nel joint commissioning committee meeting part 1 us/committees/j… · molcv medicines of limited...

An alliance of North East London Clinical Commissioning Groups

City and Hackney, Newham, Tower Hamlets, Waltham Forest, Barking and Dagenham, Havering and Redbridge CCGs

Chair: Dr Anwar Khan I Accountable officer: Jane Milligan

NEL Joint Commissioning Committee Meeting Part 1

12.30-2.20pm Wednesday 10 July 2019

Committee rooms, Unex Tower

5 Station Street, Stratford, E15 1DA

NELCA Joint Commissioning Committee - Part 1 Date and time: 12.30-2.20pm Wednesday 10 July 2019

Venue: Committee Rooms, Unex Tower, 5 Station Street, Stratford, E15 1DA

Agenda

No. Time Item Page Action required Owner

1. Welcome

1.1 12.30pm Welcome, introductions, apologies

Declarations of interestVerbal Chair

1.2 12.35pm Minutes of the last meeting and matters arising

Action log

ELHCP digital roadmap

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13 14

Approve

Monitor Note

Chair

2. Patient and public engagement

2.1 12.40pm Questions from the public Verbal Discussion Chair

3. Strategy

3.1 1pm Development of the LTP – update To follow Note Simon Hall

3.2 1.15pm ELHCP Transformation Programme – update

16 Note Simon Hall

4. Commissioning

4.1 1.25pm East London NHS Foundation Trust - updateTo be tabled

Note Navina Evans

4.2 1.40pm Better Care Fund update 20 Note Les Borrett

5. Performance

5.1 1.50pm Performance report – month 12 33 Note Archna Mathur

6. Risk Register

6.1 2pm Risk register 39 Note Kash Pandya

7. Forward planning

7.1 2.10pm Meeting planner 50 Discussion Chair

Any other business

Date of next meetings:

11 September 2019 13 November 2019

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NELCA JCC - Acronyms List

ACRONYM MEANING

A&E Accident & Emergency

APMS Alternative Provider Medical Services (a type of Primary care contract)

AQP Any qualified provider

BAF Board Assurance Framework

Bart's / BHT Barts Health NHS Trust

BHRUT Barking, Havering and Redbridge University Hospitals NHS Trust

BMA British Medical Association

CAS Clinical Assessment Service

CCG Clinical Commissioning Group

CCU Critical Care Unit

CEG Clinical Effectiveness group

CEPN Community Education Provider Network

CHP Community Health Partners

CIL Construction Industry Levy

CPD Continuing Professional Development

CQC Care Quality Commission

CQRM Clinical Quality Review Meeting

CQUINs Commissioning for Quality and Innovation (Payment Framework)

CSU Commissioning Support Unit

CYP Children and Young People

DES Direct Enhanced Service

DoH/ DH Department of Health

DToC/ DToCs Delayed Transfers of Care

ED Emergency Department

ELFT East London Foundation Trust

ELHCP East London Health and Care Partnership

ELHCP ODG East London Health and Care Partnership Operational Delivery Group

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EMIS web Egton Medical Information Systems (System that records patient consults)

EPCS Extended Primary Care Service

EPCT Extended Primary Care Team

EPR Electronic Patient Record

ETTF Estates and Technology Transformation Fund

FOI Freedom of Information

GB Governing Body

GIA Gross internal area

GLA Greater London Authority

GMC General Medical Council

GMS General Medical Services (a type of Primary care contract)

GP General Practitioner

HBPoS Health Based Places of Safety

HEE Health Education England

HLP Healthy London Partnership

HMT Her Majesty's Treasury

HUH The Homerton University Hospital NHS Foundation Trust

IAPT Increasing Access to Psychological Therapy

ICP Integrated care partnership

IG Information Governance

IMT Information Management and Technology

INEL Inner north east London

IPS Individual placement and support schemes

ITU Intensive Therapy Unit

IUC Integrated urgent care

JCC Joint Commissioning Committee

JSNA Joint Strategic Needs Assessment

KGH King George Hospital

KPI Key Performance Indicator

LAP Local Area Partnership

LAS London Ambulance Service

LAs Local Authorities

LBN London Borough of Newham

LBWF London Borough of Waltham Forest

LCFS Local Counter Fraud Specialist

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LD SAF Learning Disability Self-Assessment Framework

LEB London Estates Board

LEDU London Estates Development Unit

LES Local enhanced service

LMC Local Medical Committee

MoLCV Medicines of limited clinical value

MOU Memorandum of Understanding

MPIG Minimum Practice Income Guarantee

NAFO Newham Alternative Funding Option

NCCG Newham Clinical Commissioning Group

NDPP National diabetes prevention programme

NEL North East London

NELCA North East London Commissioning Alliance

NELCSU North East London Commissioning Support Unit

NELFT North East London Foundation Trust

NHS PS NHS Property Services

NHSE NHS England

NHSI NHS Improvement

NICE National Institute of Health and Care Excellence

NUH Newham University Hospital

ONEL Outer north east London

OOH Out of hours

OPD Outpatient department

OPE One Public Estate

PALS Patient Advice and Liaison Service

PCCC Primary Care Commissioning Committee

PCT Primary Care Trusts

PHE Public Health England

PMS Personal Medical Services (a type of Primary care contract)

PoLCV Procedures of low clinical value

PolCE Procedures of low clinical effectiveness

PPE Patient and Public Engagement

PPG Patient and Public Group

PREM Patient Reported Experience Measure

PROM Patient Reported Outcome Measures

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PTL Patient Tracking List

QIPP Quality, Innovation, Productivity and Prevention

QOF Quality Outcome Framework (Assessor Validation Reports)

R&D Research & Development

RAG Red, Amber, Green

RAS Referral assessment service

RAID Rapid Assessment Interface Discharge

RICS Royal Institute of Chartered Surveyors

RLH Royal London Hospital

ROI Return on Investment

RTT Referral to treatment

SEP Strategic Estates Plan

SMI Severe mental illness

SMW Spending Money Wisely

SPA Single Point of Access

SPR Service Program Review

STP Sustainability and Transformation Plan or Partnership

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An alliance of North East London Clinical Commissioning Groups City and Hackney, Newham, Tower Hamlets, Waltham Forest, Barking and Dagenham, Havering and Redbridge CCGs

NEL Joint Commissioning Committee – part 1 12.30-2.30pm Wednesday 8 May 2019

Committee Rooms, Unex Tower, 5 Station Street, Stratford, E15 1DA

Minutes

Present:

Khalil Ali Lay Member, NHS Redbridge CCG

Dr Atul Aggarwal Chair, Havering CCG

Henry Black Chief Finance Officer, NELCA

Richard Coleman Lay Member, NHS Havering CCG

Noah Curthoys Lay Member, NHS Tower Hamlets CCG

Sue Evans Lay Member, City & Hackney CCG

Professor Sir Sam Everington Chair, NHS Tower Hamlets CCG

Charlotte Harrison Secondary Care Consultant, NELCA

Dr Jagan John Chair, NHS Barking and Dagenham CCG

Dr Anwar Khan (Chair) Chair, NHS Waltham Forest CCG

Dr Anil Mehta Chair, NHS Redbridge CCG

Jane Milligan Accountable Officer, NELCA

Dr Muhammad Naqvi Chair, NHS Newham CCG

Kash Pandya Lay Member, NHS Barking and Dagenham CCG

Dr Mark Rickets Chair, NHS City & Hackney CCG

Fiona Smith Chief Nurse, NELCA

In attendance:

Les Borrett Director of Strategic Commissioning, NELCA

Archna Mathur Director of Performance & Assurance, NELCA

Kate McFadden-Lewis (minutes) Board Secretary, NELCA

Alison Glynn (item 4.2) Deputy Director, Transformation Delivery, NEL CSU

Simon Hall Director of Transformation, ELHCP

Matthew Henry (item 4.2) Matt Henry, Senior Transformation Delivery Manager, NEL CSU

Alan Steward (item 6.1) System Transition and OD, NELCA

Apologies:

Colin Ansell Local Authority Representative, Newham

Mark Ansell Local Authority Representative, Havering

Adrian Loades Local Authority Representative, Redbridge

Denise Radley Local Authority Representative, Tower Hamlets

Linzi Roberts-Egan Local Authority Representative, Waltham Forest

Alan Wells Lay Member, NHS Waltham Forest CCG

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No. Item

1.1 Welcome, introductions, apologies The Chair welcomed attendees to the meeting, and apologies for absence were noted as above. There were no declarations of interest.

1.2 Minutes of the last meeting and matters arising The minutes of the last meeting were accepted as an accurate record.

Actions update: JCC-5: performance of patient experience metrics will be reported on, and managed at, service level. These are regularly reviewed by the quality leads through many forums, including Healthwatches, NHS Choices feedback, complaints and the friends and family test.

JCC-7: will be included in the papers pack at the next meeting.

JCC-23: Direct booking from NHS111 into UTCs work is progressing, with solutions in place across the patch.

2.1 Questions from the public

Questions from Shujah Hamid, Integrated Heathcare Manager, North London Region, Internis Pharmaceuticals Ltd: asked in absentia.

Q1. Post the recent 10 Year Long Term NHS plan announcement, what will NEL JCC be doing differently moving forward?

Answer: Q1. A NEL system operating plan has been submitted to NHS England and can be viewed on our the ELHCP website http://www.eastlondonhcp.nhs.uk/ourplans. This will be discussed further under the STP refresh item on the agenda.

Q2. What primary and/or secondary care formulary will the seven NEL CCGs be following?

Answer:

Organisation Formulary Link

Barts Health NHS Trust

Local Formulary - Currently under development

Link not currently available - Formulary expected to go live in two weeks

BHRUT Local Formulary https://www.bhrhospitals.nhs.uk/search?term=formulary&search=Search&searchType=all

ELFT Local Formulary https://www.elft.nhs.uk/Services/Medicines-Formulary

C&H CCG & HUHFT

Joint Local Formulary http://www.cityandhackneyccg.nhs.uk/News-and-publications/the-joint-formulary.htm

NELFT Local Formulary https://www.nelft.nhs.uk/medicines-information

Redbridge CCG

Local Formulary

http://www.redbridgeccg.nhs.uk/About-us/Medicines-management/Local-Formularies.htm

Barking & Dagenham CCG

http://www.barkingdagenhamccg.nhs.uk/About-us/Medicines-management/Local-Formularies.htm

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Havering CCG http://www.haveringccg.nhs.uk/About-us/medicines-management/Local-Formularies.htm

Tower Hamlets CCG

Formulary Complete https://www.formularycomplete.com/report/public/THCCG-eBNF

Newham CCG Local Formulary

http://www.newhamccg.nhs.uk/AdminV9/Tracker/ClickTracker.aspx?type=search&id=906464|0|-1|860980|23246532&indexid=306&terms=formulary&x=/Downloads/Health-Services/medicinesMgmt/BNF%20%20Newham%20formulary%20v%2020%20-%20March%202016.xlsx

Waltham Forest CCG

Local Formulary http://bnf.walthamforestccg.nhs.uk:8080/bnf

Questions from Michael Vidal, Hackney resident: asked in absentia.

Q1. It is my understanding that all Orthopaedic Procedures have been centralised at the Olympic Park in Newham. If that is correct, can you please confirm: (i) The date the decision to do this was made. (ii) As this was a commissioning decision, can you please confirm how the duties under s.14Z2 of the National Health Service Act 2006 (as amended) were complied with in particular the duty to involve patients and the public in the developing of the proposals.

Answer: The Barts Health Orthopaedic Centre at Newham Hospital has recently opened additional capacity to support reductions in waiting times for elective surgery. It is not the case that all orthopaedic surgery within Barts is now performed at NGH – services continue at both Whipps Cross and the Royal London Hospitals and the Trust’s clinicians work with patients at time of referral to agree the best location given the treatment required and the patient’s preference.

Q2. In relation to: a) Pathway redesignb) Service redesignc) As far as not covered by a or b proposals from a Clinical Reference Group.

Can you state the process that is used to develop proposals in particular how patients and the public are involved as required by s.14Z2 of the National Health Service Act 2006 (as amended)?

Answer: The NEL CCGs follow appropriate policies where public engagement and consultation are required. Any proposals for service redesign will be considered depending on their scale and impact and discussed with providers and other stakeholders.

Question from Mary Logan, Waltham Forest Save Our NHS: The executive summary for the STP Performance report states that the NEL STP is non-compliant with standards for diagnostics, with further deterioration from previous months.

If diagnostics are not available in the medically required timescale, and easily accessible, cancers will continue to be diagnosed late, and there will continue to be poor survival rates. I note there is an Early Diagnostic Centre for N. E London based at Mile End Hospital, as well as the previously existing local diagnostics in the NEL area.

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Research on patients presenting late with cancer shows a strong correlation with distance to travel. The moving of GPs into larger hubs and away from being dotted around residential areas means some people will already be putting off going to the GP.

I realise some GP hubs are to have some diagnostics, which should benefit the patients attending there. However, others will be deterred from making the longer journey to the GP until later in the disease process. How is the impact of these changes to be monitored, and where can the public find this and other evidence re the impact of the STP changes?

Answer: The latest position on diagnostics performance has improved from the time of writing the report with performance at BHRUT improving on account of additional capacity for the provision of MRIs in particular. The North East London STP has been compliant with delivery of all cancer performance standards consistently during 2018/19.

NEL STP remains focussed on driving delivery of the diagnostic standard and also on the early diagnosis of cancer by staging cancers earlier, amongst other initiatives, which has also seen significant improvement across North East London since quarter 1 of 2017.

When approving practices to relocate to a new site, as a general rule it wouldn’t be expected to be more than 1 – 1.5 miles from their previous site. However, this is fairly flexible and would depend on analysis of a number of factors such as distribution of the patient list by reviewing a scatter map, the proximity of other local practices and accessibility and transport links. The impact on travel time is normally limited.

Co-locating GPs together in hubs will increase access to a range of services and expertise as there are many that cannot be provided in multiple sites or in smaller practices (because of space constraints). Co-locating GPs means some services may be provided alongside more easily. There is no evidence that we are aware of to support the concern that GPs moving to hubs reduces the likelihood of patients attending their GP.

In discussion on this question, it was agreed that there is a need to ensure the unintended consequences are monitored. Early diagnosis metrics are tracked and discussed at CCG and Health and Wellbeing Boards, as well as a number of other forums, and a more detailed report on this can be provided in due course.

Question from Meenakshi Sharma: Where are the Equalities Impact Assessments for the Commissioning Strategy 2018/19 - 2021/22 in light of the unwarranted variation across NEL both in terms of resource allocation and health outcomes?

Answer: EIAs were not carried out at the level of the Commissioning Strategy. An EIA is carried out for each individual service change through the business case approval process.

Meenakshi Sharma then raised her concerns that, in the move to commissioning at the NEL level, inequalities at borough level were not being monitored. Jane Milligan assured Meenakshi, and the Committee, that, in the joint approach to commissioning with the Local Authorities, this is regularly looked at a local level.

Question from Andy Walker: On midday on 3rd May Save KGH/Don't overload campaigners went to 10 Downing Street to seek a public consultation on the new plan to close KGH A&E, can this Committee support this call?

10


Answer: This question has been asked, and answered, in various other forums and received a consistent answer. The document is superseded by the statement by Jane Milligan at the BHR CCGs Joint Committee in January 2019 and by the open letter from the Local Authority, BHR CCGs and the Trust in April 2019. Both of statements were clear that the KGH A&E will remain open. We are not prepared to entertain further questions on a matter that has been fully answered.

3.1 Early Diagnosis Centre: update on patient engagement Simon Hall presented on the patient engagement work around the Early Diagnostic Centre, which is due to be opened at Mile End Hospital by the end of 2019. Discussion points included:

i. the robust patient and public engagement that has been carried out throughout this project,and the importance of this to ensure its success

ii. the need to monitor the uptake, as well as patient travel timesiii. the importance of endorsing and supporting this centre to ensure the expected positive

outcomes are realised, such as improvement on the two week wait standardiv. with positive outcomes achieved, there is potential for more centres to be rolled out across

NELv. the potential for innovative workforce modelling, such as training nurse practitioners in

diagnostic proceduresvi. the discovery programme’s work around using AI technology to identify patients at risk, to be

sent straight to test.

4.1 STP refresh Simon Hall updated the Committee on the STP refresh, outlining that the operating plan is being developed in line with the Long Term Plan via a ‘bottom up’ coproduction approach, guided by input from patients and the public, clinicians, providers and local systems. The plans will need to align with the NHS England guidance which is expected soon.

In addition to the various local engagement events, Simon Hall highlighted the upcoming engagement event planned for June, which will bring together the stakeholders, clinical programmes and systems across the STP area.

4.2 North East London Spending Money Wisely Programme Les Borrett introduced the NEL Spending Money Wisely Programme. Alison Glynn and Matthew Henry joined the meeting for the presentation of this item. Key discussion points included:

i. the proposed consultation time of six weeks, which was recommended based on the patientand public engagement and involvement already undertaken at various forums, includingJoint Overview and Scrutiny Committees and Healthwatch meetings, as well as theconsultation carried out at a national level. This programme is chiefly working to consolidatethe existing policies across NEL, and ensuring clinical best practice and national guidance isreflected

ii. the need to agree the WELC prior approval process and the possibility that there are differentprior approval processes at the WELC and BHR level, operating under an agreed NEL policy.

5.1 Performance report – month 11 Archna Mathur presented on the month 11 performance across the STP area, highlighting that the latest position on diagnostics performance has improved from the time of writing the report, with performance at BHRUT improving due to additional MRI capacity, in particular. NEL has been compliant with delivery of all cancer performance standards consistently during 2018/19. In discussion the Committee noted:

i. the difference in the end of year predicted number of patients waiting over 52 weeks,compared to waiting list size between trusts. This is due to the difference in the ability toforecast the trajectories for certain services, for example Barts have dental capacity issues

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and therefore can accurately predict the number of patients waiting over 52 weeks for that service

ii. the importance of ensuring joined up Continuing Healthcare services across the system,including more CHC assessments taking place in the community, to achieve better outcomes for patients

iii. the need for robust IT in place to support the ability to track the effect that the urgent carechoices available to patients has on A&E attendance levels

iv. the Tower Hamlets achievement on Personal Health Budgets, and the programme that isnow in place to ensure that learning and best practice is shared across the patch.

6.1 Risk Register Alan Steward presented the NELCA JCC risk register to the Committee, updating on progress made on the risk mitigations as well as highlighting three risks that have been removed from the register: the Winter Plan, Cancer Early Diagnostic Centre and the reputational risk from the perception that the JCC is removing responsibilities from local decision making. Discussion points included:

i. the need to take account of the impact of the Long Term Plan on the risksii. the need to review the mitigations in place for the risks around demand and capacity and the

estates programme transformation plans, given the capital funding bids were not successfuliii. that the mitigations on the risk around specialised commissioning are dependent on further

guidance from NHS England around the Long Term Plan. The team continues to work withNHS England to develop the proposals around the move to place based budgeting.

Anwar Khan noted that this is Alan Steward’s last meeting, and extended his thanks and best wishes for the future on behalf of the Committee.

7.1 Meeting planner: noted.

8 Any other business Les Borrett updated on the consultation for the proposed relocation of Moorfields Eye Hospital. The response from Camden CCG to the feedback from the JCC has been shared with Members, and the Committee in Common across the 14 CCGs formally approved the consultation processes at its meeting on 24 April 2019. The consultation is expected to be launched following the EU election purdah period.

Jane Milligan highlighted the three 2019 BMJ Awards winners from across NEL: Bromley by Bow Health for ‘DIY Health: 0 to 5’, Barts Health NHS Trust for ‘Violence Reduction Trauma Care’ and Barking, Havering and Redbridge University NHS Trust for ‘Stroke Senior Decision Making’.

Date of next meeting: 12.30-2.30pm Wednesday 10 July 2019

12

ReferenceMeeting

date

Minute

referenceAction Owner

Target completion

dateComment

JCC - 12 11/07/2018 3 Specialised Commissioning plans: Give assurance to the Committee that patients will be able to access specialist services diagnostics locally. Jane Milligan May-19

JCC - 14 11/07/2018 7 ELCHP digital programme: Share the governance rules on work programmes and road map with members.

Luke Readman/ Kambia Boomla Jul-19 Included in papers pack

JCC - 18 12/09/2018 5.1Commissioning Strategy 2018/19 - 2021/22:

Include an overview of the unwarranted variation across NEL, how this relates to better care for patients, as well as the implementation plan for the next update to the Committee.

Les Borrett Sep-19 The commissioning strategy update will form part of the STP long term plan refresh.

NEL JCC action log 10/7/2019

Highlighted items represent a recommendation to remove from register

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Current ELHCP Digital roadmap and governance arrangements

This short paper has been prepared in response to a request from the JCC (Action Log ref: JCC – 12), ‘ELCHP digital programme: Share the governance rules on work programmes and road map with members.’

Response: As the Digital Enablement workstream, along with the rest of the Sustainability and Transformation Plan is currently being refreshed in response to the NHS Long Term Plan, this picture is subject to change in the next few months. This is the current, ‘Plan on a page’:

14

Governance around London is currently undergoing changes. Changes in the regulatory bodies (merging NHSE and NHSI, and the creation of NHSX), along with the emergence of the One London LHCRE are all still underway. The diagrams below show the current ELHCP and proposed One London positions:

Figure 1 – Proposed One London programme governance Figure 1 – Simplified ELHCP Digital Governance

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Joint Commissioning Committee

10 July 2019

Title of report ELHCP Transformation Programme update

Item number 3.2

Author Simon Hall

Presented by Simon Hall

Contact for further information

[email protected]

Executive summary This transformation programme report highlights delivery across the range of STP transformation plans. It shows consistent programme delivery prior to development of the local response to the Long Term Plan. The Long Term Plan development process over the following months will support collaboration across work streams and between work streams and local systems. There will also be an emphasis on engagement, with an event in October following the successful initial event in June. It is envisaged that these activities will further galvanize engagement and collaboration across the transformation programmes during 19/20.

Action required For noting.

Where else has this paper been discussed?

Internally at partnership PMO meetings.

Strategic fit

Commissioningimplications

Local authority/integratedcommissioningimplications

Commissioning implications.

What does this mean for local people?

Transformation and improvement of local services.

How does this drive change and reduce health inequalities (unwarranted variation)

Impact on finance, performance and quality

Risks None.

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Progress against national priority programmes

THEME Q1 Achievements Q2 Plans

Workforce

Digital

Estates

We have completed the roll out of our NHS App for patients to use across INEL (this is already live in Barking, Havering and Redbridge) and continue to develop access to electronic patient records for local nursing homes and complete making Barts Health data available in Discovery

Plans for Q2 are:• C&H community pharmacists accessing Electronic Patient

Record (eLPR)• Direct bookings from Integrated Urgent Care/ 111 Service into

Urgent TreatmentCentres• Any to any viewing of eLPR

We have embedded our careers and marketing site into the refreshed ELHCP website for maximum impact and have begun establishing the demand for key worker housing across NEL including the type of housing required. We are particularly focusing on our workforce priorities for Mental Health and Cancer. Funding has been secured to support our Trainee Nurse Associate programme, and work isunderway via the Local Workforce Area Board (LWAB) to review priorities in the context of the Long Term Plan.

Plans for Q2 are:• Hold a Careers and Workforce Development Engagement event• Present analytics pilot to all Trusts via Directors of Human

Resources• Assess progress against Trainee Nurse Associate target and

plan as necessary• Assess initiatives across providers to support staff health and

wellbeing.

We have submitted our capital plans for the next 3 years tothe NHS in London. We’ve agreed a clear Business Case approval process both for revenue and capital business cases. We’re progressing our information gathering exercise supporting our disposal/reprovision opportunities across NEL. We’ve also made clear that we now no plans to close the King George A&E site, as there is a clear need for A&E provision at the site both now and into the future.

Plans for Q2 are:• ELHCP Capital Pipeline to be reviewed and priorities refined• Develop a central support function to review Business Cases to

ensure better quality projects• Building Delivery Plans in place to address void areas

Programme Headlines

This transformation programme report highlights delivery across the range of STP transformation plans. It shows consistent programme delivery prior to development of the local response to the Long Term Plan. The Long Term Plan development process over the following months will support collaboration across work streams and between work streams and local systems. There will also be an emphasis on engagement, with an event in October following the successful initial event in June. It is envisaged that these activities will further galvanize engagement and collaboration across the transformation programmes during 19/20. The long term plan guidance was released at the end of June and a separate briefing will be provided to the JCC on this issue.`

ELHCP Transformation Programme Highlight Report June/July

17

We held a Primary Care GP Trainee Careers Fair, developed NEL Primary Care Network (PCN) Framework and our Primary Care Strategy will be submitted to NHSE in June

Plans for Q2:• Digital First programme ‘clinical pathways’ event• Primary Care Darzi fellows begin• Regional assurance takes place

We have completed roll out Bowel Screening testing in Primary care and supported the switch over to primary HPV screening in 3 of our boroughs, commenced development programme for community pharmacists and developed plans for the new cancer alliance governance arrangements

Plans for Q2 are:• Complete the pharmacy development programme• Launch schools’ cancer awareness competition across all

boroughs

ELHCP Transformation Programme Highlight Report – June/July 2019

Progress against national priorityprogrammes


Maternity

Children

and Young

People

(0-25

Programme)

Mental

Health

Primary

Care

We have completed the implementation of the continuity of care model across all our provider sites, launched the continuity of care teams across provider sites and the development of continuity of care women’s feedback framework. We’ve also had confirmation of financial resources from NHS England to the Local Maternity System (LMS) assuring the system that funding is available for 2019/20.

We have completed a series of workshops for the development of local Urgent and Emergency Care transformation, identify and agree core targets with system representatives and sign up for NEL system wide Asthma action plan in response to the national requirement. We’ve also been working hard looking at how we can improve services for people transitioning between children’s and adult services as part of our renewed “0-25” focus.

We have held our annual ELHCP Mental Health Summit, developed mental Health investment/workforce expansion plans for 2019/20 review, and delivered the CYP Waiting times reduction initiative.

Plans for Q2:• Implement plans to reduce smoking rates amongwomen• Maternity Training compliance monitoring in place• Support the establishment of maternal medicine services (NNMS)

and Maternal Medicine Centres across London (MMC)• Working with providers to establish their plans to support the

delivery of the maternity transformation plan.

Plans for Q2:• Complete dashboard for 0-25 reporting• Begin reporting against Asthma action plan• Feedback/roll out of national Asthma pilot scheme for improved

case management

Plans for Q2:• Begin a stocktake of suicide prevention initiatives in place within

NEL and in other areas• Establish IAPT performance populated with self-report

dashboard to feed into the STP Assurance Group• Mobilise the Workforce development project in BHR

Cancer

• Scope out how the quality of cancer care reviews are captured

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OTHER TRANSFORMATION

WORKSTREAM AREAS


Progress against other key local themes

COMMUNICATIONSANDENGAGEMENT

Urgent and Emergency Care• Review of ambulance conveyances to Newham

and Queen’s Emergency Department, Whipps Cross and King George and to action learning from the review

End of Life Care• Start rollout of Hospice at Home model.

Prevention• Launch of diabetes training programme• Participated in London Fast-Track Cities HIV

prevention initiative, began to roll out testing inA&E departments (already at Homerton andRoyal London)

ELHCP website redesigned and relaunchedSuccessful Mental Health Stakeholder Engagement event Supported the 2019 GP Careers Fair, April 9, in StratfordPlanning for our 6 June stakeholder event, programme of Citizens’ Panel questions, stakeholder core brief Rollout of the NEL communications and engagement planner continues with Partner organisations.Developing an ELHCP ‘extranet’ which allows for secure sharing of information for all transformation projects Supporting Workforce with marketing and promoting careers in adult social care and health

Urgent and Emergency Care• Commencement of newly configured Royal London Urgent

TreatmentCentre

End of LifeCare• Mapping of provision across NEL and delivering on roll out

plan targeted at care homes and acute trusts.

Prevention• Pharmacy development programme, switchover to FIT

testing within the bowel screening programme. Launch of the schools’ competition

• Engagement on the “London Vision”

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An alliance of North East London Clinical Commissioning Groups

City and Hackney, Newham, Tower Hamlets, Waltham Forest, Barking and Dagenham, Havering and Redbridge CCGs


10 July 2019

Title of report Better Care Fund update

Item number 4.2

Author Les Borrett, Director of Strategic Commissioning

Presented by Les Borrett


[email protected]

Executive summary The paper updates JCC on local progress in implementing the requirements of the Better Care Fund that underpins the integration locally of health and social care. The paper identifies key deliverables in each borough from the BCF and how these will be taken forward.

Action required JCC is asked to note the update.


n/a

Strategic fit


Local authority/integratedcommissioningimplications

The BCF and associated local integration of services is a key part of the infrastructure to support development of local Integrated Care Systems. The BCF provides substantial investment into social care to support local authorities in delivering their objectives at a time of significant reductions in other funding.


Integrating health and social care budgets and services supports the improvement of responsive and efficient services to local people.


Local BCF planning allows local partners to jointly plan to reduce health inequalities and other variations in care.


All boroughs have invested at least the minimum allocation over time in their BCF, with some exceeding the baseline. There remain significant pressures on budgets particularly in local authorities which may impact on this as the current BCF system changes.

Risks Key risks are financial pressures and ongoing increases in demand linked to population and acuity. There is a risk the BCF may be seen as a process issue rather than driving integration.

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Better Care Fund update


Introduction

The Better Care Fund has become an integral part of the planning process for health and social care. This paper sets out for the CCGs and local authorities in north east London how local systems have implemented the BCF and current plans for 2019/20.

Background

Each CCG and local authority is required to submit an annual Better Care Fund joint plan which sets out how the minimum requirement for investment in pooled budgets will be utilised, including the requirement to protect the targeted funding for social care which forms part of the floor allocation to CCGs. The plans are overseen locally by Health and Wellbeing Boards.

North east London has protected baseline funding in the BCF over its life and expanded its scope when sensible to do so. It has used the funding to support key targets including reablement and reducing DToCs.

The BCF nationally is currently under review and will need to evolve as the NHS plan and the next Spending Review for local authorities roll out. As north east London moves away from current NHS commissioning models and develops Integrated Care Systems the way BCF relates to the broader system will need to change.

Planning guidance for 2019/20 has been delayed but for most boroughs it is likely to be a steady state year as systems embed change, Local HWBBs will need to sign off plans once this guidance is set out.

The BCF operates in the broader strategic context of reductions in core local authority funding, rising demand and acuity, and this has created some tensions in the ability of systems to use the flexibilities available effectively.

The subsequent sections of the report set out how each borough is taking the BCF forward.

Local Context

BHR

Joint working with the local authorities

The BHR Integration and Better Care Fund plan 2017-2019 was developed as a joint plan by the BHR Partnership of Barking & Dagenham CCG, Havering CCG and Redbridge CCG and the London Borough of Barking and Dagenham, London Borough of Havering and London Borough of Redbridge. The joint narrative recognised that there were similar priorities across the three boroughs and efficiency opportunities in pursuing a shared work plan through which joint objectives might be agreed and delivered in one place. It acknowledged the partnership ambition to move beyond just aligning the plans of the three boroughs, to increasing the integration and shared delivery where it made sense to do so, within the principles of subsidiarity.

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The Better Care Fund Plan is aligned to the BHR system A&E Delivery Board plan to manage demand on urgent and emergency care services and demonstrates the join up for delivery across health and social care. The BCF plans support some elements of demand management and supporting discharge for inpatient care.

A section 75 partnership agreement is in place for the BHR Partnership to support the delivery of the plan with budgets pooled at borough level. The governance arrangements for the overview of the Section 75 were due to transfer from the borough arrangements to the Joint Commissioning Board in 2018/19. This arrangement has slipped over the past year and is being reviewed to ensure effective management.

The CCG allocations were in line with the minimum contribution and reflected existing commitments in contracts that aligned to the BCF schemes.

In relation to risk share arrangements, the individual partners are responsible for overspends on their respective budgets within the BCF. The Partners have committed to consider using underspend/ uncommitted funds within the BCF against key risks against meeting shared BCF targets and to work on initiatives to reduce non-elective admissions in line with reductions set out in the CCG operating Plan.

BCF initiatives

A number of schemes were agreed in the 2017-19 plan to deliver the national conditions of maintaining social care, developing out of hospital services, reducing delayed transfers of care. Cross system and local schemes are summarised below:

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Better Care Fund update 23


Performance against BCF standards

The boroughs achieved their targets for reablement and residential care home placements. Non-elective admissions have remained broadly on plan for BHRUT.

Despite the requirement to meet further stretch DToC targets for well performing areas which has proved challenging, the system has maintained relatively good DTOC performance ranking 61 (B&D), 65 (Redbridge) and 67(Havering) out of 170 boroughs in England.

A programme of work, supported by the High Impact Change Model, is being taken forward through a subcommittee of the BHR A&E Delivery Board - the Discharge Working Improvement Group (DWIG).

The scope of the programme includes:

Early discharge planning – the roll out of Red to Green Ensuring consistent systems in the Trust to monitor patient flow Home First discharge to assess – moving towards a trusted assessor model Increasing CHC assessments out of hospital Enhancing health in care homes – roll out of red bag scheme

Havering and Barking & Dagenham have jointly commissioned a Help Not Hospital service with the British Red Cross (while Redbridge commissions Age UK), to facilitate smooth accompanied transfers’ home from hospital, making links to wider support in the community for those that need it.

In Havering, the council commissioned an Integrated Reablement & Rehabilitation service has delivered faster discharges, with reduced assessment and paperwork, with a higher proportion of patients being discharged within 24 hours of being declared medically fit, often much quicker.

Generally mental health DToCs have been managed well. The London Borough of Barking and Dagenham has made additional investment into mental health services, in part supported by monies

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provided within the new social care grant, to deliver of independent living beds and floating support services providing a step-down mode which has improved DTOC performance in this borough.

Planning for 2019/20

There is agreement in principle through the Joint Commissioning Board to align the BCF plan to the BHR system transformation plans, predominantly the older people and frailty transformation plan. It is not anticipated that the plan will change significantly in 2019/20 and will be refreshed for 2021/21 to and update the local vision and approach to integration.

CCG and Local Authority commissioning leads are in the process of reviewing the current plan. The London Borough of Redbridge have initiated a piece of work to scope the opportunity for developing the joint commissioning approach for older people across the system.

City and Hackney

Approach taken to BCF

The BCF plans and any related expenditure is signed off by the City and Hackney Integrated Commissioning Board (ICB).

We have a BCF oversight meeting in place between the CCG and the borough. This meets quarterly and has the following role:

Coordinating the process to define the annual priorities Maintain oversight of BCF expenditure Maintain oversight of achievement of targets and BCF deliverables Processes to manage any underspend

However, the detailed work to determine the priorities, support any transformation and manage individual contracts happens within the integrated commissioning care workstreams. The care workstreams include commissioners, providers and public representatives, therefore ensuring a collaborative approach.

Each of the service lines within the BCF are held within either the planned or unplanned care workstream.

We have not invested additional resources into the BCF. However, we have a programme of increasing pooled budgets between the local authorities and the CCG, and a governance structure through which these will be managed (i.e. the ICB), therefore we have mechanisms other than the BCF for pooling budgets.

Key Deliverables in 2017/18 and 2018/19

We have used the BCF to drive further and deeper integration between health and care services. A visit from the National BCF team in summer 2018 recognised the progress that we had made in this both at a system governance level and in front-line services.

We have used the BCF to do the following:

Delivery of an integrated reablement service which bridges the hospital, community and socialcare services. In 2018/19 this team moved to a discharge to assess model

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Provide the programme resources for our neighbourhoods development – this is non-recurrentfunding to drive a transformational and whole system shift in how we deliver out of hospitalservices to support overall system quality and sustainability

To fund a number of community based specialist services that support specific cohorts, includingasthma, palliative care, cardio-respiratory and community therapies

Falls prevention services Delivery of our urgent response admission avoidance service, Paradoc Carers’ support services

In 18/19 we have seen a reduction in both DToC and excess bed-day spend against the previous year.

We have also seen a significant improvement in the percentage of patients receiving a CHC assessment in their usual place of residence

Key Deliverables for 2019/20

Broadly, our objectives have remained consistent with previous years, however, we have committed BCF resources to the following two programmes in 19/20:

Fit for health Stroke rehabilitation Funding to support Enhanced Health in Care homes – this supplements and strengthens existing

primary care contracts.

Risks

As a system, we have identified the following risks:

Lack of a long term funding solution for social care, in the context of ongoing local authorityfinancial pressures and increasing demand

Increasing acuity and levels of complexity amongst the populations that we serve Low provision of interim and nursing home beds within the borough, with limited scope for

increasing Instability in the home-care market due to workforce pressures.

Newham

2018/19 ‐ Progress

The BCF has enabled health social care to put patients and service users at the heart of delivery. We have continued to develop joint working arrangements through multi-disciplinary team meetings, health and social care navigator roles, Rapid Response Team, supported discharge coordinators which continue to strengthen joint working with health and social care staff coming together to coordinate care for patients. We have used the BCF as a lever for integration and change and to truly join up services where it is right to do so. Service development from inception takes a collaborative approach from the outset.

All schemes have been delivered or continue on their way to implementation. We have expanded our BCF in 2018/19 to include the delivery of Wheelchair services which has been successful. In addition, Social Care has been protected in line with expectations (including Care Act support), Joint Funding initiatives were delivered within parameters and continues to be successful, equipment services were delivered with minimal Delayed Transfer of Care (DTOC) days attributable to equipment delays. Integrated Care initiatives have been developed and are now in place. For some areas, work

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continues to refine and roll out but in all BCF schemes are in line with expectations. We will be undertaking a review of all schemes as part of our refresh process.

Newham CCG and LBN have an excellent working relationship and are working in partnership to deliver a sustainable health and social care system for Newham and its residents. A real highlight for this year will be the expansion of our BCF/S75 arrangements to include Wheelchair services.

We continue with a number of the integrated care interventions including the rapid response and reablement service. We are exploring the development of a community services single point of access, social workers being core members of the health and social care Multi-Disciplinary Teams. As part of our integration work we are looking at spatial requirements and models of delivery which join up health and social care services into locality based areas providing true focus and outcomes for the local population.

Teams across all services are working positively to impact on Delayed Transfers of Care (DTOC). We have protocols in place for escalation management which has been pioneered through our Urgent Care Working Group. Newham continues to have good performance in relation to DTOC although there have been challenges this year.

There are a number of services that are supporting older people to remain at home after a hospital admission - including the Rapid Response service and the health and social care navigators. We have introduced a Hospital to Home service with wrap-around support including enablement to minimise the number of people readmitted to hospital. People with an Avoiding Unplanned Admissions (AUA) care plan who have attended A&E and or have been discharged from hospital are being reviewed by the health and social care MDTs in order to focus on maintaining people at home.

We continue to work very closely to limit residential care home admissions and review the options of short term step up beds into the community hospital and joint assessment through health and social care planning. It is important to note that Newham starts from a low baseline in relation to permanent admissions into care homes as we strive to keep residents in the community for as long as possible.

2018/19 – Key Achievements

The health and social care multi-disciplinary team meetings which are GP led and based in the GP practices with the added benefit of Social Workers who work specifically recruited to work as part of the GP MDT meetings. The core membership of the MDT is GP, Practice Nurse, Community Psychiatric Nurse, Health and Social Care Navigator, Social Worker, Community/District/Rapid Response Nurse, Therapy Lead. This programme has allowed joint working, training and clinicians coming together to look at the patient’s holistic needs regardless of the organisational boundaries to coordinate the patients care needs.

A ground-breaking venture between the Local Authority and Health partners has been developed to dramatically change the provision of health and social care in the borough by acquiring and building new facilities to deliver integrated health and social care. Health and Care Space Newham (HCSN) will develop facilities that offer GP services alongside a range of community health, social care, out of hospital, and a variety of clinical services. It will also build much-needed housing for sector staff. It is a new development model that will change the way health and social care services are delivered in Newham. HCSN is the first such partnership between a local authority and Health in the country and is the delivery vehicle for a wider strategic partnership that includes NHS Newham CCG and Newham Health Collaborative (NHC), East London Foundation Trust (ELFT) and Newham Council.

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2018/19 – Resources

The value of the BCF in 2018/19 was £140.9m (of which £53m was CCG contribution1 transferred to local authority).

2019/20 ‐ Plans

The BCF will continue to be used to address the following priorities:

Support social care Support integration / multi-disciplinary working Avoid unnecessary emergency admissions Reduce delayed transfers of care Reduce admissions to care homes Support people to live independently in their own homes.

The value of the BCF in 2019/20 is planned to grow to £146.1m (of which £53.6m is CCG contribution1 transferred to local authority).

Please note that the 2019/20 plan has yet to be finalised.

Tower Hamlets

In Tower Hamlets we have assumed that our 2018-19 programme is rolled over into 2019-20.

For the London Borough of Tower Hamlets all of the contracts tied to the BCF will end after March 2020 (if we include all extensions) so at present the total value may be at risk. However we anticipate that a new programme will be in place before this date which will be largely similar to the BCF and able to incorporate this risk.

For the CCG, as much of the contributed funding is committed to BAU contacts, none of the CCG standalone projects are at risk other than the Autism Diagnostic Service which now makes up part of ELFTs mental health contract and the Recovery College.

Nationally, the CCG minimum contribution will be increased although THCCG currently contribute significantly over the minimum threshold. However the CCG are currently uprating current contribution in line with inflation (1.8%).

The CCG and LBTH are confirming areas where there is a contractual commitment and that contract has increased, because these contracts can then be uplifted by a maximum of 1.8%. See Appendix 1 for the full BCF schedule for 2019-20 – the items highlighted are the areas to which we are awaiting confirmation whether growth has been applied.

We recently conducted an internal review of the BCF between the CCG and LA and are implementing the below to support our monitoring processes:

1. establish a BCF joint-finance working group made up of CCG and LA finance leads to discussapportionment and recycling of in-year underspends on a regular basis, seeking agreement viathe Tower Hamlets Joint Commissioning Executive (JCE) where required

1 This is the minimum CCG contribution + CCG additional fund

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2. align and update the expired S75 agreement for the BCF for 2019-20 to ensure that we are bestplaced to produce our refreshed BCF Plan when requested

3. develop a robust Programme Monitoring Framework for the Better Care Fund making the best ofuse of each commissioning organisations budget setting processes and existing monitoringresources. This will be based on the guidance provided for 2019-20 (when this is received),anticipating that the 2020-21 Programme will be similar and work can be carried forward.

Achievements

Local Incentive Scheme (LIS) – has been in place for 3 years and this is a shared scheme between THT commissioners and providers. It is intended to encourage and reward joint working that achieves the aims of Tower Hamlets Together, namely to deliver an integrated model of care for patients with complex needs, an emerging system model for patients in the last years of life (LYOL), new models of delivery for long term conditions (LTC), new models of community health services (CHS), targeted health and social care initiatives and public health prevention metrics that underpins the entire system. The scheme has been used to test risk sharing and management between partners. The LIS helped to achieve 82% annual health check uptake for people with a Learning Difficulty and 96% health action plan uptake which is over and above the national targets. These were improvements on the previous years at 74% and 64% respectively, therefore have definitely helped improve the situation locally.

Personalisation - It is a fundamental part of our vision that care and support are personalised to patients’ and service users’ needs and preferences to support patients to feel more empowered and resilient, this is a core part of the work under the BCF. Tower Hamlets is a demonstrator site for Integrated Personal Commissioning. The focus has been on developing and embedding personalised care planning, with the offer of a budget, in 4 cohorts of the population – adults with learning disabilities, adults with mental health needs, adults with two or more long term conditions and children and young people with special educational needs and disabilities (SEND). Tower Hamlets is the top performing area in London for Personal Health Budgets (PHBs), with 432 PHBs as of 31st August 2018.

Admission Avoidance and Discharge Service including Discharge to Assess - the community service offers up to 6 weeks’ input. 200 plus patients used the service between September 2016 - May 2017. On average, 20% of patients require no or reduced social care input at the end of the 6 weeks. This supported the closure of x2 community rehabilitation wards at Mile End Hospital.

Rapid Assessment Interface Discharge - this service for patients with mental health and drug and alcohol problems in Tower Hamlets has reduced hospital admissions. It is estimated that it saved approximately 2,833 bed days in the 2014/15 financial year. The occupied bed day’s data for 2016-2017 shows that when patients with mental health problems are referred to RAID they are being discharged at a faster rate evidenced by the trend line which is going down. The data shows a saving of at least 1,778 OBDs a year (an average saving of 1 OBD per patient when you exclude April 2016) and at most 4,400 OBDs a year (an average saving of 2.5 OBD if you include April 2016).

Waltham Forest

For the Waltham Forest BCF, 2019/20 is going to be a roll-over year. We are anticipating some changes to the ‘additional contributions’ part of the pooled fund, but no material changes to the ‘minimum contribution’ elements of the fund. The CCG and Council are confident of meeting the national conditions and don’t anticipate that there will be a problem getting our 2019-20 plan assured.

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We are not currently meeting our DToC trajectory, but we have been in correspondence with local BCF leads about this. The methodology used at the start of the planning period significantly disadvantaged local areas that had made significant improvements the year before. Since we have reasonable plans in place to meet the other indicators that make up the ‘High Impact Change Model for Managing Transfers of Care’ the overall level of performance should be met.

We have refreshed our iBCF Grant Schedule for 19-20. We are undertaking some re-prioritisation/triangulation on the Grant Schedule, but anticipate that agreement will be reached between LBWF and the NHS.

2018/19 progress

Reduction in non-elective admissions - During the year we raised a challenge through the CSU about the inappropriate coding of inpatient activity within Barts Health. The Trust have accepted the challenge and have adjusted the activity on SLAM, but not on SUS. When the SLAM data is reviewed, WF is delivering the NEL targets that were set at the start of the year. Two initiatives are being taken forward to improve the coding position. The other initiative involves senior clinicians from the CCG working with clinical colleagues at Barts to better understand whether the ambulatory care service model is as effective as it needs to be. These two initiatives will help clarify the true non-elective position at Whipps Cross. The outcomes of the Monmouth review are expected shortly. The contract we have negotiated with Barts Health for 19/20 includes a clause that allows NEL baselines to be re-set depending on the outcome of the Monmouth audit.

RES Admissions - WF are currently not meeting the target trajectory we set at the beginning of the year. Contributory factors include: limited alternative provision (i.e. the right type of support at home or access to sheltered/assisted living placements) and current pressures on the Reablement Service and general pressure to discharge patients from Whipps Cross Hospital. The new 'Bridging Service' was introduced at the end of Q3. This enables health care workers employed by NELFT to support residents at home immediately following discharge. This has successfully reduced the number of delayed discharges attributed to packages of care. A review of the Integrated Discharge Team (IDT) has been completed. The recommendations are being implemented and the impact on performance will be felt in 19/20.

Reablement - The Reablement Service has experienced a number of challenges over the past year. Leads are working with other system partners to make the necessary changes and to put the service on a more sustainable footing from 19/20. This involves discussing the service approach with NELFT. The further integration of LBWF funded reablement services and NHS funded rehabilitation services is also being considered. Despite some organisational challenges, the service has historically met BCF targets in this area.

Delayed Transfers of Care - We saw a significant spike in delayed transfers of care between May and September. This was the result of process challenges on the WXH wards and within the Integrated Discharge Team and reduced capacity outside of hospital. Out-of-hospital capacity challenges were exacerbated by changes in practice that were required following a CQC inspection of the Reablement Service. Capacity constraints were also exacerbated by the closure of a further nursing home in June 2018. Performance has improved considerably from September and we hope lower levels of DToCs can be sustained for 19/20 given the mitigating actions in place.

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Appendix 1: Tower Hamlets BCF Schedule 2019/20

BCF SCHEDULE 2019/20

BCF Scheme Lead

Commissioner Provider BCF Allocation

2019-20

Extended Primary Care Team CCG ELFT £13,245,567.00

Integrated Clinical and Commissioning Quality Network Incentive Scheme CCG GP Care Group £4,461,313.00

RAID CCG ELFT £2,184,862.00

Adult autism diagnostic intervention service CCG ELFT £342,289.00

Mental Health Recovery College CCG ELFT & VCS £114,096.00

Community Geriatrician Team CCG Barts Acute £119,282.00

Personalisation (IPC programme) CCG VCS £125,000.00

Psychological Support for People with Long Term Conditions (Previously Mental Health Personal Commissioning)

CCG ELFT £153,000.00

St Joseph’s Hospice CCG St Joseph’s £2,029,248.00

Voices Survey CCG St Joseph’s £30,000.00

Age UK Last Years of Life CCG VCS £91,500.00

Barts Acute Palliative Care Team CCG Barts Acute £959,086.00

Admission Avoidance and Discharge Service (incorporating Discharge to Assess) CCG THT £850,955.00

Age UK Take Home and Settle CCG VCS £114,000.00

Single Incentive Scheme CCG THT £500,000.00

OOB Social Worker CCG LBTH £60,000.00

Spot Purchase (overseen by CSU) CCG Acute £85,000.00

£25,465,198.00

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BCF SCHEDULE

BCF Scheme Lead

Commissioner Provider BCF Allocation

2019/20

Reablement Team Council Council £2,503,763.00

Community Health Team (Social Care) Council Council £928,848.00

7 Day Hospital Social Work Team Council Council £1,276,634.00

Carers Duties Council Council £722,956.00

Care Act Implementation Council Council £760,296.00

Local Authority Integration Support (Enablers) Council Council £215,745.00

Community Outreach Service (Dementia) Council VCS £57,047.00

Dementia Café Council VCS £25,930.00

Social Worker input into the memory clinic Council VCS £51,862.00

LBTH - Better Care Fund MH - Recovery College Council Barts Acute £114,096.00

LinkAge Plus (council BCF component) Council VCS

Community Equipment Services (LBTH contribution) Council Council £833,925.00

TOTAL BCF FUNDING 19/20 £7,491,102.00

LinkAge Plus (council BCF component) Council VCS £321,870.00

Community Equipment Services - ICES Council Council £791,129.00

TOTAL ICES FUNDING 19/20 £1,112,999.00

TOTAL BCF £34,069,299.00

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10 July 2019

Title of report Month 12 Performance Report/19-20 Operating Plan final performance trajectory submission revisions and issues

Item number 5.1

Author Archna Mathur, Director of Performance & Assurance, NELCA

Presented by Archna Mathur, Director of Performance & Assurance, NELCA


Archna Mathur, Director of Performance & Assurance, NELCA

[email protected]

Executive summary The paper outlines the performance headlines as at M12 2018/19 (or latest position where available) and provides an update on the Operating Plan Performance trajectories for 2019/20. Key points for the STP Exec to note:

A&E Performance June YTD

Barts Health: 85.83% vs 87.5% trajectory with Newham with themost significant performance shortfall against trajectory 89.1% vs92.33% trajectory.WX 81.79% vs 84.36% trajectory and RLH 83.02% vs 86.13%trajectory.

BHRUT: 79.24% vs 86.9% trajectory Homerton: 93.84% vs 95% trajectory.

RTT Performance March/April

Barts Health achieved the 2018/19 operating plan ask to maintain sizeof the PTL compared to March 2018 (89, 591 vs 89,706 plan).

April was 84.21% vs 85.6% trajectory with a PTL size of 88,773 (727pathways below plan).

The April position on > 52 ww was 21 vs 20 trajectory. BHRUT did not achieve the 2018/19 operating plan ask to maintain

the size of the PTL compared to March 19 (39,272 vs 28,484 plan). April was 82.1% vs 82.1% trajectory with a PTL size of 39,581 vs

38,989 plan. The April position on > 52 ww was 30 vs trajectory of zero and

deterioration from the March position of 14. Homerton did not achieve the 201819 operating plan ask to maintain

the size of the PTL at the end of March 19, (19,514 vs 18,177 plan). The key focus is on reduction of the > 52 ww at Barts Health and

BHRUT with weekly tracking of the unvalidated position, more robustoperational processes to understand breach reasons and outsourcingwhere feasible. The NEL Demand and Capacity Group has reviewedthe year end position and is assessing the risks to the 19/20 delivery ofthe key elective programme deliverables.

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Diagnostics (DM01) Performance April (< 1%)

Barts Health did not achieve the DM01 standard for April with2.64% with particular challenges in MRI and ultrasound capacity.

BHRUT did not achieve the DM01 standard for April with 10.6%against a trajectory of 8.1%. Challenges specialities are MRI,Endoscopy, and non-obstetric ultrasound.

The Demand and capacity group will repeat the capacity review againstkey modalities again as a NEL or London level solution/strategy needsto be established.

Mental Health latest Performance

CYP Access

NEL STP 2018/19 Apr–March (provisional published) YTDperformance was 24%, below the YTD target of 32%.

However comparison of local reported data with published informationsuggests that if the local CCG position was reflected in the publisheddata the STP performance at Mar-19 would be closer to 30% insteadof 24%.

IAPT Access Rate

NEL STP’s access rate performance in Jan-19 was 4.40%, 0.35percentage points below the NHSE 4.75% target; up on the previousmonth. 3/7 CCGs met target.

IAPT Recovery

NEL STP’s recovery rate performance in Jan-19 was 50.1%, achievingthe 50% standard for the first time since Sep-18. 3/7 CCGs met target.

CHC (Continual Health Care) assessments completed within 28 days

At Q4 2018/19 NEL STP performance was 64.3%, an improvementon the previous quarter but below the 80% target. Only Newham andWaltham Forest achieved the target, with the BHR CCGs accountingfor 71% of the total reported 28 day pathway breaches across NEL.Focused work is being undertaken to achieve the 28 day target byend of Q1 2019/20.

CHC Assessments in the acute setting

STP level performance at Q4 2018/19 was 10.6%, achieving the<15% maximum target.

NHS 111, Of calls triaged, % of Ambulance dispatches

In Mar-19, NEL (LAS provider) % Ambulance dispatches was8.2%, a slight reduction in performance from 8.1% in Feb-19.

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London’s position in March (10.6%) was also an improvement compared to February (11.2%).

Unvalidated performance as of week ending 28/04/19 shows animproved performance for NEL at 8.37% (London 9.36%).

NHS111 % Calls Closed as Self-care

• In Mar-19, NEL (LAS provider) performance of calls closed as self-care / Consult and Complete was 25%, which was the same as Feb-19. NEL did not achieve the standard of 33%.

Action required The JCC is asked to note this report.


This paper has been discussed at the STP Executive meeting on the 13 June 2019.

Strategic fit


Localauthority/integratedcommissioningimplications

Commissioning Implications:

Underperformance against constitutional standards creates a case for change in the way in which services are commissioned and how both elective and non elective demand is planned and managed by commissioners and primary care.

Local Authority/integrated commissioning implications:

As above with implications specifically for integrated commissioning around urgent care, reducing lengths of stay, commissioning of care home capacity for example.


Local people will be aware of how services that are commissioned to meet their needs around quality, safety and access perform, and the processes in place to provide assurance


The performance report highlights national standard performance which means that all services across England are measured in the same way for equitable delivery.


The performance report highlights where increases in activity could be driving commissioning costs e.g. A&E attendances or unplanned admissions, with the consequence of under performance against a national standard. If a performance standard is not delivered, this could impact on patient quality e.g. waiting times for outpatient appointments or planned surgery, resulting in the need to ensure processes are in place gain assurance on patient safety and minimising the risk of clinical harm. Equally, if performance standards are met, then the impact on patient outcomes will be seen e.g. delivery of the 62 day cancer standard driving improving early diagnosis and one year survival.

Risks Current risks are insufficient improvement to consistently deliver 18 weeks, reduction in over 52 week waiters, A&E standards, diagnostic access times and consistent delivery of Mental health standards

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NEL STP Performance Report

Monthly report - M12 2018/19

Produced by NEL POD Performance team V12Last updated: 17 May, 2019 36

Executive Summary

Sustained Improvement(>3months)

Recent Improvement Areas of Particular Concern Issues

The following metricsremained on track withsustained achievement oftargets across the STP forthree months or longer.

• Mental Health IAPTWaiting Times

• Extended Hours Access toPrimary Care

• Cancer 62 day

One metric moved up a category fromImproving to Category 2

• IAPT recovery rate performance in Jan-19was 50.1%, above the 50% standard for thefirst time since Sep-18.

Four metrics moved from ‘not improving’ to‘improving’

• DIAGNOSTICS: a performance of 2.98% animprovement over the previous month(7.36%) against the target of 1%. Thisimprovement is driven by improvedperformance at BHRUT.

• NHS 111: performance for % calls answeredwithin 60 seconds improved to 82.8%against 95% standard.

• LOS: NEL STP reported a total of 580 bedsoccupied. Whilst not compliant with thetarget this was an improvement from 641 inFeb-19.

• LAS handovers: In March-19 NEL STPhandovers within 15 minutes performanceimproved to 29.7% from 27.7% in Feb andhandovers within 30 minutes improved to88.3% up from 85.0%.

One metric showed a deteriorationwhich moved them down aperformance category.

DTOC: NEL STP average bed dayslost to DTOCs in Feb-19 was 97,above the target of 69. Theposition deteriorated from Jan-19position.

A number of metrics remain in thelowest category, ‘not improving’and of particular note is:

RTT: In Feb-19 the NEL PTL positionwas 6,224 pathways over-plan forthe month up from 3,713 in Jan-19,driven primarily by BHRUT (5,947pathways over-plan). 52wwincreased by 1 in Feb-19 to 34pathways up from Jan-19 (33).

• CHC completed within 28 days: At Q4 2018/19, NELSTP performance was 64.3%, an improvement on theprevious quarter but below the 80% target. OnlyNewham and Waltham Forest achieved the target,with the BHR CCGs accounting for 71% of the totalreported 28 day pathway breaches across NEL.Focused work is being undertaken to achieve the 28day target by end of Q1 2019/20.

• MH CYP Access: NEL STP 2018/19 Apr–Mar was 24%,up from 22.5% but below the 32% annual target.Significant divergence between local and nationaldata remains an important issue being addressed.This is potentially under-reporting achievement byan estimated 6.3 percentage points.

• IAPT Access rate performance in Jan-19 was 4.40%,0.35 percentage points below NHSE 4.75% Q4 target.

• MH Inappropriate Out of Area Placements: NEL STPreported a total of 435 days in Jan-19, comparedwith 280 days in Dec-18, above the STP quarterlytarget of 100. This increase was mainly at BHR andWaltham Forest CCGs reflecting demand pressuresand low bed capacity at NELFT.

Summarises the key issues from this months STP Performance Report; identifies key changes from previous month’s report including changes between the categories of performance achievement on the next slide.

Key: GREEN: Sustained Improvement >than 3mths LIGHT GREEN: Recent Improvement RED: Denotes areas of Particular Concern BURGUNDY: Denotes areas where issues persists

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ELHCP STP Executive Performance update – M12 2018/19

CHC assessments in acute setting Mental Health EIP waiting time

STP level performance at Q4 2018/19 was 10.6%,achieving the <15% maximum target.

NEL STP achieved the waiting times element of EIP across 6 of 7 CCGs in Feb-19 reporting 87.3%, above the 53% standard.

Mental Health Dementia

Mental Health IAPT recovery

NEL STP performance during Feb-19 was 67.4%, above the 66.7% national standard.

NEL STP IAPT recovery rate 3 month performance in Jan-19 was 50.1%, above the 50% standard. 3/7 CCGs achieved the standard.

Elective Care RTT

Mental Health

CYP Access

CHC referrals completed within 28

days

U&ECDTOC

TransformingCare

IP reduction LD

NEL STP achieved 86.0% in Feb-19. The NEL PTL position is 6,224 pathways over-plan for the month, mainly driven by HUH (1,296 pathways over-plan) and BHRUT (5,947 pathways over-plan).

NEL STP 2018/19 Apr–Mar was 24% below annual target 32%.

STP level performance at Q4 2018/19 was 64.3%, below the 80% target.

NEL STP average bed days lost to DTOCs in Feb-19 was 97, above the target of 69. The position deteriorated from Jan-19 position

NEL STP level performance at Feb-19 showed 50 learning disabilities patients in receipt of inpatient care, 9 patients above the target of 41.

Mental Health IAPT Access

NHS 111 Minors Breaches

A&E 4 Hour Wait

Diagnostics LOS >21 Days LAS Handovers

NEL STP performance in Jan-19 was 4.40%, 0.35 percentage points below 4.75% target. 3/7 CCGs met the target.

In Mar-19, performance for % calls answered within 60 seconds improved to 82.8% from 65.3%

% Calls abandoned within 30 seconds was 2.0%.

NEL STP achieved 99.1% in Mar-19 relatively flat with 99.1% the previous month.

NEL STP reported 245 breaches, up from 218 in the previous month.

NEL STP A&E performance in Mar-19 was 84.57%, 8.89% below the STP trajectory but a 3.28% improvement from Feb-19.

NEL STP achieved 2.98% in Feb-19 and was non-compliant with the 1% diagnostics (DM01) standard.

Improvement in NEL STP performance is driven by improvements at BHRUT this month.

In Feb-19 NEL STP remained non compliant with the ambition for LOS>21 days, reporting a total of 580 beds occupied. However this was an improvement from 641 in Jan-19 primarily driven by Barts.

In Mar-19 NEL STP handovers within 15 minutes performance improved to 29.7% from 27.7% in the previous month.

In Mar-19 NEL STP handover within 30 minutes was 88.3% from 85.0% in the previous month.

Issu

es

/ A

ctio

n /

M

itig

atio

n

Diagnostics Elective Care RTT Mental Health

NEL STP improvement in performance was driven by improvement at both BHRUT (9.22%) and Barts Health (0.39%) against the 1% Standard . BHRUT (DM01) Trajectory forecasts delivery in Apr-19.

The Trust has worked up recovery actions for the challenged modalities which is discussed at the planned care programme board and at CRG. BHRUT’s financial position is having a significant impact on overall delivery.

NEL STP performance remains challenged across Bart's Health and BHRUT. At Bart's Health the number of 52ww improved from 25 in Jan-19 to 24 in Feb-19

BHRUT continues to be monitored against the revised trajectory which is to deliver 88.43% by Mar- 19.Unvalidated position for March as of 31/03/19 is 80.4%. BHRUT and BHR CCGs agreed 19/20 RTT Trajectory as part of the Operating planning round submissions, this sees BHRUT achieve 88.1% by Mar-20 with a PTL size of 34,153.

IAPT access and recovery rates have shown an overall improvement across the STP. Thecurrent underperformance within four CCGs reflects the impact of increased annual IAPTaccess target, against a background of constrained financial investment within BHR, andin-year service re-procurement within TH. BHR and TH recovery plans are in place, withoversight through STP MH Assurance Group.

CYP Access Rate is underperforming across NEL reflecting difficulties by providers toreport CYP MHSDS data to NHS Digital. CCGs are working with providers to improve flowof CYP data. Local recovery plans are in place, with oversight through STP MH AssuranceGroup.

Not compliant and performance trajectory deteriorating /not improving

NOT IMPROVING (4)

Performance On Track against trajectory/ performance standard ON-TRACK (1)

Performance improving but not yet on track IMPROVING (3)

11

URGENT AND EMERGENCY CARE

ELELCTIVECARE

CANCER/DIAGNOSTICS

PRIMARYCARE

MENTAL HEALTH TRANSFORMING CARE

1

Key: Consecutive months in 18/19 that performance is in assigned category. Arrows denote movement between categories.

11 1 1

2

3

3

12 10 11 3

Currently compliant against trajectory/performance standard but performance at risk

AT RISK (2)

21

11

38

Title of report Joint Commissioning Committee Risk Register

Item number 6.1

Author Kash Pandya & Kate McFadden Lewis

Presented by Kash Pandya

Contact for further information Kash Pandya - [email protected]

Kate McFadden-Lewis - [email protected]

Executive summary The report presents the NELCA Joint Commissioning Committee (JCC) risk register for review.

Good governance requires each committee to hold a risk register for its responsibilities. The paper identifies 11 risks held by the NELCA JCC and indicates the mitigating action. These cover:

S1 Robust demand and capacity planning across NEL

S2 Improving self care and demand management and increasing care closer to home

S3 Securing the future of NEL health and social care providers and commissioners

S4 Improving the commissioning of specialised care

S5 Securing local council leadership for key NEL programmes

S6 Delivery of primary care at scale

E1-3 Enabling programmes of workforce, digital and estates

AD1 Streamlined and robust assurance on system transformation and improvement plans

AD2 Integrating CSU services into CCGs where required.

The report also outlines proposed changes to the JCC risk register to be agreed by the Committee.

Action required The Committee is asked to:

review the risks and mitigating action and advise on any gapsor concerns for further action

agree the proposed changes to the risk register.


NELCA SMT – 25 June 2019.

Strategic fit

Commissioning implications Local authority/integrated

commissioning implications

The risk register notes the main risks and mitigating actions to deliver the NELCA priorities. The risks should be considered and integrated into local CCG Board Assurance Frameworks where required.


The risk register sets out the key actions being implemented to address any finance, performance or quality risks.


This report highlights the main risks to deliver the NELCA priorities within the Scheme of Delegation and the actions taken to minimise the impact of those risks. It is part of making sure the work of the JCC is transparent and accountable to local people.

Joint Commissioning Committee 10 July 2019

39


Risks This report also links to the following JCC papers being presented to this meeting that provide greater detail on the key risks and the mitigating action:

3.1 Prevention: areas for collaboration across NEL

4.1 Social prescribing: commissioning arrangements and implications

5.1 Performance report

40


Purpose of the report 1. The purpose of the Joint Commissioning Committee risk register is to set out the key risks to

the North East London Commissioning Alliance (NELCA) in achieving its objectives and priorities and the actions in place to manage those risks.

Background 2. The Joint Commissioning Committee has a responsibility to maintain sound risk management

processes and ensure that internal control systems are appropriate and effective and where necessary to take remedial action. It is a key part of Good Governance.

3. The risk review uses the standard NHS methodology that considers the likelihood of the riskalongside its severity. Both measures are scored out of 5 (with 5 being the most likely andworst impact). The risk score takes account of the mitigating action proposed. This thengives a risk score and categorisation of:

4. The risk register is organised around the NEL corporate objectives. The JCC has set out itsforward plan that includes updates on its key strategies and programmes. The risk registerwill be updated each time to reflect the progress being made, as well as identifying any newrisks from the consideration of its business.

5. As the JCC is a collaborative committee of all CCGs, each Governing Body must own therisk and associated mitigating action through its risk management arrangements. The riskassessment and mitigation are set out in appendix 1. For risks that are red-rated (scored 15or greater), CCGs should ensure that these are covered in their own risk registers and BoardAssurance Frameworks.

6. Following discussions with Audit Chairs and JCC Members, it has been agreed to keep therisk management and the risk register under review to ensure the risk arrangements arerobust and embedded firmly within the ELHCP, Alliance and its member CCGs. Further workis underway – aligned to the review of NEL risk management arrangements – to improve theregister. Many of the risks identified in the register are ones that apply equally to the ELHCPas much as to NELCA. Given this, it is intended to explore how we can move potentially to acommon NEL risk register while recognising the formal accountability back to CCG members.

7. With the ambition to become a NEL ICS by 2021 we are proposing to review and revise thecurrent JCC risk register to ensure it reflects, and has oversight of, the objectives andmilestones to reach ‘mature ICS’ by 2021. The risks will incorporate the current risks as wellas those outlined in the NHS ICS Maturity Matrix. Additionally, we propose to amend theformat of the risk register to show one risk per page, and include progress of the risk scoreagainst a trajectory, template attached (appendix 2). If agreed, this new format will bepresented at the September JCC meeting.

Current Risks on the JCC Risk Register8. There are 11 risks on the JCC risk register and appendix 1 shows the full detail of these risks

and the mitigating action.

Risk rating Risk Score

Low 1 – 3 Medium 4 – 6 High 8 – 12 Severe 15 - 25

41


Progress on Risk Mitigation 9. A brief update on progress on the 11 risks is given below:

S1 - Robust demand and capacity planning across NEL 10. The 19/20 System Operating plan has been agreed. This aligns commissioner and

provider approaches to key programme and issues and includes a consolidated approachto system savings. This was approved through the ELHCP Executive and is available onthe ELHCP website. Finance and activity continues to be managed through the ODG. Thecommissioning strategy will be revised as part of agreeing the ELHCP STP refresh by Oct19.

S2 - Improving self-care and demand management and increasing care closer to home 11. The NELCA prevention programme continues to deliver existing projects including stopping

smoking, diabetes and TB. These have a focus on secondary prevention interventionsincluding interest in exploring the Ottawa model on reducing smoking as adopted in GreaterManchester. As part of the NEL response to the LTP, the programme is being refreshedincluding developing the network / locality approach that will be a major focus for work withlocal communities. In addition, the LTP makes further commitments around personalisationthat will assist with self-care. This will include social prescribing where we have significantgood practice from Tower Hamlets, City & Hackney and Waltham Forest that can assistwider learning.

S3 - Securing the future of NEL health and social care providers and commissioners 12. Payment reform is on-going and developing through the wider commissioner and provider

collaboration embedded in the NEL approach to integrated care and the 19/20 SystemOperating Plan. This will be one of the key areas considered in the refresh of the NEL STP.A risk share is in place across NEL CCGs.

S4 - Improving the commissioning of specialised care 13. The guidance is still awaited from NHSE / NHSI on the delegation of specialised

commissioning and this is now anticipated to be included in the NHS Long Term Plan.There was a focus on SpecComm and provider alignment in the 19/20 System OperatingPlan. There is ongoing engagement with NHSE to influence any proposals and currentplans and commissioning of specialised commissioning by NHSE.

S5 – Local Council Engagement 14. The main vehicle for local council involvement is through each of the integrated care

systems and engagement is good. Regular updates on NELCA and ELHCP are providedto HWBBs and OSCs. Engagement with local councils is ongoing around the INELTransformation Board (Waltham Forest, Newham, Tower Hamlets and City & Hackney).This involves both commissioners, providers and local councils. Local council chiefexecutives are engaged with the ELHCP Partnership Executive and there is ongoing liaisonbetween the Single Accountable Officer and her local MDs and local council leaders (bothpoliticians and officers).

S6 – Primary Care at Scale 15. The focus on primary care recruitment and retention continues. A review of all Federations

has been undertaken using the national maturity matric tool. This will be used to inform thebest use of primary care transformation funds in 19/20 and beyond. In addition, the newGP contract changes aimed at supporting the introduction of Primary Care Networks isbeing supported both locally and across NEL. It is aligned to the ongoing work with local

42


GP Federations. The local PCN framework is being extended to encompass ensuring PCNs are DES ready and that they do become fully functioning PCNs with their community partners.

E1 – Workforce 16. Delivery of a number of initiatives from external funding bids continues. This includes

physician associates, nursing associate apprentices, workforce support around cancer andmental health and provider collaboration on the use of bank and agency. Workforce is seenas one of the key enablers to deliver long term sustainability for NEL and it is likely to be apriority within the STP Refresh.

E2 – Digital 17. The focus continues on the delivery of the NEL Local Health and Care Record Exemplars

including clinical access, public access to care records and improving data quality. Thedevelopment of a digital front door to the NHS continues with funding in place to deliver thePrimary Care Digital Accelerator.

E3 – Estates 18. The NEL estates strategy was published fully in October on the ELHCP website. Although

no funding was secured in the Wave 4 bids, each of the NEL priority schemes areassessing potential alternative funding. The Whipps Cross business case continues to bedeveloped with the involvement of local stakeholders. There has been significantengagement with local councils around the NEL strategy including local briefings andpresentation to the BHR and INEL Joint Overview and Scrutiny Committees.

AD1 - Streamlined and robust assurance on system transformation and improvement plans 19. There is continued discussion with regulators on the 19/20 assurance process following the

integration of NHS England (commissioners) and NHS Improvement (providers). Aframework is being developed for earned autonomy and this being tested in key areas suchas mental health and A&E. The NEL reporting framework is now agreed and a regularrhythm established for the JCC, ELHCP Executive and NELCA chairs. This ensures muchgreater oversight and awareness of current performance issues.

AD2 – CSU Integration 20. The NEL programme has been paused by the national team pending the outcome of an

NHS England commissioned audit by Deloitte. It is anticipated that the review will bepublished in May. This will allow fresh consideration of any key areas for inhousing. Untilthe outcome of the review is known, NEL is working with three other London STPs todevelop an interim operating model to allow staff to work more closely and flexibly withCCG leadership.

43

10 July 2019, item 6.1 - Appendix 1

Joint Commissioning Committee – Risk Register

Ref Category Date

added Description

Prev. rating

Current risk rating Risk

owner(SRO)

Escalated to CCG GBAFs

Mitigating actions Target Targetdate Likelihood

(1-5) Severity

(1-5)

TotalScore (1-25)

Objective 1: Improving Quality of Care for local people

S1 Strategy May-18 Unless there is robust demand and capacity planning and approaches across NEL, the quality of services, health outcomes and the sustainability of both commissioners and providers will be affected negatively.

16 4 4 16 LB N

STP reviewed and refreshed with transformationprogrammes to deliver on key priorities includingmaternity, outpatients, mental health and others.NEL focus on enablers around workforce, digital andestates

19/20 System Operating Plan agreed with reviewand monitoring through Operational Delivery Group.

NEL Commissioning strategy agreed at the Sep 18JCC with further work being undertaken throughengagement with local stakeholders to refine itfurther.

Overarching strategy will be refreshed to the NHSLong Term Plan (Oct 19).

8

31/10/19

Objective 2: Securing financial stability

S2 Strategy May-18 Unless self care and demand management is improved and high quality care offered closer to home, the pressure on services will continue with a consequent effect on performance, quality and outcomes.

12 3 4 12 SH N

STP refresh of all programme underway for Oct 19. NEL prevention programme focused on secondary

prevention programmes around smoking anddiabetes. Local prevention programmes focused onboroughs and localities to allow tie into Primary CareNetworks and local communities.

New personalisation programme to be developed aspart of the STRP Refresh that will include socialprescribing drawing on the good practice in someNEL CCGs

Integrated Urgent Care continues to provide betterclinical advice and signposting to reduce pressure atED

Primary care improvement strategy to enhancecapacity and quality.

8

31/10/19

44

Ref Category Date

added Description

Prev. rating


owner(SRO)



(1-5) Severity

(1-5)

TotalScore (1-25)

S3 Strategy May-18 Unless the future of NEL health and social care providers and commissioners is secured financially there may need to be significant reductions in services with a consequent impact on health outcomes.

20 3 5 15 HB Y

19/20 System Operating Plan agreed to aligncommissioner and provider savings schemes

Risk share mechanisms in place across NEL NEL Transformation programmes to address

demand and capacity issues Monthly monitoring at ODG meeting to consider risk

and mitigation Financial Strategy Committee manages payment

reform and other STP wide finance issues.

12

31/03/20

S4 Strategy May-18 Unless specialised services are aligned with current CCG commissioned services, there is a risk of duplication and inefficiencies, as well as financial pressure on NEL commissioners and providers. 9 3 3 9 LB N

Delegation of Specialised Commissioning underreview as part of NHS England new arrangementswith further guidance expected with Long Term Plan.

Further alignment proposed between specialisedcommissioning and providers as part of 19/20Operating Plan

Ongoing SAO engagement with NHSE to influencefuture proposals and current (NHSE) specialisedcommissioning plans

6

31/03/20

Objective 3: Developing the local integrated care system

S5 Strategy Jul-18 Unless there is full engagement and involvement of local councils in developing and delivering integrated care systems and political leadership on and support of NEL-wide priorities, transformation will not be achieved fully

12 3 3 9 SH N

Approach to Integrated Care fundamental to theRefresh of the NEL STP with a focus on place-basedpartnerships

Regular engagement and participation throughHWBB and local integration programmes

Collaborative CCG framework in developmentacross Waltham Forest, Newham and TowerHamlets CCGs with INEL System TransformationBoard with providers and City & Hackney.

Regular NELCA / ELHCP updates provided toHWBB and OSCs

SAO and CCG leadership engaging regularly withCouncil leadership

6

31/10/19

45

Ref Category Date

added Description

Prev. rating


owner(SRO)



(1-5) Severity

(1-5)

TotalScore (1-25)

Objective 4: Primary care transformation

S6 Strategy Jul-18 Unless primary care at scale organisations develop at sufficient scale and pace, the improvement in resilience and quality and the primary care role in integrated care systems will not be achieved

12 3 4 12 CJ Partial

STP primary care programme oversight and localdelivery – being refreshed to ensure adequate plans

Governance structure with provider forum GPFV transformation funding to support local

development, ensuring that best practice achievedvia funding is shared across all NEL at-scaleorganisations.

New model of care workstream included in new PCTransformation programme with group beingestablished

Review of Federations and progress to date to bedeveloped through New Model of Care Workshop

Review of Federations against maturity frameworkundertaken in all CCG patches. Results to becollated and used to inform use of 2019/20transformation funding

New GP contract changes relating to introduction ofPCNs being supported at CCG and NELCA level andaligned to existing work on GP Federations

8

30/10/19

Objective 5: Progressing integrated commissioning with local councils

Objective 6: Partnerships and collaboration across north east London

E1 Enablers May-18 Unless the large scale enabling programme around workforce is delivered with all providers being aligned, working collaboratively and understanding the implications of the new models of care, local transformation and the drive towards integration of services will not be delivered.

12 3 4 12 AB N

Bank and Agency project progressing Coordinated approach to establishing training

capacity and placement allocation Workforce strategy being refreshed and aligned to

the resources available in each system as part of theSTP Refresh

Additional resources secured from HEE, funding forcancer and Mental Health programmes.

Maternity recruitment and retention programmeunderway.

New Models of Care, Recruitment of PhysicianAssociates graduates ongoing, Nursing AssociateApprentice programme in Primary Care

6

31/10/19

46

Ref Category Date

added Description

Prev. rating


owner(SRO)



(1-5) Severity

(1-5)

TotalScore (1-25)

E2 Enablers May-18 Unless the large scale enabling programme around technology is delivered with all providers aligned and understanding the implications of the new models of care, local transformation and the drive towards integration of services will not be delivered

12 2 4 8 LR N

Funding has been secured to deliver the OneLondon LHCRE, key elements of the programmenow need to be delivered in NEL

STP LTP response will include significant input fromDigital Workstream

NHSI&E review of Digital investment underway Funding in place for Primary Care Digital Accelerator

needed to help create ‘digital front door’ to the NHS

6

31/10/19

E3 Enablers May-18 Unless the large scale enabling programme around estates is delivered with all providers aligned and understanding the implications of the new models of care, local transformation and the drive towards integration of services will not be delivered

20 4 4 16 HB N

STP refresh of deliverables planned for Sep / Oct 19 Estates Board established to oversee NEL strategy

and funding bids under London Devolution Estates strategy published and engagement

programme delivered. Following no funding under Wave 4 bids potential

alternative funding is being explored.

6

31/10/19

AD1 Assurance and Delivery

May-18 Unless the assurance process with NHS England is streamlined, it will be difficult to release capacity to support delivery of local priorities and the Sustainability and Transformation Plan. Unless NEL delivers robust assurance on its improvement plans to regulators, it may lead to additional costs and a lack of control and influence over local services.

9 3 3 9 JM/AM N

NEL ICS performance and assurance framework indevelopment following the London Regional Team Operating model for earned autonomy.

Testing of approach in place with respect to RTTdelivery, mental health performance and A&Eperformance at BHRUT/Royal London and WhippsCross

Reporting documentation and rhythm established forJCC, STP Executive and NELCA chairs.

Regular bi-meetings with regulators to discuss andtest approach

6

30/03/19

Objective 7: Organisational effectiveness / organisational development

AD2 Assurance and Delivery

June-18

Unless the significant programme of in-housing from the CSU is delivered through close joint working with NELCSU; with due regard to maintaining support services before, during and after the TUPE transfers, support for clinical services, finance and control mechanisms may be compromised.

16 4 4 16 LB

(CF) N

Steering Committee established to overseeprogramme

National audit underway to review currentarrangements and rebase contracts (May 19)

Interim operating model being developed inpartnership with three other London STPs to achievesome benefits of closer working until the nationalapproach is agreed.

9

31/10/19

47

Risk grading matrix

Likelihood

Rating 1 2 3 4 5 Description Rare Unlikely Possible Likely Certain

Probability <10% 10% - 24%

25% to 45%

50% - 74% >75%

Sev

erit

y

Rating Description

A Objectives/

projects

B Harm/injury to patients, staff

visitors & others

C Actual/potential

complaints & claims

D Service

disruption

E Staffing &

competence

F Financial

G Inspection/

Audit

H Adverse media

1 Insignificant

Insignificant cost

increase/time slippage.

Barely noticeable

reduction in scope or quality

Incident was prevented or

incident occurred and there was no

harm

Locally resolved complaint

Loss/ interruption more than 1

hour

Short term low staffing leading to reduction in quality(less than 1 day)

Small loss <£1000

Minorrecommendations

Rumours 1 1 2 3 4 5

2 Minor

Less than 5% cost or time increase.

Minor reduction in

quality or scope

Individual(s) required first

aid. Staff needed <3

days off work or normal

duties

Justified complaint

peripheral to clinical care

Loss of one whole

working day

On-going low staffing levels

reducing service quality

Loss of 0.1% budget.

<£10,000

Recommendations given. Non-

compliance with standards

Local media column

2 2 4 6 8 10

3 Moderate

5-10% cost or time increase.

Moderate reduction in

scope or quality

Individual(s) require

moderate increase in care. Staff needed >3

days off work or normal

duties

Below excess claim. Justified

complaint involving

inappropriate care

Loss of more than one

working day

Late delivery of key objectives/service due to lack of staff. On-going unsafe staff levels. Small

error owing to insufficient training

Loss of more than 0.25% of budget. <£100,000

Reduced rating. Challenging

recommendations. Non-compliance with standards

Local media front page story

3 3 6 9 12 15

4 Major

10-25% cost or time increase. Failure to meet

secondary objectives

Individual(s) appear to have

suffered permanent harm. Staff

have sustained a "major injury" as defined by

the HSE

Claim above excess level.

Multiple justified complaints

Loss of more than one working

week

Uncertain delivery of services due to lack of staff. Large

error owing to insufficient

training

Loss of more than 0.5% of

budget. <£500,000

Enforcement action. Low rating.

Critical report. Major non-

compliance with core standards

Local media

short term 4 4 8 12 16 20

5 Severe

>25% cost or time increase. Failure to meet

primary objective

Individual(s) died as a result of the incident

Multiple claims or single major

claims

Permanent loss of

premises or facility

No delivery of service. Critical error owing to

insufficient training

Loss of more than 1% of

budget. >£500,000

Prosecution. Zero rating. Severely critical report.

National media

more than 3 days. MP

concern

5 5 10 15 20 25

Risk Category Severe High Medium Low

48

Appendix 2 – template NELCA Joint Commissioning Committee Assurance Framework

JCC Objective XX Risk reference

Risk description XX

CCGs impacted B&D CCG Hav CCG Red CCG N CCG WF CCG TH CCG CH CCG Risk owner

Score History and Targets Initial rating Initial date Rationale

(Graphic – showing trajectory target versus actual)

Target rating Target date Rationale

Current rating Latest review date Rationale

Controls Assurances I= internal, E= external

Date received Evidence for assurance

Gaps Proposed actions Target date

Controls Assurance

Mitigations

49


Joint Commissioning Committee and Clinical Senate meeting plan – 2019/20

Regular items:

Minutes / Action log/ Questions from the public Performance report – tailored to the agenda items and include friends and family test Future of commissioning – 2021 vision Risk register Meeting plan

Clinical Senate Joint Commissioning Committee

Month Subject / Topic Month Items

10 April

Stroke Network – developing collaborative,system wide clinical approaches across NEL

East London Prevention Program (ELoPE) –Promoting the coordination of CVD preventionacross NEL

10 April Moorfields Hospital proposals - Pre Consultation Business Case

– part II

8 May

Neurosurgery provision/reconfiguration acrossNEL

Integrated Care System & ELHCP governanceupdate

8 May

STP refresh update

Cancer Diagnostic Hub: update on patient engagement

North East London Spending Money Wisely Programme update

12 June

Stroke – Presentation of a proposed uniformstroke care pathway for NEL – Senate tocontribute support via input, feedback and nextsteps.

Neuro-Rehab – INEL STB overview ofprogramme

Spending Money Wisely – Update paper onlycirculated (no presentation)

12 June OD session – future of commissioning

Item 7.1

50


10 July Mental Health – LTP developments; senate to

input and feedback 10 July

ELFT update

Better Care Fund – update

ELHCP Transformation Programme

Update on development of LTP

o to include NELCA progress on the LTP vision

14 August LTP and London vision 14 August OD session –TBC: Bullying and Harassment awareness training

11 September

Primary Care Networks – Consideration ofuniform PCN structures and governance acrossNEL that promote collaboration and integration.

NEL LTP Enabler Workstream programmeupdate: Digital Transformation.

11 September

NELFT update

Neurosurgery

Mental Health Strategy- including crises intervention, suicide andveterans and Early Intervention in Psychosis

Aligning Commissioning Policies – engagement outcome

Update on LITA/HLP/CSU

Long Term Plan approval

Social prescribing

9 October Stroke – Strategic programme updates Whipps Cross redevelopment progress update 9 October OD session – Progress on digitalisation

13 November NEL Enabler Workstream programme update:Workforce

13 November

HUHT update Prevention – areas for collaboration across NEL (ie, Diabetes,

obesity in children)

Progress on redeveloping Whipps Cross

11 December Medicines Optimisation - Strategic Programmeupdates

11 December OD session – Workforce strategy

8 January NEL LTP Enabler Workstream programmeupdate: Infrastructure (Estates)

8 January

Update on specialised commissioning Future of commissioning – update Medicines Optimisation strategy BHRUT update

12 February Urgent & Emergency Care - StrategicProgramme updates

12 February OD session - Primary care at scale

51


0 – 25 (Children’s & Young Persons) StrategicProgramme updates

Personalisation Strategic Programme updates

11 March

ELHCP Clinical Senate review:o Terms of Reference

o Membership

o Lessons Learnt/ Future Senatedevelopments for 20/21

11 March

Operating Plan 20/21

Transforming Care

Cancer

JCC Review:

o Terms of Reference

o 2020/21 programme

JCC to be scheduled: Pathology business case Vascular Acute paediatrics Estates strategy update WEL update Demand management – update from demand and capacity group.

52

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