growing operational pressures at RFL.
Actions:
During August 2019, system partners will continue to work together to progress delivery
against QIPP schemes, including:
Attending a system outpatient workshop to collate ideas on how to reduce face to
face hospital appointments where appropriate; and
Review data to assess delivery impacts for all QIPP programmes
Use the LDG to identify and address any identified risks/issues.
2. Activity
Please note, UCLH migrated their electronic patient records system to EPIC on 31st March
2019 and so activity data should be treated with caution in the first few months of the year
while the new system becomes embedded within the Trust.
Weekly calls are in place with the Trust’s responsible Director and the Directors of Quality
and Contracting for Camden CCG, NCL Director of Performance and NCL Director of
Commissioning Data. Action logs capture the ongoing issues that are tracked through these
calls or via the contract’s technical group.
To ensure greater accuracy for the activity trends, the analysis and commentary in the next section therefore excludes UCLH data. Also to note, due to the timing of this report the activity relates to Month 2.
2.1 Overall Referral Trends The annualised trend indicates a 1.1% increase in referrals. At Trust level, there have been reductions at NMUH and at WH, with increases seen at UCLH and RFL. There has also been an increase in referrals to out-of-sector providers, particularly to Barts Health and BMI. Within NCL there is a continuing increase in Two Week Wait (Suspected Cancer) referrals across all specialties. This has oversight through the Cancer Alliance Board. QIPP schemes are expected to impact on this trend as the year progresses.
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10
2.2 First attendance Outpatients
First attendance outpatient activity reported a 4% over performance in comparison to previous year’s activity levels.
The Royal Free reported an increase of 4% year-on-year. If this activity continues to increase the 2019/20 contract construct ‘protects’ commissioners from a financial risk as over performance will be monitored against GP referrals rather than outpatient attendances. NMUH have seen a year on year growth of 5%. One of the main specialties contributing to the increase in trend was Dermatology. As this is an outsourced service, the Trust has confirmed the provider has had to resolve a number of capacity issues in order to achieve the aim of reducing the overall waiting list backlog and this has resulted in a catch up on first attendances. The Whittington reported a flat trend year-on-year.
Clinical Advice and Guidance (CAG) is a key action that can support the reduction in first outpatient attendances. By the end of 2018/29 we were reporting an increase number of referrals through this route with Royal Free receiving the highest number of requests. Ongoing monitoring continues to take place in both the Activity Review Group and individual CCG Local Delivery Teams.
Action: Increase the number of GP practices using CAG services. Being led by the Planned Care Workstream lead.
Action: CCGs to monitor own use of CAG and Tele-dermatology services through Local Delivery Team meetings. Monthly.
Action: Confirmation from the North Middlesex that Tele-dermatology service will start CAG in 2019/20.
2.3 Follow ups
Outpatient follow up activity reported a 1% increase in comparison to previous year’s activity levels.
Royal Free activity reported a reduction of 1% in comparison to previous year.
NMUH also reported reductions of5% year-on-year. The impact of the Haringey MSK triage
service (provided by Whittington Health Community services) is contributing to this
decrease.
WH on the other hand reported an increase year on year of 7%. This was across a number
of specialties including: Urology, General Medicine, Physiotherapy and Geriatric Medicine.
In order to address these trends and 2019/20 contractual outpatient efficiencies, a
‘Whittington Outpatient Transformation Board’ has been established with the intention to
review outpatient services.
Action: First to Follow Up ratios, by Provider and Speciality are monitored by the
contractual teams and queried with the Trusts as required. Monthly.
Action: NCL Commissioners and QIPP leads are collectively looking at outpatient
benchmarking with their provider through the local delivery group or transformation
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11
boards. The approach has been supported by the STP Planned Care steering group
and this is expected to remove contacts that are adding no value & inconveniencing
patients. Monthly.
2.4 Planned Care
The level of activity has increased by 6% compared with the same period as last year. Royal Free is showing a decrease in activity of 1% compared to last year. Royal Free have developed key performance indicators in collaboration with commissioners to ensure effective monitoring of the data quality, validation, training and operational grip during its RTT reporting suspension period. Progress on these areas will be monitored via the monthly RTT Steering Group and performance review meetings. Recovery action plans are in place for all high volume specialties where capacity issues have been identified, except for general surgery and maxillofacial. Commissioners are asking the Trust to provide assurance around these services. As a result, activity levels may increase. As with the outpatient first attendance increases, the level of over performance for planned care activities is ‘protected’ by the 2019/20 contract construct. Whittington and NMUH are showing increases in activity of 15% and 8% respectively compared to 2018/19. Although it is early in the reporting year, the cost of this activity, the impact on waiting times and the impact of QIPP programmes will be closely monitored by the contracts and performance teams. Action: Contract Review Group to monitor Providers activity to assess if this is taking place in the lowest cost environment. Monthly. Action: Monitor referral data and waiting list sizes at Contract and Performance meetings. Monthly. Action: NCL Commissioners and QIPP leads are collectively looking at planned care benchmarking with their provider through the local delivery group or transformation boards. The approach has been supported by the STP Planned Care steering group. Monthly. 2.5 A&E attendances
Month 2 activity is 1% above the outturn for the same period in 2018/19. NMUH and WH are
driving this increase. Compared to 2019/20 there have been 813 more patients attending
A&E for NCL CCGs.
There are more patients being recorded as attending with no investigations required. Whilst
this is a lower cost activity it is an area where demand management could have the greatest
impact.
Action: Each CCG is working alongside the UEC STP workstream on delivering
demand management schemes across NCL.
Action: Working with each of the provider A&E delivery boards, particularly at WH and
NMUH, on reducing attendances will be a key action for each CCG.
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2.6 Non Elective Admissions
Overall the growth for NEL admissions is up by 1% in comparison to the same period last year. This equates to 240 more patients treated in Non Elective settings for NCL CCGs at all Providers. RF and NMUH are both showing increases in admissions compared to last year whilst admissions at WH have reduced. It is expected that the number of admissions at RF will begin to fall as the 2019/20 contract incentivises the trust to discharge rather than admit when this is the correct pathway to follow. At NMUH stroke and neonatal/paediatric activity are contributing to the higher number of admissions that the contract monitoring group are reviewing. The zero length of stay, year on year at Month 2, is up by 7%. Contract teams will monitor for a corresponding drop in other shorter stay admissions as the impact of assessment units, ambulatory care units and urgent care centres are expected to increase and avoid admissions. 2.6.1 North Middlesex University Hospital Non Elective Audit
A clinical audit was undertaken at NMUH on 1st April 2019.
The objective of the audit was to clarify the reasons for the admission, if it could have been
avoided and if the patient could have been treated in a different setting.
The audit report is now complete and the Trust and CCG are coordinating two separate
meetings to discuss the clinical pathways and contractual implications.
2.6.1 Royal Free Non Elective Audit
A clinical audit was undertaken at Royal Free and Barnet hospital sites on the 13th February
and 24th April 2019.
The objective of the audit was to establish whether an admission to the Adult Assessment
Unit could have been avoided and whether alternative services could have been available in
primary and community services. The aim was also to inform any future commissioning
decisions.
The final report has been completed and approved by the Barnet CCG Director of
Commissioning. The final report will be presented and discussed at the Contract
Management Group on 30th July and next steps will be agreed.
33
Acute Commissioning Report
Finance and Activity
August 2019 JCC Meeting
34
Financial Performance
Month 3
2 35
Performance Against CCG Contract Plans
3
Overall Summary:
The Committee is asked to note the following when considering the NCL CCG finance and activity position for acute contracts, as at month 3,
2019/20.
• Month 3 is the first month where reporting is based on provider submitted SLAM data in contrast to earlier months where reporting was to
plan.
• Data submitted by providers for month 3 was of variable quality, which is not unusual early on in the financial year. There are known data
issues with UCLH following the implementation of their EPIC system; RFL also has an issue with its ECDS (A&E) data set; Whittington
data is being further investigated as there are increases in acuity and some out of sector providers’ data was not submitted and was
accrued to plan.
• Based on the information that is available, we can report the four main NCL acute providers forecast over performance for the year of
£4.6m. This includes £0.5m over performance at NMUH, £2.1m at RFL and £2m at Whittington.
• QIPP was reported on plan for Month 3.
• Other providers (see slide 7) report a forecast outturn variance of £1.8m. Highest over performers included Moorfields (£0.8m), Guys and
St Thomas’s (£1.4m) and Homerton (£0.6m). This was partially offset by under performance at Chelsea and Westminster (£0.3m), West
Herts Hospitals (£0.3m) and St George’s (£0.3m).
36
Performance Against CCG Contract Plans
4
Adjustments:
NCL CCGs have included the following adjustments in the reported position at Month 3.
• QIPP adjustments have been put through based on plan, assuming 100% achievement.
• Seasonality adjustments have been applied to NMUH (£0.2m) and Whittington (£1.1m). This adjustment is based on SUS data and due to
variable quality, seasonality adjustments were excluded for RFL and UCLH.
• Critical care forecast variances have been adjusted by 75% under/over performance to smooth out the impact of high cost patients in the
early part of the year.
• Out of sector providers with no submission or reported with known errors have been reported to plan.
Risks:
• In year QIPP monitoring will reflect a more realistic QIPP delivery profile as the year progresses.
• Any over performance at Whittington cannot be mitigated through contract form because the contract is a standard ‘Payment by Results’
contract. This contrasts with the other three main in sector acute Trusts where CCGs will be able to partially mitigate any over
performance through contract form.
37
Month 3 Acute Performance against
CCG Plans
5
The table below report the acute financial performance against CCG plans:
CCG plans assume delivery of a higher QIPP value, i.e., more savings, than the value of QIPP included in the signed
contracts.
Adverse / (Favourable)
Commissioner Provider YTD CCG Plan YTD Actual YTD Variance Annual CCG
Plan Annual Actual
Annual
Variance
Movement
from last
month
NHS Barnet CCG North Middlesex University Hospital NHS Trust 658,049 687,120 29,071 2,633,624 2,755,798 122,174 122,174
Royal Free London NHS FT 50,844,919 51,101,900 256,981 203,489,620 204,518,098 1,028,478 1,028,478
University College London Hospitals NHS FT 7,050,462 7,050,462 0 28,217,091 28,217,091 0 0
Whittington Health NHS Trust 3,118,997 3,609,309 490,312 12,482,730 12,604,998 122,268 122,268
NHS Barnet CCG Total 61,672,427 62,448,790 776,363 246,823,065 248,095,985 1,272,920 1,272,920
NHS Camden CCG North Middlesex University Hospital NHS Trust 83,988 96,013 12,025 341,034 385,074 44,040 48,074
Royal Free London NHS FT 17,289,683 17,380,559 90,876 68,206,477 68,569,464 362,987 850,904
University College London Hospitals NHS FT 18,492,138 18,492,138 (0) 73,325,390 73,325,390 0 0
Whittington Health NHS Trust 1,570,377 1,582,507 12,130 6,225,259 6,320,934 95,675 251,596
NHS Camden CCG Total 37,436,186 37,551,217 115,030 148,098,160 148,600,861 502,701 1,150,573
NHS Enfield CCG North Middlesex University Hospital NHS Trust 29,695,096 30,130,513 435,417 118,780,382 119,954,000 1,173,618 1,173,618
Royal Free London NHS FT 21,099,297 21,205,797 106,500 84,397,189 84,926,000 528,811 528,811
University College London Hospitals NHS FT 4,253,783 4,253,783 (0) 17,015,126 17,015,122 (4) (4)
Whittington Health NHS Trust 1,304,250 1,240,813 (63,437) 5,217,000 5,258,924 41,924 41,924
NHS Enfield CCG Total 56,352,426 56,830,907 478,480 225,409,697 227,154,046 1,744,349 1,744,349
NHS Haringey CCG North Middlesex University Hospital NHS Trust 22,080,283 21,377,847 (702,436) 88,321,134 87,127,303 (1,193,831) (1,193,831)
Royal Free London NHS FT 5,726,322 5,754,512 28,190 22,905,290 23,019,978 114,688 114,688
University College London Hospitals NHS FT 6,356,443 6,356,443 0 25,425,774 25,425,774 (0) 0
Whittington Health NHS Trust 15,047,490 15,628,983 581,493 60,189,962 60,971,426 781,464 781,464
NHS Haringey CCG Total 49,210,538 49,117,785 (92,753) 196,842,160 196,544,481 (297,679) (297,679)
NHS Islington CCG North Middlesex University Hospital NHS Trust 227,873 318,427 90,554 926,014 1,277,101 351,087 351,087
Royal Free London NHS FT 3,271,186 3,288,025 16,839 13,293,206 13,360,560 67,354 67,354
University College London Hospitals NHS FT 19,060,620 19,060,620 0 77,457,148 77,457,148 0 0
Whittington Health NHS Trust 17,241,438 18,672,063 1,430,625 70,064,489 71,023,363 958,873 958,873
NHS Islington CCG Total 39,801,117 41,339,135 1,538,018 161,740,858 163,118,172 1,377,314 1,377,314
Grand Total 244,472,694 247,287,834 2,815,139 978,913,940 983,513,546 4,599,606 5,247,478
38
Month 3 Acute Performance
(includes Out of Sector)
6
The table below reports the acute financial performance by provider against CCG plans:
‘Other Acute’ contains i) Private Providers ii) Overseas iii) London Ambulance Service (LAS) contract iv) Non Contract Activity
v) Service Level Agreement exclusions (e.g. activity at RFL outside the main contract) vi) Prior Year Impacts and vii) Acute
demand reserves.
The actual forecast over performance for the year of £4.6m across the four main acute contracts for the five CCGs is after
allowing for 100% QIPP delivery. Total acute over performance is £3.5m over plan.
Adverse / (Favourable)
Service Provider Description YTD CCG Plan YTD Actual YTD Variance Annual CCG
Plan Annual Actual
Annual
Variance
Movement
from last
month
North Middlesex University Hospital NHS Trust 52,745,289 52,609,920 (135,369) 211,002,188 211,499,276 497,088 501,122
Royal Free London NHS FT 98,231,407 98,730,793 499,386 392,291,782 394,394,100 2,102,318 2,590,235
University College London Hospitals NHS FT 55,213,446 55,213,446 0 221,440,529 221,440,525 (4) (4)
The Whittington Hospital NHS Trust 38,282,552 40,733,674 2,451,122 154,179,440 156,179,644 2,000,204 2,156,125
Sub Total 244,472,694 247,287,834 2,815,139 978,913,940 983,513,546 4,599,606 5,247,478
Other Provider Contracts 15,455,671 15,489,286 145,629 133,914,342 135,707,934 1,793,592 1,344,898
Other Acute 51,233,343 50,673,112 (672,245) 133,164,455 130,253,536 (2,910,920) (1,546,479)
Grand Total 311,161,709 313,450,232 2,288,523 1,245,992,737 1,249,475,015 3,482,278 5,045,897
39
Month 3 Acute Performance
(Other Providers)
7
The table below reports the acute financial performance at all NHS contracted acute providers, excluding the main four, this
includes out of sector providers:
Adverse / (Favourable)
ServiceProviderDescription YTD CCG Plan YTD Actual YTD Variance Annual CCG
Plan Annual Actual
Annual
Variance
Movement
from last
month
Barts Health NHS Trust 6,494,715 6,493,179 (1,536) 26,106,750 26,106,750 0 (0)
Moorfields Eye Hospital NHS Foundation Trust 5,357,207 5,477,379 120,171 21,510,398 22,266,924 756,526 756,526
Royal National Orthopaedic Hospital NHS Trust 1,912,494 1,853,089 (59,405) 7,661,598 7,625,804 (35,794) (35,789)
Barking, Havering and Redbridge University Hospitals NHS Trust271,425 232,633 (38,792) 1,088,362 937,425 (150,937) (150,937)
Imperial College Healthcare NHS Trust 4,692,121 4,675,831 (16,290) 18,667,246 18,922,596 255,349 255,349
Royal Brompton & Harefield NHS Foundation Trust 546,954 547,425 470 2,191,888 2,191,888 0 (256,038)
The Royal Marsden NHS Foundation Trust 303,555 255,795 (47,760) 1,216,956 1,048,505 (168,451) (249,297)
King's College Hospital NHS Foundation Trust 630,977 615,095 (15,882) 2,532,233 2,505,780 (26,453) (29,391)
Great Ormond Street Hospital for Children NHS Foundation Trust849,053 849,053 0 3,405,371 3,405,371 0 0
Chelsea and Westminster Hospital NHS Foundation Trust1,018,405 933,551 (84,854) 4,084,829 3,818,347 (266,482) (266,482)
The Princess Alexandra Hospital NHS Trust 180,427 180,427 (0) 721,713 721,713 0 0
Homerton University Hospital NHS Foundation Trust 3,524,355 3,670,959 146,604 14,173,488 14,799,253 625,765 529,153
West Hertfordshire Hospitals NHS Trust 377,907 304,263 (73,644) 1,512,448 1,240,361 (272,087) (272,087)
Guy's and St Thomas' NHS Foundation Trust 3,333,307 3,641,370 308,064 13,379,652 14,791,524 1,411,873 1,411,873
St George's University Hospitals NHS Foundation Trust 333,842 241,254 (92,589) 1,339,777 1,004,061 (335,716) (347,981)
London North West University Healthcare NHS Trust 3,470,368 3,471,439 1,071 13,892,764 13,892,764 (0) 0
East and North Hertfordshire NHS Trust 107,217 107,217 0 428,869 428,869 0 0
Grand Total 33,404,329 33,549,958 145,629 133,914,342 135,707,934 1,793,592 1,344,898
40
Activity Trend Analysis
Month 2
8 41
Demand: GP Referred Activity
9
42
Outpatients Activity: First Attendances
10
* UCLH data is not included in the details above.
43
Outpatients Activity: Follow Up Attendances
1144
Elective Activity: Planned Care
1245
Activity Deep Dive
Unscheduled Care : Accident & Emergency (A&E)
13
* UCLH data is not included in the details above.
46
Unscheduled Care : Non-elective Admissions
* UCLH data is not included in the details above.14 47
1
NCL Joint Commissioning Committee Thursday, 1 August 2019
Report Title NCL Acute Services Quality & Performance Report – July 2019
Date of report: 18 July 2019
Agenda Item
3.2
Lead Director /
Manager
Paul Sinden Director of Performance, Planning and Primary Care for NCL CCGs
Tel/Email [email protected]
GB Member Sponsor
Not applicable.
Report Author
Richard Cartwright Associate Director Provider Performance NEL CSU
Tel/Email [email protected]
Name of Authorising Finance Lead
Not applicable. Summary of Financial Implications: Not applicable.
Report Summary
This report provides a summary of the operational performance across NCL acute providers and the actions to address areas for improvement in 2018/19. The report also includes updates on patient safety, patient experience and service quality impacted by operational service performance. The exception reports summarise the key issues impacting across NCL and individual CCGs for the following providers:
North Middlesex University Hospital
Royal Free London Hospital
University College London Hospital
Whittington Health
Royal National Orthopaedic Hospital and Moorfields Eye Hospital London Central and West Unscheduled Care Collaborative - Integrated Urgent Care service (NHS 111 and GP out-of-hours) provider
London Ambulance Service. The detailed NCL Acute Services Quality and Performance Report for May 2019 is available from here.
Recommendatio
n
The NCL Joint Commissioning Committee is asked to:
COMMENT on the actions being taken to deliver improvements in service quality and operational performance across NCL
APPROVE the NCL JCC Quality and Performance Report, May 2019.
Identified Risks
and Risk
Management
Actions
The main risks and mitigations to note are included in the risk register for the Joint Commissioning Committee and include: Performance risks to delivery of NHS Constitution Standards for Accident and Emergency, Cancer 62-days and Referral to Treatment.
48
2
Conflicts of Interest
Not applicable.
Resource
Implications
Not applicable.
Engagement Not applicable.
Equality Impact
Analysis
Not applicable.
Report History
and Key
Decisions
Not applicable.
Next Steps Summary and detailed reports are also shared with NCL CCGs for additional monitoring at committees and governing bodies where appropriate.
Appendices
Not applicable.
What CCG does this relate to
Barnet CCG, Camden CCG, Enfield CCG, Haringey CCG, Islington CCG
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3
NCL Acute Quality & Performance Summary Report
March 2019
1. Introduction
This paper focuses on progress being made in addressing operational performance and quality of service issues in the following key areas:
Patient Experience;
Never Events & Serious Incidents;
Urgent and Emergency Care;
Referral to Treatment Waiting Times;
Cancer Waiting Times;
Diagnostics Waiting Times. 2. Patient Experience North Middlesex University Hospital remains the lowest performing Trust in London for A&E, Inpatient and outpatient Friends and Family Test. A Friends and Family Test (FFT) workshop was held to agree a Trust wide approach to achieve higher response and positive recommendation rates. In addition FFT was included in the April Ward Managers away day. FFT posters, including a QR code, are displayed above all kiosks in the Emergency Department to raise its profile and encourage more people to give feedback. Apprentices in the Emergency Department are actively seeking feedback on a daily basis. Following publication of the national CQC inpatient survey results on 20th June 2019, Healthwatch Enfield have been commissioned to support the Trust through having targeted interviews with patients in up to 10 ward and service areas, including the Emergency Department, to identify top themes, and then to support the teams address the findings. The Trust will then receive a report in July 2019 setting out all the cross-cutting themes, recommendations for action, and how staff have been supported to encourage feedback and understand these responsibilities and how best to use current systems. At the 28th June Clinical Quality Review Group (CQRG) commissioners received the NMUH Integrated Performance Report that went to the June 6th Trust Board (April data). Positive recommendations in the A&E Department were 62.7% in April. The Responsible Director of Nursing’s Action plan to improve patient experience in A&E stated the following:
Improving the FFT response rates and positive recommendations was included in the Ward Managers Away day in April 2019 and an FFT workshop on 18th February 2019. Key actions for the Emergency Department (ED) team included: Displaying the updated FFT poster above all kiosks in the department to raise their profile and
encourage more patients to give feedback. QR codes have been added to the poster and updated posters need to be printed and displayed in ED (due May 2019);
Promoting other methods of completing the feedback including text message FFT and web-based via the Trust website. QR codes will allow more patients to provide feedback. Cards have been produced to give patients and visitors
The Emergency Department team, led by the Head of Nursing and nursing/admin team leaders and apprentices continue to prioritise the collection of patient feedback – daily;
The Themes identified in the feedback are being triangulated with the findings of the national Emergency Department (ED) patient survey to inform the development of the patient experience plan for ED. The ED Head of Nursing reports on the work being done in response to FFT findings at the bi-monthly Patient Experience Group meeting.
Commissioners are planning an Insight Visit to the Emergency Department in September 2019 and this will include a review of the above actions along with any actions arising from the recent Healthwatch Enfield report.
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3. Never Events & Serious Incidents In May 2019 there were six Never Events reported in North Central London. There were three Never events at the Whittington, and one each at Royal Free London, North Middlesex University Trust and University College London Hospital.
Across NCL, 24 serious incidents were reported in May 2019, the highest number since December 2018.
Clinical Quality Review Groups for each provider scrutinise and challenge on a monthly basis the serious incidents reports for trends and new incidents.
In July 2019 UCLH attended the Committee Seminar, with the Trust providing assurance by setting out in detail the investigation and learning undertaken from Never Events that took place in 2018/2019. Actions the Trust has undertaken includes reporting all Never Events to the Quality and Safety Committee, providing support to staff involved in the events, ensuring Duty of Candour lead appointed for each event, enhancing safety visits, ensuring learning in line with Care Quality Commission “Opening the door to change” document, and introducing a surgical pause to help prevent wrong site surgery. The introduction of EPIC (the Trust’s new patient information system) was not a causal factor in the increase in Never Events experienced in February and March 2019. The Trust’s Quality Account for 2019/20 sets out how the prevention of Never Events is being addressed including the adoption of the Barts Health risk assessment tool.
The Committee Seminar has previously met with Royal Free London to review Never Events, and one of the actions from the Seminar with UCLH was to consider how to share learning from Never Events across providers in North Central London. Feedback from Trusts indicates that peer reviews are effective in encouraging learning. In addition, following a workshop with NHS London (alignment of NHS England and NHS Improvement) the establishment of a Quality Surveillance Advisory Group (QSAG) for North Central London is being considered with membership from CCGs, Trusts, NHS London, Health Education England and the Care Quality Commission. This would mirror the existing London-wide Quality Surveillance Advisory Group.
4. Care Quality Commission – Royal Free London Action Plan The Care Quality Commission (CQC) undertook a planned and comprehensive inspection of the Royal Free London (RFL) between December 2018 and January 2019 and gave the trust an overall rating of ‘requires improvement’. This is a deterioration from the previous inspection in 2016 when the overall CQC rating was ‘Good’. This was summarised to the Committee in June 2019. The Trust has submitted the full action plan to address the care Quality Commission findings, and Barnet CCG is working with the Trust to support implementation of the plan. Implementation is monitored through the Clinical Quality Review Group. In June 2019 the Committee asked for an update on the Trust’s progress against the milestones to improve their working culture. The detailed report provides an overall overview of the action plan, and within this Trust have undertaken a number of actions to address this issue, including:
Increasing the number of ‘speak up’ champions in order to provide staff with a safe opportunity to raise concerns;
Multi-disciplinary safety huddles in theatres;
Dedicated staff listening sessions in the top five areas where bullying and harassment is reported as per the staff survey results;
Dedicated bullying and harassment group that feeds into the People Committee;
Bullying and harassment videos shared at staff network meetings and individuals are encouraged to speak up where they experience or see behaviour which could be considered to be bullying and harassment;
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‘Joy in work’ improvement collaborative bullying and harassment quality improvement project underway - a different approach to improving behaviours in teams;
Ongoing development to embed Values and Behaviours. 5. Accident & Emergency Performance In line with the rest of London and the national position, the four hour standard across NCL remains difficult to achieve, although all providers have had some days of good performance. Barnet Hospital continues to be the most challenged site in NCL, although the Whittington has seen difficult days in July with performance dropping to below 80%. The Royal Free (site) and North Middlesex University Hospital have seen the strongest performance against the standard in recent weeks. Performance against the standard has improved at UCLH.
Given the pressure on emergency departments and broader urgent and emergency care systems in NCL on 19 July 2019 the NCL Urgent and Emergency Care Programme Board held a summit to agree actions to improve performance. The summit was set in the following context:
Performance against the four-hour waiting time standard below last year nationally by 7% and in London by 4%;
An increase in attendances at emergency departments particularly Type III (low acuity attendances) that could be seen elsewhere in the urgent care system;
Patient flow problems due to high bed occupancy linked to the volume of patients with a long length of stay in hospital beds;
Pressure on local Trust cost improvement programmes from the increase in emergency patient flows, particularly indicated by Wittington Health and North Middlesex University Hospital.
In response to the pressure regulators have asked urgent and emergency care systems to take the following measures to accelerate measures to improve streaming and flow
Reducing extended lengths of stay in hospital beds (over 21 days) in line with the target to reduce extended stays by 40% by March 2020 compared to March 2018;
Opportunities to extend GP streaming within emergency departments with relatively low levels identified at Whittington Health and UCLH compared to London average;
Accelerated implementation of same day emergency care and frailty pathways as targeted in national planning guidance for 2019/20.
Given the above the NCL Urgent and emergency care Programme Board was asked to identify actions that could improve performance before winter 2019/20. The full write-up is to follow, with initial proposals being:
Enhanced senior cover in emergency departments and primary care (hubs) in the evening to match the recent increase in patient flows from 4pm;
Acute Mental Health Professional (AMHPs) cross-Borough coverage starting with out-of-hours to reduce waits for mental health assessments and onward referral into mental health beds where required;
Bring forward London Ambulance Service direct access into same day emergency care services (in line with clinical protocols)l at all acute units to avoid conveyance into emergency departments;
Move forward on direct booking across urgent care system;
Ensure existing capacity in NCL rapid response services (with two-hour turnaround) utilised with referrals from GPs, London Ambulance Service, and Integrated Urgent Care;
Clarity on provision of wound care services to prevent emergency department presentations;
Multi-Agency Discharge Events (MADE) in mental health trusts as per acute trusts to maintain internal patient flows and release bed capacity.
A&E Delivery Boards will now agree how the above actions can be implemented. 6. London Ambulance Service The category 1 response time target (most urgent) was achieved in all NCL CCGs in May 2019. Response times in Barnet, Enfield and Haringey are consistently the most challenged.
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London Ambulance Service (LAS) have been invited to attend the Committee Seminar in September 2019 to provide an update on performance improvement including lowering response times in Enfield, Haringey and Barnet. There are a number of actions in place to improve performance in Barnet, Enfield and Haringey. These include:
Two additional vehicles/crews rostered at Chase Farm and one at Edmonton;
Active working with A&E departments to reduce ambulance handover delays, with plans targeting no handovers taking more than 30 minutes from October 2019;
The Edmonton Group Manager is engaging with the borough planner to reduce traffic calming measures;
Sector events have been held with the aim of reducing A&E attendances;
Promoting the use of the Directory of Services and Co-ordinate my Care to support conveyance to community services rather than into emergency departments where appropriate ;
NCL recruitment has been prioritised for the Edmonton and Friern Barnet ambulance stations;
Enfield CCG’s Rapid Response team is planned to be available for LAS referrals from July as an alternative to conveyance to hospital where appropriate;
Trajectories have been set to increase the number of See and Treat (patient seen by emergency response but conveyance to emergency department not required) and Hear and Treat incidents (advice and action agreed with patient without sending out an emergency response with no further action required from LAS. This will include onward referral to a GP or pharmacist).
7. Referral to Treatment Waiting Times Royal Free London continue to suspend national reporting of Referral to Treatment waiting times data following the identification of issues with the Patient Tracking List. Using a newly constructed list from April 2019, the Trust is starting to produce more reliable data which is being monitored locally in partnership with Barnet CCG and regulators. May 2019 data showed that NCL CCGs did not meet the national Referral to Treatment (RTT) standard of ensuring patients wait no longer than 18 weeks from referral to treatment. Individually all CCG’s failed to meet the target. Great Ormond Street Hospital, the Royal National Orthopaedic Hospital and University College London Hospital all failed to meet the 18 week RTT standard in May 2019. Between March and May 2019 the Patient Tracking List for NCL patients grew by over 7,000. This was largely driven by a reported increase in the number of patients waiting at University College London Hospital. This increase is principally attributable to the installation of the new Patient Administration System, and is discussed more fully below. To support patient experience, commissioners in NCL proactively review all patients waiting over 38 weeks and work with providers to minimise the risk of 52 week breaches occurring. Root cause analyses and clinical harm reviews are carried out on all long waiting patients and monitored by Clinical Quality Review Groups. The NCL Referral-to-Treatment Delivery Group has been established to focus on maintaining waiting lists within March 2018 levels (as per Operating Plan Guidance for 2018/19 and 2019/20) through mutual aid across NHS Trusts, implementation of STP initiatives including clinical advice and navigation, and insourcing or outsourcing capacity where mutual aid cannot provide sufficient NHS capacity. All Trusts have been asked to provide information on the likely impact on waiting times accruing from pension changes that deter consultants providing additional sessions to reduce any waiting time backlogs. The results, once received, will be picked up through contract meetings and the NCL Referral-to-Treatment Delivery Group.
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8. Cancer Waiting Times In May 2019, NCL providers achieved aggregate performance of 76% against the 85% 62-day cancer waiting time operational standard. This was a deterioration on previous month (80% in April 2019). The under-achievement continues to be largely attributable to delays with the prostate, upper and lower gastrointestinal, lung and gynaecological cancer pathways which are under review. Improvement actions are focused on delivering compliance with primary care referral pathways, streamlining diagnostic phase of pathways and increasing treatment capacity to match increasing demand. NCL Trusts are also receiving support from NHS Interim Management and Support (IMAS) Team and NHS Improvement. In June 2019 the Committee receive a report on a series of cancer service developments being implemented to improve patient experience and outcomes and reduce waiting times for treatment. An update on questions about the service developments asked by the Committee in June 2019 is provided below:
Patient engagement in roll-out of Faster Diagnostic Standard (FDS) includes engagement with patient representatives at London wide FDS events and NCL Cancer Commissioning board so far. Plan to engage further with patient groups (patient participation groups and Healthwatch) will be developed in the next few months through working closely the CCG/borough teams;
In 2019/20 Trusts are shadow reporting in readiness to implement and meet the cancer diagnosis target in the NHS Long Term Plan. Across NCL approximately 40% of all cancers have staging reported to allow measurement of the faster diagnosis standard. The ambition is to increase this to at least 95% of all cancers. Plans are in place to improve recording of staging data, as this will have an impact on achievement of the Long Term Plan ambition for 75% of cancer patients to be diagnosed at stage 1 or 2 by 2028, current performance is 53%. Future updates will be provided;
Timescales have yet to be determined on the inclusion of more higher-risk patients in the qFIT roll-out that will help to further reduce diagnostic endoscopy referrals. Timescales are still unclear as data collection and cleansing from all pilot sites are still ongoing. Pooled data will then have to be analysed and a national threshold and safety netting approach agreed before FIT can be implemented. Further clarification is being sought from clinical lead of the local pilot.
Actions to include more vulnerable / disadvantaged patients in the lung study includes: Provision of face to face interpreting services through Language Line (the main provider for most
NHS organisations); Longer appointments if required by patients due to requirement for an interpreter; Provision of translated materials in the top 3 languages requested for across North Central and
North East London (Polish, Turkish, Bengali); UCLH and Mile End Hospital sites have dedicated moving and handling facilities for patients with a
physical disability that require specialist support. All sites are wheelchair accessible; Staff provide support at the sites to those that may have lower levels of English but do not require
an interpreter, to complete relevant health history and lifestyle questionnaire; Working with a communications agency to specifically target communities that typically have lower
engagement in healthcare and screening services. Our communication channels include working with businesses and organisations such as local pharmacies, libraries, leisure centres, councils, to ensure that we are raising awareness of the study and different communities take up their invitations;
All materials produced took into consideration the reading levels of the target population and were tested with patient groups to ensure that the literature was not a barrier to participation.
Provision of FIT for more vulnerable / disadvantaged patients includes all patients being supported by primary care to undertake the test if needed. The Equality Impact Assessment for the service indicates that patient information leaflets are also being translated into 10 other languages;
Communications to encourage take-up of lung cancer screening need to be carried out in accordance with information governance rules. NCL information governance and freedom of information leads have reviewed the study processes in order to provide a further level of assurance to Primary Care that all data will be handled in accordance to the GDPR and Data Protection Act. This has been communicated to primary care via the NCL GP & Primary Care Cancer Newsletter. Additional communications include via NCL Cancer Clinical Leads, Cancer Research UK Facilitators and GP newsletters/bulletins. Practice
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uptake of the study is currently Barnet (85%), Camden (38%), Enfield (72%), Haringey (37%), and Islington (59%);
Actions to recover the two-week breast symptomatic waiting time standard at NMUH includes the faulty mammography machine back up and running, the symptomatic backlog being cleared although the Trust continue to have workforce capacity constraints, and the trust is out to advert for additional breast radiologist to build resilience. These actions are expected to deliver month on month improvements in two-week wait breast symptomatic performance and recovery of the standard by the end of September 2019.
9. University College London Hospital data validation Following implementation of a new Patient Administration System at UCLH, the Trust is reporting increases in the number of patients waiting in the Diagnostics and Referral to Treatment (18 weeks) data. UCLH have identified errors on the Diagnostic Patient Tracking List (PTL) as a result of data migration to the new system and subsequent user action in the new system (EPIC). The Trust are currently not confident that the April reported position represented an accurate account of performance against the Diagnostics standard, and therefore took the decision to not report against this standard for the May reporting period. Reporting will resume for September 2019 performance. In order to resolve reporting issues for both returns, the Trust has recruited an external validation team and are engaging in extensive data analysis. The focus of the team will be on the longest reported waiting patients as a priority. Camden CCG have a weekly teleconference with the Trust and regulators to discuss EPIC implementation.
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Table 1 - NCL CCG Performance Scorecard
Data Source: NHS Digital via North East London Information Exchange
Table 2 - NCL Provider Scorecard
Data Source: NHS Digital via North East London Information Exchange
Table 3 – Ambulance Response Times
Data Source: LAS Performance Report and NHS Digital National Reports
Performance Measure
Area
Description Reporting
FrequencyThreshold
In Month (May
2019 - unless
otherwise
stated)
YTD
In Month (May
2019 - unless
otherwise
stated)
YTD
In Month (May
2019 - unless
otherwise
stated)
YTD
In Month (May
2019 - unless
otherwise
stated)
YTD
In Month (May
2019 - unless
otherwise stated)
YTD
In Month (May
2019 - unless
otherwise
stated)
YTD
Monthly 92% 87.9% 87.9% 85.0% 85.0% 89.7% 89.7% 90.4% 90.4% 87.9% 87.9% 88.3% 88.3%
Monthly 0 2 4 0 0 4 8 1 3 1 1 8 16
Monthly n/a 11654 n/a 13571 n/a 12287 n/a 17500 n/a 18889 n/a 73901 n/a
Monthly n/a -58 n/a 706 n/a 559 n/a 211 n/a 972 n/a 2390 n/a
Diagnostics Monthly 1%94.0% 95.2% 96.7% 95.9% 94.8% 96.3% 98.9% 98.0% 98.8% 97.7% 96.1% 96.5%
Cancer 2 Week Waits Monthly 93% 90.3% 90% 88.2% 88.9% 92.2% 90.1% 94.5% 92.2% 94.3% 92.3% 91.6% 90.5%
Monthly 93%
87.7%88% 88.0% 87.3% 82.3% 78.6% 90.7% 79.8% 97.4% 88.1%
88.5%84.3%
Cancer 31 Day Waits Monthly 96%99.0% 99% 97.4% 97.4% 98.0% 97.9% 94.9% 97.0% 100.0% 100.0% 97.8% 97.8%
Monthly 94%100.0% 100% 100.0% 100.0% 100.0% 100.0% 100.0% 71.4% 100.0% 100.0% 100.0% 94.8%
Monthly 98%100.0% 100% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
Monthly 94%95.2% 95% 100.0% 100.0% 100.0% 97.9% 100.0% 96.3% 100.0% 91.7% 98.3% 97.4%
Cancer 62 Day Waits Monthly 85%81.1% 81% 70.4% 69.8% 87.9% 87.5% 64.1% 75.4% 81.8% 80.4% 78.8% 81.4%
Monthly 90%100.0% 100% 100.0% 71.4% 100.0% 100.0% 100.0% 100.0% n/a n/a 100.0% 93.8%
Monthly100.0% 100.0% 100.0% 100.0% 86.8% 86.9% 86.4% 89.7% 100% 100.0% 90.1% 91.4%
Enfield CCG Islington CCG NCL STP
18 weeks RTT - Incomplete Pathway
Haringey CCGBarnet CCG Camden CCG
RTT
18 weeks RTT - Incomplete Pathway PTL (in month)
18 weeks RTT - Incomplete Pathway PTL (change from previous month)
Number of 52 week RTT pathways - incomplete pathways
Percentage of patients waiting 6 weeks or more for a diagnostic test (nb no UCLH data for May 2019 )
Percentage of patients receiving subsequent treatment for cancer within 31-days where that treatment is a
Radiotherapy Treatment Course
Percentage of patients receiving first definitive treatment for cancer within 62-days of an urgent GP referral
for suspected cancer
Percentage of patients receiving first definitive treatment for cancer within 62-days of referral from an NHS
Cancer Screening Service
Percentage of patients receiving subsequent treatment for cancer within 31-days where that treatment is
Surgery
Percentage of patients receiving subsequent treatment for cancer within 31-days where that treatment is an
Anti-Cancer Drug Regime
Percentage of patients receiving first definitive treatment for cancer within 62-days of a consultant decision
to upgrade their priority status
Percentage of patients seen within two weeks of an urgent GP referral for suspected cancer
Percentage of patients seen within two weeks of an urgent referral for breast symptoms where cancer is not
initially suspected
Percentage of patients receiving first definitive treatment within one month of a cancer diagnosis
Performance Measure
Area
Description Reporting
FrequencyThreshold
In Month (May
2019 - unless
otherwise
stated)
YTD
In Month (May
2019 - unless
otherwise
stated)
YTD
In Month (May
2019 - unless
otherwise
stated)
YTD
In Month (May
2019 - unless
otherwise
stated)
YTD
In Month (May
2019 - unless
otherwise stated)
YTD
In Month (May
2019 - unless
otherwise
stated)
YTD
Monthly 92% 94.9% 94.5% n/a n/a 80.0% 81.7% 92.1% 92.1% 92.1% 92.6% 87.5% 88.2%
Monthly 0 0 n/a n/a 18 26 0 0 6 13 24 39
Monthly 10806 n/a n/a n/a 53677 n/a 19567 n/a 42919 n/a 127876 n/a
Monthly -288 n/a n/a n/a 2948 n/a 1307 n/a 813 n/a 4782 n/a
Diagnostics Monthly 1% 0.8% 0.6% 7.0% 5.4% n/a n/a 0.8% 0.8% 3.4% 3.2% 5.0% 5.1%
A&E Monthly 95% 86.4% 86.4% 86.1% 85.3% 87.2% 83.1% 90.1% 87,8% 98.7% 98.8% 88.6% 87.4%
Monthly 95% 86.4% 86.4% 83.6% 82.8% 87.2% 83.1% 90.1% 87,8% 98.7% 98.8% 84.8% 83.0%
Trolley Waits in A&E Monthly 0 2 2 0 0 0 3 7 8 0 0 9 13
Monthly90% 93.6% 93.2% 91.0% 91.5% 92.0% 91.1% 91.7% 92.1% n/a n/a 92.6% 92.4%
Monthly 0 90.3% 88.5% 91.0% 95.0% 97.3% 95.5% 97.3% 96.6% n/a n/a 92.6% 91.2%
Monthly - 264 613 319 661 51 159 35 91 n/a n/a 669 1524
Monthly 0 1 11 22 77 0 7 4 9 n/a n/a 27 104
Cancer 2 Week Waits Monthly 93% 91.7% 89.3% 90.1% 89.3% 90.3% 89.8% 97.7% 96.4% 96.8% 91.9% 91.5% 90.3%
Monthly93% 79.4% 64.5% 90.9% 89.3% n/a 75.6% 97.4% 97.7% n/a n/a 88.8% 83.5%
Cancer 31 Day Waits Monthly 96% 98.0% 98.8% 97.3% 96.5% 96.1% 96.3% 100.0% 100.0% 94.4% 95.6% 97.0% 96.9%
Monthly94% 100.0% 100.0% 93.9% 90.0% n/a n/a 100.0% 100.0% 100.0% 100.0% 96.1% 92.7%
Monthly98% 100.0% 100.0% 100.0% 100.0% n/a n/a 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
Monthly94% 98.2% 98.0% 100.0% 100.0% n/a n/a n/a n/a 100.0% 100.0% 98.7% 98.9%
Cancer 62 Day Waits Monthly 85% 83.5% 86.7% 74.0% 79.6% 75.3% 71.5% 76.7% 82.3% 78.6% 65.6% 75.8% 77.8%
Monthly90% 100.0% 100.0% 96.8% 93.5% 100.0% 100.0% 100.0% 100.0% n/a n/a 95.7% 94.3%
Monthly88.2% 97.9% 93.1% 86.2% 84.6% 93.0% 100% 100% 80% 87% 88.7% 87.1%
Cancelled Operations Quarterly 100% 88.24% 86.46% 79.20% 79.20% 82.42% 86.57% 96.15% 96.15% 87.40% 87.40% 87.20% 88.13%
Quarterly No Threshold 68 210 130 477 276 887 26 65 220 975 720 2614
11.80% 12.90% 20.80% 15.50% 15.60% 13.40% 3.80% 16.30% 12.60% 9.50% 12.80% 10.70%
NCL STP
18 weeks RTT - Incomplete Pathway
% of LAS arrival to handover greater than 30mins - May 2019
Number of LAS arrival to handover greater than 60mins - May 2019
Number of LAS arrival to handover greater than 30mins - May 2019
UCLHOther (BMI, GOSH, Moorfields,
RNOH) NMUH
LAS Patient Handover Times - HAS compliance: LAS patient handover times recorded via HAS - May 2019
RFL
Total time spent in A & E <4 hours (all types) - June 2019
Total time spent in A & E <4 hours (type 1) - June 2019
Patients who have waited over 12 hours in A&E from decision to admit to admission - June 2019
Number of 28-day breaches as a % of all cancelled operations (2018/19 Quarter 4)
Percentage of patients receiving subsequent treatment for cancer within 31-days where that treatment is
Surgery
Percentage of patients receiving subsequent treatment for cancer within 31-days where that treatment is a
Radiotherapy Treatment Course
Percentage of patients receiving first definitive treatment for cancer within 62-days of an urgent GP referral
Percentage of patients receiving first definitive treatment for cancer within 62-days of referral from an NHS
Cancer Screening Service
Percentage of patients receiving first definitive treatment for cancer within 62-days of a consultant decision
to upgrade their priority status
Cancelled ops - breaches of 28 days readmission guarantee (2018/19 Quarter 4)
Number of last minute cancelled operations by the hospital for non-clinical reasons (2018/19 Quarter 4)
Whittington
Percentage of patients receiving subsequent treatment for cancer within 31-days where that treatment is an
Anti-Cancer Drug Regime
Percentage of patients seen within two weeks of an urgent GP referral for suspected cancer
Percentage of patients seen within two weeks of an urgent referral for breast symptoms where cancer is
not initially suspected
Percentage of patients receiving first definitive treatment within one month of a cancer diagnosis
Ambulance Handover
RTT
18 weeks RTT - Incomplete Pathway PTL (in month)
18 weeks RTT - Incomplete Pathway PTL (change from previous month)
Number of 52 week RTT pathways - incomplete pathways
Percentage of patients waiting 6 weeks or more for a diagnostic test
Sector Key Performance Indicator Target Barnet Camden Enfield Haringey IslingtonNorth Central
LondonBarnet Camden Enfield Haringey Islington
North Central
London
Category 1 Mean00:07:00 00:06:35 00:05:45 00:06:36 00:06:07 00:05:47 00:06:12 00:06:30 00:05:46 00:06:38 00:06:10 00:06:02 00:06:15
Category 1 90th Centile00:15:00 00:11:01 00:09:46 00:10:52 00:09:44 00:09:51 00:10:27 00:11:06 00:09:53 00:11:13 00:09:58 00:10:01 00:10:34
Category 2 Mean00:18:00 00:19:23 00:14:29 00:21:40 00:18:19 00:16:13 00:18:17 00:18:53 00:14:28 00:20:43 00:17:51 00:16:04 00:17:51
Category 2 90th Centile00:40:00 00:37:47 00:27:28 00:43:28 00:34:43 00:31:58 00:36:27 00:37:04 00:27:51 00:41:40 00:34:20 00:30:58 00:35:35
Category 3 Mean01:00:00 00:55:28 00:55:41 01:11:55 01:12:05 00:54:37 01:02:09 00:50:57 00:48:41 01:04:53 01:05:14 00:50:20 00:56:05
Category 3 90th Centile02:00:00 02:05:38 02:08:59 02:48:35 02:41:33 02:10:04 02:26:08 01:55:32 01:48:27 02:32:37 02:38:04 01:55:50 02:13:19
Category 4 90th Centile03:00:00 03:40:50 03:26:07 03:46:56 05:51:19 02:51:41 03:44:56 03:34:10 03:22:45 03:31:22 04:22:14 02:51:27 03:38:11
May-19 2019/20 Year to Date (May 2019)
London
Ambulance
Service
Response
Times - North
Central
London CCGs
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Table 4 – Integrated Urgent Care Service Scorecard
Data Source: London Central West Unscheduled Care Collaborative Reports
Please note: The Key Performance Indicators highlighted in grey are included for reference but not currently monitored in the contract.
Table 4 – Provider Quality Dashboard
May-19
Apr-19 May-19
NCL-IUC NCL-IUC
Engaged calls Performance ≤0.1% 0.0% 0.0%
Abandoned calls Performance <5% 3.1% 4.0%
Answer Time Performance ≥95% 100.0% 100.0%
Average waiting time Performance <00:01:00 00:00:43 00:00:48
Call waiting time Performance≥85% *Part of
Roadmap85.1% 82.2%
Life threatening referrals Performance 100% 100.0% 100.0%
Meeting individuals needs Quality 100% 100.0% 100.0%
Safeguarding Quality 100% 100.0% 100.0%
Triage rate Quality TBA 105.9% 103.7%
Transfer to 999 Performance TBA 11.3% 11.3%
Attend Accident & Emergency Department Performance TBA 8.6% 9.2%
Referred to Primary Care and other dispositions Performance TBA 54.0% 53.3%
Warm Transfers Performance 98% 53.0% 52.7%
Time taken for call back Performance 100% 45.9% 43.8%
Notifications Quality 100% 100.0% 100.0%
Patient Education Quality 100% 100.0% 100.0%
Qrt 1
Quality and Performance Indicators KPI Type Target
Performance Measure
Area
Description Reporting
FrequencyThreshold
In Month (May
2019 - unless
otherwise
stated)
YTD
In Month (May
2019 - unless
otherwise
stated)
YTD
In Month (May
2019 - unless
otherwise
stated)
YTD
In Month (May
2019 - unless
otherwise
stated)
YTD
In Month (May
2019 - unless
otherwise stated)
YTD
In Month (May
2019 - unless
otherwise
stated)
YTD
MSSA Monthly No Threshold 3 8 6 16 6 9 2 6 4 6 21 45
MRSA Cases Monthly 0 0 0 0 0 0 0 0 0 0 0 0 0
C.Diff Cases Monthly Trust Specific
Monthly & YTD3 6 4 6 8 14 0 0 1 1 16 27
Annual Target n/a 51 n/a 100 n/a 57 n/a 19 n/a n/a n/a 227
Monthly - 8 15 8 13 6 6 1 5 1 1 24 40
Monthly 0 1 3 1 1 1 1 3 3 n/a n/a 6 8
Monthly n/a 84.4% 87.1% 87.0% 87.7% 94.6% 94.7% 97.40% 97.10% 97.1% 97.3% 94.1% 94.4%
Monthly n/a 79.7% 77.8% 96.3% 94.0% 88.9% 88.8% 91.4% 90.8% 98.1% 97.7% 91.4% 91.2%
Monthly n/a 65.6% 64.2% 84.2% 83.8% 86.3% 84.6% 78.6% 78.6% 91.4% 92.4% 82.6% 81.7%
FFT % Recommended - Outpatients
FFT % Recommended - A&E
Number of Serious Incidents (SIs) Reported (Including Never Events)
FFT % Recommended - Inpatients
Number of Never Events
HCAI
Serious Incidents
NCL STPUCLHOther (BMI, GOSH, Moorfields,
RNOH) NMUH RFL Whittington
57
NCL Joint Commissioning Committee Thursday, 1 August 2019
Report Title Risk Register for the North Central London Joint Commissioning Committee
Date of report
25 July 2019
Agenda Item
4.1
Lead Director /
Manager
Paul Sinden Director of Performance, Planning and Primary Care
Tel/Email [email protected]
GB Member Sponsor
Not applicable.
Report Author
Paul Sinden Director of Performance, Planning and Primary Care
Tel/Email [email protected]
Name of
Authorising
Finance Lead
Not Applicable Summary of Financial Implications
The Risk Register assists the NCL JCC in managing its most significant financial risks.
North Central London Joint Commissioning Committee Risk Register
1. Introduction This paper provides an overview of the updated risk register for the North Central London (NCL) Joint Commissioning Committee (JCC). The risk register covers areas of commissioning delegated to the Committee by the five North Central London CCGs in November 2016. The paper sets out:
Strategic updates on risks on the NCL JCC Risk Register for August 2019.
2. Risks The Committee is asked to note the most material risks, with current risk ratings of 12 and above. There are 14 risks on the NCL Joint Commissioning Committee (JCC) Risk Register with 7 risks having a current risk score of 12 or higher. The NCL JCC Risk Register is being further developed and strengthened so the detailed register is not included and instead includes the strategic highlight report. Key Highlights: In addition to the updates in the strategic highlight report additional mitigations undertaken since April 2019 include the following for each key risk: JCC1 – Delivery of Cancer 62-day waiting time standard
Additional cancer pathway expertise into UCLH, funded by NHS England, from April 2019 to further support recovery of the waiting time standard in particular for prostate pathways;
Independent report making recommendations into sustainable delivery of 62-day waiting time standard for the prostate pathway received;
NCL task and finish group established, moving away from the North Central and North East London approach, to provide greater local focus;
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Actions to support delivery of cancer service developments to improve patient outcomes and reduced waiting times, as set out in the Acute Performance and Quality Report.
JCC2 – Delivery of waiting time standard for A&E
After action reviews for winter 2018/19 are being carried out by each A&E Delivery Board to inform plans for winter 2019/20;
Performance summit held by NCL Urgent and Emergency Care Programme Board on 19 July 2019 to identify actions to improve performance against the four-hour waiting time standard. Initial actions include: Enhanced senior cover in emergency departments and primary care (hubs)
in the evening to match the recent increase in patient flows from 4pm; Acute Mental Health Professional (AMHPs) cross-Borough coverage
starting with out-of-hours to reduce waits for mental health assessments and onward referral into mental health beds where required;
Bring forward London Ambulance Service direct access into same day emergency care services (in line with clinical protocols)l at all acute units to avoid conveyance into emergency departments;
Move forward on direct booking across urgent care system; Ensure existing capacity in NCL rapid response services (with two-hour
turnaround) utilised with referrals from GPs, London Ambulance Service, and Integrated Urgent Care;
Clarity on provision of wound care services to prevent emergency department presentations;
Multi-Agency Discharge Events (MADE) in mental health trusts as per acute trusts to maintain internal patient flows and release bed capacity.
JCC13 – Ensuring management of winter pressures supports recovery of waiting time standards for A&E, cancer and protects capacity for elective pathways. In addition to actions in JCC2 above in June and July 2019 A&E Delivery Boards have submitted plans to improve patient flow:
Plans to reduce extended lengths of stay (over 21 days) by 40% by March 2019 compared to March 2018 with weekly discharge profiles submitted to encourage reducing this patient cohort;
Plans to eliminate ambulance handovers waits into emergency departments in excess of 30 minutes from October 2019;
Plans to increase GP streaming in emergency departments. JCC 20 – Delivery of referral-to-treatment (RTT) waiting time standard
Further planned care summit held on 19 July in support of delivering our medium term financial strategy an delivering the target in the NHS Long Term Plan to reduce face-to-face outpatient appointments by 30% over five years;
To support patient experience, commissioners in NCL proactively review all patients waiting over 38 weeks and work with providers to minimise the risk of 52 week breaches occurring.
JCC26 - Ensuring service delivery to support contract management
All CCG Acute QIPP plans for 2019/20 (3% of contract baselines) are set against identified schemes. Plans equate to delivery (3%) in 2018/19;
The Acute Contract report sets out how CCG QIPP schemes are being better aligned with provider cost improvement programmes including establishing joint transformation teams to support delivery both QIPP delivery and provider cost reductions.
JCC28 – Supporting system recovery through contracts
Workshop to develop medium-term financial strategy for NCL held on 3 May 2019, focusing on both recovery actions for 2019/20 and developing actions for the medium-term to bring NCL as a system into financial balance;
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Financial plans for 2020/21 are being developed in preparation for submission of the NCL response to the NHS Long Term Plan. First cut plans will go to the STP Directors of Finance meeting on 26 July 2019 for consideration;
Cap and collar constructs have been agreed for the contracts with Royal Free London and North Middlesex University Hospital for 2019/20, and a block contract for UCLH in 2019/20 and 2020/21.
Recommendation The NCL Joint Commissioning Committee is asked to:
NOTE the report and updates to the Committee risk register;
PROVIDE FEEDBACK on the risks included;
IDENTIFY if there are any additional strategic risks falling within the remit of the Committee.
Identified Risks
and Risk
Management
Actions
The committee’s risk register is a risk management document which highlights the most significant risks to the achievement of the CCG’s strategic objectives. The risk register is a standing item for each meeting of the NCL JCC.
Conflicts of Interest
Conflicts of interest are managed robustly and in accordance with the NCL Conflicts of Interest Policy.
Resource
Implications
The risk register focuses on risks relating to delivery of the strategic objectives of the five CCGS in North Central London delegated to the Committee:
Commission the delivery of NHS constitutional rights and pledges;
Improve the quality and safety of commissioned services;
Improve health outcomes, address inequalities and achieve parity of esteem;
Maintain financial stability and ensure sustainability through robust planning and commissioning of value-for- money services.
Engagement
The report is presented to the Committee with membership including elected GP representatives, lay members, Healthwatch, Public Health and representatives from each NCL London borough.
Equality Impact
Analysis
This report was written in accordance with the provisions of the Equality Act 2010.
Report History
and Key
Decisions
The initial risk register for the Committee has been developed with reference to existing risk registers from individual CCGs, and then updated for actions to mitigate existing risks and the addition of new emerging risks.
Next Steps Work is underway to streamline risk reporting across North Central London, with registers across the Sustainability and Transformation Plan, CCGs, the NCL JCC and NCL Primary Care Committee-in-Common.
Appendices
1. NCL JCC Risk Tracker 2. NCL JCC Risk Heat Map 3. Risk Scoring Key
What CCG does this relate to
Barnet CCG, Camden CCG, Enfield CCG, Haringey CCG, Islington CCG
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Risk ID Risk Title Risk Owner Strategic Update FEB APR JUN AUG
JCC1
Delivery of Cancer 62-day
waiting time standard
(Threat)
Paul Sinden,
Director of
Performance,
Planning and
Primary Care
Delivery of performance standard further supported recently by:
• Operating Plan for 2019/20 includes recovery of the standard by October 2019 for NCL CCGs,
with this based on the refreshed recovery plans with providers developed through the local
Cancer Alliance;
• The refreshed recovery plan focuses on pathways with the most frequent breaches – prostate
(urology) and bowel (lower GI);
• Programme plan under development to implement the Governance review of NCEL Cancer
Alliance including recommendations to strengthen their performance role;
• Independent report making recommendations into sustainable delivery of 62-day waiting time
standard for the prostate pathway received;
• NCL task and finish group established, moving away from the North Central and North East
London approach, to provide greater local focus;
• Actions to support delivery of cancer service developments to improve patient outcomes and
reduced waiting times, as set out in the Acute Performance and Quality Report.
12 12 12 12 12
JCC2
Delivery of four-hour waiting
time standard for A&E
(Threat)
Paul Sinden,
Director of
Performance,
Planning and
Primary Care
Delivery of performance standard further supported recently by:
• Each A&E Delivery Board has implemented plans for winter 2018/19, with the plans supporting
an improvement in ambulance turnaround times at all emergency departments, and a reduction
in delayed transfers of care;
• After action reviews for winter 2018/19 are being carried out by each A&E Delivery Board to
inform plans for winter 2019/20;
• Performance summit held by NCL Urgent and Emergency Care Programme Board on 19 July
2019 to identify actions to improve performance against the four-hour waiting time standard.
16 12 12 12 12
JCC13
Ensuring that management of
winter pressures supports
recovery of waiting time
standards for A&E and
cancer and protects capacity
for elective pathways (Threat)
Paul Sinden,
Director of
Performance,
Planning and
Primary Care
In addition to the update in JCC2 above:
• Surge hub support, provided by Northeast London Commissioning Support Unit (NELSCU), has
been extended from 5 days to 7 days for the winter period. The surge hub support delivery of
escalation actions as urgent and emergency care system pressure increases;
• Operating plan profiles elective activity to minimise routine work at times of peak demand for
emergency pathways. Capacity for emergency surgery and cancer maintained over the winter
period;
• Plans to reduce extended lengths of stay (over 21 days) by 40% by March 2019 compared to
March 2018 with weekly discharge profiles submitted to encourage reducing this patient cohort;
• Plans to eliminate ambulance handovers waits into emergency departments in excess of 30
minutes from October 2019;
• Plans to increase GP streaming in emergency departments.
16 16 16 16 16
JCC20
Delivery of referral-to-
treatment (RTT) waiting time
standard (Threat)
Paul Sinden,
Director of
Performance,
Planning and
Primary Care
Work to keep waiting lists within March 2018 levels includes:
• Establishment of NCL RTT Delivery Group to provide system-wide solutions and mutual aid to
maintaining waiting lists within March 2018 levels;
• Providers have undertaken initial demand and capacity work to identify areas of deficit and
surplus capacity to support NCL-wide work, and through this group capacity alerts have been put
in place for pain management services at Royal Free London;
• Further planned care summit held on 19 July in support of delivering our medium term financial
strategy an delivering the target in the NHS Long Term Plan to reduce face-to-face outpatient
appointments by 30% over five years;
• To support patient experience, commissioners in NCL proactively review all patients waiting
over 38 weeks and work with providers to minimise the risk of 52 week breaches occurring.
12 12 12 12 9
JCC Risks- Highlight Report2019/20
Movement
From Last
Report
Target
Risk
ScoreCurrent Risk Score
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JCC25
Ensuring effective contract
management (Threat)
Paul Sinden,
Director of
Performance,
Planning and
Primary Care
Contract performance in 2018/19 has been supported by:
• Additional capacity for the claims and challenge that has supported the successful resolution of
claims;
• Activity deep dive established to better identify activity run-rates in contracts, the impact of
Sustainability and Transformation Plan and QIPP interventions, and changes to counting and
coding by providers.
12 12 12 12 12
12Additional mitigations underway include:
• Alternative contract forms in place to incentivise STP delivery – UCLH block contract; cap and
collar at NMUH and Royal Free London;
• A Payment Mechanism Group with providers has been established to agree local tariffs for
Sustainability and Transformation Plan interventions where required including for tele-
dermatology and Clinical Advice and Navigation;
• Development of QIPP governance process across NCL to support delivery of interventions;
• All CCG Acute QIPP plans for 2019/20 (3% of contract baselines) are set against identified
schemes. Plans equate to delivery (3%) in 2018/19;
• The Acute Contract report sets out how CCG QIPP schemes are being better aligned with
provider cost improvement programmes including establishing joint transformation teams to
support delivery both QIPP delivery and provider cost reductions.
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JCC28
Supporting system financial
recovery through contracts
(Threat)
Paul Sinden,
Director of
Performance,
Planning and
Primary Care
Mitigations underway include:
• Workshops to develop medium-term financial strategy for NCL held on 3 May and 19
July 2019, focusing on both recovery actions for 2019/20 and developing actions for the
medium-term to bring NCL as a system into financial balance;
• NCL-wide and Borough-based “Intergreat” events held with NCL STP stakeholders to
simulate the introduction of local integrated care systems. The outcome will inform
planning for 2019/20;
• Establishment of Local Delivery Groups with providers to support delivery of QIPP and
provider cost improvement programmes;
• Financial plans for 2020/21 are being developed in preparation for submission of the
NCL response to the NHS Long Term Plan. First cut plans will go to the STP Directors of
Finance meeting on 26 July 2019 for consideration;
• Cap and collar constructs have been agreed for the contracts with Royal Free London
and North Middlesex University Hospital for 2019/20, and a block contract for UCLH in
2019/20 and 2020/21.
20 20 20 20 16
JCC26
Ensuring service delivery to
support contract management
(Threat
Paul Sinden,
Director of
Performance,
Planning and
Primary Care
12 12 1212
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BAF Risk Heat Map
2 3 4 5
3
4
5
Consequence
Likelihood
2
1
1
Current Risk Score: Target Risk Score:x x
JCC 1JCC 1
JCC 2JCC 2
JCC 26
JCC 26
JCC 28
JCC 20
JCC 13
JCC 13
JCC 20
JCC 28JCC 25
JCC 25
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Risk Scoring Key This document sets out the key scoring methodology for risks and risk management.
1. Overall Strength of Controls in Place There are four levels of effectiveness:
Level Criteria
Zero The controls have no effect on controlling the risk.
Weak The controls have a 1- 60% chance of successfully controlling the risk.
Average The controls have a 61 – 79% chance of successfully controlling the risk
Strong The controls have a 80%+ chance or higher of successfully controlling the risk
2. Risk Scoring
This is separated into Consequence and Likelihood. Consequence Scale:
Level of Impact on the Objective
Descriptor of Level of Impact on the Objective
Consequence for the Objective
Consequence Score
0 - 5% Very low impact Very Low 1
6 - 25% Low impact Low 2
26-50% Moderate impact Medium 3
51 – 75% High impact High 4
76%+ Very high impact Very High 5
Likelihood Scale:
Level of Likelihood the Risk will Occur
Descriptor of Level of Likelihood the Risk will Occur
Likelihood the Risk will Occur
Likelihood Score
0 - 5% Highly unlikely to occur
Very Low 1
6 - 25% Unlikely to occur Low 2
26-50% Fairly likely to occur Medium 3
51 – 75% More likely to occur than not
High 4
76%+ Almost certainly will occur
Very High 5
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3. Level of Risk and Priority Chart
This chart shows the level of risk a risk represents and sets out the priority which should be
given to each risk:
LIKELIHOOD
CONSEQUENCE
Very Low
(1)
Low (2)
Medium (3)
High (4)
Very High
(5)
Very Low (1)
1 2 3 4 5
Low (2)
2 4 6 8 10
Medium (3)
3 6 9 12 15
High (4)
4 8 12 16 20
Very High (5)
5 10 15 20 25
1-3
Low Priority
4-6
Moderate Priority
8-12
High Priority
15-25
Very High Priority
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Glossary of Acronyms
A&E – Accident and Emergency
AQI – Ambulance Quality Indicators
AQP – Any Qualified Provider
BRS - Building the Right Support
CAG - Clinical Advisory Group
CETR - Community Education and Treatment Review
CIP – Cost Improvement Plan
CQRG – Clinical Quality Review Group
CQUIN - Commissioning for Quality and Innovation
CRC - Colorectal cancer
CTG – Contract Technical Group
DG - Diagnostic Guidance
ECDS – Emergency Care Data Set
ED – Emergency Department
EDIS - Eating Disorder Intensive Service
EHCNMB - Education, Health and Care Needs Management Board
EQIA – Equality Impact Assessment
FIT - Faecal Immunochemical Test
FRF - Financial Recovery Fund
FT – Foundation Trust
GIRFT – Getting It Right First Time
HCHJC - Head of Children’s Health Joint Commissioning
HEE - Health Education England
ICS - Integrated care system
IMAS – Interim management and support
LAS – London Ambulance Service
LCW - London Central West Unscheduled Care Collaborative
LDCT - Low dose computed tomography
LDG – Local Delivery Group
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LeDeR - Learning from Deaths report
MADE - Multi-Agency Discharge Events
MFF - Market Forces Factor
MRI - Magnetic resonance imaging
MRSA - Meticillin Resistant Staphylococcus Aureus
MSA – Mixed sex accommodation
NCEL - North Central and Northeast London
NG – NICE Guidance
NLP - North London Partners
NMUH – North Middlesex University Hospital
OT – Occupational Therapy
PACE - Post-Acute Care Enablement
PCBC - Pre-consultation business case
PELC - Partnership of East London Co-operatives
POD - Point of Delivery
PPG - Practice participation groups
PSF – Provider Sustainability Fund
PTL – Patient Tracking List
QIPP – Quality, Innovation, Productivity and Prevention
QIST – Quality Improvement Support Team
RAT - Rapid assessment and treatment process
RFL – Royal Free London
RNOH - The Royal National Orthopaedic Hospital
RTT – Referral to Treatment
SCAN - specialist CAMHS team for children and young people with learning
disabilities and neuro-developmental disorders
SUS – Secondary Users Service
TCPs - Transforming Care Partnerships
TCST - Transforming Cancer Support Team
TST – Transforming Services Team
UCLH – University College London Hospital
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UEC - Urgent and Emergency Care
UTC – Urgent Treatment Centre
VCS – Voluntary and community sector
YTD – Year to date
2ww – Two-week wait
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Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20
Agenda Items
1. Standing Items
Apologies √ √ √ √ √ √
Declarations of Interests √ √ √ √ √ √
Register of Gifts and Hospitality √ √ √ √ √ √
Minutes of Last Meeting √ √ √ √ √ √
Action Log √ √ √ √ √ √
Forward Planner √ √ √ √ √ √
AOB √ √ √ √ √ √
2. Governance
Remit of the Committee √ √
Terms of Reference- Annual Review √ √
Appointment to Chair of the Committee √ √
3. Activity and Performance
Acute Contract Report √ √ √ √ √ √
Acute Performance and Quality Report √ √ √ √ √ √
Integrated Urgent Care Report - within
acute reports √ √ √ √ √ √
Learning Disabilities- Transforming Care
Cohort √ √ √
4. Commissioning
System Intentions 2020/21 √
Planning for 2019/20 √
Planning for 2020/21 √ √
5. Risk
NCL Joint Commissioning Committee Risk
Register √ √ √ √ √ √
6. Other Items
Procedures of limited clinical effectiveness √ √
Interdependent services including mental
health √
7. Business Cases - dates to be
confirmed
Adult Elective Orthopaedics √ √ `
Moorfields Eye Hospital Clinical Case for
Change √ √
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