newham ccg board part i meeting...2.35pm integrated quality and performance report 17 approval f...

Newham CCG Board Part I Meeting

2-4pm Thursday 22 February 2018 Committee Rooms, Newham CCG

4th Floor Unex Tower, 5 Station Street, London E15 1DA

ACRONYM MEANING

A&E Accident & Emergency

ACS Accountable Care System

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

BAU Business as usual

BCP Business continuity plan

BHRUT Barking, Havering and Redbridge University Hospitals NHS Trust

BMA British Medical Association

CAS Clinical Assessment Service

CCG Clinical Commissioning Group

CCG IAF Clinical Commissioning Group Improvement and Assessment Framework

CCU Critical Care Unit

CEG Clinical Effectiveness group

CEPN Community Education Provider Network

CHN Community Health Newham Directorate

CHP Community Health Partners

CHS Community Health Systems

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

DASL Drug and Alcohol Service in London

DES Direct Enhanced Service

DoH/ DH Department of Health

DoPM Department of Psychological Medicine

DRSS Diabetes Retinopathy Screening Service

DToC Delayed Transfers of Care

ED Emergency Department

ELFT East London Foundation Trust

ELHCP East London Health and Care Partnership

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

HoT Heads of Terms (Contract Summary)

HUH The Homerton University Hospital NHS Foundation Trust

IAPT Increasing Access to Psychological Therapy

ICC Integrated Care Committee

ICP Integrated care partnership

ICS Integrated Care System

IG Information Governance

IMCA Independent Mental Capacity Advocate

IMT Information Management and Technology

INEL Inner North East London

IPS Individual placement and support schemes

ITT Invitation to Tender

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

LD Learning Disability

LD SAF Learning Disability Self-Assessment Framework

LEB London Estates Board

LEDU London Estates Development Unit

LES Local enhanced service

LMC Local Medical Committee

MHCC Mental Health Commissioning Committee

MM Medicines management

MoLCV Medicines of limited clinical value

MOU Memorandum of understanding

MPIG Minimum Practice Income Guarantee

MSK Musculoskeletal

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

NHC Newham Health Collaborative

NHS PS NHS Property Services

NHSE NHS England

NHSI NHS Improvement

NICE National Institute of Health and Care Excellence

NUH Newham University Hospital

NWP Newham Wellbeing Partnership

OOH Out of hours

OPD Outpatient department

OPE One Public Estate

PALS Patient Advice and Liaison Service

PCCC Primary Care Commissioning Committee

PCH Primary Care Home

PCT Primary Care Trusts

PHE Public Health England

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

PPE Patient and Public Engagement

PPG Patient and Public Group

PREM Patient Reported Experience Measure

PROM Patient Reported Outcome Measures

QIPP Quality, Innovation, Productivity and Prevention

QOF Quality Outcome Framework (Assessor Validation Reports)

R&D Research & Development

RAG Red, Amber, Green

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

SPA Single Point of Access

SPR Service Program Review

STP Sustainability and Transformation Plan or Partnership

THCCG Tower Hamlets Clinical Commissioning Group

TOR Terms of reference

TSCL Transforming Services Changing Lives

TST Transforming Services Together

UCC Urgent Care Centre

UCLP UCLPartners/ University College London Partners

UCWG Urgent Care Working Group

UEC Urgent and Emergency Care

UTC Urgent Treatment Centre

WELC Waltham Forest, East London and City (Integrated Care Programme)

WFCCG Waltham Forest Clinical Commissioning Group

Whipps X / WX Whipps Cross Hospital

WTE Whole Time Equivalent

NCCG Board Part I 2-4pm Thursday 22 February 2018 Committee Rooms, Unex Tower, 5 Station Street, Stratford, E15 1DA

Agenda

No Time Item Page Action Required Owner

1. Welcome

1.1 2pm Welcome, introductions, apologies • Declarations of interest

Verbal Chair

1.2 2.05pm Minutes of the meeting held 13 December 2017

• Action log

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10

Approval

Discussion Chair

1.3 2.10pm Accountable Officer’s Report 11 Information J Milligan

2. Patient and public engagement

2.1 2.30pm Public questions Verbal Discussion Chair

3. Strategic and discussion items

3.1 2.35pm Integrated Quality and Performance Report 17 Approval F Smith

3.2 2.45pm Board Assurance Framework 35 Approval S Sanghera

3.3 2.55pm Finance and QIPP Report 66 Approval L Wei

3.4 3.05pm 2018/19 Star Chamber and Governance Process 70 Discussion F Smith

3.5 3.15pm Better Care Fund – Section 75 Agreement 75 Approval S Douglas

3.6 3.25pm East London Health Care Partnership: update 88 Note J Milligan

3.7 3.35pm North East London Commissioning Arrangements: Constitutional changes 97 Approval Chair

3.8 3.45pm Conflicts of Interest and Gifts and Hospitality policy update 122 S Sanghera

3.9 3.50pm Ivory ward reconfiguration 144 Note Chair

4. Any other business

5. Date of next meetings: 2-4pm, Committee Rooms, Unex Tower

• 26 April 2018• 28 June 2018• 27 September 2018

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http://www.newhamccg.nhs.uk/

NHS Newham CCG Board Part I 1.30-3.30pm Wednesday 13 December 2017 Committee Rooms, 4th Floor, Unex Tower, 5 Station Street, Stratford, E15 1DA

Minutes

Present: Elected Voting Members

Dr Clare Davison Elected GP Representative, Newham CCG

Dr Catherine Gaynor Elected GP Representative, Newham CCG

Dr Ambady Gopinathan Elected GP Representative, Newham CCG

Dr Nasim Joarder Elected GP Representative, Newham CCG

Dr Muhammad Naqvi (Chair) Deputy Chair and Elected GP Representative, Newham CCG

Dr Bapu Sathyajith Elected GP Representative, Newham CCG

Dr Rima Vaid Joint Deputy Chair and Elected GP Representative, Newham CCG

Appointed Voting Members Wayne Farah Vice-Chair, Lay Member Patient & Public Engagement Newham CCG

Ajith Lekshmanan Lay Member for Audit and Governance, Newham CCG

Jane Milligan Accountable Officer, Newham CCG

Grainne Siggins Executive Director – Strategic Commissioning, LBN National Policy Lead & Trustee – ADASS

Fiona Smith Registered Nurse, Newham CCG

Lei Wei Interim Chief Finance Officer, Newham CCG

Appointed Non-Voting Members:

Andrea Lippett Lay Member Remuneration, Newham CCG

Meradin Peachey Director of Public Health, LBN

Dr Ashwin Shah Co-opted Member, Newham CCG

Hazel Trotter Practice Manager Representative, Newham CCG

In attendance:

Selina Douglas Interim Managing Director, Newham CCG

Selina Rodrigues Healthwatch Newham

Satbinder Sanghera Director of Partnerships and Governance, Newham CCG

Kate McFadden-Lewis (minutes) Board Secretary, Newham CCG

Apologies Dr Prakash Chandra Chair and Elected GP Representative, Newham CCG

Chetan Vyas Director of Quality & Development, Newham CCG

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1. Welcome, introduction, apologies for absence and declarations of interest 1.1 The Chair welcomed the members to the meeting and with a quorum being present the meeting was

declared open. Apologies were received from Dr Prakash Chandra, Chair and Elected GP Representative and Chetan Vyas, Director of Quality & Development, Newham CCG.

The Chair welcomed Jane Milligan to her first Newham CCG Board meeting in her new role as Accountable Officer.

1.2 Minutes of the last meeting The minutes of the meeting held 11 October 2017 were accepted as an accurate record.

1.3 Action log • CCG161: this action can now be closed.• CCG159: S Douglas updated that the Ivory Ward reconfiguration update will come to the next

meeting.

1.4 Chief Officer’s report J Milligan presented the Chief Officer’s report, providing an update on work undertaken by the CCG team since the last Board meeting.

2. Patient and public engagement

2.1 Public questions: None.

3. Strategic items 3.1 Integrated Quality and Performance Report

F Smith presented the newly integrated Quality and Performance Report to the Board, providing an update against the reported Quality and Performance Indicators for the three Providers from which Newham CCG commissions health services.

Key issues include, A&E Performance, Mixed Sex Accommodation breaches, A&E FFT scores and Emergency c-section rates. The Board were given assurance that robust actions are in place to ensure improvement, particularly in the red RAG rated areas.

3.2 Finance and QIPP Report L Wei presented the CCGs performance for 2017-18 and reported a month seven balanced financial position for Newham CCG, with the delivery of QIPP and efficiency saving target on track. The Board noted the significant risk, and the mitigations in place to maintain this position.

L Wei then updated on financial planning for 2018-19, advising that the outcome of the Star Chamber process will be reported to the Board at the 14 February 2018 meeting.

Discussion points included: i. that it is important that all of the potential options for efficiency savings are considered in the

Star Chamber process, including the unpalatable decisionsii. the need to ensure that all of the current contracts in place are rigorously enforced to maximise

efficienciesiii. the Star Chamber process as an opportunity to drive out wasteiv. the Star Chamber process as a tool that could be incorporated into the CCG’s standard

governance process.

It was agreed to discuss the Star Chamber process in more detail again at the next Board Development session. (ACTION: LW/SD/CV)

3.3 Board Assurance Framework S Sanghera presented the current position of the BAF for 2017/18, reporting an improvement in rating for BAF.04, BAF.05 and BAF.06 and assured the Board that actions are in place to improve the other risks before the end of the financial year, such as the deep dive process.

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W Farah then reported on the deep dive, recently carried out by the Primary Care Commissioning Committee, into BAF.07, with the aim to enable the Committee to give assurance to the Board that the risks around delivery of the primary care strategy are being effectively managed. As a result of the discussion at the Committee meeting, a number of additional internal control measures have been put in place to ensure the delivery of the CCG’s primary care strategy through the key delivery vehicles including Primary Care Home, the Newham ACS and the Newham AFO.

In discussion the Board noted: i. that it is key to ensure the continued development of leadership skills in primary careii. the importance of ensuring that there are short term as well as long-term solutions to the

primary care workforce issueiii. the need to closely monitor the risk throughout the transfer of CCG functions in the

development of a sustainable and viable GP Federationiv. the importance of ensuring a focus on the national and wider system challenges and what they

mean for Newham.

3.4 NEL commissioning arrangements - outline of phase two J Milligan updated Members on phase two of the proposals to develop and implement new commissioning and governance across North East London. Discussion points included:

i. that this is a work in progress with the primary focus on stabilising the system and establishinggovernance arrangements, in shadow form initially

ii. that these new arrangements are vital in supporting the move towards accountable care and anoutcomes based approach, as well as strengthen the CCGs interface with NHS England andNHS Improvement

iii. concern around the pace of the changes and the need to ensure that proper process isfollowed

iv. the importance of ensuring communication and maintaining the good partnership working withLBN throughout this process

v. the need for clarity and clear communication around the changes, at both the local and STPlevel

vi. that it is important to ensure that the financial envelope remains the same.

It was agreed that the caveats as outlined by Newham CCG Board Members would be discussed in more detail at the Board development session on 10 January 2018. (ACTION: JM/CV)

3.5 2016/ 2017 Annual Safeguarding Reports R Vaid presented the 2016/ 2017 Annual Safeguarding Reports for Children and Adults. Discussion points included:

i. the importance of ensuring that robust processes are in place, particularly aroundwhistleblowing

ii. that joint working with LBN and ELFT is key to strengthening this processiii. the designated doctor for looked after children will be in place in January 2018, and it is

important to ensure that a succession planning process is in place for continuity of this role.

It was agreed that the issue of GP access to information on children at risk be escalated to Luke Readman. (ACTION: CV)

3.6 Special Educational Needs and Disabilities (SEND) Inspection Readiness S Douglas reported on NCCG’s action plan for ensuring SEND requirements are implemented, assuring the Board that, although there are some areas that remain red RAG rated, the CCG is on track and will be “inspection ready”.

S Douglas then presented the Best For All Strategy to the Board, Newham’s five year strategy for securing the best possible provision and the best possible outcomes for all our children and young people. The Board approved the strategy for implementation.

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3.7 Ambulance Response Programme for Governing Bodies S Douglas presented the update report on the new national ambulance response times and London Ambulance Service readiness. Discussion points included:

i. the need for NCCG to be made aware should any incidents arise as a result of thisii. the importance of good patient engagement and clear messaging to the local communityiii. with the focus on meeting the 15 minute handover target, it is key to ensure the focus also

remains on safety in A&E.

Action: S Douglas to ensure the Board are sighted on incident levels during the ARP pilot.

4. AOB: None

5. Date of next meeting: 1.30-3.30pm Wednesday 14 February 2018 Committee Rooms, 4th Floor Unex Tower, 5 Station Street, Stratford, E15 1DA

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Action reference

Meeting date

Minute reference Action Owner Update

CCG159 13/09/2017 3.3Update report in the Ivory Ward reconfiguration, to include the outcome of the consultation with stakeholders.

S Douglas On the agenda for February 2018 meeting.

CCG161 13/12/2017 3.2 Discuss the Star Chamber process in detail at the next Board Development session.

L Wei/ S Douglas/ C Vyas

CCG162 13/12/2017 3.4Discuss the caveats as outlined by Newham CCG Board Members in detail at a Board development session.

J Milligan/ C Vyas

CCG163 13/12/2017 3.5The issue of GP access to information on children at risk to be escalated to Luke Readman.

C Vyas

CCG163 13/12/2017 3.7 Ensure that the Board are sighted on incident levels during the ARP pilot. S Douglas

Newham CCG Board part I action log - 22/02/2018

Highlighed items represent a recommendation to remove from register

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Newham CCG Governing Body Thursday 22 February 2018 Committee rooms, 4th floor Unex Tower

Title Single Accountable Officer Report

Agenda item 1.3

Author Selina Douglas, Interim Managing Director

Presented by Jane Milligan, Accountable Officer

Contact for further information

Selina Douglas, Interim Managing Director [email protected]

This paper is for Information

Action required Note for Information.

Executive summary

The report provides an update on work undertaken by the CCG team since the last Board meeting including:

• NCCG achievements – diabetes care and cancer diagnostic performance• 111 Procurement• Winter• Primary care update• Progress and update for the Integrated Care System for Newham• Audiology service redesign• Enhanced Health in Care Homes• National eRS Paper Switch Off: Advice and Guidance• CAMHS Crisis Response for Children and Young People• Operating plan

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Single Accountable Officer Report

1 Achievements

1.1 Diabetes Care Rated ‘Outstanding’ in Newham Patient education, regular reviews and giving patients access to a team of specialists have contributed to Newham CCG being rated as ‘Outstanding’ for its diabetes care, following a 2016/17 assessment by NHS England.

Our success can be attributed to a number of initiatives, such as structuring education sessions around patient needs including when and where sessions are held. As well as classroom-based learning, Newham’s community prescription work has also been at the heart of tackling diabetes in the borough, with eligible patients enrolled in free activity-based education sessions through schemes such as walking football.

Every patient is also given an individual care plan with a team of specialists available to support them with their care. In addition, GPs are sharing learning with each other across the borough. The 2016/17 diabetes rating is based on two key diabetes indicators:

• Diabetes patients that have achieved all the National Institute for Care Excellence (NICE)recommended treatment targets (HbA1c, blood pressure and cholesterol for adults and HbA1c forchildren).

• People with diabetes diagnosed less than a year who attend a structured education course.

1.2 Cancer Diagnostics Performance The Secretary of State for Health has congratulated Newham CCG on improving diagnostic performance. This means more patients are being tested within the target waiting time of six weeks. Over one month, we improved the number of patients who waited longer than six weeks from 2.2% to 1.1%. The national target is a maximum of 1% of patients waiting longer than six weeks. This was further reduced in the last month so that as of the end of December, only 0.79% of patients waited longer than six weeks at Bart Health.

This has been achieved by putting a considerable effort in to recruitment and planning in certain areas of testing (chiefly MRI and CT) where staffing and limited resource has been an issue. Diagnostic testing, as a whole, was set back considerably as a result of the cyber-attack on the NHS last year, and it is testament to the hard work of all those involved that this was resolved so quickly.

In his letter, Jeremy Hunt, Secretary of State for Health said that “the CCG is a real example to others, demonstrating how to improve performance in a short space of time and ensure patients get the care they deserve”. He also passed on his congratulations to staff saying “the service they give makes a real difference to the lives of many of the area’s sickest and most vulnerable patients”.

2. North East London Commissioning AllianceWe held a further session on 14 February to help establish the NEL Joint Commissioning Committee. Although we ran this as an OD session, part of the session was simulating a JCC considering a number of reports around the planning guidance, maternity and a risk register. The session went well and showed good participation from all members taking a NEL approach to issues (rather than more parochial stances) with a strong focus on improving services and outcomes and making a difference. It also highlighted a number of areas to improve on before the JCC goes live including the layout of the room, the overall format of papers and having sharper, more action focused reports that are presented jointly by the lead JCC member and officers.

The stocktake of arrangements across NEL CCGs is coming to the end of Phase 1 and I will be discussing with the CCG Chairs the particular areas to focus on to improve collaboration across NEL.

We continue to work on our recruitment and I hope that we will advertise the permanent MD roles by the end of February I will be bring forward proposals for the Chief Financial Officer following further discussions with the CCG Chairs.

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I continue to get out and about meeting stakeholders and staff across North east London and I see this as a key part of my role. In the last few weeks I have met with LMC chairs and attended the ONEL Joint Overview and Scrutiny Committee. I have now met with a number of the PE groups and we are looking to form a network for PPE leads across NEL to learn from each other and spread good practice. With the planning guidance being published I have also attended workshops for the STP leads across London to consider the implications for London and how it can help promote our ambitions around integrated care partnerships. I also attended the ONEL Joint Overview and Scrutiny committee. I continue to meet with staff and by mid-April I will have attended all CCGs staff awaydays.

3. 111 Procurement UpdateThe 111 procurement has now been finalised with LAS as the successful bidder. Mobilisation has commenced, in terms of ensuring the new pathways link to the mobilisation plan will be overseen by the Commissioning Committee. In addition to this, local arrangements are being worked through with providers who are linked to these pathways, i.e. mental health services, UTC and GP OOH. A full mobalisation is being developed and the board will be updated throughout the process.

4. WinterNewham University Hospital has experienced significant surges throughout January. There has been some good performance meeting the 95% target; however, the overall performance is 90.27% (against a site level trajectory of 93.60%). Attendances are up 9.2% on the same period in the previous year that is an additional 892 attendances in that week. Overall, admissions are down 10% on the year; however, the week ending 21st January has shown an increase in admissions which is in line with winter expectations. The hospital is faring well in terms of overall comparison across London, although under significant strain.

The CCG has funded Out-of-Hospital schemes win relation to respiratory and IV pathways for children, mental health crises support and increasing the capacity within the dressing clinic.

Throughout the winter pressure period, NCCG, LBN and ELFT are running regular virtual CHC eligibility panels to help facilitate timely hospital discharges. Initial feedback from the discharge team is that this is having a significant impact on reducing DTOC numbers.

5. Primary Care UpdateUpper Road Medical Centre Dr Abdul Zakaria was the sole provider of a General Medical Service contract managing a list of 3,376 patients until his retirement on 10 November 2017. Under delegated responsibilities from NHS England, the CCG is responsible for supporting patients to access alternative arrangements for patient care as a result of this retirement. Essex Lodge was identified as having the capacity and capability to provide caretaking arrangements for this patient population at Upper Road Medical Centre until 28 February 2018, pending a decision regarding next steps for their care.

All patients registered with the practice were invited by letter and text to engagement meetings on 30 November and 7 December 2017. Thirty-five patients attended these meetings and Bengali interpretation was provided for those attendees who required it.

As part of the equality impact assessment for this practice, a survey was circulated to all Newham practices asking about their clinical/non-clinical staff and premises capacity and capability to register patients from Upper Road Medical Centre between March and May 2018, should the list be dispersed. Sixteen practices responded to advise that they had the capacity to register patients from this practice between them.

The relatively small list size of this practice, together with the further reduction in numbers since Dr Zakaria retired does not make it a financially viable contract to offer for procurement. The Primary Care Commissioning Committee approved the dispersal of this patient list with effect from 1 March 2018.

6. Progress and update for the Integrated Care System for NewhamEarlier last year, the CCG Board committed to the development of an integrated system for Newham. An Accountable Care System (ACS) offers an exciting new way of working, bringing together primary care with

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their health and social care colleagues to take joint-responsibility for the cost and quality of care for Newham within an agreed budget. It offers Newham the opportunity to become a flagship for collaborative working and innovation in whole-system delivery.

A full programme plan has been reported to the board previously, the purpose of this update is to provide the board with an update. The following areas have been prioritized during December and January:

a) Development of a simplified common narrative built upon a joint vision and principlesb) Communications and Engagement Strategyc) Joint Quality and Outcomes Framework.

Work is progressing at pace on the main building blocks including Building Healthy Communities, Urgent Treatment Centre Procurement and Primary Care Home.

It has been agreed with the Board and LBN that a joint project will be initiated to take review existing joint commissioning arrangements and the forward plan for joint commissioning between NHS Newham CCG and London Borough of Newham.

7. Audiology Service RedesignThe CCG are currently awaiting the outcome of the service review in relation to the audiology service provided by Barts. The aim is to move away from a consultant-led model to an audiologist-led model which will improve access and quality and deliver efficiencies. The outcome of the review will be available in March 2018, upon which Newham CCG and associate commissioners will commence the redesign.

8. Enhanced Health in Care HomesNewham are an active part of the NEL Enhanced Health in Care Homes Improvement Collaborative. Local initiatives have led to significant reductions in the number of LAS conveyances from Newham care homes.

Newham are now in the lowest quartile for number of ambulance call outs and conveyances in London. This has been the result of a number of initiatives including providing expert support to care homes through an in-reach pilot. This has been developed by a partnership between LBN, ELFT and the CCG.

The pilot has been designed to raise the level of support to care homes by responding quickly and supporting unscheduled care avoidance and upskilling care homes. The emphasis has been on prevention though earlier intervention and asking care homes to use every hospital discharge and A&E attend or LAS call out as an opportunity for improved care planning for residents.

9. National eRS Paper Switch Off: Advice and GuidanceThe WEL CCGs continues to work with Barts Health in their attempts to move towards all consultant-led specialties being referred only via the electronic Referral Service (eRS), meeting the national expectation for delivery by October 2018. Currently, Barts have over 80% of services available through eRS and work continues to ensure that training and education for clinicians and administrative support.

Similarly, the national direction is for eRS to publish A&G to at least 75% of all specialities by April 2019, and these are being piloted to understand how best this is utilised going forward.

Newham CCG are currently piloting 3 of the 10 schemes (Tele-Dermatology, Cardiology and Endocrinology) within the WELC with Barts Health. Endocrine has been opened up to all practices in Newham whilst others have taken a staggered approach to testing elements within the specialities.

Initial referrals have been received and the pilots across WELC with Barts Health leads are now considering how to scale up activity to understand the task at hand. Tele-Dermatology and Cardiology are considering its pilot practices and pushing this beyond its single cluster and share this more widely; whilst Endocrinology will monitor its performance in Newham and consider alternative approaches, should the performance not improve over the coming months.

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10. CAMHS Crisis Response for Children and Young PeopleNCCG was successful in bidding for 2 elements of funding for the above, as part of the East London Consortium. Bid 1 improves the face-to-face response at points of crisis and emergency, and will focus on extending the current offer to children, young people and their families. The intention is to divert where appropriate, from A & E into more home based approaches to managing crisis. Bid 2 focusses on training and supporting A & E staff and paediatric staff to identify and respond to crisis presentations.

11 Operating Plan 11.1 Planning Guidance The NHS already has two-year contracts and improvement priorities set for the period 2017/19. These were based on the NHS Operational Planning and Contracting Guidance 2017-2019 published in September 2016 and reflected in the March 2017 document Next Steps on the NHS Five Year Forward View.

Given that two-year contracts are in place, 2018/19 will be a refresh of plans already prepared. This will enable organisations to continue to work together through STPs to develop system-wide plans that reconcile and explain how providers and commissioners will collaborate to improve services and manage within their collective budgets.

11.2 Planning Assumptions for Emergency Care, Referral to Treatment Times and Integrated Care Systems

11.2.1 Emergency Care The Planning Guidance expectation is that the Government will roll forward the goal of ensuring that aggregate performance against the four-hour A&E standard is above 90% for the month of September 2018, that the majority of providers are achieving the 95% standard for the month of March 2019, and that the NHS returns to 95% overall performance within the course of 2019.

Commissioner and provider plans will be expected to demonstrate how they will complete the implementation of the integrated urgent care strategy that was commenced this year, and how sufficient capacity will be available to meet planned activity growth through a combination of additional beds and/or:

• Reductions in delayed transfers of care (DTOCs), both through reducing NHS-driven DTOCs andthrough continuing to work with local authorities to reduce social care DTOCs

• Reductions in average length of stay, including a focus on those patients with the longest length ofstay as identified in the stranded patients metrics.

11.2.2 Referral to Treatment Times The 2018/19 allocations now allow for improvements in the volume of elective surgery being funded next year, and improvements in the number of patients waiting over 52 weeks.

A more significant annual increase in the number of elective procedures compared with recent years means commissioners and providers should plan on the basis that their RTT waiting list, measured as the number of patients on an incomplete pathway, will be no higher in March 2019 than in March 2018 and, where possible, they should aim for it to be reduced.

11.2.3 Integrated Care Systems The term ‘Integrated Care System’ is being used replacing health and care systems and for those areas previously designated as ‘shadow accountable care systems’.

The Planning Guidance reinforces the move towards system working in 2018/19 through STPs and the voluntary roll-out of Integrated Care Systems. Integrated Care Systems are those in which commissioners and NHS providers, working closely with GP networks, local authorities and other partners, agree to take shared responsibility (in ways that are consistent with their individual legal obligations) for how they operate their collective resources for the benefit of local populations.

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11.3 Key Deliverable for 2018/19 Key deliverables are drawn from the ‘Next Steps on the NHS Five Year Forward View’ and focuses on the following:

• Mental Health• Cancer• Primary Care• Urgent and Emergency Care• Transforming Care for People with Learning Disabilities• Maternity

Each area of focus has a number of deliverables for 2018/19.

However the focus is not a comprehensive list of ‘Next Steps’ deliverables for 2018/19, simply an ‘aide memoire’ covering these service improvement areas. CCGs and STPs should also continue to work to reduce inequalities in access to services and in people’s experiences of care.

11.4 Process and Timelines The task for commissioners to update the 2018/19 year of existing two-year plans to take account of the points set out in the Planning Guidance.

The key timelines are: • All commissioners and providers are expected to provide a draft Operating Plan by 8 March 2018• Final Board or Governing Body approved Operating Plans submitted 30 April 2018.

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CCG Board Meeting 22 February 2018 Committee Rooms

Title Integrated Quality and Performance Report

Agenda item 3.1

Author Saem Ahmed, Newham CCG, Head of Quality and Development Justin Roper, Newham CCG, Associate Director of Quality Lisa Clarkson, Newham CCG, Head of Quality

Presented by Fiona Smith, Newham CCG, Chair of Quality, Performance and Finance Committee


Chetan Vyas, Newham CCG, Director of Quality and Development, [email protected] Selina Douglas, Newham CCG, Interim Managing Director [email protected]

This paper is for Monitor

Action required The Board are asked to:

NOTE the actions taken by Newham CCG or CSU on behalf of Newham CCG in relation to the Red and Amber RAG rated Quality Indicators reported on an exception basis.

NOTE the assurances provided in relation to the other Quality matters reported on.

Executive summary

The report asks the CCG Board to note the performance against the KPIs, the key exceptions and the actions taken in relation to improvement.

Supporting papers Integrated Quality and Performance Board Report supporting this paper

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mailto:[email protected]


How does this fit with NHS Newham CCG strategy?

Values: Collective clinical leadership Effective & collaborative communication Patient/Public voice throughout our decision making Transparency with our decision-making and leadership Accountability and responsibility Caring culture and behaviour Working with our partners to improve health outcomes

Aims: Improving health outcomes through developing models of integrated care and focusing on prevention Reducing inequalities and improving accessibility Reducing quality variation Ensuring equity of Health and Wellbeing outcomes

Where has the paper been already presented?

Presented at the January 2018 Quality, Performance and Finance Committee.

Risk The risks in relation to Barts Health and East London Foundation Trust are around non-delivery and these are reported on in the appended report.

Newham CCG Board Assurance Framework reference BAF.06.

Equality impact This document relates to all Newham residents in the 9 protected characteristics that are covered by the Equality Act 2010 and our Equality Duties.

Stakeholder engagement

No consultation has taken place nor is it required for this report.

Financial Implications

This paper is for monitoring performance & quality across material contracts for Newham CCG. Some of the issues presented issues may have financial consequences in future periods. These are yet to be fully determined but if not already embedded in budgets or reserve provision, a further Board decision would be required to release any additional expenditure commitment.

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1. Introduction and background

1.1

1.1.1

1.1.2

The January 2018 Intergrated Quality and Performance Report provides an update against the reported Quality and Performance Indicators for the 3 Providers from which Newham CCG commissions health services in addition to providing an update on other quality and performance related matters.

Barts Health

Green rated areas Incomplete over 52 weeks waits at zero. 2 week cancer wait at 97.5% against a target of 93% 2 week cancer wait: Breast Symptom 100% against a target of 93% 31 day cancer wait: 1at definitive treatment 99.1% against target of 96% 31 Day Cancer Wait: Subsequent treatment (Surgery) at 99% against a target of 94% 31 Day Cancer Wait: Subsequent treatment (Chemotherapy) at 99.4% against a

target of 98% 31 Day Cancer Wait: Subsequent treatment (Radiotherapy) at 97.7% against a target

of 94% 62 Day Cancer Wait: GP Referral at 85.7% against a target of 85% 62 Day Cancer Wait: Screening service 94.7% against a target of 90% Maternity scores from Friends and Family Test − % positive at 100% against a target

of 95% C.diificle 6 and below the year to date threshold of 82 No MRSA reported

Amber rated areas Inpatient scores for friends and family tests at 92% against a target of 95%

Red rated areas Diagnostics over 6 week’s performance at 1.9% against a threshold of 1%. A&E All Types Performance Trust wide performance at 80.2% below the 95% target 16 Mixed Sex Accommodation Breaches reported A&E scores from Friends and Family Test score at 80% against a target of 95% Emergency C-section rate at 21% against a threshold of 18% 1 Never Event reported by the Newham site.

Non RAG indicators 19 Reported Amber Alerts 3 Reported Serious Incidents

All amber and red issues are being discussed with Barts Health and assurances are sought on improvement plans and trajectories through various meetings with the Trust.

East London Foundation Trust – Mental Health

Green rated areas Adult Delayed Transfer of Care at 0% against a threshold of 2.5% Older Adult Delayed Transfer of Care at 0.5% below the 2.50% threshold

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Referral to assessment within 24 hours (Face to face or Telephone) above the 86.7%target.

Percentage of patients commencing treatment package within 2 weeks (%) at 100%against a target of 50%

Percentage of CPA patients assessed within 28 days at 97.7% above the target of95%

Percentage of new Older adult patients assessed within 28 days at 90% above thetarget of 95%

Proportion of patients on CPA who were followed within 7 days after discharge frominpatient care – Adults at 100% above the target of 95%

Patients seen Within 9 weeks (%) CAMHS at 95.1% above the target of 92.2% Adult re-admissions within 28 days at 7.4% against a target of 7.5% Older Adult re-admissions within 28 days at 0% against a threshold of 7.5% Zero Mixed Sex accommodation breaches Discharge notification sent to GP within 48 working hours of patient's discharge at

96.4% above the target of 96.4% Clinical sharing information with GP at 90.2% against a target if 90% Reduction of medication errors through medicines reconciliation on admission to

hospital- 95% Medicine reconciliation within care plans within 72hours of admission at98.6%.

Amber rated areas • Proportion of patients seen within 4 hours of referral to DoPM at 93.0% below the

target of 95%

• Friends and Family Test - % positive at 89.0% below the 90% target

Red rated areas Percentage of PTS patients starting treatment within 18 weeks (referral to

commencement of treatment) at 57.0% below the 95% target.

Non RAG indicators 0 Reported Amber Alerts 0 Reported Serious Incidents

All amber and red issues are being discussed with East London Foundation Trust and assurances are sought on improvement plans and trajectories through the East London Foundation Trust Clinical Quality Review Meetings

East London Foundation Trust – Community Health

Green rated areas Percentage of urgent referrals seen within 2 working days Foot Health at 100% above

the 90% target Over 18 Weeks of patients with waiting times between referral & first appointment at

Percentage against the target of 0% Percentage of urgent referrals (within 24 hours) Responded to within 24 hours EPCT

at 100% above the 90% target Percentage of routine referrals (within 72 hours) Responded to within 72 hours EPCT

at 100% above the 90% target Percentage of stroke patients seen within 24 hours/NWD Community Neuro at 100%

against the target of 100%

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Percentage of patients receiving treatment within 2 weeks of referral at 100% against atarget of 100%

Percentage of Urgent referrals seen within 2 working days Diabetes at 100% against atarget of 100%

Child Development Centre - Percentage of patients with waiting times betweenreferral & first appointment under 4 weeks against 4.8% against a target of 6%

Over 18 Weeks of patients with waiting times between referral & first appointmentChildrens Occupational Therapy at 0% against a target of 0%

Childrens Occupational Therapy - children who have shown improvement on agreedTherapy Outcome Measures following direct intervention at 86% against a target of80%

Friends and Family Test positive responses at 99% VTE Assessment Audit at 100%

Amber rated areas Child Development Centre - 18 Weeks of patients with waiting times between referral

& first appointment at 3.6% against a target of 0%

Red rated areas Diabetes – Percentage of referrals seen within 6 weeks in line with service

specification/clinical practice at 81% below the target of 90% Childrens Occupational Therapy - patients seen within 6 weeks of referral at 11.1%

against a target of 40%

Non RAG indicators 0 Reported Amber Alerts 2 Reported Serious Incidents 9 Reported Pressure Ulcers

Other Quality Matters The most recent Newham CQR/ Oversight and Assurance Meeting took place in

January 2018 and details are within the report The most recent ELFT Community Health Services CQRM took place in December

2017 and details are within the report The most ELFT Mental Health Services CQRM took place in December 2017 and

details are within the report Progress update in relation to the National Trauma Peer Review Barts Health KPI Review meeting took place in December 2017 and details are within

the report Mental Health Service Performance Review took place in January 2018 and details are

within the report Community Health Service Performance Review Meeting took place in January 2018

and details are within the report

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Integrated Quality and Performance Board Report

January 2018 22

Purpose• The purpose of this report is to provide the Quality, Performance and Finance Committee with

an update on quality and performance matters across our local Provider organisations.

• The report covers the following providers:o Barts Healtho East London Foundation Trust (Mental Health)o East London Foundation Trust (Community Health)

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Key Headlines Barts Health/Newham Site ELFT – Mental Health ELFT – Community HealthKey exceptions:

• Diagnostics over 6 weeks above the1% threshold. - Red

• A&E All Types Performance. – Red• Mixed Sex Accommodation (MSA)

breaches – Red• A&E scores Friends and Family Test –

Red• Inpatient scores from Friends and

Family Test – Amber• Emergency c-section rate – Red• 1 reported Never Event• 19 reported Amber Alerts.• 3 reported Serious Incidents.

Key exceptions:• Proportion of patients seen within 4 hours of

referral to DoPM (%) - Amber• Friends and Family Test - % positive slightly

below the target. – Amber• Percentage of PTS patients starting treatment

within 18 weeks (referral to commencement of treatment). – Red

Key exceptions:• Diabetes Service - Number and % of

referrals seen within 6 weeks in line withservice specification/clinical practice below90% target. - Red

• Child Development Centre - % of 18Weeks of patients with waiting timesbetween referral & first appointment abovethe 0% threshold. – Amber

• Childrens Occupational Therapy - % ofpatients seen within 6 weeks of referral –Red

• 9 Grade 3 or 4 pressure ulcers• 2 reported Serious Incidents

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CQC Domains Outcome Site/Service KPI Indicator Target Apr May Jun Jul Aug Sep Oct Nov

Barts Health/Newham University Hospital TrustEf

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Barts Health Incomplete over 52 week waits 0.0 0.0 0.0 0.0 0.00 0.00

Barts Health Diagnostics over 6 weeks 1% ND 8.2% 5.8% 3.4% 3.7% 2.3% 1.9%

Barts Health 2 Week Cancer Wait 93% 97.5% 96.5% 96.6% 97.8% 98.0% 98.0% 97.5%

Barts Health 2 Week Cancer Wait: Breast Symptoms 93% 98.1% 95.2% 98.5% 99.4% 99.0% 100.0% 100.0%

Barts Health 31 day Cancer Wait: 1st definitive treatment 96% 97.8% 100.0% 97.4% 98.9% 99.3% 99.6% 99.1%

Barts Health 31 Day Cancer Wait: Subsequent treatment (Surgery) 94% 98.5% 96.4% 95.7% 96.3% 100.0% 97.0% 99.0%

Barts Health 31 Day Cancer Wait: Subsequent treatment (Chemotherapy) 98% 100.0%100.0%100.0%100.0%100.0% 100.0% 99.4%

Barts Health 31 Day Cancer Wait: Subsequent treatment (Radiotherapy) 94% 100.0% 98.3% 100.0% 99.2% 100.0% 98.1% 97.7%

Barts Health 62 Day Cancer Wait: GP Referral 85% 90.1% 80.8% 69.5% 82.4% 87.5% 85.9% 85.7%

Barts Health 62 Day Cancer Wait: Screening service 90% 100.0% 83.9% 56.3% 90.5% 100.0% 95.7% 94.7%

Barts Health A&E All Types Performance 95% 81.8% 84.9% 89.5% 88.4% 88.7% 86.6% 81.4% 80.2%

Newham University Hospital A&E All Types Performance 95% 81.8% 84.9% 89.5% 93.4% 94.6% 90.4% 92.4%

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Barts Health Mixed Sex Accommodation (MSA) breaches 0 6.0 11.0 12.0 17.0 14.0 15.0 10.0 16.0

Newham University Hospital A&E scores from Friends and Family Test − % positive 95% 93.0% 93.0% 84.0% 93.0% 91.0% 88.0% 80.0%

Newham University Hospital Maternity scores from Friends and Family Test − % positive 95% 93.0% 92.0% 94.0% 92.5% 92.0% 98.0% 100.0%

Newham University Hospital Inpatient scores from Friends and Family Test − % positive 95% 94.0% 93.0% 94.0% 90.0% 92.0% 93.0% 92.0%

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Newham University Hospital Emergency C-section rate <18% 23.1% 21.6% 16.4% 21.0% 19.1% 19.4% 21.0%

Newham University Hospital VTE Risk Assessment 95% 99.5% 98.1% 98.7% 99.3% 98.1% 97.4%

Barts Health C.Difficile <82 9.0 9.0 8.0 10.0 6.0 6.0 6.0

Newham University Hospital MRSA 0 0.0 0.0 0.0 1.0 0.0 1.0 0.0

Newham University Hospital Occurrence of any Never Event 0 0.0 0.0 0.0 1.0 0.0 0.0 0.0 1.0

Barts Health Reported Amber Alerts 7.0 31.0 10.0 23.0 11.0 30.0 13.0 19.0

Newham University Hospital Reported Serious Incidents (Newham site) 6.0 5.0 11.0 7.0 4.0 3.0 7.0 3.025

Key Exceptions Indicator Perform. Further intelligence Actions taken by CCG/CSU

Barts Health

Diagnostics over 6 weeks

1.9% • The Trust reported an underperformance in October with98.06% against the 99% standard. Provisional data forNovember shows a position of 98.16%.

• The Trust has cited a number of challenged modalitiesincluding; neurophysiology, MRI and CT scanning

• Trust continues to work towards recovery of the standard across allmodalities.

• The Contract Review Group is monitoring progress against the recoverytrajectory.

A&E All Types Performance

80.2% Nov (BH)

• All three sites underachieved against local trajectories forDecember. Week ending 31stDecember, the Trust reported anincrease of all type attendances by 2.7% in comparison to thesame reporting period last year.

• All three sites report increased attendances in comparison tolast year, with NUH attendances up by 1.6%.

• Trajectories and improvement actions are being monitored at the Trustwide A&E Delivery Board.

• Daily updates are being reported by the Trust which supports earlydiscussions with the Trust to support improvement.92.4%

Oct (NUH)

Mixed Sex Accommodation Breaches

16 • 5 of these related to the Newham site and 11 related to WhippsCross. These appear to have occurred at the Intensive CareUnit with a range of destination locations.

• Royal London site have carried out significant work to reduce MSAbreaches and are currently reporting zero.

• This was discussed at the January CQRM and a report will be providedfor the next CQRM outlining any changes in the way MSA breacheshave been calculated and why there has been an increase in MSAbreaches on the Newham site. The Newham site breaches appears tobe related to bed availability (or availability of staff to cover the beds).

• Nationally due to bed pressures no fines are to be levied on Trustsdeclaring MSA breaches.

A&E scores from Friends and Family Test − % positive

80% • The Trust data for November 2017 is has not been publishedon the NHS England website, and therefore the data providedwas reported to in the previous months report.

• The Trust are currently in the process of changing the organisationdelivering FFT and this may have had an impact on the datasubmission. It is expected that the new provider will be focused onincreasing the response rate

Inpatient scores from Friends and Family Test − % positive

92% • The Trust data for November 2017 is has not been publishedon the NHS England website, and therefore the data providedwas reported to in the previous months report.

• The Trust are currently in the process of changing the organisationdelivering FFT and this may have had an impact on the datasubmission. It is expected that the new provider will be focused onincreasing the response rate

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Indicator Perform. Further intelligence Actions taken by CCG/CSU

Barts Health

Emergency C-section rate

21.0% • Acuity in the Unit affects fluctuations in the emergency C-sectionrate. The more high risk women in labour and more inductions ofLabour, the higher the CS rate will be. Therefore the CS reviews areabout ensuring practise is evidenced based, clinicians are followingrobust guidelines and to exclude variations in clinical practice etc.

• Weekly reviews at the MIR meeting with a multi professional teamcontinue.

• Performance against this KPI is monitored at the monthly BartsHealth KPI Review Meeting.

Never Event

1.0

• Barts Health Newham hospital site reported a Never Event inNovember 2017, involving a retained foreign object. A 32 year oldpatient, who had had an elective C-section for breech presentationon 17/06/2016, presented to clinic on 03/08/2017 with a lump abovea caesarean scar in the location where she had a suprapubic drain.This was reviewed and explored under local anaesthetic and a 3cmlong plastic tube was removed. Initially, it was believed this was partof the drain that had broken off upon removal and as such would notmeet the NE criteria, but further investigation has suggested that theobject may be a trochar drain cover and as such did meet NEcriteria.

• Immediate action taken by the Trust: local guidance / adherence withpolicy and good practice is being reviewed in obstetric theatres andgeneral theatres.

• Given that it took the site longer than 3 months to report the NeverEvent from the time the patient re-presented in August 2017, theCCG requested information about the reasons for the delay at theNovember 2017 CQRM.

• The Trust provided a timeline of steps taken between the incidentidentification and declaration on StEIS; there were delays startingwith failure to report to Trust Datix, disagreements about whetherthe incident meets criteria and who should be informed.

• The investigation is in progress, the final report is due 07/02/2018.

Reported Amber Alerts

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• Of the 30 Amber Alerts (12) were reported on the NewhamUniversity Hospital site, (2) for the Whipps Cross Hospital site, (4) onthe Royal London Hospital site and (1) for the Mile End Hosptial site.

• The Newham Hospital site Amber Alerts related to Communication,Access/Appointment issues and care/treatment.

• Amber Alerts are sent to the Trust for investigation and responsesare sent to the GP practice.

• Key exceptions or themes are escalated via CQRMs.• Thematic Analysis provided to the CCG Board.

Reported Serious Incidents (Newham site) 3

• Three serious incident reported related to surgical/invasiveprocedure, sub-optimal care and treatment and medication incidentmeeting SI criteria.

• All Serious Incidents are subject to a Root Cause Analysis as perthe National Serious Incident Guidance.

• Serious Incident reports are quality assured for learning by theCSU and approval of closure with the CCG.

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Inpatient Services Adult Delayed Transfer of Care 2.5% 1.4% 1.2% 1.5% 0.0% 0.0% 1.3% 0.4% 0.0%

Inpatient Services Older Adult Delayed Transfer of Care 2.50% 3.2% 4.0% 4.9% 4.5% 3.3% 3.5% 4.0% 0.5%

Crisis Resolution and Home Treatment Referral to assessment within 24 hours (Face to face or Telephone) 80% 86.8% 81.7% 84.8% 80.1% 88.1% 78.3% 80.3% 86.7%

Early Intervention (EI) Percentage of patients commencing treatment package within 2 weeks (%) 50% 100.0% 92.3% 77.8% 93.8% 100.0% 77.8% 88.9% 100.0%

Community Mental Health Team (CMHT) % of CPA patients assessed within 28 days 95% 93.7% 90.2% 92.6% 96.8% 91.4% 94.7% 97.1% 97.7%

Older Adult Community Services % of new Older adult patients assessed within 28 days 95% 85.7% 100.0%100.0%100.0% 87.0% 92.3% 95.0% 90.0%

Psychological Therapy Service Percentage of PTS patients starting treatment within 18 weeks (referral to commencement of treatment) 95% 65.7% 57.0%

CPA Proportion of discharges from hospital followed up within 7 days (%) 95% 92.1% 93.3% 95.7% 93.8% 96.2% 88.5% 96.3% 100.0%

CAMHS Patients seen Within 9 weeks (%) 95% 97.3% 98.9% 98.8% 95.0% 93.9% 92.2% 90.5% 95.1%

Emergency MH Liaison Services Proportion of patients seen within 4 hours of referral to DoPM 95% 97.0% 100% 91.0% 96.0% 88.0% 95.0% 89.0% 93.0%

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Inpatient Services Adult re-admissions within 28 days 7.5% 7.3% 3.7% 7.0% 7.4% 4.9% 5.3% 8.4% 7.4%

Inpatient Services Older Adult re-admissions within 28 days 7.5% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

Inpatient Services Mixed Sex accommodation breaches 0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Percentage of reviews completed including CORC measure

Percentage of young people who have shown improvement as measured by CORC outcome measures 85% 85.0% 86.0%

Other Quality Indicators (Corporate) Friends and Family Test - % positive 90% 89.0% 92.0% 90.0% 89.0% 90.0% 89.0% 88.0% 89.0%

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Other Quality Indicators (Corporate) Discharge notification sent to GP within 48 working hours of patient's discharge (95%) 95% 94.5% 97.9% 95.1% 94.3% 94.3% 94.5% 94.3% 96.4%

Other Quality Indicators (Corporate)Clinical sharing information with GP- Trust to send GP a CPA review outcome letter/or copy of care plan by either NHS.net email account, safehaven fax or letter within two weeks of CPA review for 90% of patients.

90% 81.3% 82.1% 90.2% 83.5% 88.7% 90.7% 84.1% 90.2%

Other Quality Indicators (Corporate)Reduction of medication errors through medicines reconciliation on admission to hospital- 95% Medicine reconciliation within care plans within 72hours of admission

95% 97.0% 99.1% 100.0% 99.8% 99.1% 99.1% 97.3% 98.6%

Mental Health (Corporate) Reported Amber Alerts 0.0 1.0 0.0 0.0 1.0 2.0 2.0 0.0

All (Corporate) Reported Serious Incidents (Newham site) 2.0 1.0 3.0 4.0 7.0 1.0 3.0 0.028


East London Foundation Trust (Mental Health)

Friends and Family Test - % positive 89.0% • Performance is just below target.• The recently published Mental Health Community Survey,

conducted by Quality Health on behalf of the CQC as part ofthe National Patient Survey (NPS) Programme, reportedthat whilst the percentage of service users reporting a goodexperience overall increased to 67.4% from 64.8% last year(compared to 70.2% nationally), overall the results areindicative of a decline in the quality of experience reportedby ELFT community mental health service users. .

• ELFT’s December quality board report evidenced that the

percentage of patients extremely likely to recommend theirservices was showing a downward trend, with 6 consecutivedata points in a negative direction.

• This was discussed at January’s consortium CQRM. The

Trust advised that there was no immediate explanation forthis, with no particular Directorate showing a significantdecline.

• The Trust noted that the Mental Health CommunitySurvey did not have sufficient respondents from Newhamto provide an outcome and most of the respondents werefrom the Luton and Bedfordshire locality.

• The Trust recognised the concern and advised that theChief Nurse and Deputy Chief Executive had chaired aproject board overseeing the concerted effort to deliver atransformation of community mental healthcare whichincluded a wide range of QI schemes.

• A local deep dive into Newham patient experience will beundertaken at February’s CQRM.

Proportion of patients seen within 4 hours of referral to DoPM

93.0% • Performance is just below target.• The DoPM team have seen a steady increase in

referrals.

• The CCG continues to monitor and hold the Trust toaccount on performance against the target through themonthly Service Performance Review Meeting.

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Foot Health Service % of urgent referrals seen within 2 working days 90% 100.0%100.0%100.0%100.0% 100.0% 100.0% 100.0% 100.0%

Foot Health Service Over 18 Weeks of patients with waiting times between referral & first appointment (%) 0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

EPCT % of urgent referrals (within 24 hours) Responded to within 24 hours 90% 90.0% 86.0% 92.0% 100.0% 100.0% 100.0% 100.0% 100.0%

EPCT % of routine referrals (within 72 hours) Responded to within 72 hours 90% 91.0% 89.0% 94.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Community Neuro % of stroke patients seen within 24 hours/NWD 100% 100.0% N/A 100.0%100.0% 100.0% 100.0% 100.0%

Community Neuro % of patients receiving treatment within 2 weeks of referral 90% 100.0% 89.3% 100.0%100.0% 100.0% 100.0% 100.0%

Diabetes % of referrals seen within 6 weeks in line with service specification/clinical practice. 90% 100.0% 85.0% 90.0% 85.0% 86.0% 85.0% 78.0% 81.0%

Diabetes % of Urgent referrals seen within 2 working days 100% 100.0% 66.0% 96.0% 95.0% 100.0% 100.0% 100.0% 100.0%

Child Development Centre % of patients with waiting times between referral & first appointment under 4 weeks 6% 0.0% 3.6% 5.3% 5.2% 0.0% 1.6% 5.4% 4.8%

Child Development Centre % 18 Weeks of patients with waiting times between referral & first appointment 0% 0.0% 0.0% 1.3% 5.3% 14.5% 24.6% 14.4% 3.6%

Childrens Occupational Therapy % of patients seen within 6 weeks of referral 40% 28.0% 17.0% 28.0% 38.0% 40.0% 23.0% 30.0% 11.1%

Childrens Occupational Therapy % Over 18 Weeks of patients with waiting times between referral & first appointment 0% 0.0% 0.0% 5.1% 0.0% 0.0% 0.0% 0.0% 0.0%

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Friends and Family Test (Corporate) Friends and Family Test - % positive 90% 92.0% 94.0% 92.0% 94.0% 92.0% 93.0% 92.0% 99.0%

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VTE Assessment Audit (Corporate) VTE Assessment Audit 100% 100.0%100.0%100.0%100.0% 100.0% 100.0% 100.0% 100.0%

Community Health (Corporate) Reported Amber Alerts 0.0 1.0 2.0 3.0 1.0 0.0 2.0 0.0

Incidents reported by month under ELFT Care - Adults Services Pressure Ulcers Grade 3 and 4 9.0 5.0 5.0 5.0 10.0 15.0 9.0

All (Corporate) Reported Serious Incidents (Newham site) 0.0 0.0 1.0 0.0 0.0 2.0 0.0 2.030

Indicator Perform. Further intelligence Actions taken by CCG

East London Foundation Trust (Community Health)

% of referrals seen within 6 weeks in line with service specification/clinical practice (Diabetes Service)

81.0% • Underperformance currently relates to vacancies in the service.• Interviews have taken place for the lead role on the 13/11. Adverts have been

placed for the other 3 vacancies but the responses initial received by the trusthave not met the criteria set. The service has re-advertised for the post and wouldbe shortlisting once advertisement is closed.

• A trajectory has been provided by the Trust which states that they will be backwithin target by April 2018.

• An update was presented at theJanuary 2018 Technical Sub-Group.

• Monitoring of this will take placeat the monthly Technical Sub-Group.

% 18 Weeks of patients with waiting times between referral & first appointment (ChildDevelopment Centre)

3.6% • Performance has significantly improved, with the November 2017 performanceseeing the best performance compared to the previous 4 months.

• This accounted for 3 of 76 children seen outside of 18 weeks. All 3 children wereseen within +4 to +7 days of the 18 week target time.

• The expectation of this is for performance to continue to improve over theremainder of this year to meet target.


• Monitoring of this would takeplace at the monthly TechnicalSub-Group.

% of patients seen within 6 weeks of referral (Childrens Occupational Therapy)

11.1% • The November 2017 performance has been the lowest performance to date. Theservice continues to see a high demand.

• 5 of 45 children were seen within 6 weeks. The number of children removed fromthe waiting list varies month to month, depending on how many blocks of therapyare complete and what therapists are able to take on to their caseload. This isevidenced in the activity figures, which lower first contacts, but overall highcontacts (initial plus follow-up).


• Monitoring of this would takeplace at the monthly TechnicalSub-Group.

• A service wide review is currentlybeing undertaken by thecommissioning team.

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East London Foundation Trust (Community Health)

Grade 3 and 4 pressure ulcers

9

• There was nine reported acquired pressure ulcers in the most recent reportingmonth. Eight of these were Grade 3 and one was Grade 4.

• The Trust have a quality improvement project in reducing pressure ulcers and hasshown significant reduction over a greater period of time.

• Local reviews are undertaken to ensure lessons are learned.

• The CCG monitors improvementsand learning through the monthlyQuality Dashboard which is reportedinto the Clinical Quality ReviewMeetings.

• Agenda item on December CQRMto discuss outcomes of actionsbeing taken and plans for the future.

Reported Amber Alerts 0

• None reported for the most recent reporting month.

Reported Serious Incidents

2

• Two serious incident reported related to treatment delays and pressure ulcermeeting SI criteria.

• All Serious Incidents are subject to aRoot Cause Analysis as per theNational Serious Incident Guidance.

• Serious Incident reports are qualityassured for learning by the CSU andapproval of closure with the CCG.

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Other quality and performance matters Topic Subject Matter Summary

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edNewham University Hospital Clinical Quality Review (CQR)/ Oversight and Assurance Meeting

• The Newham CQR/ Oversight and Assurance Meeting took place in January 2018 and discussedthe following:

o Children's and young peoples Deep Diveo Review of the Safeguarding Partnership Review – into older peoples wardso Update in relation to the Quality Improvement Plano Peer Review findings – visits across the siteo Thematic reviews of serious incidents, Datix incidents and complaints

East London Foundation Trust -Newham Community Health Clinical Quality Review Meeting (CQRM)

• The Community Adults and Children CQRM meeting took place in December 2017. The meetingdiscussed the following areas:

o Patient Appliance Service Line Presentation Service Line Presentation and Quality Assurancevisit

o Pressure Ulcer work updateo Deep Dive – safeguarding across community serviceso Children's paediatric SLT service line presentationo SEND preparation and progresso CQC readiness Audit

East London Foundation Trust - Newham Mental Health Service Clinical Quality Review Meeting (CQRM)

• The Mental Health Adults and CAMHS CQRM meetings took place in December 2017 . Themeeting discussed the following areas:

o CAMHS Risk Registero Follow up on the action plan following the CAMHS quality assurance visit in June 2017.o Home Treatment Team quality assurance visito Psychological Therapies Pathway

National Trauma Peer Review Newham University Hospital, Barts Health NHS Trust

• There was a review in January 2018 of the progress of NUH progress against the national peerreview programme. Previously as reported to the Quality Committee in September 2017, 7 seriousconcerns were identified a number of these were longstanding.

• It was highlighted at the January meeting that significant progress had been made against theseconcerns and appropriate mitigation in place. This will be brought to CQRM in Spring.

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Topic Topic Subject Matter Summary

Perf

orm

ance

Upd

ate

CQ

C d

omai

ns: S

afe/

Effe

ctiv

eBarts Health KPI Review Meeting

Monthly WEL Performance Review Meeting

• The Barts Health KPI Review Meeting took place in December 2017 and discussed thefollowing:

o Remedial action planso Performance Dashboard & Escalationo Discharge Summaryo Quarter 2 CQUIN Performance.

Mental Health Service Performance Review Meeting

Monthly Service Performance Meetings

• The Mental Health Service Performance Review Meeting took place in January 2018and discussed the following:

o Psychological Therapy Services Exception Reporto Delayed Transfer of Care Datao Themed Report – Delayed Transfer of Care and Length of Stayo Month 8 Performance Reporto Reduction of admissionso DoPM Service Performance Report

Community Health ServicePerformance Review Meeting

Monthly Service Performance Meetings

• The Community Health Service Performance Review Meeting took place in January2018 and discussed the following:

o Finance Reporto Technical Sub Group Meeting Feedback of escalation of KPIso Clinical Quality Review Meeting Feedbacko Focus on Children Services on issues and concernso Focus on Adults Services on issues and concerns

34

Newham CCG Board 22 February 2017 Committee Rooms, 4th Floor, Unex Tower

Title Board Assurance Framework

Agenda item 3.2

Author Jason Clarke, Risk and Information Governance Manager, NCCG

Presented by Satbinder Sanghera, Director of Partnerships and Governance, NCCG


Satbinder Sanghera, Director of Partnerships and Governance, NCCG [email protected]

This paper is for Decision

Action required The Board is asked to agree the following: • Agree the current BAF risk ratings• Note the reduction in risks highlighted in section 2.1• Discuss the next steps listed in section 3.

Executive summary

The report asks the Board to agree the current position of the BAF for 2017/18.

Supporting papers Appendix A – Board Assurance Framework Report


Values Accountability and responsibility


No previous presentation to any meeting.

Risk Inadequate governance arrangements, and/or a failure to operate a robust risk management system would expose the organisation to the risk that the CCG would be unable to manage and mitigate identified risks or barriers to achieving its stated priorities.

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Equality impact The CCG has a strong and unequivocal commitment to promoting equality for all our communities. We believe that Newham CCG should be an exemplar of good practice and able to demonstrate consistently that we are innovative and at the forefront of pushing boundaries for greater equality. We think that our approach to patient and public engagement provides a blueprint for our work because our PPE work has now begun to be mainstreamed across all commissioning activity. We consider equalities to be integrally linked to quality and our PPE approach and over the next year we will be looking to how we can mainstream within quality and PPE, our equalities objectives.

The CCG expects that the next stage of our PPE work will focus on a more flexible approach intrinsically linked to commissioning activities and that equalities will be central to that, likewise the work on quality processes and indicators and improvement will encompass equalities considerations.

The CCG has reviewed the EDS2 (Equality Delivery System) that sets out the CCG’s Equality Objectives, undertake an equalities analysis of policies and services and set out the work that we will be undertaking with patient, stakeholders and providers. The Board has started the process to agree a revised Equalities Strategy will commit the CCG to SMART actions underlined with the approach identified above that will aim to ensure that equalities is embedded within the organisation. A key action will be to communicate to all commissioning committees their responsibility in relation to equalities impact assessments and targets and to monitor their compliance.


None.


CCG faces reputational and financial risks if risks identified in this paper are not sufficiently mitigated. Plans outlined in this paper address these issues, however inherent financial risk remains.

36


1.1 1.1.1

Introduction The Board Assurance Framework (BAF) is the primary mechanism by which the Board of NHS Newham CCG is appraised and updated on material risks which may affect the CCG’s ability to deliver its strategic objectives as set out in the Operating Plan.

2. Key considerations

2.1 2.1.1

2.1.2

2.1.3

2.1.4

2017-18 CCG Board Assurance Framework Changes to previous iterations of the BAF The BAF has been presented to, and approved by, the Board in June, September, October and December (all 2017). During discussions with CCG officers, the following BAF risks have been reduced:

BAF.05 Failure to effectively monitor the quality of commissioned services, with a focus on ensuring the delivery of better clinical outcomes (Risk rating reduced from 8 to 4)

BAF.06 Failure to effectively monitor the performance and activity of commissioned services, with a focus on ensuring the delivery of better clinical outcomes (Risk rating reduced from 12 to 8)

BAF.08 Failure to effectively develop and implement the re-designed urgent care pathway and understand the inter-dependencies with the NHS 111 procurement (Risk rating 16 reduced from 16 to a 12)

2.2 2.2.1

2017-2018 BAF risks The current BAF heat map is as follows:

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2.2.2

2.2.3

2.2.4

2.2.5

Listed below is the current risk rating for each of the BAF risks. In future reports, the only the high risks will be highlighted in this section of the report:

BAF.01 – Failure to meet NHS Constitutional standards (Risk rating: 16)

Management response: “The Trust continues to not be compliant with the A&E standard.

The Trust continues not to report on the RTT standard of seeing and treating patients within 18 weeks of referral due to the concerns regarding the data quality at the trust and the RTT Recovery Board continues to have oversight of the recovery plan.

The Trust has agreed with NHS England and NHS Improvement to return to reporting on performance against the RTT standard from April 2018.”

BAF.02 Failure to effectively meet the CCG's financial targets and savings plans in 2017/18 (Risk rating 20)

Management response: “The CCG is currently reporting a balanced financial position to NHSE. However, significant financial challenges in 2017/18 and future years should be noted. As part of the Sustainability &Transformation Partnership the CCG is also required to deliver its planned surplus to ensure the Group achieves a financial control total set by NHSE. Currently there are commissioners and providers within the Group who are unlikely to deliver their element of the control total. The CCG is under pressure to find ways of supporting them so the total can be delivered. In the worst case scenario, failure to deliver the total could mean the CCG allocation uplift being withheld which would immediately make our 2018/19 financial position untenable.

Successful implementation of our QIPP and savings programmes, combined with effective management of agreed budgets, is the key to deliver our financial target and maintain sustainability. The Finance Team is working closely with our budget holders and staff to ensure we can all deliver our financial commitments and support the wider health economy. However, if the financial situation deteriorates further, then the Interim Chief Finance Officer and finance team may have to bring in additional control measures to control or reduce spend or achieve greater efficiencies.”

BAF.03 Failure to implement the key programmes within the Sustainability and Transformation Plan and therefore failure to achieve the system control total. (Risk rating: 16)

Management response: “This risk continues to be rated as high as whilst there is currently good progress in relation to the delivery of the 8 work streams within the STP the system is currently not projected to achieve its control total. These work streams, which are monitored under the governance arrangements by the East London Health and Care Partnership (ELHCP) Board, are key to enabling the partnership and the individual organisations within the STP to achieve their control totals.

At the end of Month 6 the system is reporting a year to date deficit that is behind plan. This is driven by Barts Health NHS Trust’s financial position. The Trust has a recovery plan in place to catch up on the delayed activity as a result of the cancellation of appointments during this period but there continues to be a significant risk of the control total for the system not being achieved for 2017-18.”

BAF.04 Failure to effectively integrate health and social care by progressing BHC and ACS (Risk rating 16)

Management response: Newham ACS – In the next 3 months:

1. We will develop and agree a simplified narrative explaining ACS and a joint vision with ourstakeholders

2. Continue the procurement process re Urgent Treatment Centre (including Rapid Response) –the new service to ‘Go Live’ on 1st September 2018

3. Engage and recruit patient and public representatives for Building Healthy CommunitiesProgramme (Community Transformation) and further develop our plans

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2.2.6

2.2.7

2.2.8

2.2.9

2.2.10

4. Ensure Training and induction for PPE sessions5. Implement the Rapid Site Testing for Primary Care Home and ensure the testing embeds the

Multispecialty Community Provider approach6. Initial discussions between health and local authority have started and to produce an

overarching draft outline outcomes framework7. Continue to test ACS development through a variety of engagement channels8. To Co-produce a Communications & Engagement outline strategy on the back of the

discussion paper9. Communication and consistent messaging will be developed10. Building Healthy Communities through the process of Structured Collaboration will be

launched – 1st March 2018 with a series of workshops and gateways11. Align the governance arrangements across Health & Social Care – workshops early February

2018

BAF.05 Failure to effectively monitor the quality of commissioned services, with a focus on ensuring the delivery of better clinical outcomes (Risk rating 4)

Management response: It is recommended to reduce the likelihood across both BAF Risk 5.01 and 5.02 thereby reducing the current overall risk to 4 and to a RAG rating of Green. It is believed that the large number of controls in place and the level of internal and external assurance that is provided supports this risk reduction to below the target rating.

BAF.06 Failure to effectively monitor the performance and activity of commissioned services, with a focus on ensuring the delivery of better clinical outcomes (Risk rating 8)

Management response: “The CCG has mechanisms in place to manage the performance of providers through various contractual forums including meetings with defined triggers and a process for escalation. Underperformance is discussed at these meetings in relation to mitigation and performance improvement. The internal controls have been reviewed with some changes made in recent months to increase effectiveness. The monitoring of performance and activity is proportionate to the value and risk associated with the contract.”

BAF.07 Failure to effectively develop a primary care strategy that is adequately resourced to service Newham residents and secure a sustainable and viable GP Federation. (Risk rating 16)

Management response: Progress has been made in a number of primary care strategy and GP Federation areas. Whilst the overall risk rating has not decreased a number of internal controls will achieve key milestones before the end of the financial year. This is anticipated to provide a degree of confidence that the risk could be decreased ahead of the next Board meeting.

BAF.08 Failure to effectively develop and implement the re-designed urgent care pathway and understand the inter-dependencies with the NHS 111 procurement (Risk rating 12)

Management response: The procurement for the UTC is currently on trajectory and the development of links between the two continues to be worked through. A legal challenge had been presented with regard to the contract award for 111. This challenge has now been resolved. The 111 contract has now been awarded and mobilisation has commenced with an estimated go live date of August 2018.

As a consequence of this, the risk has now been reviewed and given that controls with regards to mobilisation are in place the risk has been downgraded to a 12.

BAF.09 Failure to equip staff, the Board and clinical leaders with the skills, knowledge and expertise to enable the delivery of the CCG's priorities and commissioning agenda. (Risk rating: 12)

Management response: “The target risk rating will be achieved shortly after this Board meeting as a number of controls will be confirmed as complete at the end of February 2018.

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3. Next Steps

3.1.1

3.1.2

3.1.3

To ensure that we are continually developing the CCG’s risk management approach, work is currently taking place in the following areas, and the following actions will be undertaken prior to the next report to the Board in April 2018.

Internal audit: The Board Assurance Framework is built into the CCG’s annual audit schedule for 2017/18, and took place in February 2018. The scope of the audit was agreed with the CCG’s Risk and Information Governance Manager and the outcome of the audit, and any key actions arising will be reported to the Board, via the Audit Committee. The outcome of the audit will help to formulate the Head of Internal Audit opinion within our 2017/18 Annual Report.

In light of a number of potential emerging risks facing the CCG over the coming months, we have held preliminary discussions with internal audit to ensure that the 2018/19 BAF audit covers the full breadth of our risk management approach both operationally and strategically. The aim of which will be to ensure that the revised BAF reporting process outlined in 3.1.2 has been effectively implemented, and provides the Board with the necessary assurances.

2018/19 BAF: After discussions between the CCG’s Audit Committee Chair, Director of Partnerships and Governance and Risk and Information Governance Manager the current view is that the majority of the current BAF risks will carry over into 2018/19. We will be proposing a number of alterations to the wording, structure and alignment of current BAF risks for the Board to consider in April 2018. These amendments will support the Board and its subcommittees to effectively manage the risks associated with the delivery of the strategic objectives of the CCG, as directed by the Board.

The CCG is currently reviewing the organisation’s objectives and vision to ensure that they remain fit for purpose within the changing North East London health landscape. Staff will be asked to support the review at the CCG’s staff conference on 20 February 2018. Any amendments or revisions to the CCG’s objectives will be reflected in the BAF in 2018/19.

4. Revised BAF reporting process to the Board

4.1.1 After discussion with the CCG Chair and CCG Audit Committee Chair a recommendation has been made that the BAF report becomes more of a highlight exception report from June 2018, to align with the formation of our new Board. It should be noted that it is felt that the current process works, and provides the CCG’s Board with the necessary assurances around the management and mitigation of risk. However in trying to ensure that the process is constantly evolving and seeking improvements, a proposal has been made to streamline the information received at Board, with a view to ensuring that focused and targeted discussions are taking place at the right levels within the organisation. The aim is to keep the Board focused on the robustness of the assurance mechanisms in place, and ensure that executive leads and Committee Chairs make the necessary links to the achievement of the strategic priorities set out by the Board.

The new BAF report will be introduced to the Board by the Chair of the Audit Committee and Lay Member for Audit and Governance.

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Board Assurance Framework

Document information

Version 5.0 February 2018

Chair: Dr Prakash Chandra Interim Managing Director Officer: Selina Douglas

41

Contents 2. Purpose and Scope ........................................................................................................... 3

2.1 Board Assurance Framework ...................................................................................... 3

2.2 Risk Management Governance ................................................................................... 3

2.3 Strategic Objectives ..................................................................................................... 3

2.4 Risk Identifiers ............................................................................................................. 4

2.5 Newham CCG Risk Grading Matrix ............................................................................. 4

2.6 Risk Rating Matrix ....................................................................................................... 6

2.7. Common abbreviations used in the BAF ..................................................................... 7

42

2. Purpose and Scope

2.1 Board Assurance Framework The primary purpose of the Newham CCG Board Assurance Framework (BAF) is to:

1) Act as a mechanism for alerting and appraising the Board of the main risks toachieving to the CCG in terms of achieving strategic objectives as set out in theOperating Plan

2) List, evaluate and provide assurance to the Board regarding the mitigations in placeto the reduce the likelihood or impact of the risk

3) Summarise to the Board the remedial or proposed actions that further mitigate thelikelihood or impact of the risk

The BAF is also an important document for providing external assurance (to NHS England, Internal Audit and patients and public) that the CCG is sighted on its risks and has a robust system of internal control.

2.2 Risk Management Governance Risk Management is embedded in Newham CCG’s Governance Structure:-

The Audit Committee is responsible for scrutinising the group’s Risk Management policies and procedures. Accountable to the group’s Board, the Committee provides the Board with an independent and objective view of the group’s financial systems, financial information and compliance with laws, regulations and directions governing the group in so far as they relate to finance.

The Executive Committee is responsible for approving internal control arrangements, risk sharing and pooling agreements.

The Chief Officer is responsible for approving the group’s arrangements for business continuity and emergency planning.

The Chief Finance Officer is responsible for approving the group’s Counter Fraud, Security Management and Risk Management arrangements.

The Governing Board is responsible for approving and monitoring the Board Assurance Framework.

2.3 Strategic Objectives BAF risks have been linked to the core strategic objectives of Newham CCG, as outlined in the Newham CCG Operating Plan. These are:

1.1. To ensure community health services are responsive, located at the heart of our communities and able to meet the current and future needs of the population

1.2. To develop a primary care system that is modern, accessible and robust enough to care for the local population now and into the future

43

1.3. To ensure our population can access effective, high quality urgent and emergency care in and out of hospital

1.4. To develop a strong and sustainable acute system that places the needs of the patient at the heart of its design

1.5. To be central to a whole system approach working across traditional boundaries to effectively tackle health inequalities and make a positive impact on the health and social care economy of East London

1.6. Staff and clinical leaders are equipped with the skills and expertise to enable the delivery of the CCG’s priorities and commissioning agenda

1.7. To review and improve the existing governance structures to ensure they effectively support the delivery of our corporate and strategic objectives and our statutory duties

It is recognised that a number of BAF risks could be linked to more than one of the above strategic objectives.

2.4 Risk Identifiers Each BAF risk will be assigned a unique risk identifier (number) linked to the applicable strategic objective.

2.5 Newham CCG Risk Grading Matrix

Risk Impact

Assessing the possible impact of a risk in conjunction with the likelihood of the risk occurring is used to determine the risk rating.

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Risk Rating

Risk Category

High(Risk Rating 15-25)

Medium(Risk Rating 8-14)

Low(Risk Rating 1-7)

High categorisation level risks are not acceptable under any circumstances as they will (i) be highly likely to prevent the achievement of the corporate, principle and business objectives and will damage the organisation’s reputation, politically and financially as well as creating a

significant and unacceptable response from stakeholders, (ii) impact on individual or population health outcomes resulting in death. They require specific monitoring and

appropriate action plans at Board level to ensure that their impact is mitigated at the earliest opportunity

Medium categorisation risks are generally not acceptable as they are likely to (i) cause much disruption and efficiency losses to the achievement of corporate, principle and business objectives, (ii) impact on individual or population health outcomes resulting in greater

chances of suboptimal health outcomes. They require specific monitoring and appropriate action plans at individual directorate senior management level to ensure that their impact

does not increase to a higher risk level

Low categorisation risks are in general at an acceptable level of risk as they are (i) unlikely to cause much disruption and efficiency losses to the achievement of corporate, principle and

business objectives, (ii) impact on individual or population health outcomes resulting in some chances of suboptimal health outcomes. They are unlikely to require specific application

of resources and will be subject to on-going review and monitoring at a departmental / functional level

Risk Category desription

45

2.6 Risk Rating Matrix The table below can be used to help to determine an appropriate risk rating. Examples are not exhaustive and are given to aid assessment only.

46

2.7. Common abbreviations used in the BAF Below is a list of commonly used abbreviations that are found in the risk summary of the BAF. These are detailed below for ease of reference:

Barts/BHT Barts Health NHS Trust

BCP Business Continuity Plan

CEG Clinical Effectiveness Group (provider of primary care data quality and informatics and analytics services to the CCG and Newham GP Practices)

CCG Clinical Commissioning Group

COI Conflict of Interest

CQC Care Quality Commission

CQN Contract Query Notice

CQRM Clinical Quality Review Meeting

CQUIN Commissioning for Quality and Innovation

DES Direct Enhanced Service

DoH Department of Health

ELFT East London Foundation Trust (The provider of Community and Mental Health Services in Newham)

EPCT Extended Primary Care Team

EPCS Extended Primary Care Services

FBC Full Business Case

F&A Finance and Activity

FOI Freedom of Information

HoT Heads of Terms

HWBB Health and Wellbeing Board

IAPT Improving Access to Psychological Therapies

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IC Integrated Care

IG Information Governance

IM&T Information Management and Technology

ITT Invitation to Tender

KPI Key Performance Indicator

LA Local Authority

LAS London Ambulance Service

LBN London Borough of Newham

LD Learning Disability

LIS Local Incentive Scheme

LMC Local Medical Committee

NEL (CSU) North East London (Commissioning Support Unit)

NELIE North and East London Information Exchange (A web based commissioning analytics tool)

NHSE NHS England

NUH Newham University Hospital

OOH Out of Hours

PDP Personal Development Plan

PMC Practice Member Council

PPE Patient and Public Engagement

QIPP Quality, Innovation, Productivity and Prevention (a large-scale programme developed by the Department of Health to drive forward quality improvements in NHS care, at the same time as making up to £20 billion of efficiency savings by 2014/15)

DoPM Department of Psychological Medicine

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RAG Red, Amber, Green (e.g. the status of a risk or performance indicator)

RAP Remedial Action Plan

RLH Royal London Hospital

RTT Referral to Treatment

SI Serious Incident

SLA Service Level Agreement

SMT Senior Management Team

SPG Strategic Planning Group

SPR Service Performance Review Meeting

TDA Trust Development Authority

TNA Training Needs Analysis

ToR Terms of Reference

UCC Urgent Care Centre

WEL Waltham Forest and East London (CCGs) – WEL CCGs are: Newham, Tower Hamlets and Waltham Forest. *WELC CCGs also includes City and Hackney CCG.

WHX Whipps Cross Hospital

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17-18 Risk Profile

Risk ID Risk Summary Risk Owner Initial Risk Rating Latest Forecast Trend

End of Year

Target Review Date

BAF.01 Failure to meet NHS Constitutional standards. Selina Douglas 16 16 8 31-Jan-2018

BAF.02 Failure to effectively meet the CCG's financial targets and savings plans in 2017/18. Lei Wei 20 20 10 07-Feb-2018

BAF.03 Failure to implement the key programmes within the Sustainability and Transformation Plan and therefore failure to achieve the system control total

Selina Douglas 16 16 8 29-Jan-2018

BAF.04 Failure to effectively integrate health and social care by progressing BHC and ACS. Selina Douglas 16 16 8 08-Feb-2018

BAF.05 Failure to effectively monitor the quality of commissioned services, with a focus on ensuring the delivery of better clinical outcomes. Chetan Vyas 12 4 8 07-Feb-2018

BAF.05.01 Failure to effectively monitor the quality of Barts Health, with a focus on ensuring the delivery of better clinical outcomes. Chetan Vyas 12 4 8 07-Feb-2018

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Risk ID Risk Summary Risk Owner Initial Risk Rating Latest Forecast Trend

End of Year

Target Review Date

BAF.05.02 Failure to effectively monitor the quality of East London Foundation Trust, with a focus on ensuring the delivery of better clinical outcomes. Chetan Vyas 12 4 8 07-Feb-2018

BAF.06 Failure to effectively monitor the performance and activity of commissioned services, with a focus on ensuring the delivery of better clinical outcomes.

Selina Douglas 16 8 8 05-Feb-2018

BAF.07 Failure to effectively deliver a primary care strategy that is adequately resourced to service Newham residents and secure a sustainable and viable GP Federation.


BAF.07.01 Failure to effectively deliver a primary care strategy that is adequately resourced to service Newham residents Selina Douglas 16 16 8 08-Feb-2018

BAF.07.02 Failure to secure a sustainable and viable GP Federation Selina Douglas 16 16 8 08-Feb-2018

BAF.08 Failure to effectively develop and implement the re-designed urgent care pathway and understand the inter-dependencies with the NHS 111 procurement


BAF.09 Failure to equip staff, the Board and clinical leaders with the skills, knowledge and expertise to enable the delivery of the CCG's priorities and commissioning agenda.

Chetan Vyas 12 12 8 08-Feb-2018

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BAF.01 Failure to meet NHS Constitutional standards.

Risk Owner Lead Committee

Next Review

Date

Current RAG Status

Direction of Travel

Selina Douglas

Executive Committee 23-Mar-18 Red

Original Risk Current Risk Target Risk

Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date

4 4 16 4 4 16 4 2 8 31-Mar-2018

Control Control Description Internal Assurance External Assurance Gaps in Control Status

BAF.01a NHS Standard Contract

The NHS Standard Contract provides a number of contract clauses to facilitate the tracking of performance against NHS Constitutional Standards and incentivise delivery.

a) Completed and signedContract documentation b) SDIPs - STPtrajectories - specific levels of performance, on a monthly basis during 2017-18 against the Operational Standards in relation to Provider performance against Sustainable and Transformational Fund (STF) performance trajectories and assurance requirements. c) Remedial Action Plans(RAPs)

a) NHSE Assuranceprocess.

a) Data quality concerns -Agreed data quality recovery plan with Trusts to improve quality in data, especially in relation to RTT monitoring at the monthly standard meeting. Partially

Effective

BAF.01b Contract Review Group

The CRG is a contractual requirement between Commissioner and Provider - General Condition 8 (GC8). This is the main contract meeting each month and is the forum for escalation of non contract compliance, which includes a provider not delivering NHS Constitutional requirements.

a) CRG Terms ofReference b) CRG meeting minutes.c) Clinical Strategy Group

a) National standardsb) Monthly assurancemeeting

a) Lack of oversight ofthe RTT position due to the Trust not reporting. External organisation will be supporting prior to the return to reporting.

Partially Effective

BAF.01c Performance reports to QPFC

Reports produced by NELCSU for the CCG's QPFC to advise group members on the current provider performance against the NHS Constitutional Standards.

a) Weekly and monthlyperformance reports produced by NELCSU. b) Specific deep diveanalysis sub reports c) QPFC Terms ofreference

Partially Effective

BAF.01d Performance Reports to the Board

CCG Board receives a performance report which includes performance against the national standards for all the commissioned providers.

a) High level summaryPerformance report submitted to the Board. b) Additional reports toCommittees providing more granular analysis. c) Integrated Quality andPerformance Report to Quality, Performance and Finance Committee and the Board. d) Head of Performancenow in post.

Integrated report to the Board is a new process and it is accepted that the first few iterations will take some time to iron out the effectiveness of the report. Partially

Effective

BAF.01e Commissioning Collaborative Committee

Monthly meeting of the Barts Health Contract lead, Chief Officers and Chief Finance Officers from the Waltham Forest, East London and the City (WELC) CCGs.. Commissioners for Barts Health will review performance and prepare for contract review group. This will be chaired by Tower Hamlets CCG as the lead commissioner.

a) Terms of Reference for the CCC. b) Meeting minutes ofthe CCC. c) Adhoc reports to theCCC.

Partially Effective

BAF.01f Urgent Care Working Group

Monthly meeting of the Urgent Care Working Group to oversee the delivery of the A&E standard for the Newham

a) Urgent Care WorkingGroup b) System Review Group

Partially Effective

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site. (System Cabinet) c) Terms of Reference forsite level meetings d) Meeting minutes ofsite specific meetings. e) A&E standardsf) Reporting packsproduced by the Trust.

BAF.01g A&E Delivery Board

A&E delivery board is in place across the Trust with oversight of the A&E improvement plan.

- Terms of reference - A&E delivery board receives escalated issues from UCWG as a regular agenda item. - A&E Delivery Board monitors the progress of the Improvement Plan.

Partially Effective

BAF.01h A&E Improvement Plan

The A&E Improvement Plan submitted by the Trust to highlight the actions being taken to address demand management.

The detail of the Improvement Plan was approved at the September Board.

- NHS England and NHS Improvement have approved the plan. Fully Effective

BAF.01i RTT, Diagnostics and Cancer meeting

RTT, Diagnostics and Cancer monthly meeting.

a) RTT, Diagnostics andCancer monthly meeting terms of reference and minutes. b) Reporting backsproduced by the Trust.

Partially Effective

BAF.01j RTT Recovery Board

Monthly meeting of the RTT Recovery Board providing oversight of RTT recovery plan.

- Newham CCG is a commissioner representative on the Recovery Board as host commissioner. - Reports through the Barts Collaborative Commissioning structures - Return to reporting schedule agreed.

- NHS England and NHS Improvement are present.

Fully Effective

Mitigating Action Due Date Assigned To Latest Note Status

BAF.01a Reporting Timetable 31-Mar-2018

BAF.02 Failure to effectively meet the CCG's financial targets and savings plans in 2017/18.


Next Review

Date

Current RAG Status

Direction of Travel

Lei Wei Executive Committee 23-Mar-18 Red



5 4 20 5 4 20 5 2 10 31-Mar-2018


BAF.02a 2017-18 Budget

Budget has been agreed with all budget holders Fully Effective

BAF.02b Monthly budget holder meetings

Monthly meetings are held with budget managers and budget holders to ensure robust discussions and performance monitoring of potential financial risks on areas of concern.

a) Notes to monthlybudget managers and budget holders. b) Monthly detailedreport to SMT.

Partially Effective

BAF.02c Monthly reporting to NHS England

Detailed financial performance and financial positions are reported to NHS England via monthly returns.

- Month end reporting on day 7 and 8 submitted to NHSE.

- Monthly financial position return and Non-ISFE return to NHS

Fully Effective

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England. - Monthly calls with NHSE on financial position.

BAF.02d CCG Executive Committee

Assurance, advice and recommendations on all maters relating to finance are made to the CCG's Executive Committee.

Executive Committee ToR Executive Committee minutes and action logs. Committee deep dives into finances and QIPP

Partially Effective

BAF.02e Audit Committee

The Audit Committee is responsible for scrutinising the CCG's financial policies and procedures, providing to the Board with an independent and objective view of the CCG's financial systems, financial information and compliance with laws, regulations and directions governing the CCG in so far as they relate to finance.

a) Audit Committee ToR,b) Meeting minutes andaction logs.

a) Assurance fromauditors to support financial governance arrangements.

a) Relatively new AuditCommittee Chair

Partially Effective

BAF.02f Finance Report to the CCG Board

The CCG Board receive a regular finance report based on the latest financial performance and budget management.

a) Board Finance andQIPP report b) Board Meeting Minutesc) CCG Chairs Meetingd) Assurance fromExecutive Committee scrutiny to suppo

a) Relatively new CFO.

Partially Effective

BAF.02g Quality Performance and Finance Committee

The Quality Performance and Finance Committee is responsible for providing assurance to the Board that the necessary financial considerations with regards to business case and proposed procurement financial components have been undertaken. This assures the appropriate identification and management of financial risk (including QIPP schemes, Transformation schemes, investment proposals and funding bids has been undertaken.

a) Quality Performanceand Finance Committee Minutes b) Quality Performanceand Finance Committee Terms of Reference c) Committee Reportsincluding integrated quality, finance and performance deep dives i.e. Ivory Ward relocation.

a) Relatively new CCGCommittee.

Partially Effective

BAF.03 Failure to implement the key programmes within the Sustainability and Transformation Plan and therefore failure to achieve the system control total


Next Review

Date

Current RAG Status

Direction of Travel

Selina Douglas

Executive Committee 23-Mar-18 Red



4 4 16 4 4 16 4 2 8 31-Mar-2018


BAF.03a NEL Programme Board

The NEL Programme Board is responsible for the oversight and planned delivery and is made up of the Chief Officer/Chief Executive of CCG and Provider organisations.

- STP Submission Plan - Independent Chair to facilitate discussions in place.

- System is currently not on track to achieve the control total, largely due to the impact of the cyber attack and the financial positions of Barts Health's and BHR CCG's.

Partially Effective

BAF.03b Development of STP governance arrangements

Programme Board has initiated a working group including lay members of provider and commissioning organisations to make recommendations on the STP governance arrangements.

- Partnership agreement signed up to by partner organisations and in place at the end of June 2017.

- Ongoing review of governance arrangements and joint commissioning committee. The first development meeting has been held and the 2nd is scheduled for 14/02/18.

Partially Effective

54


BAF.03c STP Leadership Workstream

A Chief Executive/Chief Officer is leading each of the work streams with project management support and detailed delivery plans in place for 17/18.

- Detailed delivery plans in place for 17/18. - Work streams and plans reviewed regularly at the STP Board meeting.

- Programme reviewed by the Inner North East London Joint Health Overview & Scrutiny Committee.

Fully Effective

BAF.03d Finance Strategy Group

The Finance Strategy Group validates the financial model and NEL plans to close the gap. The group is also responsible for oversight of the delivery of the system control total.

- Representation and leadership from DoFs from Trusts and CFOs from CCGs - STP Board receives performance against control total monthly. - STP Board undertakes a deep dive review of one work stream at each Board meeting. - Currently reviewing draft risk share agreement.

- NHS England and NHS Improvement approval of the plans.

- Risk share arrangements are currently being developed.

Partially Effective

BAF.03e STP Executive

Made up of work stream leads, the STP Executive monitors the progress of each work stream on behalf of the STP Board.

Progress reviews of the delivery of the progress of the plans and work streams.

Partially Effective

BAF.03f Overview Delivery Group

The Overview Delivery Group (ODG) meets monthly and monitors financial risk, reporting into the STP Board.

a) Terms of Referenceb) Minutes of Meetingsc) Reports into the STPBoard

NHSE/NHSI engagement and involvement in the group, Fully Effective


BAF.03a Financial Strategy Paper

24-Jan-2018

BAF.04 Failure to effectively integrate health and social care by progressing BHC and ACS.


Next Review

Date

Current RAG Status

Direction of Travel

Selina Douglas

Commissioning Committee 23-Mar-18 Red



4 4 16 4 4 16 4 2 8 08-Jun-2017


BAF.04 Governance arrangements

Alignment of the governance arrangements with the major transformation programmes. The Governance arrangements were approved by the CCG Board in April 2017 and support robust decision making.

- Governance arrangements reviewed by SRO. - Board update report to PI Board in April 2017. - Internal organisational governance arrangements (PCCC, ACS Board, ACS Working Group, Commissioning Committee, Integrated Adult Health and Care Board) - Whole system governance (NCCG Board, ACS Collaboration Board, Provider Board)

- Collaborative approach ensuring that the Collaborative (commissioner-provider) board is aligned to the statutory framework of respective organisations.

Partially Effective

BAF.04b Accountable Care System (ACS)

Working group to support the development and delivery of the ACS implementation and controls.

- ACS Working group minutes and papers - CCG Officers in

Partially Effective

55


Working Group attendance - Lay memberparticipation

BAF.04c Primary Care Commissioning Committee

Newham CCG Primary Care Commissioning Committee

- ACS Reports andupdates presented andbuilt into the Committee'sforward planner.

Partially Effective

BAF.04d Provider Forum

Monthly meeting of providers and commissioners.

- a number of meetingsheld to date- Meeting minutes andagenda- a core TaF developed tosupport the developmentof ToRs for the providerforum to move to aCollaboration Board -developing a TsF groupto develop the joint visionand simple agreednarrative.

- Collaborative approachto ensure that the finalToRs of CollaborationBoard is aligned to thestatutory framework ofeach respectiveorganisation. Partially

Effective

BAF.04e Structured Collaboration Workstream Lead profiles and workplans

Profiles report for each of the identified work streams t the key outcomes that need to be achieved. This links to the governance and accountability framework which has been developed.

- Profile reports andneeds assessment inplace that identify keywork programmes.

- NHS England assuranceand alignment to ISAPgateways processes.

- Subject matter expertsand Officer support to beconfirmed by SMT.- Resource requirementsand alignment.

Partially Effective

BAF.04f Committee Reports

Reports, presentations and briefings provided to various internal, joint and external committee meetings and tp respective board/committee meetings for decision making.

- Reports to CCGCommittees (includingthe Board and PrimaryCare CommissioningCommittee)- Updates to Health andWellbeing Board.

Partially Effective

BAF.04g DoPM Logs

DoPM logs reported on a fortnightly basis to the ACS working group.

- Internal reportingmechanisms.- Risks and Issues logs.- Agendas and meetingminutes.

Partially Effective

BAF.05 Failure to effectively monitor the quality of commissioned services, with a focus on ensuring the delivery of better clinical outcomes.


Next Review

Date

Current RAG Status

Direction of Travel

Chetan Vyas

Quality Performance and Finance Committee

23-Mar-18 Green



4 3 12 4 1 4 4 2 8 31-Mar-2018

BAF.05.01 Failure to effectively monitor the quality of Barts Health, with a focus on ensuring the delivery of better clinical outcomes.


Next Review

Date

Current RAG Status

Direction of Travel

Chetan Vyas


23-Mar-18 Green

56



4 3 12 4 1 4 4 2 8 31-Mar-2018


BAF.05.01a Monthly Quality Oversight and Assurance/Clinical Quality Review Group Meeting (CQRM)

Regular meetings with Newham Site around quality and improvement.

- Terms of Reference for Newham Oversight and Assurance Meeting. - Newham Oversight and Assurance meeting papers

- Performance monitoring arrangements - Agendas and minutes from Barts CQRM and SPR meetings

Fully Effective

BAF.05.01b Monthly Quality Intelligence Report

Monthly report on quality intelligence to the CCG Quality, Finance and Performance Committee.

- Monthly Quality Intelligence Report Fully Effective

BAF.05.01c Key Performance Indicator (KPI) Review Meetings

Regular meetings with Barts Health to review performance against KPIs

- Terms of Reference for Barts Health KPI Review Meeting. - Barts Health KPI Review meeting papers. - ToR reviewed following commissioner feedback - Deep dive schedule in place.

Fully Effective

BAF.05.01d Newham site Maternity Quality and Performance group meeting

Regular meetings with Newham site Maternity team to review performance and quality.

- Maternity Quality and Performance Sub Group Meeting Papers

- These meetings are under review, along with maternity assurance across STP.

Partially Effective

BAF.05.01e Amber Alert Process

Mechanism for GPs to report quality issues in relation to Barts Health.

- Amber alert reporting and response forms. - Amber alert database

- Timeliness of reporting. Trust reporting but on average 18-20 days and not the 13 day standard.

Partially Effective

BAF.05.01f Barts Health Care CQC visits

Regulator (CQC) visits to Barts Health. - NUH presentation to the CCG Board - Newham site report from CQC - Whipps Cross site report from CQC - Barts Health CQC report

- CQC visit

Fully Effective

BAF.05.01g Quality Assurance Visits

Visits to Wards by the CCG to observe first hand the quality of care being delivered to patients.

- Quality Assurance visit framework. - Quality Assurance visit reports and action plans

- Quality Assurance Visits at Barts Health

- Forward Planner of visits for 2017/18 developed but not fully operational.

Fully Effective

BAF.05.01h WELC Serious Incident Panel Meeting

Joint panel with WELC to review and approve closure of Serious Incidents.

- WELC SI Panel Terms of Reference - WELC SI Panel papers

- Review of the structure of the panel is on hold pending Serious Incident Framework (national framework expected beginning 2018/19)

Fully Effective

BAF.05.01i Quality Leads Meeting

Regular meetings with WELC Quality Leads and Teams.

- Terms of Reference for WELC Quality Leads meetings - Quality Leads papers of meetings - CQRM Deep dives

Fully Effective

BAF.05.01j Commissioning for Quality and Innovation (CQUIN)

Proportion of healthcare providers income conditional on demonstrating improvements in quality and innovation in specified areas of patient care.

- Deep dive for SEPSIS at September CQRM. Escalated to CRG. - CQUIN reviewed at Barts Health KPI meeting.

- Commissioning for Quality Framework

- 2 year CQUINs across 2017-19. As such the some of the impact of the outcome measures will not be assured until much later in the process.

Partially Effective

BAF.05.01k Integrated Quality Report to the Board

Regular reports to the CCG Board around performance against quality measures.

- Integrated Quality and Performance dashboard with updated information. Fully Effective

57


BAF.05.01l Quality, Performance and Finance Committee

CCG Quality, Committee and Finance Committee

- Committee Terms of Reference - Committee Minutes, agendas and reports.

Fully Effective

BAF.05.01m Director of Quality, Chief Medical Director and Chief Nurse Meetings

Bi-Monthly meeting between WEL CCGs, Director of Quality Barts Health, Chief Medical Officer and Chief Nurse to discuss hot topics and quality issues.

- CCG engagement and involvement in the group. Partially

Effective

BAF.05.01o Quality Surveillance Group

Attending regional quality surveillance group to share and gain intelligence regarding Barts Health quality matters with NHS England, CQC, HEE and CCG colleagues.

- Data collated and shared with stakeholders (NHSE, CQC, HEE) as part of the QSG.

- NHSE Assurance - Deep dives undertaken at the meetings to provide scrutiny and assurance.

Fully Effective

BAF.05.01p Contract Review Group

Escalation Review Group - Terms of reference - Meeting agendas, minutes and reports

- Review of escalation process being discussed through the KPI review meeting.

Fully Effective

BAF.05.01q Clinical Harm Review Group

Regular meetings with Barts Health to review clinical harm of patients with long RTT and cancer waits.

- CCG membership and scrutiny at the meeting. - Group Terms of Reference. - Group minutes, reports and agendas.

- Trust's delivery against the improvement plan.

Fully Effective

BAF.05.01r Newham Site Quality Improvement Board

Monthly internal site assurance meeting covering the delivery of the Quality Improvement Plan. The CCG is a member as a critical friend.

- Terms of reference - CCG Membership - Minutes, reports and agendas.

Fully Effective

BAF.05.01t Newham Site Quality & Safety Committee

Monthly internal site assurance meeting covering Quality and Safety. The CCG is a member as a critical friend.

- Terms of Reference - CCG Membership - Minutes, reports and agendas

Fully Effective

BAF.05.01u Site Integrated Safeguarding Committee

Internal Site and Integrated Safeguarding Committee. The CCG is a member as a critical friend.

- Terms of reference - CCG Membership - Minutes, reports and agendas

Fully Effective

BAF.05.01v Joint QI project

CCG led joint quality improvement project with ELFT and Barts Health. Aim of the project is to increase patient and staff satisfaction with the discharge process from NUH wards into the EPCT .

- Agenda - Papers

- Project commenced in October 2017 and outcome will not be measurable until end of 2018.

Fully Effective

BAF.05.02 Failure to effectively monitor the quality of East London Foundation Trust, with a focus on ensuring the delivery of better clinical outcomes.


Next Review

Date

Current RAG Status

Direction of Travel

Chetan Vyas


23-Mar-18 Green



4 3 12 4 1 4 4 2 8 31-Mar-2018


BAF.05.02a Monthly Clinical Review Meeting (CQRM)

Regular meetings with ELFT around quality and improvement.

- Terms of Reference for CQRMs (Community [adults and children], Mental health, Consortia) - Papers for CQRM meetings

Agendas and Minutes of ELFT CQRMs.

Fully Effective

58


- Papers for CQRM meeting

BAF.05.02c Service Performance Meetings (SPR)

Regular meetings with ELFT to review performance against KPIs.

- Community Health Service Performance Review meeting Terms of Reference - - Community Health Service Performance Review meeting minutes

Agreed reporting through contracts via KIP and Information Schedule Reporting. Fully Effective

BAF.05.02d Amber Alerts Process

Mechanism for GPs to report quality issues in relation to ELFT.

- Timely responses raised - Improvement in process - Majority of responses received within 13 working day timeframe.

Fully Effective

BAF.05.02e Quality Assurance Visits

Visits to services by the CCG to observe first hand the quality of care being delivered to patients.

- Quality Assurance visits framework - Quality Assurance visits reports and action plans - Quality Assurance visits forward planner - MH Visits commenced in October 2017

Fully Effective

BAF.05.02f ELC Serious Incident Panel

Joint panel with ELC to review and approve the closure of SIs

- Meeting every two months held. - Action plans and evidence of chases/closures.

Fully Effective

BAF.05.02g Quality Leads Meeting

Regular meetings with WELC Quality Leads and Teams.

- Terms of Reference for the WELC Quality Leads Meeting - Quality Leads Papers and Minutes

Fully Effective

BAF.05.02h Commissioning for Quality and Innovation

CQUIN Review process with ELFT. - Evidence of reviews - 2 Year CQUINs across 17-19 so even at the end of year 1, it will be difficult to assure the effectiveness of the deliver, even though the monitoring continues.

Partially Effective

BAF.05.02i Quality Report to the Board

Regular reports to the CCG Board around the performance against quality measures.

- Quality reports to CCG Board.

- Patient stories to CCG Board. Fully Effective

BAF.05.02j Quality, Performance and Finance Committee

CCG Quality, Finance and Performance Committee.

- CCG QPFC Terms of Reference and Quality Exception Reports. Fully Effective

BAF.05.02k Monthly Quality Exception Report

Monthly Quality Exception report to the CCG's Quality, Performance and Finance Committee.

Monthly quality exception report to Quality, Performance and Finance Committee

Fully Effective

BAF.05.02m QI Forum

Internal overview of the delivery against the QI Programmes.

- CCG attendance at the meeting - Meeting reports - Meeting minutes and agenda.

- Linked to year end. Will be able to review the effectiveness of the programmes closer to year end.

Fully Effective

BAF.05.02n Technical Sub-Group

Confidential weekly rmeeting with the Trust to discuss recovery performance against KPIs

- Agenda - Terms of Reference - Minutes - Papers

Fully Effective

BAF.05.02o Joint QI project

CCG led joint quality improvement project with ELFT and Barts Health. Aim of the project is to increase patient and staff satisfaction with the discharge process from NUH wards into the ECPT service.

- Agenda - Paper - Progress measured on QI Life online platform

- Project commenced in October 2017 and outcomes will not be measurable until end of 2018.

Fully Effective


BAF.05.02e Quality Assurance Visits

31-Oct-2017 Chetan Vyas MH quality assurance visits commenced as of October 2017. Completed

59

BAF.06 Failure to effectively monitor the performance and activity of commissioned services, with a focus on ensuring the delivery of better clinical outcomes.


Next Review

Date

Current RAG Status

Direction of Travel

Selina Douglas


23-Mar-18 Amber



4 4 16 4 2 8 4 2 8 30-Mar-2018


BAF.06a Contract Review Group

Contract review group with Barts Health - CRG Terms of Reference - CRG Minutes and Reports

Fully Effective

BAF.06b Barts Health KPI Review Meeting

Review meeting with Barts to review and address compliance with KPIs Fully Effective

BAF.06c Local Performance Meetings

Various performance meetings, such as the Urgent Care Centre Quality and Performance meeting and the Maternity Quality and Performance Meeting.

Fully Effective

BAF.06d Technical Sub Group

TSG to review the quantifiable KPIs and undertake trend analsyis and review trajectories.

- Minutes, Agendas and reports - Monthly action logs - Linkage with CSU Contract Review Group - Monthly queries raised with the providers.

Fully Effective

BAF.06e Service Performance Review Meeting

Service Performance Review Meetings for ELFT and Community Health Services.

- Terms of Reference and meeting minutes - Action logs and plans. - Triangulation with CSU Contract Monitoring process and the Technical Sub Group.

Fully Effective

BAF.06f CSU Contract Monitoring

Contract monitoring and analysis undertaken by the CSU on the CCG's behalf.

- Review of data quality issues and matters arising from reporting. -Actions and queries logs and evidence that actions have been dealt with or escalated where necessary. - Governance arrangements and linkage with Technical Sub Group.

- Cross review from NEL CSU Contracts team on the accuracy and consistency of data reported by providers.

Fully Effective

BAF.06g Quality Assurance Visits

Visits to services by the CCG to observe first hand the care being delivered to patients.

- Quality Assurance Visits framework - Quality Assurance visits reports and action plans - Quality Assurance visits forward planner. - MH visits commenced in October 2017 - Quality Assurance visits at Barts undertaken.

Fully Effective

BAF.06h Integrated Performance and Quality Report

An integrated quality and performance dashboard has been developed to highlight the key performance and quality exceptions to the Board, via the

- Integrated report presented to the QPFC - Integrated report presented to the Board

Fully Effective

60


Quality Performance and Finance Committee.

- Minutes from QPFC and Board - Agendas from QPFC and Board

BAF.07 Failure to effectively deliver a primary care strategy that is adequately resourced to service Newham residents and secure a sustainable and viable GP Federation.


Next Review

Date

Current RAG Status

Direction of Travel

Steve GilvinPrimary Care

Commissioning Committee

23-Mar-18 Red



4 4 16 4 4 16 4 2 8 31-Mar-2018

BAF.07.01 Failure to effectively deliver a primary care strategy that is adequately resourced to service Newham residents


Next Review

Date

Current RAG Status

Direction of Travel

Selina Douglas

Primary Care Commissioning

Committee 23-Mar-18 Red



4 4 16 4 4 16 4 2 8 31-Mar-2018


BAF.07.01a Revised Primary Care Strategy

The CCGs Primary Care Strategy is continuously being refreshed

- Primary Care Commissioning Committee ToR - Primary Care Commissioning Committee Minutes - Latest revision of the PCS - Estates Strategy - IT Roadmap - TST Workforce Plan - Areas of Primary Care QIPP are actively managed to ensure delivery.

- NHSE GP Five Year Forward View - Internal Audits - Patient and Public engagement

Fully Effective

BAF.07.01b Effective utilisation and management of spend

Review of contractual spend as part of the monthly review of budgets, tracking of EPCS/LIS claims, reviews of performance against the contract on APMS and other outcome measures.

- Finance Report to NCCG Board - Finance Report to PCCC - Finance report to QPFC - Regular contract monitoring

- NHS England approval and reviews. - Clinical Effectiveness Group reviews - Claims validation.

Fully Effective

BAF.07.01C Referral Pathway Service

Introduction of an RPS scheme. - Minutes of Primary Care Commissioning Committee - RPS reporting

- Newham and London wide LMC - NHS England approval of the schemes.

- Lack of engagement from practices. Partially

Effective

61


- RPS training rolled out to CCG and Practice staff - Quarterly update to Quality, Performance and Finance Committee - Significant group and on-site training provided to practices. This will be an ongoing requirement as practices familiarise themselves with the initiative.

BAF.07.01d Primary Care Workforce Programe

The CCG is working with partners such as UEL and UCLP as part of the development of a range of work streams and programmes to support the development of the primary care work force within Newham.

-Workforce data report to Primary Care Commissioning Committee

- GP Education Steering Group - Community Education Providers Network (CEPN) Board - Practice Managers Development programme - Progress on overseas recruitment of Drs and Physician Associates programme being managed centrally.

- Centralisation of the overseas recruitment programmes means that Newham have limited control over the time frames for completion. Partially

Effective

BAF.07.01e Practice Quality Improvement Group

Practice Quality Improvement Group is a sub group of the Primary Care Commissioning Committee and supports with the review of quality and performance issues within Practices and monitors the identified improvement and action plans.

- Agenda, ToR and minutes from meetings. - Escalation of key issues to PCC Part II.

- NHSE membership of the group.

Fully Effective

BAF.07.01f Primary Care Estates Strategy

The CCG has developed a Primary Care Estates Strategy and are committed to ensuring the provision of primary care provision within Newham. The delivery of the strategy is dependent on having modern fit for purpose premises within which to deliver a range of services typically provided within an acute setting, such as diagnostics.

- Primary Care Estates Strategy 2017-20 - Primary Care Commissioning Committee - Newham Alternative Financing Option

- GP Forward View - Cabinet approval of the business case and funding proposals in June 2016. Full Cabinet approval on the full business case being granted on 21/11/17 - NHS England, Department of Health and NHS Property Services discussions held regarding the acquisition of assets, financial model and business case.

- Awaiting full sign off from NHSE on 9 February 2018.

Partially Effective

BAF.07.01g Extended access provision

The CCG have implemented extended hours access within primary care after running a successful pilot between October 2016 and March 2017.

- Review of 8-8 pilot process and data - 8-8 pilot reports to Primary Care Commissioning Committee - Delivery of extended hours service within Newham - Report to PCC Part I in November 2017 and PCC Part II in January 2018. Approval given for procurement in February 2018.

Partially Effective

BAF.07.01h IT Strategy and Re-procurement

The CCG have a GP IT Strategy, supported by the GP Forward View, to improve IT infrastructure and service delivery within Newham.

- GP IT procurement signed off by PII Board in June 2017. - Contract and performance review meetings with NELCSU as the provider.

- GP Forward View assurance to NHS England.

- Roll out of IT infrastructure including Wi-Fi services across all practices not complete. Significant progress made and only a handful of practices left to roll out.

Partially Effective

BAF.07.01i Primary Care Home

Partially Effective


BAF.07.01c Wi-Fi roll out across 31-Dec-2017 Significant progress made on the roll out. Only a handful of On Track

62


practices practices remain and will be completed by the end of the financial year.

BAF.07.02a Report to PCC 29-Nov-2017 Steve Gilvin Report to the Primary Care Commissioning Committee on the Federations updated governance and accountability arrangements. On Track

BAF.07b RPS Training roll out 13-Oct-2017 Mohsin Patel Roll out of training completed. Completed

BAF.07.02 Failure to secure a sustainable and viable GP Federation


Next Review

Date

Current RAG Status

Direction of Travel

Selina Douglas

Primary Care Commissioning

Committee 23-Mar-18 Red



4 4 16 4 4 16 4 2 8 31-Mar-2018


BAF.07.02a Oversight of Federation Governance

Regular reporting cycle to the CCG's Interim Managing Director, Chair of the CCG and AD for Primary Care from the Chair and Chief Officer of NHC.

- Reports to SMT, CCG Board and PCCC - a letter of assurance from the Federation over management of conflicts of interest.

- NHS England's COI Guidance

- Lack of formal reporting of revised governance structures. Partially

Effective

BAF.07.02b Control of funding for the Federation

Arrangements for audit and oversight of NHC funding.

- Primary Care Commissioning Committee reports to PII in November 2017 and January 2018

- External auditors appointed by NHC. - Independent Audit Committee Chair appointed by NHC

- Lack of output reports.

Partially Effective


BAF.07.02a Report to PCC 29-Nov-2017 Steve Gilvin Report to the Primary Care Commissioning Committee on the Federations updated governance and accountability arrangements. On Track

BAF.08 Failure to effectively develop and implement the re-designed urgent care pathway and understand the inter-dependencies with the NHS 111 procurement


Next Review

Date

Current RAG Status

Direction of Travel

Selina Douglas

Commissioning Committee 23-Mar-18 Amber



4 4 16 4 3 12 4 2 8 31-Mar-2018


BAF.08a Route to market going to Board

The Route to market for UCC went to the Board in June 2017 and we are planning to go to a competitive procurement.

- Report taken to Part III Board meeting in June for approval on the procurement approach. Fully Effective

63


- Decision taken to proceed with competitive procurement for UTC.

BAF.08b Delegated authority to finalise procurement

A group of non conflicted Board members and Executive Officers are in the process of finalising the contract.

- Internally lead delegated team. - Procurement has now gone live.

Fully Effective

BAF.08c 111 Mobilisation

With a preferred bidder and a project plan in place, the CCG will be moving towards contract mobilisation.

- CCG Commissioning Committee to oversee the procurement process and contract mobilisation. - Internal team of non conflicted Board Members and Non Exec to lead the contract mobilisation - The contract is now in mobilisation with arrangements in place to monitor mobilisation through the commissioning committee.

Partially Effective

BAF.08d 111 Procurement Process

111 Procurement process has been completed and there is a preferred bidder.

- Signed off at PIII Board meeting. - The contract is now in mobilisation with arrangements in place to monitor mobilisation through the commissioning committee

Collaborative approach across STP with various SMEs giving input into the Bidder selection and ITT.

Partially Effective


BAF.08a STP Mobilisation 31-Mar-2018 Julie Van Bussel Mobilisation currently on track and being monitored via the Commissioning Committee. On Track

BAF.08b Report to PIII Board 20-Dec-2017 Julie Van Bussel Paper currently being worked through ahead of presentation to the Board. On Track

BAF.09 Failure to equip staff, the Board and clinical leaders with the skills, knowledge and expertise to enable the delivery of the CCG's priorities and commissioning agenda.


Next Review

Date

Current RAG Status

Direction of Travel

Chetan Vyas Executive Committee 23-Mar-18 Amber



4 3 12 4 3 12 4 2 8 31-Mar-2018


BAF.09a Staff annual appraisals

The annual review of staff performance against their set objectives.

- Staff appraisal forms completed by line managers - Assurance sought from CCG Senior Management Team

- Testing compliance against the completion targets. Partially

Effective

BAF.09b Actus performance management system

A system to manage performance against objectives on a regular basis. The system has a robust reporting tool.

Actus Performance System reports Partially

Effective

64


BAF.09c Staff Development

Staff Development Programme 2017/18 - Staff Development Prospectus - Publicity communications regarding Development sessions - Slide decks from development sessions

Fully Effective

BAF.09d Board Development

Board Development sessions - Agendas from Board Development sessions - Slide decks from the sessions

Fully Effective

BAF.09e Staff development work plans

Staff development work plan - Action plan - Actions being completed from the Staff Action Plan - Friday staff bulletin articles which confirm a number of actions being completed. - Updated review of completed actions

Fully Effective

BAF.09f Staff Engagement

CCG Staff Meeting Monthly CCG Staff Meeting agendas Fully Effective

BAF.09g Staff Engagement

CCG Staff Barometer – anonymous monthly barometer to gauge staff health and well-being

- Staff communications publicising the monthly Staff Barometer - Staff Barometer analysis

Fully Effective

BAF.09h Staff Engagement

CCG Staff Conference - Final agenda for 20 February 2018

Partially Effective

BAF.09i CCG Organisational Development plan

6 month Organisational Development plan to support the CCG workforce, Board and Clinical Leaders through the current transition phase. The plan seeks to equip the CCG workforce, Board and Clinical Leaders the appropriate skills and development to enable the delivery of the CCG priorities and plans

- 6 month Organisational Development plan

Partially Effective

BAF.09j Staff Development

Review of Personal Development Plans -Thematic review of Personal Development Plans to gauge ongoing development requirements of staff

Fully Effective


BAF.09a Review of staff annual appraisals

15-Dec-2017 Chetan Vyas Testing the compliance of staff annual appraisals and objective setting underway. Expected completion date was initially the end of October 2017, but this has this revised to early December 2017.

Completed

65

Newham CCG Board meeting Part I, Thursday 22 February 2018 Committee rooms, 4th Floor Unex Tower

Title Finance Report Month 9

Agenda item 3.3

Author Lei Wei, Interim Chief Finance Officer Newham CCG

Presented by Vincent Heneghan. Assistant Finance Director, Newham CCG


[email protected] Lei Wei, Interim Chief Finance Officer Newham CCG


Action required The Board is asked to: • Note CCG’s financial position as at 2017/18 Month 9 including QIPP and

additional saving target delivery. • Note the possibility NEL risk share deployment within a short time-scale, and

approve delegated authority to the CCG Chair, Interim MD, and Interim CFO for action.

• Note the progress of the CCG’s financial planning for 2018/19.

66


Executive summary

Month 9 Financial Position On 30 March 2017 the CCG submitted a balanced Operating Plan financial template and this was subsequently included as part of the STP 5 year plan and Capped Expenditure Plan submission, the last version of which was submitted on 2 June 2017).

The CCG Board approved the Operating Plan budgets inclusive of a £7.5m surplus and £16.09m QIPP plan at its meeting on 12 April 2017. The detailed budget book was available for inspection at the meeting.

Newham CCG reported a balanced financial position at M9 2017/18 and the delivery of QIPP and efficiency saving target is on track.

The trends to date reflected costs pressures mainly in A&E, planned care and maternity services across main acute providers. Other than the implication due to activity shift, there are also concerns on the financial impact of the mandated IR adjustments and move to HRG4+. These are national issues, and a London-wide working group has been established to conduct technical reviews and support continued CCG discussions with the regulators. The work is due to be concluded in February 2018. In other significant areas of spending (i.e. Prescribing, Continuing Health Care) financial risk started becoming materialised. Especially for prescribing, there have been national cost pressures for short-supplied drugs, and work is still on-going at national level in managing the risk. As at M9, CCG’s contingency of £4.1m has been applied to manage the financial position.

The NHSE instituted monthly teleconference on the financial year end projection continued in addition to standard regulator reporting. Consolidated reporting for the ELHCP area has also been in place, and welcome Board Member’s scrutiny.

QIPP and Efficiency Month 9 analysis of the QIPP position and other savings targets indicated that in total the potential financial risk was £10.6 million against a total savings target of £23.7m, which is an improvement on the previous reporting period. The scale of risk is expected to further reduce with the year-end discussions with main providers coming to conclusions.

The Executive Committee has initiated a 2017/18 QIPP deep dive process from mid-September. A number of actions have been identified since to increase achievement against QIPP targets and explore new opportunities to mitigate the risk of shortfall in the current trajectory. Further review on the QIPP position and progress against actions previously identified will be conducted in February 2018. Based on Executive Committee review and discussions, the outcome and proposals that require executive decision-making will be reported to the CCG Board.

NEL Risk Share The September 2017 Finance Report updated the Board with regard to the risk share arrangements. The update noted the Board support for the continuation of the risk share arrangements in 2017/18 based around the national requirement to hold an additional contingency reserve and the nationally approved use in 2016/17 of this form of reserve by all STP CCGs to balance the commissioner position.

Subject to the CCG delivering its statutory requirement to meet its surplus target, a similar application of the risk reserve is proposed if required to deliver the

67

overall STP commissioner control total. Although not confirmed as at the reporting writing, there is likely to be requirement for such support which would be drawn from this reserve. The Board should note that the requirement from the previous year (Over time the risk share process will be neutral and will only be utilised under conditions approved by the NEL CFOs and supported by NHSE) remain and will be applied. Approval is sought at this Board meeting as the requirement may require action within a short time-scale to meet technical deadlines. Where this is the case, the CCG Chair, Interim MD and Interim CFO will have delegated authority to action on behalf of the CCG Board, and details will be reported to the next Executive Committee where issues relating to risk share have previously been addressed.

For 2018/19 the collective intention of CFOs is to revise the risk-share arrangements to ensure they reflect the emerging Operating Planning requirements and remain robust and transparent. These will be developed by the STP lead CFO and presented to the Board at a future meeting. In the interim the current Board approach on risk sharing will be maintained in 2018/19.

It is a Board duty for the CCG to manage within the resources provided to it and achievement of our financial targets will therefore be an overriding priority. Detailed reports are provided to the Executive Committee and the Quality, Performance and Finance Committee to enable the appropriate levels of control to be exercised on the Board’s behalf. In the event of a risk to the delivery of Board financial targets, a remedial action plan will be presented to these Committees and any agreed actions proposed in the subsequent Board Report for ratification.

2018/19 Financial Planning In preparation for 2018/19 Financial Year the CCG CFO has identified the initial business rules that will be applied in building next year’s Operating Plan Financial Template and the budget setting processes. The Interim CFO has also been in discussion with NEL CFO colleagues in relation to the Financial Framework for developing ICS proposals. While these are still at the discussion stage, ICS planning should proceed on the basis that this will be applied to ensure the overall sustainability of CCGs and the NELCA health economy as a whole. Both 2018/19 budget setting process and Financial Framework for developments including ICS have been discussed at the CCG’s Senior Management Meeting and reported to the CCG Board in September 2017. The requirements are clearly restrictive and underline the scale of the CCG challenge. However, by ensuring that planning and preparation is undertaken at an early stage, particularly in regard to the 2018/19 QIPP plan, the opportunities for the CCG to meet the requirements while still delivering its priorities is maximised.

The CCG is currently in process of refreshing the 2018/19 Operating Plan, following the Planning Guidance released by regulators on 2nd February 2018. Despite the increase of allocation, Newham still face significant financial challenges in the coming financial year. There is no drawdown of funding allowed in 2018/19, and similar level of QIPP target as previous years is required. The outcome of the Operating Plan refresh and any proposals that require executive decision-making will be reported to the CCG Board in March/April 2018.

Star Chamber process for QIPP development The third round Star Chamber review is scheduled on 8th February 2018, in line with the CCG financial planning timetable. The outcome and proposals that require executive decision-making will be reported to the Board in the meeting. Actions identified will be followed up at the CCG’s Senior Management Team and Executive Committee on a regular basis.

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Supporting papers None.


Values: Accountability and responsibility – Requirement to meet target surplus Aims: Ensuring equity of Health and Wellbeing outcomes


The Month 8 financial position has been reviewed in detail by the Executive Committee.

Risk The Financial Plan and effective Financial monitoring, reporting and control (including the QIPP programme) as identified in the Finance and Activity Plan is an essential component in identifying and managing financial risk and ensuring the CCG delivers its statutory financial requirements.

The risk of failure to deliver this is identified specifically in BAF.05

Equality impact Effective delivery of the financial plan will support the CCG in achieving its duty to reduce inequality of health provision and outcomes for the residents of Newham.


This report has been subject to no specific prior consultation but reflects comments from NHSE scrutiny and assurance processes and any comments, queries or suggestions raised by CCG members, the Board or Newham residents in relation to earlier reports.


The report provides a high level view of the CCG’s financial performance in 2017/18 and financial planning status for 2018/19.

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Newham CCG Board Thursday 22 February 2018 Committee Rooms, Unex Tower

Title Newham CCG 2018/19 Star Chamber and Governance Process

Agenda item 3.4

Author Saem Ahmed, Newham CCG, Head of Performance and Planning

Presented by Fiona Smith, Newham CCG, Board Registered Nurse and Chair of the Quality Performance and Finance Committee


Selina Douglas, Newham CCG, Interim Managing Director, [email protected]

This paper is for Discussion

Action required Discuss the content of the report.

Executive summary

The report asks board to • Note the Star Chamber process• Note the QIPP target and progress• Discuss the assurance processes

Supporting papers No supporting papers with this report


Values Collective clinical leadership Transparency with our decision-making and leadership Accountability and responsibility

Aims Reducing inequalities and improving accessibility Reducing quality variation Ensuring equity of health and wellbeing outcomes


Star Chamber on the 08 February 2018

Risk BAF.02 – Failure to effectively meet the CCG’s financial targets and savings plans in 2017/18.

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Equality impact This document relates to all Newham residents in the 9 protected characteristics that are covered by the Equality Act 2010 and our Equality Duties.


No consultation has taken place nor is it required for this report. However specific schemes will require consultation and therefore this would be done as part of the QIPP scheme development.


Newham CCG is facing a challenging financial year against increasing demand and delivery of national agreed targets both in 17/18 and 18/19. This paper outlines the governance and process around identifying 18/19 QIPP schemes which is needed in order for the CCG to discharge a number of duties including fiscal responsibility. The paper outlines the outcome of the Star Chamber process and indicates upcoming timescales in order to deliver the challenge. Finance will continue to work closely with commissioners and all parties in order for this to be achieved.

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1.1

1.1.1

1.1.2

1.1.3

1.1.4

This paper is to update the Board on the process and outcomes of the Star Chamber Process, and the governance framework for the 2018/19 QIPP.

The purpose of Star Chambers is to: • provide Board members with information on the QIPP challenge for 18-19• challenge the 18-19 schemes in terms of quality impact, delivery, finance and risk• provide Board members with assurance of the QIPP process and delivery to meet the 18-

19 QIPP challenge• seek approval from Board members on 18-19 QIPP schemes

Membership of the Star Chamber included the CCG Deputy Chair, the Chair of the Quality, Performance and Finance Committee, the Chair of the Audit Committee, the Interim Managing Director, the Director of Quality and Development and the Interim Chief Finance Officer.

The Star Chamber process took place in three phases between December 2017 and February 2018. The first phase reviewed 18/19 QIPP schemes for approval, the second phase reviewed further schemes and assurance requested in phase one for approval, and the third phase reviewed delivery plans, governance, risks and took a stock take of the 18/19 QIPP position.

A total of 46 QIPP schemes were put forward to Star Chamber which included Planned Care schemes (24), Unplanned Care (3), Medicine Management and Estates (2) and other (17) which includes budget savings and IT.

2. Outcome from Star Chamber

2.1

2.1.1

2.1.2

2.1.3

The schemes put forward to Star Chamber included transactional schemes (32) and transformational schemes (14).

The outcome from Star Chamber was as follows: • Approved 40 schemes (26 transactional and 14 transformational)• Partially approved 1 scheme (transactional and transformational)• Not approved 2 schemes (1 transactional and 1 transformational)• Roll over from 17-18 schemes (3 transformational schemes).

Each scheme put forward to Star Chamber was supported by draft delivery plans which included how and when the savings would be realised, risks/mitigation, and planning in terms of phasing of savings through 18-19. These will be worked up further to provide a more granular level of detail that enables performance management of scheme delivery.

Where deemed necessary the schemes are required to undertake a Quality Impact Assessment and Equalities Impact Assessment which will be taken through the appropriate governance mechanisms for approval.

3. Governance assurance

3.1 External Review Deloitte were commissioned by NHSE to undertake a review of CCGs QIPP governance processes and this focused on five domains:

• Monitoring and Reporting• Stakeholder & Provider Engagement• Programme Management Capacity• Planning Cycle• QIPP Documentation

The outcome of the review is presented in figure 1. below. It demonstrates that Newham CCG is the only CCG in London to receive a strong green rating (all statements answered positively) across the five domains.

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3.1.1

Fig. 1 Outcome of the Deloitte CCGs QIPP review

Newham CCG 2018/19 QIPP Internal Governance Framework The internal governance framework is outlined in figure 2 below, which describes the 18-19 QIPP governance process and the roles and responsibility of the committees.

NEWHAM CCG BOARD Financial Strategy

Quality, Performance & Finance Committee –Scrutiny

and Assurance

Executive Committee – Continuous monitoring &

Delivery

Primary Care Commissioning Committee – Consider business case proposals in relation to primary care

Commissioning Committee – Consider business case proposals in relation to all non-primary care

QIPP Star Chamber – Scrutiny and assurance of QIPP Proposals

Fig. 2 Newham CCG QIPP Governance 2018/19

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4. Recommendation

4.1 The Board are asked to • Note the Star Chamber process• Note the QIPP target and progress• Discuss the assurance processes• Approve this paper.

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Newham CCG Board Thursday 22 February 2018 Committee Rooms, Unex Tower, 5 Station Street, Stratford, E15 1DA

Title Better Care Fund – Section 75 Agreement

Agenda item 3.5

Author Asma Ali, Newham CCG, Head of Commissioning & Transformation - ACS

Presented by Selina Douglas, Newham CCG, Deputy Chief Officer


Asma Ali. Newham CCG, Head of Commissioning & Transformation - ACS [email protected]


Action required The Newham Board, for the reasons set out in the report, are asked to: 1. Sign-Off the extension of joint Better Care Fund section 75 agreement

between the Newham Council and Newham Clinical Commissioning Group, to deliver the outcomes associated with Better Care Fund for a duration of 3 years – 1st of April 2018 to 31st March 2021 (with an annual service review/contribution refresh each year).

2. Delegate authority for all necessary decisions that involve Newham CCGwith respect to the implementation and operation of the Better Care Fundand section 75 agreement (including adding/removing schemes from thepool), to the Managing Director (interim) of Newham CCG in consultationwith the Chair of Newham CCG.

3. Note that the function of monitoring the implementation and operation of theBetter Care Fund and the section 75 Agreement will be overseen by stafffrom the CCG and Council through the existing BCF Delivery Group whichwill provide monitoring updates to the Health & Wellbeing Board for theduration of the section 75 agreement.

4. Note the contents of a similar report to the London Borough of Newham(LBN) Cabinet on the 7th of Dec which was approved by the Mayor inconsultation with LBN Cabinet (Appendix – 1).

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Executive summary

This report seeks approval from Newham Board to extend the agreement under section 75 of the National Health Services Act 2006, between Newham Council and Newham NHS Clinical Commissioning Group, to govern the delivery of Better Care Fund Plan for Newham. This will be overseen by the Health and Wellbeing Board, with delegated authority to the Managing Director of NCCG to make executive decisions on behalf of NCCG and to the Executive Director of Strategic Commissioning to make decisions on behalf of the local authority.

Supporting papers .Appendix 1 – Section 75 extension – LBN Cabinet Report


Explain which single value and single aim the report best fits – delete others as appropriate. Values Working with our partners to improve health outcomes Aims Improving health outcomes through developing models of integrated care and focusing on prevention


The Report at Appendix – 1 has been presented to LBN Cabinet on 7th Dec 2017.

Risk xx

Equality impact Individual schemes and initiatives funded by the Better Care Fund will be subject to consultation and robust Equality Impact Assessments where required. This will ensure compliance with the Equality Act 2010 including the Public Sector Equality Duty at section 149.


Advise where consultation has taken place.


Section 8.1 of the report – Appendix 1

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Newham CCG Board meeting Part I, 18 February 2018 Committee rooms, 4th Floor Unex Tower

Title East London Health Care Partnership: Update

Agenda item 3.6

Author Alan Steward, BHR CCGs, System Transition and OD SRO

Presented by Jane Milligan, Single Accountable Officer, NHS Newham CCG


Alan Steward, BHR CCGs, System Transition and OD SRO. [email protected] 07500 559031


Action required The Board is asked to: 1. Note the report.

Executive summary

The report updates the NHS Newham CCG Board on the progress made by the East London Health and Social Care Partnership (ELHCP) to deliver the NEL Sustainability and Transformation Plan. It briefly sets out:

• the proposed changes to the governance arrangements to enhance theeffectiveness of ELHCP and ensure it can drive the changes required to improve services and health outcomes

• the latest summary of progress on the main transformation programmesdelivered through the ELHCP

• the work of the Clinical Senate• the bid for Local Health and Care Record Exemplars• the review of ELHCP organisational development• the main communication and engagement developments in the last quarter.

Supporting papers Appendix A – Transformation Delivery Report

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Values Working with our partners to improve health outcomes The proposals offer all CCGs of North East London a stronger focus for collaborative work and efficiencies of commissioning process that will both underpin the development of local integrated care systems and secure the delivery of priorities set out in the Five Year Forward View. Aims Ensuring equity of health and wellbeing outcomes By working through the ELHCP all parts of the system can develop a coherent and integrated approach to ensure improved services and outcomes and support the delivery of effective Integrated Care Systems. Strengthened collaborative arrangements at NEL enable greater resources to focus on local integrated health and social care.


N/a

Risk This report is aligned to Risks 3 and 4 on the Newham Board Assurance Framework. Risk 3 - Failure to implement the key programmes within the Sustainability and Transformation Plan and therefore failure to achieve the system control total Risk 4 - Failure to effectively integrate health and social care by progressing BHC and ACS.

Equality impact This document relates to all Newham residents in the 9 protected characteristics that are covered by the Equality Act 2010 and our Equality Duties. The ELHCP supports providers and commissioners working together to develop a set of agreed outcomes to improve the health and well-being of their population and in particular target those groups that have traditionally been disadvantaged. This supports directly the development of Integrated Care Systems and the opportunity to address many of the challenges that local people have consistently identified as key barriers to better services such as ‘hand offs’ between providers, ‘telling my story once’ and improving the complete patient journey. These have been consistent themes identified by successive engagement exercises. The devolvement of specialised commissioning will further strengthen the ability of commissioners to join up services and address more locally the key health challenges for our population. Any specific service changes will be subject to an equalities impact assessment.


Not applicable


There are no direct financial implications of the report.

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Report 1. The East London Health and Care Partnership (ELHCP) brings together the 12 local NHS

organisations (commissioners and providers) and eight local councils to improve health and careservices and outcomes. It takes the lead around the NEL Sustainability and Transformation Plan(STP). This report sets out:• the proposed changes to the governance arrangements to enhance the effectiveness of ELHCP

and ensure it can drive the changes required to improve services and health outcomes• the latest summary of progress on the main transformation programmes delivered through the

ELHCP• the work of the Clinical Senate• the bid for Local Health and Care Record Exemplars• the review of ELHCP organisational development• the main communication and engagement developments in the last quarter.

2. It is intended to provide an update on the ELHCP at each meeting of the CCG GB.

ELHCP Governance 3. The ELHCP has been operating for over 12 months bringing together commissioners, providers and

other partners including local councils and the voluntary and community sector. Over the last twoquarters (and emphasised in the new planning guidance issued by NHSE), it is timely to review theELHCP governance. This is driven by two elements: the focus on developing and acceleratingintegrated care partnerships (formerly accountable care systems) and the establishment of the NELCommissioning Alliance and the appointment of a Single Accountable Officer.

4. In January both the ELHCP Board and Executive agreed to:• strengthen the Partnership Executive so that it meets monthly and is composed of the Chief

Executives and other senior leaders from across NEL including all major providers, CCGs, primarycare, local councils and the Clinical Senate. The CCGs are represented on the Executive throughthe Single Accountable Officer and the NELCA Chair of Chairs (Dr Anwar Khan)

• change the Board to an NEL Assembly that meets every 3 months with a range of stakeholders.This will take a themed approach to each meeting with an overall focus on health and wellbeing,prevention and self-care. It will provide strategic advice to the Executive as it looks to deliver thekey ambitions and transformation set out in the STP.

5. Further work was requested to define more closely the links between the ELHCP Executive and thethree System Delivery Boards established to deliver the local integrated care partnerships and aroundthe relationship and reporting to regulators (assurance). Future ELHCP updates will ensure CCG GBsare updated on the progress being made.

6. The ELHCP has also started a review of the current NEL Sustainability and Transformation Plan. Thisis to take account of the updates to the Five Year Forward View, the latest Planning Guidance issuedby NHSE and the formation of the NEL Commissioning Alliance. This will set out the key decisions anddeliverables for 2018/19. An update will be provided to the next GB meeting on the outcomes of therefresh.

Delivery of the NEL Sustainability and Transformation Plan (STP) 7. The ELHCP drives the transformation programmes within the NEL Sustainability and Transformation

Plan. A monthly summary that sets out the progress, key delivery risks and any mitigating action isattached at Appendix A.

8. Key progress areas to note are:• Primary Care: A common provider development framework has now been established. The

framework has 5 key elements that help move the federations in the 7 CCG areas along theirdevelopment journey, developing clear system plans to ensure each is moving towards ouraspirations and goals

• UEC: The IUC 111 and Clinical Assessment Service (CAS) has now been awarded to LAS. TheCAS service will enable patients to receive fast efficient clinical advice, with improved onwardreferral pathways, reducing the number of steps in key pathways into pharmacy, primary care,UTC, social care and mental health

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• Cancer: Focus on achieving and maintaining cancer waiting time targets. Preliminary figures on12 January 2018, show that the system will remain above trajectory for those treated in December.Focus of the NEL 62 day group remains on delivery, achieved through working with providers inNEL and NCL such as UCLH, sharing learning across the system and carrying out root causeanalysis (RCA) to prevent re-occurrence of problems and with the support of the regional cancerdelivery board

• Mental Health: ELHCP Mental Health workstream's Delivery Group 2 'Improving Access andQuality' has prioritised IAPT service transformation across East London to ensure all CCGs canimprove and maintain their services and support delivery of IAPT access standards.

Clinical Senate 9. The Clinical Senate is developing its 2018/19 priorities and it is currently focusing on 4 areas:

• at the January meeting it was agreed to prioritise a systematic NEL approach to Outpatientstransformation and a delivery plan will be presented to the April JCC outlining the Senate’srecommendations for implementation. This priority was supported by the ELHCP Executive andBoard.

• the February meeting reached agreement on the clinical model for mental health support toprimary care and agreed that a local mental health network be established to develop the deliveryplan

• a survey is being undertaken of views on the Senate’s role and its operating model and this will bediscussed in March with recommendations to come to the ELHCP Executive for agreement.

• the forward business plan for the senate is under development and should be available by March.This will focus on those areas which the Senate wants to prioritise this year and the frame for theirwork and also those STP programme areas where there is a need for debate about the clinicalmodel.

Digital: Local Health and Care Record Exemplars 10. NHS England (NHSE) is about to launch a call for proposals for up to five Local Health and Care

Record Exemplars (LHCREs) programmes that can ‘raise the bar’ in how the NHS, and its partners,share data to help deliver better care for our citizens. Each exemplar will be granted £7.5m availablefrom 18/19 to 19/20 for each locality – matched with local investment and resource to implement androll out their exemplar programme. Up to 5 of these will be awarded nationally. The LHCREs will showhow data can be shared appropriately, and for what purposes, across venues of care within localities atscale and adhering to secure, robust and transparent information governance frameworks. They willdemonstrate practical approaches to continuous patient, professional and public engagement andshow how appropriate and compliant data sharing directly improves the quality and efficiency of carewhile reducing health care inequalities.

11. North east London is further ahead with this work compared to other areas across the country, withsignificant and ongoing work on the eLPR (east London Patient Record) and Discovery/PopulationHealth programmes. Following discussion with NHSE, it is now confirmed that north east London(ELHCP Informatics Group) will lead on the development of this pan London proposal in collaborationwith the full London system. Active discussions are underway with the five London STPs to seeksupport for and frame the bid. It is anticipated that the NHSE call will be launched towards the end ofFebruary 2018 with a six-week timeline for submission and a decision on the successful LHCRE bidsby the end of April 2018.

12. The ELHCP Board supported both a NEL bid and that NEL is leading the bid for London. IndividualCCGs are being engaged and the programme is being discussed in more detail at the next NELInformatics Steering Group on 6 March 2018.

Organisational Development 13. Alongside the refresh of the Sustainability and Transformation Plan, a review of the ELHCP

organisational development strategy and plan is underway. It will build on the early successes of theprogramme in securing support from Staff College to support medicines optimisation, end of life careand diabetes work and with the Dartmouth Institute to support Integrated Care Partnerships. This willbe integrated into the enabler workstream around workforce and seek to link together theorganisational development needed to deliver the STP priorities in 18/19 and beyond.

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Communication and Engagement 14. The ELHCP undertakes communication and engagement across NEL on some areas of the STP. In

the last quarter, the Partnership’s external website www.eastlondonhcp.nhs.uk has been rebuilt with animproved structure to bring it in line with industry standards. One of the site’s new features is a sectiondevoted to health and care workforce recruitment and retention. This is work in progress but a previewis available at http://elhcpcareers.speedwaystaging.co.uk/.

15. There is a significant focus on improving recruitment and retention as one of the key enablers for theSTP. The maternity transformation workstream is running a campaign to attract more midwives –Careers are born in east London - that is being launched at the end of February. There is also supportto the primary care quality improvement programme to promote the significant improvements in primarycare since the launch of the programme and there is a stakeholder event for the digital workstream on21 February, focusing on shared patient records and telehealth.

16. Finally, a report on the successful ELHCP Health and Housing Conference last October has now beenpublished on the Partnership website. The key findings will be taken into account in the refresh of theSTP.

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http://www.eastlondonhcp.nhs.uk/

http://elhcpcareers.speedwaystaging.co.uk/

Transformation Highlight Report

North East London STP January 2018

Mehreen Arshad

NCEL STP Aligned Lead

NHS England Newham

Barking and Dagenham

Havering

Redbridge

Tower Hamlets

City & Hackney

Appendix A

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The one accountable officer appointment by the seven CCG governing bodies has been completed, System winter resilience is underway in primary, community and secondary care; including the appointment of directors for winter, General Practice resilience planning and AEDB winter monitoring. Accountable Care Systems – development of the sub-systems and their relationship with North East London Commissioning Board to improve provider and commissioner relationships in system delivery NEL Joint Commissioning Committee agreed – go live April 2018

STP Headlines

Progress against national priority programmes

PRIMARY CARE

Established a provider development framework for at-scale primary care providers Clear action plans for developing increased workforce Developed NEL international GP recruitment bid

UEC

CANCER

MENTAL HEALTH

THEME Progress

Progressed against provider development frameworks for at-scale primary care providers

Meeting with CCGs and at-scale providers to ensure plans are in place for further improvements in preparation for 2018/19

Progress LAS mobilisation plan to meet Go Live date Roll out of 111 bookable appointments to GP Hubs TH and WF CCG Early adopter programme to book 111 appointments into NEL GP practices 111 MH Warm Transfer SOP to C&H/TH/WF being developed UTC Designation dates for other sites underway

Map screening uptake levels in NEL and conduct gap analysis on challenges within primary care in implementing cancer pathways

Increase % seen in week 1, aiming to reducing timelines towards day 28, in 2020 of informing of diagnosis and onward referral by day 38 where appropriate.

Baseline and bid for IPS schemes complete Development of comparative framework for IAPT services Engagement plan for review of psychosis pathways Learning and recommendations from Liverpool suicide prevention and others Improving access and quality, dementia, access standards and waiting times

Next Steps

Consistent CWT performance since compliance against the 62 day standard for Q3 Shared learning across system, all Root Cause Analysis to prevent recurrence of avoidable breaches Collaboration and pathway work across the NEL and NCL STP with particular reference to Prostate

IUC 111 and CAS awarded to London Ambulance Service with expected Go Live date Summer 2018 NHS Online commenced 18th January for BHR and WF CCG 111 Bookable appointments to GP Hubs in BHR operational 111 MH Warm Transfer SoP to MH BHR /WF services to be signed imminently UTC Designation sign off for Queens and KGH

Implemented governance framework for five workstreams: NEL wide suicide strategy; improving quality and access for IAPT – meeting future targets; demand and capacity: Develop effective psychosis pathway and review pathways for other conditions; Improve whole system outcomes - achieve physical health check targets; Commissioning and New Models of Care - align focus of commissioning and contracting to support new models of care

Risk / Issue Mitigation 1 Quality standards: There is a risk that with the focus being on financial or performance

delivery, the quality and clinical standards will not be central to planning and approval of transformation plans. This could impact on the quality and clinical impact on patients

NHSI providing input to support the system to control this risk. New operating model for CCGs and systems will support monitoring and managing risk (set up of quality surveillance group) to look at quality outcomes

2 Programme Outcomes: There is a risk that there is variation across all services clinical standards for primary and community services. This will impact on the quality outcomes for the various populations NEL services delivery

The Clinical Senate is currently informed by variation benchmarking presenting from work streams, Right Care and annual contracting information. The development of a NEL wide quality group will support the monitoring of risk of variation, approval process of business cases and escalating severe variation risk

3 Although contracts have been agreed with all providers, there is a risk of a financial gap opening up if the transformation, QIPP and CIP schemes do not deliver and some are high risk.

Operational Delivery Group to review high risk CIP and QIPP to identify work stream level mitigation plans. Plan to develop joint approach to the identification and implementation of CIP and QIPP

4 Due to limited funding for initiatives, there is a risk of prioritisation from other parts of the system, including the potential knock on effect from any reductions in Local Authority funding

Confirm through next stage of ELHCP design and Operating Framework

5 There is a risk that there is insufficient programme resource to deliver the ELHCP programmes Funding proposal developed and potential sharing of programme funding. Recruitment of central PMO roles, possibility of secondments. Review of programme structure underway

STP Risks / Issues

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Full year extrapolation forecasting at £260m deficit. At month 8 the reported full year forecast was £94.9m. Financial strategy: The ELHCP Payment Development Steering Group reviewed and summarised feedback on the Payment Reform consultation. The reform will help develop payment to support health and care objectives in NEL.

Engagement with stakeholder has helped identify perceptions of stakeholders, emerging principles, and areas that need further research. Next steps are to collaborate and shape upcoming discussions of the ELHCP working towards our aim of better serving our population.

Enabler Headlines

Risk / Issue Mitigation

1 Finance: There is a risk of £165.05m within the full year forecast position. This is particularly the case for Barts and BHRUT who are currently forecasting significant improvements in their positions in comparison to their YTD deficits. This £165m risk relates to significant back-loading of efficiency plans across both commissioner and provider plans.

The main contributors to the system deficit position are Barts Health and BHRUT. Both organisations are currently in discussions with regulators with a view to improving their forecast position.

2 Estates: The size of East London Health and Care Partnership/ NEL footprint means there is a risk that the capacity to manage the population growth is at stake. This will make it difficult to implement the necessary change programmes (particularly Whipps Cross proposals).

1. Development of estates strategy and function should be in place particularly for Whipps Cross 2. All organisations need to demonstrate adherence to the estates strategy 3. Securing funding to implement the strategy is essential for successful implementation4. An agreed Memorandum of Understanding should be circulated across all organisation with a NEL wide estates function.

Enabler Risks / Issues

Progress against Enabler Programmes

THEME Progress Next Steps

FINANCE

WORKFORCE

DIGITAL

ESTATE

Month 8 Contract Triangulation gap £31m and £41m forecast. Month 8 System gap excluding triangulation gap £147.3m and £173.3m including triangulation. Forecast full year deficit at month 8 excluding triangulation was £53.2m and £94.9m including triangulation.

Month 8 year to date forecast is £173.3m deficit. Refresh control total tool for month 8 Successful bids for maternity and CYP Transformation funding and National Mental Health winter funding

Well-established shared record system in INEL eLPR used in the Newham UCC to view GP records, and in the pilots that are underway to test new ways of

working in Outpatients Discovery programme receiving data from Homerton, Barts Health and the majority of GPs, combined to give a

single view of the patient record

Next Gateway requires London partners to complete a robust London Capital Plan by end of this FY, consolidation of STP Plans, working at a centralised capital total requirement for NEL and an agreed prioritisation matrix to be able to ranked different projects

Draft ELHCP Estates Strategy – to be signed off by the STP Executive committee Agreed Asset Management and Utilisation Strategy across ELHCP including void liability for the commissioners Progressing with the Back office consolidation strategy including all providers and commissioners – linked to

Productivity work stream

LWAB established and HEE resource provided New Role Development – including funding for MAs, PAs, NA System level interventions including a review to inform system level response and apprenticeships strategy GP International Recruitment Programme Primary care modelling and enabler programme implemented

Payment reform consultations responses review. Refresh control total tool for month 9 Develop financial model to evidence the potential additional staffing

requirements or not of implementing continuity of care model.

Expansion of the eLPR into BHR. BHRUT and Barking & Dagenham GPs have committed to connecting. Work underway with suppliers

Connection of eLPR to London Health and Care Information Exchange NELFT and LB Newham contributing data to eLPR City of London Corporation and LB Hackney connecting to eLPR

Finalise strategy and prioritisation list for London Plan Void management plan with action plan per building setting financial targets per

CCG for 17/18 Infrastructure Delivery Plan showing project interdependencies between systems

Require service location data from providers (Nov – Jan) Finalise asset database to allow for mapping (Jan – March) Estate Reconfiguration options explored

ELHCP wide development of apprenticeship plan Economic review of embedding the NA role across ELHCP

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Progress against STP local themes

AO and Commissioning

Landscape Arrangements

Operating model design in progress (proposal team of system leaders and corporate directors) Interim SMT posts established (MDs, Director of Strategic Commissioning) ELHCP Governance being amended to compliment and align System stakeholder session delivered in December 2017 Stocktake of CCG arrangements underway to identify opportunities for shared approaches and good practice

Development of ACSs

ACS plans have been developed on three footprints: BHR / WEL / C&H Governance structures developing over 18 months to support new vision, largely advisory however successful in

bringing partners together to explore new operating models Joint Commissioning arrangements and supporting governance have been established Contract payment mechanism under review following system consultation Detailed self assessment update was developed for STP SROs Workshop in January 2018

Contract Round

Barts and NELCA working to agree year end deal in 2 weeks and making progress on 2018/19 contract. Escalation for latter due this month.

BHRUT and NELCA agreeing scope of expert determination with a view to rapid conclusion via nationalregulators agreeing impact on 2018/19 as soon as possible. Intention is to minimise scope of national arbitration through engaging with Trust.

King George Hospital

Public statement with BHRUT/ELHCP and NHSI published Nov 17 and BHR Integrated Care Partnership Board updated on December 2017

STP letter on congruence of KGH SOC and WX SOC and alignment with out of hospital strategy submitted to NHSI in January 2018

THEME Progress

Detailed governance (and CCG constitutional changes) Substantive Recruitment of MDs and other Executive posts underway Formal JCC members in recruitment (Lay members and others) System stakeholder session planned for March 2018 to review and launch OD plan in delivery Jan – Mar (JCC and Executive sessions) Stocktake outcomes Phase 1 – Jan / Feb, Phase 2 to consider opportunities

Assessing London Devolution implications Developing NEL ACS strategic framework Clinical strategy development Provider alliance development and response to commissioning test areas Next steps on the STP/commissioning agenda and the ACS programme

STP has systems in place to meet deadline of 28th February. All other contracts expected to be achieved except for some risk on ELFT CHS.

Public statement published NHSI preparing approvals report with a view to submission to NHSI Resources Committee in February 2018

Submission of approvals report to NHSI Resources Committee in February 2018

Next Steps

Winter

All tranches of winter funding now received i.e. acute, mental health, 111 and UEC totalling £6,270,257. Tracking of scheme implementation and impact across all tranches of received funding is in progress and reported to NHSE/I as appropriate

Heightened daily focus and priority is managing pressures relating to increasing circulating flu as measured by confirmed cases in ITU/HDU, in other beds and number of daily newly diagnosed cases

Focus on Christmas and New Year wash up ensuring clarity on refining high impact interventions in and out of hospital to support delivery against Q4 STF i.e. performance and streaming.

Communications and Engagement

Established online information and resource centre for Partnership organisations – The Briefing Room Rebuilt Partnership external website for ease of use Organised Health & Housing conference to identify actions in relation to the wider determinants on health Produced simpler narrative on transformation programmes to explain what we are doing and what it means Produced initial Live & Work in East London brochure to support workforce recruitment and retention

Recruitment and retention campaigns for maternity and workforce programmes Campaign to support quality improvement in primary care Developing stakeholder relations with east London voluntary sector, Healthwatch,

local colleges and universities Continuing to build relationships with local authorities and encouraging

involvement in transformation programmes

Support Requirements

Support Request Action Required

1 At present the approach to the distribution of transformation funding is fragmented and not always best targeted at local priorities.

A more locally tailored and targeted approach of transformation funding enabling STPs to have greater influence on the process, aligned with prioritisation in line with London Devolution.

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Newham CCG Board meeting Part I, Thursday 22 February 2018 Committee rooms, 4th floor Unex Tower

Title North East London Commissioning Arrangements

Agenda item 3.7

Author Alan Steward, BHR CCGs, System Transition and OD SRO

Presented by Dr Muhammad Naqvi, Deputy Chair, Newham CCG


Alan Steward, BHR CCGs, System Transition and OD SRO. [email protected] 07500 559031


Action required The Board are asked to: 1. Note the membership and leadership of the Joint Commissioning Committee2. Review and approve the Scheme of Reservation and Delegation for the Joint

Commissioning Committee3. Approve the proposed constitutional changes for consultation with member

practices.

Executive summary

The report asks the NHS Newham CCG Board to support proposals for new commissioning and governance arrangements across North East London. It builds on the updates provided at previous Board meetings. This paper:

• Advises the governing body of the membership and leadership of the shadowJoint Commissioning Committee.

• Sets out the proposed arrangements for establishing the JointCommissioning Committee including the Scheme of Reservation and Delegation

• Sets out the constitutional changes required by NEL CCGs to establish theJCC and ensure it operates effectively.

Supporting papers • Appendix A – JCC Chair of Chairs JD• Appendix B – Scheme of Reservation and Delegation• Appendix C – Addendum for Committees in Common• Appendix D – Addendum for Primary Care Committees

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Values Working with our partners to improve health outcomes The proposals offer the 7 CCGs of North East London a stronger focus for collaborative work and efficiencies of commissioning process that will both underpin the development of local accountable care systems and secure the delivery of priorities set out in the Five Year Forward View. Aims Ensuring equity of health and wellbeing outcomes By working together the 7 CCGs will be able to deliver efficiencies in commissioning and develop an aligned approach to working with local providers to ensure their long term sustainability and which will support the delivery of effective Integrated are Systems. Strengthened collaborative arrangements will enable access to greater commissioning resources and free up time to build on the progress already made locally on integrated health and social care.


This paper builds on the reports submitted to Board meetings since September 2017.

Risk The key BAF risk this report corresponds to is: BAF.02 – Failure to effectively meet the CCG’s financial targets and savings plans in 2017/18. BAF.03 – Failure to implement the key programmes within the Sustainability and Transformation Plan and therefore failure to achieve the system control total. Agreeing the recommendations of this report will assist the CCG to deliver on the above priorities and mitigate the risks by contributing to : • Supporting the development of an Integrated Care System in the borough throughestablishing a framework to facilitate provider trusts participation in the system and implementation of a reformed payment mechanism • Delivering financial sustainability against a backdrop of increasing demand. Theappointment of a Single AO (combined with the role of STP lead) is key to securing the transfer and application of transformation funds to North East London; • Securing the decentralisation of the commissioning of specialised services throughthe appointment of a Single AO and assisting the CCG to join up services and improve patient outcomes. • Programme risks were highlighted and discussed in the Board Developmentsession in November. The JCC will manage risk at NEL and ensure these are reflected in CCG Board Assurance Frameworks where necessary.

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Equality impact This document relates to all Newham residents in the 9 protected characteristics that are covered by the Equality Act 2010 and our Equality Duties. The proposals themselves will enable the development of Integrated Care Systems across North East London and will therefore potentially allow providers and commissioners to work together to develop a set of agreed outcomes to improve the health and well-being of their population and in particular target those groups that have traditionally been disadvantaged. As the Board has previously discussed the Integrated Care System provides the opportunity to address many of the challenges that our population have consistently identified as key barriers to better services such as ‘hand offs’ between providers, ‘telling my story once’ and improving the complete patient journey. These have been consistent themes identified by successive engagement exercises. The devolvement of specialised commissioning will further strengthen the ability of commissioners to join up services and address more locally the key health challenges for our population. Future specific service changes will be subject to an equalities impact assessment.


The specific proposals in the report have been discussed in Newham CCG Board Development sessions in November 2017. A report was also presented at the Inner North East London Joint Health Overview and Scrutiny Committee on 6 September 2017 and discussions have taken place with key local stakeholders including LBN, Newham Health Collaborative and other local providers within the emerging accountable care system. The new Single Accountable Officer has also undertaken engagement with key stakeholders since her appointment.


It is not possible to cost the proposed changes until further work is completed on the functions that will be delegated to a north east London level and any impact on the composition of local borough and shared teams. All CCG chairs and the Single Accountable Officer have committed that it is required that the proposed changes will cost no more than the current management costs. CCGs have previously agreed a financial risk sharing arrangement in order to ensure the achievement of overall financial performance for the 7CCGs.

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Introduction and Purpose

1. This report updates all North east London (NEL) CCG Governing Bodies on theestablishment of the new commissioning arrangements. It builds on the previousGoverning Body reports and discussions at Board Development sessions and theshadow meetings of the Joint Commissioning Committee. The paper recommends thatGBs agree formally to establish the Joint Commissioning Committee and move toconsult with member practices to amend CCG constitutions to allow these changes.

2. These new arrangements are vital to deliver North east London’s:• Strategic alignment with the NHS Five Year Forward View and in particular the

commitment to develop Accountable Care Systems (ACS)• Sustainability for the whole system including providers, commissioners and partners• Improvements in outcomes, quality and performance and reducing variation across

North east London.

North East London Commissioning Arrangements

Governance 3. The proposed new commissioning arrangements require robust North east London

governance. This is being driven through a wider group of CCG lay members andpartners. Through a number of engagement sessions the proposals have beendeveloped to provide the further detail needed to recommend the required NEL CCGgovernance and any changes. These are how the Joint Commissioning Committee willbe established and work with the seven CCG Governing Body’s and sets out howdecision making will happen. It is recognised that the future Integrated Care System willrequire integrated commissioning arrangements with Councils. The JointCommissioning Committee membership includes non-voting local authorityrepresentation. The membership of the JCC is set out below.

CCG Chair Lay Member LA Rep Barking & Dagenham

Kash Pandya (acting Chair until elections complete)

Kash Pandya Mark Tyson

Havering Dr Atul Aggarwal Richard Coleman Mark Ansell Redbridge Dr Anil Mehta Khalil Ali Adrian Loades City & Hackney Dr Clare Highton.

Mark Ricketts (new Chair from 1 April 2018)

Sue Evans Ellie Ward (City of London) Gareth Wall (Hackney)

Waltham Forest Dr Anwar Khan Alan Wells Linzi Roberts-Egan Newham Dr Prakash Chandra Andrea Lippett Grainne Siggins Tower Hamlets Dr Sam Everington Noah Curthoys Denise Radley

Recruitment of the Nurse and secondary care consultant will commence in March.

4. At the December GB meeting, the Terms of Reference of the Joint CommissioningCommittee were agreed to operate in shadow form through to March 2018. The JCChas met twice in shadow form. Firstly with all Chairs and Lay Members to focus on thekey elements where further clarity and develop a joint understanding of the role andresponsibilities so the JCC. The second meeting included the proposed CCG membersof the JCC (Chair and Lay Member) and included a session in shadow form to look atthe requirements needed to have an effective JCC before it goes live in April 2018. Thefinal terms of reference will be submitted to GBs in March to allow an April go-live. Thiswill reflect the lessons learned from the shadow sessions.

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Leadership of Joint Commissioning Committee 5. A part of establishing the NELCA Joint Commissioning Committee and under its

Shadow Terms of Reference agreed at all GB in December 2017, three leadershippositions were agreed. These are:1. Chair to be selected and elected by the CCG Chairs only2. Deputy-Chair to be selected by the Chair from the CCG chairs.3. Vice Chair must be a Lay Member to chair any meetings or undertake any other

duties where the Chair / Deputy has a COI or a perceived COI. The Vice Chair is tobe selected and elected by the Lay Members alone.

6. The CCG Chairs and Single Accountable Officer agreed the job description for the Chairof the JCC and this is attached at Appendix A.

7. Nominations were invited from the shadow JCC members with provision to run a ballotshould there be more than one nomination for each position. Only one nomination wasreceived for the Chair and Vice-Chair and subject to ratification at the JCC’s first formalmeeting, these will be agreed. The Chair will be Dr Anwar Khan and the Vice Chair willbe Kash Pandya. Dr Khan has selected Dr Prakash Chandra to be his deputy throughto the end of his term as a CCG Chair (June 18). From July 18, he has selected Dr AnilMehta to be his deputy.

Constitutional Changes 8. To establish the new joint commissioning arrangements requires changes to some CCG

constitutions. The changes required to each CCG constitution to enable the JointCommissioning Committee and the Single Accountable Officer to operate within theframework agreed by the seven CCGs are set out below. The proposed changes reflectthe advice given by each Governing Body when making the original decision to increasecollaborative working in 2017 plus the advice received from the solicitors Capsticks andBeachcroft.

9. CCG GBs will then need to consult with member practices to approve the changes. Inso doing the previous legal advice provided by legal representatives has been taken intoaccount. As this will require constitutional changes we have also taken the opportunityto reflect the latest Conflict of Interest guidance and update the Primary CareCommissioning Committee’s terms of reference where relevant as this does not apply toall CCGs. There will also be a proposed terms of reference for Committees in Common.This is a matter of good governance to ensure that there is a common understanding ofhow Committees in Common will function in North East London. The section will alsodeal with voting and with the process to elect a Chair.

10. Scheme of Reservation and Delegation (App B) sets out the services and functions thatthe NEL CCG Governing Bodies wish to delegate to the newly established JointCommissioning Committee. These align to the outline scheme of delegation proposedin the September 2017 Governing Body report.

Single Accountable Officer / Managing Director 11. The existing Constitutions allow the CCG to share staff with other CCGs for delivering

commissioning functions in the section “Joint commissioning arrangements with otherClinical Commissioning Groups”. These clauses do not extend to allow the jointappointment of a single Accountable Officer for the seven CCGs as membership of theGoverning Body and responsibility of non-commissioning functions are outside theirremit.

12. The ability of the single Accountable Officer to attend all the meetings of the sevenmember Councils, Governing Bodies and their committees will be challenging. It is

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inevitable that a number of management techniques will need to be used to allow the normal operating of the governance functions for the CCGs. In most cases careful integrated planning between the Governing Body secretaries will be sufficient and easily undertaken within the existing Constitution powers. There are however three techniques that require amendments to the Constitution: • Deputisation for Joint Appointments• Joint Commissioning Committee• Committees in Common

13. It is expected that the management of the CCGs functions will be split between thosethat could benefit from an economy of scale and therefore be handled at a NEL CCGlevel, whereas other functions remain best managed by a local CCG team. Seniormanagers would be required to lead both the NEL teams and the local teams. TheManaging Director from each of the CCGs would be nominated as a deputy for theAccountable Officer and provide the necessary cover at a Governing Body / Committeemeeting. There are a number of advantages of having a named deputy in each CCG,rather than appointing an additional local senior CCG manager to the Governing Body.These advantages are:• The existing balance of clinical/non-clinical membership remains unchanged.• The Accountable Officer continues to retain the accountability and consistency of the

input to decision-making from the staff.• It is considerably easier to maintain the quorum for governing body / committee

meetings.

14. As a result of the newly created Managing Director post, the CCG constitutions will beamended to reflect the respective responsibilities of the Accountable Officer andManaging Director including financial thresholds. It is proposed to move to a standardform across NEL that sets out the responsibilities at each level.

Joint Commissioning Committee 15. The NEL CCGS have agreed to set up a Joint Commissioning Committee (JCC) to

enable collaborative commissioning for the whole of North East London.

16. The CCG Constitution template has a section titled: “Joint commissioning arrangementswith other Clinical Commissioning Groups”. This is present in all NEL CCGconstitutions. The provisions of this section should be sufficient to enable each CCG toestablish a JCC and committees in common. However for some CCGs, it is necessaryto name them in the main body of the constitutions as a generic new committee clauseis absent. Since it is likely that the JCC will be making significant strategic decisions, itwould be good practice to add the JCC to the list of Governing Body committees in themain body of all NEL CCG Constitutions.

17. All seven CCG constitutions must specify how the governance of the JCC operates andwhat functions have been delegated to it. This information is recorded in the Constitutionappendices: “Scheme of Reservation and Delegation” and referenced in the JCC’s“Terms of Reference”.

18. The attachments for the Scheme of Reservation and Delegation (SORD), JointCommissioning Committee (App B), sets out the key function of the JointCommissioning Committee to provide assurance that there will be no duplication withCCG Boards. The SORD JCC will be reviewed towards the end of 2018/19 to ensurethat it reflects accurately the role of the Committee.

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Committees in Common 19. The Joint Commissioning Committee has a number of limitations and in order for the

Single Accountable Officer to work effectively across North East London, the Constitutions need to add a greater degree of collaborative flexibility. This can be achieved through the use of “Committees in Common” arrangement.

20. A “Committees in Common” arrangement is where the same committee from more thanone CCG meets at the same time, same place with the same agenda and makes thesame decisions.

21. The limitations of the Joint Commissioning Committee are:• Legally, it can only consider commissioning functions• To be quorate it must have all CCGs present. This makes it difficult to decide upon

matters that involve only six or fewer CCGs.• It is unable to include other CCGs in its decision making on an adhoc basis.

22. By contract the “Committees in Common” arrangement may:• Consider any function or use any power delegated by the Governing Body to the

specific committee that is meeting in common.• Set up an arrangement of any two or more CCG committees as required by the

matter to be decided upon;• Invite the same committees from non-NEL CCGs to join a “Committees in Common”

arrangement as required by the matter to be discussed.

23. Technically, there is no requirement for any change of an individual CCG Constitution toenable the use of the “Committees in Common” arrangement. In its purist form, each ofthe same committees hold their meeting at the same time in the same place with thesame agenda and each has its own set of minutes.

24. However there are some practical details that make the use of the purist form of“Committees in Common” impractical. These are:• A meeting is not effective if it has more than one chair person and especially if there

are seven chair persons.• A meeting is not effective if there is a very large number of members present.• A meeting is not effective if there are more than one sets of Terms of Reference.• A meeting is not effective if the Governing Body has a perception that there is a

majority vote that overrules its committee’s decision.

25. A solution to these shortfalls is to provide in the CCG Constitution enabling clauses.These give consent / encouragement to the CCG’s Committees to work collaborativelywith the same committee in other CCGs. It also provides an addendum to all CCGcommittee Terms of Reference setting out how the “Committees in Common” meetingwill be conducted.

26. The detailed recommendations for change to constitutions are set out below.

27. Recommendation 1: The following clause is added to the NEL CCG Constitutions at thesection listed below the text:

X.X Joint Appointments with other OrganisationsThe CCG may make joint appointments including joint appointments with otherCCGs. Any such joint appointments will be supported by a memorandum ofunderstanding between the organisations that are party to these joint appointments.

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Where a Joint Appointment is made, the appointee may choose a named deputy in each of the CCGs. The named deputy must be agreed by the chair of the Governing Body.

CCG Insertion Point Barking & Dagenham CCG:

After 7.9 (Deputy clause only)

City & Hackney CCG: After 7.4 (nb 7.14 covers is a different issue) Havering CCG: After 7.9 (Deputy clause only) Newham CCG: After 7.3 (Except first sentence.) Redbridge CCG: After 7.9 (Deputy clause only) Tower Hamlets CCG: After 6.5 Waltham Forest: After 7.9 (Deputy clause only)

28. Recommendation 2: The following line is added to the NEL CCG Constitutions, whereappropriate, at the section listed below the text:

Heading Number Current Joint Arrangements Sub- Heading No. Joint Commissioning Committee The Joint Commissioning Committee has been established to include the seven North East London CCGs. The committee will exercise such commissioning powers as are delegated to it by the Governing Body and set out in the Scheme of Reservation and Delegation approved by the Governing Body.

Any decision must be made unanimously (as described by the Committee Terms of Reference) with the other partner CCGs listed in the Terms of Reference.

CCG Insertion Point Barking & Dagenham CCG:

After 6.6.11.8 becomes 6.6.12

City & Hackney CCG: After 7.6.1 becomes 7.6A (or 7.7 with all future paragraphs increased by one)

Havering CCG: After 6.6.11.8 becomes 6.6.12 Newham CCG: After 6.7.11 becomes 6.8 Redbridge CCG: After 6.7.11.8 becomes 6.7.12 Tower Hamlets CCG: Replace whole of section 6.7.12 and replace 6.7.12 with

“Not Used” Waltham Forest: After 6.5.4d New Heading 6.5.4e

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29. Recommendation 3: The following line is added to the NEL CCG Constitutions “Schemeof Reservation and Delegation” at the section listed below the text using one of theformats:

Policy Area Decision Joint Commissioning Committee

COMMISSIONING & CONTRACTING FOR CLINICAL SERVICES

The committee will exercise such delegated powers as are transferred to it by the Governing Body and set out In the Terms of Reference approved by the Governing Body. Any decision must be made unanimously (as described by the Committee Terms of Reference) with the other partner CCGs listed in the Terms of Reference.

30. Recommendation 4: The JCC Terms of Reference with its Schedules and Annex areadded as an appendix to each of the NEL CCG Constitutions.

31. Recommendation 5: The following paragraph is added to the NEL CCG Constitutions,where appropriate, at the section listed below the text:• Committees in Common Arrangement

All Governing Body Committees may meet with similar committees of other CCGs,using the “Committees in Common” arrangement, where the committee chairconsiders there is a value of working collaboratively on one or more specificissues. When the Committee Chair chooses to meet using a “Committees inCommon” arrangement, the additional Terms of Reference for “Committees inCommon” will be applied to the usual Committee’s Terms of Reference.

32. Recommendation 6: The Terms of Reference Addendum for the use of a “Committeesin Common” meeting arrangement (Appendix B) is added as an appendix to each of theNEL CCG Constitutions.

33. Recommendation 7: The following clauses add the requirement for a Conflict of InterestGuardian to the Constitution

The CCG shall appoint a Conflict of Interest Guardian who will normally be the AuditCommittee Chair and whose responsibilities shall be to:a) Act as a conduit for GP practice staff, members of the public and healthcare

professionals who have any concerns with regards to conflicts of interest;b) Be a safe point of contact for employees or workers of the CCG to raise any

concerns in relation to this policy;c) Support the rigorous application of conflict of interest principles and policies;d) Provide independent advice and judgment where there is any doubt about how to

apply conflicts of interest policies and principles in an individual situation;e) Provide advice on minimising the risks of conflicts of interest.

34. Recommendation 8: To approve for recommendation to member practices the draftCCG constitution that sets out all the changes required.

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Next Steps

35. To ensure that the North east London commissioning arrangements are implementedformally from 1 April 2018, the following next steps are proposed.• CCG GBs undertake consultation with member practices to approve the

constiutional changes• JCC continues to meet in shadow form with lessons learnt being submitted to CCGs

in March for final proposals.• Recruitment commences on the vacant JCC positions of nurse and secondary care

consultant

Appendices Appendix A – JCC Chair of Chairs JD Appendix B – Scheme of Reservation and Delegation Appendix C – Addendum for Committees in Common Appendix D – Addendum for Primary Care Committees

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NEL Chair of Chairs of Joint Commissioning Committee Job Description

Job purpose

The Chair of Chairs will be responsible for leading the NEL Joint Commissioning Committee (JCC) and the collective commissioning arrangements in the ELHCP. This will involve providing strategic direction, leadership and influence, clinical engagement, financial management and service redesign and development. An overview of NEL clinical areas will be required to influence and deliver the NEL commissioning strategy initiatives with NEL CCG chairs and wider clinical leaders.

The Chair of Chairs must:

• Lead the NEL JCC to:• drive improvements in health outcomes and experience of care for local people and reduce

variation in quality and services in NEL• drive sustainability for NEL commissioners, providers and partners• align and deliver the NHS Five Year Forward View and develop accountable care systems• ensure that services commissioned by the NEL JCC align with those commissioned locally so that

a coherent clinical strategy is in place

• Engage with NEL CCG Chairs and other clinical leaders and organisations to deliver the priorities setout in the NEL Commissioning Plan and ensure effective CCG and clinical participation to acceleratethe improvements in health services.

• Ensure that NEL has appropriate arrangements in place to exercise its delegated functions effectively,efficiently and economically and in accordance with the principles of good governance.

• Enable NEL to develop further its commissioning capability and track record of delivery.

• Work collaboratively with counterpart clinical leadership roles across London to support the devolutionagenda

Job role

The Chair of Chairs of the NEL JCC will be NEL CCGs Clinical Leader and the role and responsibilities will include those as set out in Section X of NEL CCGs’ Memorandum of Understanding (MOU).

The Chair of Chairs’ roles and responsibilities will also include:-

• Leading the NEL JCC, ensuring it discharges its duties and responsibilities as set out in the NELCCGs’ MOU / Terms of Reference - in conjunction with the Single Accountable Officer and supportedby the Director of Strategic Commissioning

• Ensuring proper constitutional and governance arrangements are in place and support the SingleAccountable Officer in upholding these

• Work with the Vice Chair (Lay Member) to ensure any potential conflicts are managed

• Lead the building of the shared vision of the aims, values and culture of the NEL JCC taking account ofthe views of local people and stakeholders

• To act as ambassador and champion for NEL CCGs.

• Providing the support to foster the development of local accountable care systems, integratedcommissioning and provider collaboration

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• Engage actively with local people, clinicians and community representatives to shape NEL healthservices by promoting co-design and collaboration between clinicians, practitioners and local people.

• Act as convener and champion for NEL and the NEL JCC at local, regional and national meetings andevents including regional assurance meetings with regulators

• To lead the planning and delivery of opportunities to improve health outcomes across NEL by linking tothe NEL clinical senate and ensuring its plans are delivered

• To promote and champion with providers the delivery of high quality and cost effective services toimprove health outcomes and satisfaction with local health and social care services.

• To ensure transparency and personal accountability for all NEL JCC decisions including finance,quality and performance.

• To communicate effectively with constituent CCGs and wider stakeholders to deliver the NEL JCCcommissioning plan through co-design and collaboration.

• To role model the values and ambitions of the NEL JCC

• To lead the regular evaluation of the performance of the NEL JCC, its sub-committees and members

• To undertake the objective setting and appraisal with the SAO on behalf of all CCG chairs

• To ensure the effective flow of business between the NEL JCC and CCG Governing Bodies

• Establish the operating model for specialised and services commissioned by the NEL JCC.

Key Deliverables

• Chair 80% of NEL JCC formal meetings

• Prepare and deliver the Chair’s Annual Report on the NEL JCC business and achievements

• To manage the NEL JCC business effectively and to the highest standards of governance particularlyaround conflict of interest and confidentiality

• Provide leadership, advice and guidance to NEL JCC members

• Objective setting and appraisal for the SAO

• Work with the SAO to ensure the NEL JCC is effective and undertake set the objectives and undertakeappraisals of NEL JCC members

• Support and encourage NEL JCC members to monitor, scrutinise and challenge on the business of theNEL JCC

• To deliver its agreed strategic objectives, improved health outcomes; reduced health inequalities andimproved quality and patient experience

• Engagement with clinical and practitioner leaders to promote collaboration and joint working

• Close and effective working with the local authority leaders (political and executive) on jointcommissioning and the integration of services

• Foster and promote transparent accountability within NEL JCC member organisations, wider ELHCPmembers and NHSE

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• Promote the sustainable, effective and efficient use of resources to deliver the NEL commissioningstrategy

• Put a focus on local people at the heart of the NEL JCC and especially disadvantaged groups

This job description gives a general outline of the post and is not intended to be inflexible or a final list of duties. It may therefore be amended from time to time in consultation with the post holder.

Tenure The appointment would be for 2 years.

Remuneration The Chair of Chairs would be expected to undertake their duties within 1 session per week. This would be additional to any other duties they were required to carry out for their “home” CCG. Remuneration would be in line with their “home” CCG.

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Person Specification

Criteria Essential Desirable Education and knowledge

• Knowledge of NHS Governance systems,codes of practice etc.

• Knowledge of establishingcorporate structures andframeworks

Experience • Chairing complex professional meetings at asenior level and ability to chair in an efficientmanner

• Significant experience of working with boards• Experience in resolving transactional

conflicts to deliver both high quality servicesand the highest value for money forstakeholders

• Experience of working across agency andprofessional boundaries and collaborativeand partnership working

• Experience of chairing a similar board

• Experience of chairing jointcommittees

• Experience of working withprofessionals and membersof the public to improveservices and create value formoney for stakeholders

• Experience of managingstrategic change in a politicalcontext

Skills • Communication skills: interpersonalpresenting, media relations, maintaining apositive public and professional profile.

• Ability to influence key stakeholders anddecision makers in a multi-agency/partnerenvironment.

• Assertive, Clear thinking and able tonegotiate.

• Ability to generate and develop good workingrelations across partnership board memberorganisations at Board and seniormanagement levels.

• Problem solving skills: Ability to identifyissues and areas of risk and lead partners toeffective resolution and decision.

• Chairing skills: Ability to organise, co-ordinate and follow through on key decisions,manage competing or differing views andpositively challenge to achieve the desiredoutcome.

• Significant skills in negotiating to assist inmanaging and resolving conflict.

• Ability to recognise discrimination in its manyforms and promote Equal Opportunitiespolicies within the operation of the NEL JCC.

• Ability to ensure high standards ofconfidentiality in terms of individual casesand sensitive cross organisational matters.

• Enthusiasm, commitment and adetermination to carry forward a complexagenda.

• Ability to enthuse and gain the commitmentof others.

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Appendix B

Scheme of Reservation & Delegation (Functions related to NEL Commissioning arrangements)

This Scheme of Reservation & Delegation relates primarily to those functions considered as part of the North East London Commissioning arrangements and provides clarity on some of the other key issues to avoid any misunderstandings. It is not intended to be a comprehensive scheme relating to all CCG functions and responsibilities.

Delegation from Members Practice

CCG Board - Services

Functions Joint Commissioning

Committee - Services

Functions

• Children’s services(NHS and joint)

• Business cases andservice changerequests

• Needs assessmentand demand andcapacity planning

• Procurement• Contracting and

contractmanagement

• Joint work with LA• Setting outcomes for

providers• Outcome monitoring• Decommissioning

services• Consultation and

engagement – localpeople, members,local organisations(providers, councils,VCS)

• Specialisedcommissioning

• Business cases andservice changerequests

• Needs assessmentand demand andcapacity planning

• Contracting andcontractmanagement

• Joint work with LA• Setting outcomes for

providers• Outcome monitoring• Decommissioning

services• Consultation and

engagement – localpeople, members,local organisations(providers, councils,VCS) – done vialocal CCGarrangements

• Primary caredevelopment,contracting,prescribing

• LAS

• Termination ofPregnancy

• IUC

• Joint Commissioningwith LA – LearningDisability / CHC /prevention / elderly /BCF

• Maternity Planning

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Delegation from Members Practice

CCG Board - Services

Functions Joint Commissioning

Committee - Services

Functions

• Community Servicescontracting

• Mental health (acutebeds only)

• MH contracting –except inpatients

• NHSE assurance(except throughexception doneelsewhere eg A&E)

• AcuteCommissioning andcontracting (local)

• Approve ACSframework

• Borough workforcedelivery

• Integrated CareDevelopment

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2018/19 JOINT COMMISSIONING COMMITTEE – DETAILED SCHEME OF DELEGATION

The Scheme of Delegation 2018-19 sets out those functions that are to be delegated by the CCGs to the JCC and those that are reserved for individual CCGs. It is intended to be reviewed in March 2019 at which time other functions may be delegated.

As the experience of CCG Boards suggest there is unlikely to be many votes taken, in the unlikely event that there is, the Joint Commissioning Committee membership and voting system relies on all CCGs agreeing with a proposal for recommendations to be implemented.

It is also the case that the subsidiarity principle applies and that the Joint Commissioning Committee will be dealing with matters that apply to all or most of the CCGs. The functions identified below emanate from previous discussions with Chairs and are reflected in the terms of reference of the JCC. There are also a series of corporate functions such as financial, quality and performance that would be core activity for any key commissioning body.

Finally, it is the case that the scheme will need to be regularly reviewed to ensure that the JCC is considering issues that allow the Committee to fulfil its role. It is also a recognition that some issues will only become material once the Committee starts meeting formally.

The Joint Commissioning Committee will have the following role for services and budgets delivered across NEL CCGs.

With respect to the Sustainability and Transformation Plan (STP) • Operational responsibility for the work which needs to be undertaken to implement

the STP Strategy and Priorities from the commissioners perspective that impact on all seven CCGs and in so doing integrate into the STP process as the representative voice of NEL CCGs.

With respect to the commissioning of LAS, 111, and Specialised Services • Approve a common NEL wide Commissioning Strategy for these services• Approve needs assessment, demand management and capacity planning

assumptions• Approve a commissioning plan for each service• Approve arrangements for consultation and engagement with Patients, Providers,

Local Authorities and Members• Review and monitor recovery plans for pathways or contracts that are significantly

off track• Approve the decommissioning of delegated services• Approve the contracting approach with Providers and any contract management in

relation to those contracts• Approve financial contributions and incentive payments• Approve the business cases.

With respect to Maternity Services • Approve Maternity Services Capacity Planning for NEL

With respect to NHSE Assurance • Approve assurance process and approach with CCGs that feeds into the NHSE

assurance process.

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With respect to Infrastructure • Approve NEL Workforce strategy to support the commissioning and financial strategy

and monitor progress and implementation• Approve IT digital Strategy for NEL to support the commissioning and financial

strategy and monitor implementation• Approve Estates Strategy framework for NEL CCGs and monitor implementation of

the action plan

With respect to Financial Strategy • Approve JCC Financial Strategy and ensure alignment with the STP Financial

Strategy• Approve Provider Payment Mechanisms to replace Payment by Results• Approve revised payment mechanism strategy for acute services• To adopt risk sharing agreements for CCGs that take into account the services

commissioned locally and their effectiveness• Approve core financial processes, timetable and plans including operating financial

plans, CCG and STP Financial strategies and agreements, budget setting and riskassessment.

• Monitor and oversee programme, administrative, collaborative (STP/TST etc.) andcapital budgets and financial performance.

• Review business cases and proposed procurement financial components for serviceswithin the remit of the JCC to ensure appropriate identification and management offinancial risk (including QIPP schemes, Transformation schemes, investmentproposals and funding bids).

• Identify and recommend allocation or reallocation of resources where appropriate forservices within the remit of the JCC to improve performance or ad hoc performanceand financial issues that may arise.

• Review reporting arrangements to ensure these remain fit for purpose andappropriate to meet the JCC accountabilities and assurance in collaborativearrangements.

With respect to Quality and Performance • Continuous improvement in the quality of services commissioned on behalf of the

CCGs through the development of a common quality assurance and reportingframework and quality improvement strategy

For consideration in 2019/20

There are a number of other possible areas that could be included in the scheme of delegation but should be considered as part of the review for 2019/20. In particular: • Approve a Provider Commissioning Framework to align Acute Services across NEL• Approve an Alignment Framework for the development of Out of Hospital and

Primary Care at Scale• Approve needs assessment, demand and capacity planning, provider outcomes

and outcome monitoring for these strategies• Agree the contracting approach to acute and mental health providers• New and revised clinical pathways for services that impact upon all or most of the

CCGs

It should be noted that local acute responsibilities will continue to stay with CCGs.

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Appendix C

XXX CCG(Add name of CCG) Terms of Reference

Addendum for Committees in Common arrangement

Introduction 1. This Terms of Reference Addendum is to be added to the CCG’s Committee Terms of Reference,

when the Committee wishes to meet with other similar committees from other CCGs using the “Committee in Common” (CIC) meeting arrangement. The terms in this paper should be read in conjunction with the main Terms of Reference of the Committee wishing to use them.

2. The CCG has a number of established Governing Body Committees. The NEL CCG Governing Bodieshave instructed that their Committees may meet using a CIC arrangement where the business iscommon to two or more CCGs. These additional Terms of Reference set out the specialmembership, remit, responsibilities and reporting arrangements of a meeting using the CICarrangement and are incorporated into each Clinical Commissioning Group’s Constitution.

Purpose 3. The purpose of the Committee wishing to use the CIC meeting arrangement remains unchanged

from its Terms of Reference and the Scheme of Reservation and Delegation.

4. The CiC may consider any matter that is of interest to two or more CCGs.

5. The CiC has the same authority, as its constituent committees, to commission any reports or surveysit deems necessary to help fulfil its obligations.

Membership 6. The CiC membership is made up of:

• The participating CCG Committees (Voting)

Meetings 7. The CiC will adopt the Newham CCG Standing Orders relating to the conduct of meetings, agendas

and declaration of interest with the exception of the clauses in this addendum.

Meeting Chair 8. The CiC membership will appoint a CCG lay member to be the chair.

Frequency 9. The Committee Chairs will agree an annual schedule of meetings with the CiC meeting secretary.

The programme will be circulated to all CiC members.

Quoracy 10. Quorum for each of the participating committees will be the current quorum specified for each CCG

within their current terms of reference.

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Decision making 11. A decision made at a CIC meeting shall be binding on the constituent CCGs when the following

criteria have been met: • The decision is within the bounds of the CIC delegated functions;• Each CCG Committee has one vote;• A decision has been unanimously agreed.

Voting 12. Voting will be by consensus with the outcome clearly recorded in the minutes of each Committee.

13. Should the participating Committees have a differing view and decision, a vote will be taken witheach CCG Committee having one vote. A record will be made in the minutes and the item deferredto the following meeting with advice sought from the participating CCG Chairs.

14. Should consensus still not be achieved at the next meeting, the decision made will represent that ofeach of the individual Committees. A record of the decisions will be added to the minutes and anotification made to each of the CCG Governing Bodies. For clarity, in this scenario the differentdecisions of each of the committees are not binding on the other participating CCG GoverningBodies.

In Attendance 15. The CiC Convenor will agree with the Committee Chairs the attendance of other individuals required

to enable effective decision-making.

16. Where individuals attend a CiC meeting, this will be noted as “in-attendance” in the minutes.

Conflicts of Interest 17. For clarity - The Conflicts of Interest policies of Newham CCG apply to the working of the CiC.

Reporting arrangements 18. The minutes of the CiC will consist of a set of identical minutes for each of the participating CCGs.

19. The minutes of each Committee will be reported to each of the participating Governing Bodies forinformation when agreed as accurate by the CiC. The individual CCG reporting arrangements to theGoverning Body is set out in their Constitution.

20. The CiC will present an Annual Report to each Governing Body on the actions taken by the CiC tocomply with its Terms of Reference.

Administration 21. Support for the CiC will be arranged by the Accountable Officer.

Review of Terms of Reference Addendum 22. The Committee will review this Terms of Reference Addendum annually at one of its meetings.

Changes in the Terms of Reference Addendum need to be approved by each Governing Body and reflected in each CCG’s Constitution.

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Appendix D

XXX CCG(Add name of CCG) Primary Care Commissioning Committee

Terms of Reference

1. Introduction1.1. In accordance with its statutory powers under section 13Z of the National Health Service Act

2006, NHS England has delegated the exercise of the functions specified in Schedule 2 of the Delegation Agreements to these Terms of Reference to xxx CCG.

1.2. The CCG has established the Xxx CCG Primary Care Commissioning Committee (“Committee”). The Committee will function as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers.

1.3. The ongoing relationship the Primary Care Commissioning Committee will have with NHS England will be revised on an ongoing basis, though this will be outlined in Schedule 4 of the Delegation Agreement.

1.4. It is a committee comprising representatives of the following organisations: • xxx CCG• NHS England• LB xxx• Local Medical Committee (LMC)• Healthwatch

2. Statutory Framework2.1. NHS England has delegated to the CCG authority to exercise the primary care commissioning

functions set out in Schedule 2 of the Delegation Agreements in accordance with section 13Z of the NHS Act.

2.2. Arrangements made under section 13Z may be on such terms and conditions (including terms as to payment) as may be agreed between the NHS England Board and the CCG.

2.3. Arrangements made under section 13Z do not affect the liability of NHS England for the exercise of any of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including:

a) Management of conflicts of interest (section 14O);

b) Duty to promote the NHS Constitution (section 14P);

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c) Duty to exercise its functions effectively, efficiently and economically (section 14Q);

d) Duty as to improvement in quality of services (section 14R);

e) Duty in relation to quality of primary medical services (section 14S);

f) Duties as to reducing inequalities (section 14T);

g) Duty to promote the involvement of each patient (section 14U);

h) Duty as to patient choice (section 14V);

i) Duty as to promoting integration (section 14Z1);

j) Public involvement and consultation (section 14Z2).

2.4. The CCG will also need to specifically, in respect of the delegated functions from NHS England, exercise those set out below: • Duty to have regard to impact on services in certain areas (section 13O);• Duty as respects variation in provision of health services (section 13P).

2.5. The Committee is established as a Committee of the Xxx CCG Governing Body in accordance with Schedule 1A of the “NHS Act”.

2.6. The members acknowledge that the Committee is subject to any directions made by NHS England or by the Secretary of State.

3. Role of the Committee3.1. The Committee has been established in accordance with the above statutory provisions to

enable the members to make collective decisions on the review, planning and procurement of primary care services in Xxx, under delegated authority from NHS England.

3.2. In performing its role the Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England and Xxx CCG, which will sit alongside the Delegation Agreement and terms of reference.

3.3. The functions of the Committee are undertaken in the context of a desire to promote increased co-commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers.

3.4. The role of the Committee shall be to carry out the functions relating to the commissioning of primary care services under section 83 of the NHS Act.

3.5. This includes the following: • GMS, PMS and APMS contracts (including the design of PMS and APMS contracts,

monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract);

• Newly designed enhanced services (“Local Enhanced Services” and “Directed EnhancedServices”);

• Design of local incentive schemes as an alternative to the Quality Outcomes Framework(QOF);

• Decision making on whether to establish new GP practices in an area;• Approving practice mergers; and• Making decisions on ‘discretionary’ payment (e.g., returner/retainer schemes).

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3.6. The Committee will also carry out the following activities: a) To plan, including needs assessment, primary care services in Xxx;b) To undertake reviews of primary care services in Xxx;c) To co-ordinate a common approach to the commissioning of primary care services

generally;d) To manage the budget for commissioning of primary care services in Xxx.

3.7. The Committee is accountable for exercising the agreed delegated functions from NHS England; these functions operate at practice level and not at individual Primary Care Contractor level.

4. Geographical Coverage4.1. The Committee will comprise of decisions relating to Primary Care in Xxx.

5. Membership5.1. The Committee shall consist of:

• Chair – Lay Member• Lay member (Vice Chair)• Associate Lay Members X2• Chief Accountable Officer• CCG Chair• Director of Primary Care Development• CCG Chief Finance Officer• Secondary Care consultant• General Practitioner (not within North East London)• Director of Commissioning & Planning (or equivalent)• Director of Quality & Performance (or equivalent)

Non Voting Members

• GP Locality Clinical Leads x3 Representatives• NHS England (London Regional Team) Representative• HealthWatch Representative• LMC Representative• Health & Wellbeing Board Representative

5.2. The Chair of the Committee shall be a CCG Lay Member and will be appointed at the first meeting of the Committee.

5.3. The Vice Chair of the Committee shall be a CCG Lay Member and will be appointed at the first meeting of the Committee.

5.4. The Committee may invite ad-hoc members to advise it on specific matters within its Terms of Reference from time to time as appropriate.

5.5. There will be an annual review of the Committee’s Membership and Terms of Reference to support it efficient functioning.

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6. Conflicts of Interest6.1. Conflicts of Interests will be managed in accordance with the CCG‘s current policy; ‘Standards

of Business Conduct and Managing Conflicts of Interest Policy’.

6.2. Any conflicted Members may be required to leave the meeting for the relevant discussions, as appropriate under direction by the Chair.

7. Meetings and Voting7.1. The Committee will operate in accordance with the CCG’s Standing Orders. The Business

Manager for Xxx CCG will be responsible for giving notice of meetings. This will be accompanied by an agenda and supporting papers and sent to each member representative no later than 5 working days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify.

7.2. Each member of the Committee shall have one vote. The Committee shall reach decisions by a simple majority of members present, but with the Chair having a second and deciding vote, if necessary. However, the aim of the Committee will be to achieve consensus by decision-making wherever possible.

7.3. The Chair shall determine if any conflicted member should leave the discussion or be excluded from the decision making process.

8. Quorum8.1. The Committee will be quorate with 7 out of the 12 voting Members in attendance, with at

least one Lay Member Present who is not the Chair (but can include Associate Lay Members), and the Chief Accountable Officer or Chief Finance Officer in attendance.

9. Frequency of meetings9.1. The Committee shall meet at least quarterly in public with the inclusion of ad hoc seminars

held in private for developmental purposes.

10. Meetings of the Committee10.1. Meetings of the Committee shall:

a) be held in public, subject to the application of 31(b);

10.2. the Committee may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.

10.3. Members of the Committee have a collective responsibility for the operation of the Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view.

10.4. The Committee may delegate tasks to such individuals, sub-committees or individual members as it shall see fit, provided that any such delegations are consistent with the parties’ relevant governance arrangements, are recorded in a scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest..

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10.5. The Committee may call additional experts to attend meetings on an ad hoc basis to inform discussions.

10.6. Members of the Committee shall respect confidentiality requirements as set out in the CCG’s Constitution.

10.7. The Committee will present its minutes to the London Area Team of NHS England and the governing body of Xxx CCG for information, including the minutes of any sub-committees to which responsibilities are delegated under paragraph 34 above.

10.8. The CCG will also comply with any reporting requirements set out in its Constitution.

11. Decisions11.1. The Committee will make decisions within the bounds of its remit.

11.2. The decisions of the Committee shall be binding on NHS England and Xxx CCG.

11.3. The Committee will produce an executive summary report which will be presented to theLondon Area Team of NHS England and the governing body of Xxx of the CCG.

12. Reporting12.1. The Committee will report to the CCG Governing Body on the decisions made within the

bounds of its remit.

13. Immediate and urgent decisions13.1. There may be instances when the Committee is required to make a decision in advance of

the regular full committee meetings in light of unforeseen circumstances. Depending on the urgency of the matter such decisions may need to be immediate (i.e. to be made in 24 hours) or urgent (i.e. to be made in timeframes longer than 24 hours but in advance of the next scheduled meeting).

13.2. The Director of Primary Care Development will decide when an immediate or urgent decision is required and will initiate the decision making process.

13.3. In the instances where an immediate decision is needed the Director of Primary Care Development will arrange a meeting with the Chair or Vice Chair (if Chair is not available) and the CCG Accountable Officer to take the decision. Such decisions will only be taken in exceptional circumstances, such as the need to close a practice due to clinical reasons or contractor death. Any immediate decisions taken under this procedure will be presented at the next Committee meeting.

13.4. In the instances when the Director of Primary Care Development deems it necessary to request an urgent decision the Chair will be contacted. The Chair or Vice Chair (if Chair not available) may deem it necessary to call a meeting at short notice outside the regular full committee meetings as set out in paragraph 27 above.

14. Review14.1. It is envisaged that these Terms of Reference will be reviewed bi-annually in Year 1 and then

annually thereafter, reflecting experience of the Committee in fulfilling its functions. NHS England may also issue revised model terms of reference from time to time.

15. Primary Care Commissioning Committees in Common15.1. The Primary Care Commissioning may meet as a “Committees in Common” with other CCGs

using additional terms as set out in the addendum.

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Newham CCG Board meeting Thursday 22 February 2018 Committee rooms, Unex Tower

Title Gifts, hospitality and anti-fraud and bribery policy - update

Agenda item 3.8

Author Satbinder Sanghera, Director of Partnerships and Governance, NCCG

Presented by Satbinder Sanghera, Director of Partnerships and Governance, NCCG


Satbinder Sanghera, Director of Partnerships and Governance, NCCG [email protected]


Action required The Board are asked to approve the changes made to NCCG’s Gifts, hospitality and anti – fraud and bribery policy in line with the revised NHS England guidance.

Executive summary

The report asks Board to consider proposed changes to NCCG’s Gifts, hospitality and anti-fraud and bribery policy to take account of the updated NHS England national guidance.

Changes include: • gifts from suppliers or contractors of low value (up to £6) can now be accepted

and not declared • thresholds for gifts from other sources have been amended:

o can now accept gifts of under £50 in value (increased from £10) fromnon-suppliers and non-contractors and do not need to be declared

o gifts over £50 in value can be accepted on behalf of an organisation,but not in a personal capacity

• hospitality thresholds have been amended:o under £25 does not need to be declaredo between £25 and £75 can now be accepted and must be declaredo over £75 should be refused, unless senior approval is given and a clear

reason given.

Supporting papers Managing conflicts of interest: revised statutory guidance for CCGs 2017: https://www.england.nhs.uk/wp-content/uploads/2017/06/revised-ccg-coi-guidance-jul-17.pdf

Appendix A – NCCG revised Gifts, hospitality and anti – fraud and bribery Policy

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https://www.england.nhs.uk/wp-content/uploads/2017/06/revised-ccg-coi-guidance-jul-17.pdf

https://www.england.nhs.uk/wp-content/uploads/2017/06/revised-ccg-coi-guidance-jul-17.pdf


Values Transparency with our decision-making and leadership Accountability and responsibility

Aims Reducing inequalities and improving accessibility


No previous presentation to any meeting.

Risk Links to BAF.01 Failure to meet NHS Constitutional standards.

Equality impact The Policy applies to all those involved in decision making within the CCG including Board Members, Clinical Leads, Cluster Leads, GP Members, Executive and all members of staff, and is intended to protect patients, taxpayers and staff covering health services in which there is a direct state interest.

This document relates to all Newham residents in the 9 protected characteristics that are covered by the Equality Act 2010 and our Equality Duties.


None.


None.

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Gifts, hospitality and anti – fraud and bribery Policy

V0.5 (February 2018)

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Appendix A

Contents 1 Purpose and scope ................................................................................................................ 3

2 Responsibilities ..................................................................................................................... 3

3 Definitions .............................................................................................................................. 5

3.1 Gifts ................................................................................................................................. 5

3.2 Hospitality ....................................................................................................................... 6

3.3 Sponsored events ........................................................................................................... 7

4 Guiding documentation ......................................................................................................... 7

4.1 The Bribery Act 2010 ........................................................................................................... 7

4.2 Pharmaceutical Companies ................................................................................................ 7

5 Policy ...................................................................................................................................... 8

5.1 Introduction ..................................................................................................................... 8

5.2 Policy statement .................................................................................................................. 8

5.3 Guide to Gifts and Hospitality – Refusal and Acceptance ........................................... 9

5.4 Gifts from patients / members of the public ............................................................... 10

5.5 Gifts from Office holders or work colleagues. ............................................................ 10

5.6 Guide to other Hospitality/Offers of Hospitality - Refusal and Acceptance .............. 10

6 Gifts and Hospitality Register ............................................................................................. 11

7 Penalties ............................................................................................................................... 12

8 Fraud and Corruption .......................................................................................................... 12

9 Bribery Act ........................................................................................................................... 13

9.1 What is the Bribery Act? .............................................................................................. 13

9.2 When did it come into force? ....................................................................................... 13

9.3 Why is it relevant to NHS organisations, professionals and staff? ........................... 13

9.4 Why is it relevant to the NHS Protect? ........................................................................ 13

9.5 What is bribery? ............................................................................................................ 13

9.7 Who can be prosecuted under the Bribery Act? ........................................................ 14

9.8 Who will investigate and prosecute these new offences? ......................................... 14

9.9 What penalties can be imposed? ................................................................................. 14

9.10 What can NHS organisations do to comply? .............................................................. 14

9.11 What is meant by ‘adequate procedures’? ................................................................. 15

9.12 Is there any guidance on what constitutes adequate procedures? .......................... 15

9.13 What should I do if I suspect bribery is occurring? ................................................... 15

Appendix 1: The Nolan Principles ............................................................................................. 16

..................................................................................................................................................... 17

Appendix 2: Register of Gifts and Hospitality Declaration Form ............................................. 17

..................................................................................................................................................... 17

Appendix 3: Scenarios and case studies………………………………………………………….....18

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Introduction

Managing conflicts of interest appropriately is essential for protecting the integrity of NHS Newham Clinical Commissioning Group from perceptions of wrong doing or impropriety including all groups relating to commissioning, contracting and procurement processes and where decision making is required by those members’. The CCG must meet the highest level of transparency to demonstrate that conflicts of interest are managed in a way that does not undermine the probity and accountability of the CCG.

This policy sets out the approach that the CCG will implement to identify, manage and record any potential or actual conflicts of interests that may arise as part of the commissioning of healthcare for Newham CCG. This policy is issued in accordance with statutory guidance under Sections 14O and 14Z8 of the National Health Service Act 2006 (as amended by the Health and Social care Act 2012). The act sets out clear requirements for CCGs to make arrangements for managing actual and potential conflicts of interests, to ensure they do not affect, or appear to affect, the integrity of the CCGs decision making processes. These requirements are supplemented by procurement-specific requirements in the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013. This policy has been drafted with consideration given to the NHS England Guidance on Co-Commissioning, released in December 2014. The revised statutory guidance for CCGs updated in June 2017 has been incorporated.

This policy should be read in conjunction with the CCG’s Constitution, the CCG’s Conflicts of Interest Policy and Sponsorship Policy. The CCG will ensure that North and East London Commissioning Support Unit (CSU) and other Contractors are aware of the contents of this policy if applicable.

1 Purpose and scope

The purpose of this policy is to provide guidance to staff and office holders on the action that can, or should, be taken in the event that they are offered gifts and/or hospitality, make it clear where the boundaries of acceptable conduct lie and to protect the property and finances of the NHS and of patients in our care.

NHS Newham CCG does not tolerate fraud and bribery within the NHS. This policy applies to all employees of NHS Newham Clinical Commissioning Group (NCCG), any staff who are seconded to NCCG, contract and agency staff and any other individual working on NCCG premises. This Policy also applies to NCCG Office Holders, e.g. Members of the Governing Board and its Committees/Sub-Committees including all groups relating to commissioning, contracting and procurement processes and where decision making is required by those members

The CCG will ensure that North and East London Commissioning Support Unit (CSU) and other Contractors are aware of the contents of this policy if applicable. Where an individual fails to comply with this policy disciplinary action may be taken in accordance with the CCG’s Disciplinary Policy and its Constitution. The CCG’s disciplinary policy is located on the staff intranet and on the CCG’s website

2 Responsibilities

Party Key Responsibilities Director of Partnerships & Governance

• Monitor and ensure compliance with this policy.

• Advising staff / Office Holders on the contents of thispolicy.

• Providing guidance for staff / Office Holders on refusal oracceptance for gifts or hospitality.

• Maintaining a central register of gifts and hospitality.

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• Receive declarations for inclusion in the Gifts andHospitality Register.

• Ensure that this policy is compliant with pertinentlegislation and guidance.

All Managers • Ensuring that their staff are aware of, and adhere to, thispolicy.

• Make declarations of receipt of gifts or hospitality whererequired.

• Provide advice and guidance to staff on the receipt of gifts /hospitality in the first instance, and

• Consult the Director of Partnerships & Governance whereadditional guidance is required.

All Staff • Ensuring they are aware of, and follow this policy.

• Make declarations of receipt of gifts or hospitality whererequired in consultation with their line manager.

• Refuse gifts, inducements or hospitality other than items ofmodest value.

• Staff with authority to commit expenditure must declare anyrelevant and material interests.

• Do not use your official position for private gain.• Respect confidentiality of business information.

• Act in accordance with the seven Nolan principles (SeeAppendix 1) on standards in public life: selflessness,integrity, objectivity, accountability, openness, honesty andleadership.

Local Counter Fraud Specialist

• The LCFS’s role is to ensure that all cases of actual orsuspected fraud and bribery are notified to the ChiefFinancial Officer and reported accordingly.

• Investigation of the majority cases of alleged fraud withinNCCG

• The LCFS will regularly report to the Chief Financial Officeron the progress of investigations and when/if referral to thepolice is required.

• The LCFS and the Chief Financial Officer, in conjunctionwith NHS Protect, will decide who will conductinvestigations and when/if referral to the police is required.

Office Holders • The NCCG Governing Board has also determined thatOffice Holders (e.g. members of Committees/Sub-Committees) must comply with this policy.

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Commissioning Leads and Procurement Leads

Lay Member for Governance and Audit Chair

General Practitioners (GPs)

Commissioning Leads and Procurement Leads and any staff leading on any relevant procurements within the CCG must ensure that bidders, contractors and direct service providers adhere to this policy, and that

the service re-design and procurement processes used by the CCG reflect the procedures set out in this policy.

The Chair of the Audit Committee has a lead role in ensuring that the Governing Body and the wider CCG behaves with the utmost probity at all times. The Chair of Audit Committee oversees key elements of governance including the appropriate management of conflicts of interest. In addition they will provide a view of the working of the CCG with a strategic and impartial focus and will take the Chair’s role for discussions and decisions where the Chair has made a declaration of interest and has to withdraw from a meeting due to the conflict.

Following guidance from The General Medical Council (GMC) the CCG will ensure that any GPs with a responsibility for or involvement in

commissioning of services must:

• Satisfy themselves that all decisions made are open, fairand transparent and comply with legislation.

• Keep up to date and follow the guidance and codes ofpractice that govern the commissioning of services.

• Formally declare any interest that they, or someone closeto them, including their business partner, or their employerhas in a provider company.

• Take steps to manage any conflict between their duties asa GP and their commissioning responsibilities, for exampleby excluding themselves from the decision.

• Take steps to manage any conflict between their duties asa GP and their commissioning responsibilities, for exampleby excluding themselves from the decision making processand any subsequent monitoring arrangements.

3 Definitions

3.1 Gifts A gift is defined as any item of cash or goods, or any service, which is provided for personal benefit, free of charge or at less than its commercial value.

All gifts of any nature offered to CCG staff, board and committee members and individuals within GP member practices by suppliers or contractors linked (currently or prospectively) to the CCGs business should be declined, whatever their value (subject to this, low cost branded promotional aids may be accepted and not declared where they are under the value of a common industry

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standard of £6). The person to whom the gifts were offered should also declare the offer to the Director of Partnerships & Governance so the offer which has been declined can be recorded on the register.

Gifts offered from other sources should also be declined if accepting them might give rise to perceptions of bias or favouritism, and a common sense approach should be adopted as to whether or not this is the case:

• CCG staff should not ask for any gifts• Gifts of cash and vouchers (e.g. vouchers, tokens, offers of remuneration to attend

meetings whilst in a capacity working for or representing the CCG) to individuals mustalways be declined, whatever their value and whatever their source, and the offer whichhas been declined must be declared

• Modest gifts under a value of £50 may be accepted and do not need to be declared• Gifts valued at over £50 should be treated with caution and only be accepted on behalf of

an organisation (ie a charity). These must be declared• A common sense approach should be applied to the valuing of gifts (using an actual

amount, if known, or an estimate that a reasonable person would make as to its value)• Multiple gifts from the same source over a 12 month period should be treated in the same

way as single gifts over £50 where the cumulative value exceeds £50.

3.2 Hospitality A blanket ban on accepting or providing hospitality is neither practical nor desirable from a business point of view. However, individuals should be able to demonstrate that the acceptance or provision of hospitality would benefit the NHS or CCG.

Modest hospitality provided in normal and reasonable circumstances may be acceptable, although it should be on a similar scale to that which the CCG might offer in similar circumstances (e.g., tea, coffee, light refreshments at meetings). A common sense approach should be adopted as to whether hospitality offered is modest or not. Hospitality of this nature does not need to be declared to the Director of Partnerships & Governance, nor recorded on the register, unless it is offered by suppliers or contractors linked (currently or prospectively) to the CCG’s business in which case all such offers (whether or not accepted) should be declared and recorded.

Meals and refreshments: • Under a value of £25 - may be accepted and need not be declared.• Of a value between £25 and £75 - may be accepted and must be declared.• Over a value of £75 - should be refused unless (in exceptional circumstances) senior

approval is given. A clear reason should be recorded on the CCG’s register of interest as towhy it was permissible to accept.

• A common sense approach should be applied to the valuing of meals and refreshments(using an actual amount, if known, or a reasonable estimate).

Travel and accommodation: • Modest offers to pay some or all of the travel and accommodation costs related to

attendance at events may be accepted and must be declared.• Offers which go beyond modest, or are of a type that the CCG itself might not usually offer,

need approval by senior staff, should only be accepted in exceptional circumstances, andmust be declared. A clear reason should be recorded on the CCG’s register of interest as towhy it was permissible to accept travel and accommodation of this type. A non-exhaustivelist of examples includes:

o offers of business class or first class travel and accommodation (including domestictravel)

o offers of foreign travel and accommodation.

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There may be some limited and exceptional circumstances where accepting the types of hospitality referred to in this paragraph may be contemplated. Express prior approval should be sought from a senior member of the CCG (e.g. the Director of Partnerships & Governance or equivalent) before accepting such offers, and the reasons for acceptance should be recorded in the CCGs register of gifts and hospitality. Hospitality of this nature should be declared to the Director of Partnerships & Governance and recorded on the register, whether accepted or not. In addition, particular caution should be exercised where hospitality is offered by suppliers or contractors linked (currently or prospectively) to the CCG’s business. Offers of this nature can be accepted if they are modest and reasonable but advice should always be sought from a senior member of the CCG (e.g. the the Director of Partnerships & Governance or equivalent) as there may be particular sensitivities, for example if a contract re-tender is imminent. All offers of hospitality from actual or prospective suppliers or contractors (whether or not accepted) should be declared and recorded.

Covers a wide spectrum and can include: Free meals, drinks, receptions, meetings sponsored by drug companies, hospitality tents at shows, exhibitions or conferences, music and cultural events, sport and leisure events, particularly golf competitions, use of company facilities, hotel accommodation and holidays.

3.3 Sponsored events Newham CCG has decided that, as a commissioning organisation, offers of sponsorship from any provider or potential provider of any health goods or service or other form of good or service should not be accepted as a matter of principle.

4 Guiding documentation The key piece of legislation governing this policy is the Bribery Act 2010. This is summarised below:

4.1 The Bribery Act 2010 Under the Bribery Act 2010 it is a criminal offence to:

• Bribe another person by offering, promising or giving a financial or other advantage to inducethem to perform improperly a relevant function or activity, or as a reward for already havingdone so, and

• Be bribed by another person by requesting, agreeing to receive or accepting a financial orother advantage with the intention that a relevant function or activity would then be performedimproperly, or as a reward for having already done so.

These offences can be committed directly or by and through a third person and, in many cases, it does not matter whether the person knows or believes that the performance of the function or activity is improper.

It is, therefore, extremely important that staff adhere to this and other related documentation (See Associated CCG documentation) when considering whether to offer or accept gifts and hospitality and/or other incentives.

4.2 Pharmaceutical Companies All private companies must now adhere to the Bribery Act 2010. Where pharmaceutical companies are involved, inducements and hospitality must comply fully with the Medicines (Advertising) Regulations 1994 (regulation 21 ‘Inducements and hospitality’.

Any person who contravenes regulation 21(1) is guilty of an offence, and liable, on summary conviction to a fine not exceeding £5000, and on conviction on indictment to a fine, or to imprisonment for a term not exceeding two years, or both. Anyone contravening regulation 21(5) is also guilty of an offence and is liable, on summary conviction to a fine not exceeding £5000’. The

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Medicines Control Agency (MCA) Guidelines on Promotion and Advertising set out the standards to be followed.

If an offer received is contrary to the above, details should be sent to the Director of Partnerships & Governance who will take up the matter with the company concerned.

5 Policy

5.1 Introduction NCCG manages a large commissioning budget. It is therefore imperative for office holders to not place themselves in a position where it appears their judgment has been compromised through the acceptance of inappropriate gifts or hospitality.

In some circumstances the acceptance of a gift from an organisation or individual could appear to influence the action of a member of staff and compromise the member of staff’s position. This is because a gift is never really a gift; there is always an element of mutuality.

The standards that the public demand from their office holders are high and the great majority of people in public life meet those high standards. However it is imperative that a clear policy outlining where the boundaries of acceptable conduct lie is made available.

This policy sets out some guiding principles covering the acceptance of gifts and hospitality, including references to interests in contracts. It does not provide for every eventuality and, therefore, staff/Office Holders should not hesitate to seek advice from their Line Manager or the Director of Partnerships & Governance.

The action of all CCG staff and Office Holders must not give rise to, or foster the suspicion that they have been, or may have been, influenced by a gift or consideration to show favour or disadvantage to any person or organisation. Staff/Office Holders must not allow their judgement or integrity to be compromised in fact or by reasonable implication.

NCCG is committed to taking all necessary steps to counter fraud and bribery. To meet its objectives, it has adopted the seven-stage approach developed by NHS Protect:

• the creation of an anti-fraud culture• maximum deterrence of fraud• successful prevention of fraud which cannot be deterred• prompt detection of fraud which cannot be prevented• professional investigation of detected fraud• effective sanctions, including appropriate legal action against people committing fraud and

bribery, and• effective methods of seeking redress in respect of money defrauded.

NCCG will take all necessary steps to counter fraud and bribery in accordance with this policy, the NHS Anti-Fraud Manual, the policy statement ‘Applying Appropriate Sanctions Consistently’ published by NHS Protect and any other relevant guidance or advice issued by NHS Protect.

5.2 Policy statement As a general rule the CCG believes that:

Gifts or offers of hospitality must be refused if there could be any doubt about the propriety of accepting them.

If in any doubt at all as to whether or not to accept gifts or hospitality, staff/Office Holders should immediately seek the advice of their Line Manager or the Director of Partnerships & Governance.

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5.3 Guide to Gifts and Hospitality – Refusal and Acceptance The following flow charts outline NCCG’s policy and procedure with regard to gifts and hospitality; including from patients and colleagues.

Has the offer of a ‘Gift’ to a member of staff, board member or clinical/cluster lead or individuals within GP member practices come from a supplier or contractors (current or prospective) linked to the CCG’s business

(whatever the value),

No Yes

Has the offer of a ‘Gift’ come from another source that might give rise to perceptions of bias or favouritism approved works?

No Yes

Is the gift from a patient/member of public given as ‘Thank you’ or an acknowledgement for services performed during the course of NCCG work?

No Yes

Is the ‘gift’: cash (including gift vouchers) or cash equivalents (e.g. vouchers, tokens, offers of remuneration to attend meetings whilst in a capacity working for or representing the CCG) ? Yes

Is the gift less than £6?

You do not need to register on the Gifts and Hospitality Register. Offers of gifts by a company to NCCG or a members of staff/Office Holder, such as calculators, mugs, ornaments or books, may be accepted where the notional value is under £6 providing it is for use at work. Such gifts tend to bear the company’s name or insignia and can, therefore be regarding as being in the nature of advertising matter these gifts do not have to be declared

No Yes

You must register any gift in the register for gifts and hospitality

The gift must be refused and declare the offer in the

regsiter

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The CCG document ‘THCCGCGO0020 Register of Gifts and Hospitality Declaration Form’ is attached as Appendix 2 to this document and is available on request from the Director of Partnerships & Governance.


5.4 Gifts from patients / members of the public Offers of gifts (e.g. flowers, chocolates, etc. but not cash/gift vouchers) by members of the public to staff may be accepted where the notional value is less than £10 when given as acknowledgment for services performed in the course of their work.

Whilst such gifts do not have to be declared, the CCG records them as a means of providing a balance to complaints. They should, therefore, be reported.


Where an individual believes they have been offered a generous gift to secure preferential treatment for a patient the gift should both be refused and declared, and the Director of Partnerships & Governance should be informed.

5.5 Gifts from Office holders or work colleagues. Gifts given by Office Holders/work colleagues to other Office Holders/work colleagues are, of course, acceptable and do not have to be declared.

If in any doubt at all as to whether or not to accept gifts or hospitality, staff/Office Holders should immediately seek the advice of their Line Manager or Director of Partnerships & Governance.

5.6 Guide to other Hospitality/Offers of Hospitality - Refusal and Acceptance The Bribery Act 2010 does not prevent companies from providing hospitality provided it is ‘reasonable’ and ‘proportionate’. The CCG will, therefore, continue to receive offers. The CCG approach to accepting hospitality is summarised below:

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6 Gifts and Hospitality Register

The Gifts and Hospitality Register is maintained by the Director of Partnerships & Governance. Particular mention should be made if:

• The Gifts/Hospitality were offered to, or received by, staff/Office Holders in any part of aprocurement process, and

Is the offer of hospitality a working breakfast, a working lunch or dinner integral to a meeting, training event, presentation, conference, seminar or similar event where the attendance is in

NCCG’s interest?

No Yes

Is the offer of hospitality, a lunch, dinner, reception or comparable function organised by an embassy, cultural organisation, professional

equivalent, where attendance is in NCCG’s interest?

Yes This is acceptable and does

not need to be declared

Is the offer of hospitality an offer to attend a private, social or sporting function?

No

Yes

This should be refused if they go beyond modest or a type that the CCG itself

might offer. This includes hospitality of a value of above £75 and in particular

offers of foreign travel and accommodation

No

Attendance at relevant company sponsored conferences is acceptable where it is clear that the hospitality is corporate rather than personal and any possible purchasing decisions are not compromised. However, prior approval is required.

When receiving authorised hospitality, staff/Office Holders should be particularly sensitive as to its timing in relation to decisions which NCCG may be taking affecting those providing the hospitality. However, account must be taken of the nature of the relationship between NCCG and the organisation concerned and the scale of the hospitality offered. If there is any doubt the offer should be declined.

All other offers of hospitality should be declared to your line manager, or the Director of Partnerships & Governance who will recommend refusal or acceptance.

If refusal is recommended, then arrangements should be made for the hospitality to be refused at the earliest opportunity with an appropriate explanation.

There is no further action required

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• The Gifts/Hospitality were offered by companies, or other organisations, with which theCCG has a contractual, grant giving or regulatory relationship, or is actively consideringsuch a relationship.

7 Penalties

This policy describes conduct which staff/Office Holders are expected to observe. Failure to do so could render an individual liable to disciplinary proceedings and may lead to criminal proceedings under the Bribery Act 2010.

Fraud is defined as if fraud and /or corruption are suspected, the matter must be reported immediately to the CCGs Local Counter Fraud Specialist of the Chief Finance Officer. Contact details for these individuals can be found on the CCG’s webpage.

8 Fraud and Corruption

If fraud and /or corruption are suspected, the matter must be reported immediately to the CCGs Local Counter Fraud Specialist of the Chief Finance Officer. Contact details for these individuals can be found on the CCG’s webpage. Alternatively, staff may report any suspicions via the Whistleblowing Policy.

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9 Bribery Act

9.1 What is the Bribery Act? The Bribery Act 2010 reforms the criminal law of bribery, making it easier to tackle this offence proactively in the public and private sectors.

It introduces a corporate offence which means that commercial organisations will be exposed to criminal liability, punishable by an unlimited fine, for negligently failing to prevent bribery. It repeals the UK’s existing anti-corruption legislation – the Public Bodies Corrupt Practices Act 1889, the Prevention of Corruption Acts of 1906 and 1916 and the common law offence of bribery – and provides an updated and extended framework of offences to cover bribery both in the UK and abroad.

A copy of the Act can be found here: http://www.legislation.gov.uk/ukpga/2010/23/contents Accompanying explanatory notes and other publications can also be found on the NHS Protect intranet: http://www.nhsbsa.nhs.uk/3354.aspx

9.2 When did it come into force? The Bribery Act received Royal Assent in April 2010 and came into force on 1 July 2011.

9.3 Why is it relevant to NHS organisations, professionals and staff?

9.3.1 Professionals and staff For the purposes of the Bribery Act, a ‘trade’ or ‘profession’ is considered a business. This means that, whether individually or in partnership, GPs, pharmacists, dental practitioners, opticians, finance professionals, etc. will also be subject to and personally liable under the Bribery Act.

9.4 Why is it relevant to the NHS Protect? The remit of NHS Protect includes preventing, detecting and investigating fraud and bribery in the health service. It is stated in the Standards for Providers that both offences must be tackled.

9.5 What is bribery? Bribery is generally defined as giving someone a financial or other advantage to encourage that person to perform their functions or activities improperly or to reward that person for having already done so.

9.6 What are the key provisions of the Bribery Act? The Bribery Act sets out four offences:

Section 1 - Offering, promising or giving a bribe to another person to perform a relevant ‘function or activity’ improperly, or to reward a person for the improper performance of such a function or activity.

Under the Bribery Act, a ‘relevant function or activity’ is any function of a public nature or any activity connected with a business, performed in the course of a person’s employment or performed by or on behalf of a body of persons, whether corporate or unincorporated, which meets one or more of the following conditions:

• a person performing the function or activity is expected to perform it in good faith

• they are expected to perform it impartially

• they are in a position of trust by virtue of performing it.

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Section 2 - Requesting, agreeing to receive or accepting a bribe to perform a function or activity improperly, irrespective of whether the recipient of the bribe requests or receives it directly or through a third party, and irrespective of whether it is for the recipient’s benefit.

Section 7 - Failure of a commercial organisation to prevent bribery (the corporate offence). This is a ‘strict liability’* offence and an organisation can be found guilty of ‘attempted’ or ‘actual’ bribery on the organisation’s behalf. It should be noted that Section 1 or section 6 needs to be proven for a section 7 offence to apply.

Section 14 – Offering or receiving a bribe or bribing foreign official. This section applies if an offence under sections 1, 2 or 6 is committed by a body corporate.

* Strict liability offences do not require proof of intention or recklessness – in other words, itis not necessary for the prosecution to show that the company intended to make the bribe in bad faith, or that it was negligent as to whether any bribery activity took place.

9.7 Who can be prosecuted under the Bribery Act? Any individual associated with an organisation who commits acts or omissions forming part of a bribery offence may be liable for a primary bribery offence under the Act or for conspiracy to commit the offence with others – including, for example, their employer.

Likewise, a senior management or Governing Body member who consented to or connived in a section 1 or 6 bribery offence will, together with the organisation, be liable for the section 7 ‘corporate offence’ under the Act.

9.8 Who will investigate and prosecute these new offences? No proceedings for an offence under the act may be commenced in England and Wales except by or with the personal consent of the Director of Public Prosecutions, the Director of the Serious Fraud Office or the Director of Revenue and Customs Prosecutions.

9.9 What penalties can be imposed? An offence under section 1 (bribing another person) or section 2 (being bribed):

• A person guilty of an offence under these sections is liable, on summary conviction (i.e. iftried in a magistrates’ court) to imprisonment for a term not exceeding 12 months (subjectto section 11(4)(a)), a fine not exceeding the statutory maximum, or both. On conviction onindictment (i.e. in Crown Court), they are liable to imprisonment for a term not exceeding 10years, a fine, or both.

• Any person associated with the organisation in question (this could be an agent orsubsidiary of the organisation as well as an employee) who is guilty of an offence underthese sections is liable, on summary conviction, to a fine not exceeding the statutorymaximum and on conviction on indictment to a fine.

An offence under section 7 (failure of commercial organisations to prevent bribery):

• An organisation guilty of an offence under this section is liable, on conviction on indictment,to a fine. (NB: Even if an organisation has delegated the relevant activities a namedindividual, it remains responsible for them.)

A ‘twin-track’ approach can be used to take action against an individual under section 1 and an organisation under section 7 simultaneously.

9.10 What can NHS organisations do to comply? An organisation will have to show that it has implemented ‘adequate procedures’ designed to prevent individuals associated with that organisation from engaging in bribery in order to avoid liability.

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9.11 What is meant by ‘adequate procedures’? This relates to relevant compliance protocols and procedures that a commercial organisation can put in place to prevent bribery by individuals associated with it. This might include training, briefing or new internal procedures. The adequate procedures will constitute a ‘complete defence’ for an organisation.

Under the Bribery Act, a person is considered to be associated with a commercial organisation if they perform services for it or on its behalf. This person can be an individual or an incorporated or unincorporated body.

9.12 Is there any guidance on what constitutes adequate procedures? The Bribery Act requires the Secretary of State for Justice to publish guidance about procedures that relevant commercial organisations can put in place to prevent individuals associated with them from engaging in bribery. The two pieces of guidance were published in April 2011. The full guidance can be found at http://www.justice.gov.uk/guidance/docs/bribery-act-2010-guidance.pdf whilst the quick-start version can be found at http://www.justice.gov.uk/guidance/docs/bribery-act-2010-quick-start-guide.pdf. NHS Protect has also issued guidance as part of its Bribery Act guidance and training package. These documents are available on the NHS Protect secure extranet.

9.13 What should I do if I suspect bribery is occurring? Staff should report any suspicions or allegations of bribery immediately to one of the following:

• their Local Counter Fraud Specialist• their organisation’s whistleblowing function• the relevant regional Area Anti-Fraud Specialist• the NHS Fraud and Corruption Reporting Line (0800 028 40 60) or the online fraud

reporting form• at www.reportnhsfraud.nhs.uk

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http://www.justice.gov.uk/guidance/docs/bribery-act-2010-guidance.pdf

Appendix 1: The Nolan Principles

The Nolan Committee set out ‘Seven Principles of Public Life’ which it believed should apply to all in the public service. These Principles have been adopted by the CCG Governing Body. The principles are:

Selflessness Holders of public office should act solely in terms of the public interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends. Integrity Holders of public office should not place themselves under any financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties.

Objectivity In carrying out public business, including making public appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit.

Accountability Holders of public office are accountable for their decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office.

Openness Holders of public office should be as open as possible about all the decisions and actions that they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands.

Honesty Holders of public office have a duty to declare any private interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest.

Leadership Holders of public office should promote and support these principles by leadership and example.

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Register of Gifts and Hospitality Declaration Form [Period]

Please ensure that one of these forms is completed for each and any instance of gifts, hospitality, consultancies, sponsorship, and support for travel, education and training. Please refer to the Policy on gifts and hospitality for guidance on what should be declared.

Name of Declarer:

Describe below acceptance of the offer. Include a value if known. Examples may include support from a commercial company for travel to a conference, payment for consultancy advice, or invitations to sporting events or meals. Casual gifts and modest hospitality are regarded as being valued at no more than £6 and declarations for this are not required.

Details of provider/company

Was the offer accepted or declined?

Reason for acceptance/refusal

Disposal method e.g. gift has been donated to charity

I certify that the information I have given in this declaration form is correct and to the best of my knowledge. Should it later be discovered that I have given false information in order to obtain an advantage, I understand that my employment could be terminated by dismissal and that I may be subject to criminal investigation.

Declarer signature Date

Name and title

Please note that if there is any likelihood of a conflict of interest, you must discuss the issues with your line manager who should co- sign this form before it is sent into the Director of Partnerships

& Governance

Appendix 2: Register of Gifts and Hospitality Declaration Form

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Scenario 1

A GP is also a member of the CCG Governing Body, and sit on the panel for making procurement decisions. The CCG tenders for paediatric services, and the practice partner of the GP has a financial interest in one of the providers bidding for work.

Threats:

• The GP member has failed to declare the business interest of their GP partner. Were theyto then influence the procurement process to award the contract to their business partner, itcould be construed that they have abused their position in order to make a gain for another.

• The GP member has declared the interest of the business partner, but is still allowed tohold decision-making powers in the procurement process. If the business partner is thenawarded the contract this could lead to accusations of favouritism in the process and achallenge on the fairness of the process.

Solution:

First and foremost, the GP member should be required to declare all interests held by themselves or their business partners and spouses, which have relevance to the health sector, in line with the CCG policy. Secondly, there should be a clear process for linking declarations of interest to the procurement process, and declarations of individuals involved in the procurement process should be checked each time a procurement involving those individuals is undertaken.

The CCG should also remove the GP member from any decision-making process. The GP member may be able to add value to the procurement process from a technical point of view, but should not be part of the final decision-making process. Their contribution to the process should be clearly noted throughout by the CCG.

If technical expertise is required in the procurement process, but the only person able to offer the expertise is the individual with the conflict, the CCG can consider seeking the expert advice from a source unconnected to the CCG (essentially seeking consultancy services).

Utilising an independent expert further protects the CCG from any future challenge from any party who may wish to challenge the decision making process as to the award of any contract. Additionally the CCG can demonstrate that it has acted fairly and transparently and applied adequate procedures in line with Ministry of Justice guidance.

Scenario 2

A contracts manager for a CCG is involved in the process of tendering for the design of a new corporate logo. The tender process has not been completed and no final decision has been made. The manager and a colleague have been invited by one of the companies tendering, to a rugby game. For the past few years the colleague, in their own time, has been regularly attending design workshops offered by the company. The colleague is not on the tender panel, nor are they involved in the decision-making process for that tender. The Contracts Manager, however, will be.

Threats:

• Even though the colleague is not involved in the tender process, they may be perceived tohave influence as they have an association with one of the companies tendering, and workin the department that will be determining the outcome of the tender.

• The contracts manager is in a decision-making position and acceptance of hospitality fromone company, and not others, may be construed as influencing their ability to be impartial incarrying out their public duty to award the tender.

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Solution:

The contracts manager and their colleague should follow the CCG policy relating to gifts and hospitality which they are bound by. To avoid any perception of a conflict of interest, it would be wise for the colleague to disclose their previous association with the company to the CCG. It is also advisable for the offer of gifts and hospitality to be declared to the CCG by both individuals in advance of acceptance, so that challenge can be made if required, and a determination as to whether the offer can be accepted can be made independently.

If the contracts manager accepts the hospitality, the CCG should request that the contracts manager restrict their involvement by refraining from being part of the decision-making in the tender process.

This enables the CCG to demonstrate they have considered any undue influence on the process and have acted accordingly to ensure a fair and transparent process.

Scenario 3

A procurement process is underway to award contracts for a number of community physiotherapy services. One of the potential providers approaches a GP with a large influence within the CCG. The provider offers to pay for the use of the GP’s practice to undertake the physiotherapy services, in exchange for the awarding of a number of the contracts. The provider has actually put forward a strong tender to the CCG for the contracts, and has a good chance of successfully winning a percentage of the contracts.

Threats:

• If the approach from the provider is not reported to the CCG or the Local Counter FraudSpecialist by the GP, and the provider who sought to influence the procurement outcome isawarded contracts, there may be allegations made that the procurement process is not fairand that individuals have received incentives to reach a decision. These allegations wouldcause serious damage to the CCG’s reputation, even if the GP had not exercised anyinfluence over the process.

• Regardless of the strength of the provider’s tender bid, by making inappropriate offers ofincentives, the provider has demonstrated they are not adhering to the Bribery Act 2010and therefore could be considered as an unsuitable provider.

Solution:

The GP should immediately report the approach to the CCG and/or the Local Counter Fraud Specialist. The CCG should allow the LCFS to make enquiries to determine whether there is any substance to the allegation of ‘offering a bribe or incentive’, to influence the behaviour of the GP. Depending on the outcome of the LCFS enquiries, a decision should be made by the CCG as to whether to exclude the provider from the tender process.

If the GP fails to report the offer of a bribe, and this subsequently comes to light, the CCG should direct the LCFS to investigate both parties accordingly.

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Real-Life Case Studies

Since the implementation of the Bribery Act there have been three successful prosecutions in the United Kingdom as follows:

• The first case concerned Munir Patel, 22 who was handed a three-year prison term forbribery and ordered to serve six years concurrently for misconduct in a public office. He helped more than 50 offenders avoid prosecution in exchange for sums of up to £500 in relation to speeding fines and other court related matters.

• The second case concerned Mr Mawia Mushtaq, who became the first person to besuccessfully prosecuted under the Act for offering (as opposed to receiving a bribe). Having failed a driving test before an Oldham Council licensing officer necessary to secure a taxi licence, Mr Mushtaq offered the sum of £200 (later increased to £300) if the result of the test were changed to a pass. The officer was not so easily corrupted as Mr Patel. He refused the bribe and reported the matter to his manager and later the police. Mr Mushtaq was sentenced to 2 months imprisonment, suspended for 12 months.

• The third case concerned a Mr Yang Li. Mr Li, a Masters student at the University of Bath,was unsatisfied with the 37% mark he was awarded for a 12,000 word essay; the pass mark was 40%. He was given three options by his professor: appeal the mark; resubmit the essay; or withdraw from the course. Mr Li proposed a fourth option. He placed £5,000 on the table, stated that he was a “businessman” and told the professor he could keep the money if the mark was raised. The professor refused. As Mr Li replaced the money in this pocket, he dropped an imitation firearm on the floor, which had presumably been brought as a back-up in case his first attempt at coercion was unsuccessful. The police were called in and Mr Li was prosecuted. In April 2013, Mr Li was jailed for 12 months (both for the attempted bribery and for possession of an imitation firearm) and ordered to pay £4,800 in costs.

Parallels can be drawn with these cases which relate to NHS services, for example those staff involved in the Procurement cycle being offered lavish ‘entertainment’ prior to a tender to persuade them to choose a particular supplier/contractor above another.

The individual responsible would no doubt suffer similar consequences as the persons named above, however the corporate offence of failing to prevent bribery could also be implied if the CCG has not taken adequate procedures to mitigate against its risk of ‘negligently failing to prevent a bribe’.

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Newham CCG Board meeting Thursday 22 February 2018 Committee rooms, 4th floor Unex Tower

Title Ivory Ward reconfiguration

Agenda item 3.9

Author Sally Parkinson, NCCG/LBN, Associate Director Collaborative Commissioning

Presented by Dr Muhammad Naqvi, Deputy Chair, Newham CCG


Sally Parkinson, NCCG/LBN, AD Collaborative Commissioning – [email protected] Tel: 020 3816 2390

This paper is for Monitor

Action required The Board are asked to: Note any impact on performance and quality since the permanent move of the Ivory Ward for older adults with functional mental health issues from the Newham Centre for Mental Health to the Mile End Hospital site.

Executive summary

The report asks the Board to consider the report which gives an update on the permanent move of the Ivory Ward beds for older adults with functional mental health issues at Newham Centre for Mental Health on the Newham University Hospital site to the Mile End Hospital site.

Supporting papers N/A


Values Working with our partners to improve health outcomes Aims Improving health outcomes through developing models of integrated care and focusing on prevention.


This paper is an update on a ward move; the original paper seeking permission was presented at: Quality, Performance and Finance Committee – 25 May 2017 Quality, Performance and Finance Committee – 29 June 2017 Quality, Performance and Finance Committee – 31 August 2017 Newham CCG Board – 13 September 2017

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Risk BAF.04.02 - Failure to effectively monitor the quality of commissioned services for East London Foundation Trust BAF.03.02 Failure to effectively monitor performance and activity levels of non-acute providers

Equality impact The cohort using these services is small and no generalisations on gender and ethnicity can be made on such as small sample size, however the ward is used for those over 65 years old so any impacts would be on this age cohort.

A Quality Impact Assessment was undertaken by ELFT at time of move and appropriate mitigations put in place


ELFT have undertaken consultation with staff, patients and families/carers as part of the move to the Mile End site.


Newham CCG is facing a challenging financial year against increasing demand and delivery of national agreed targets. Past utilisation of beds on Ivory Ward has achieved poor value for money of CCG resources. The reorganisation of beds and its generated savings encourages better use of funds through understanding patient demand. This paper provides an update on the performance and quality since the permanent move. Recurrent savings made have gone towards the delivery of QIPP in year. Recovery of estates and corporate overheads are still being pursued.

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1.1

1.1.1

1.1.2

1.1.3

1.1.4

The Ivory Ward was a 13 bed ward located at Newham Centre for Mental Health which served older adults (over 65) with functional mental health issues.

In May 2017 patients on Ivory Ward at the Newham Centre for Mental Health temporarily moved to the Columbia Annexe at the Mile End site in Tower Hamlets. This initial move was to allow for some refurbishment work to be undertaken at the Newham Centre; the move also provided an opportunity to consider the permanent relocation of older persons’ in-patient services to the Mile End site.

The CCG’s QPF Committee received separate papers on the Ivory Ward in May, June and August 2017 in order to provide assurance that both the temporary and permanent moves were robust in terms of quality, performance and finance. The permanent move was approved by the Board in September 2017.

This paper gives an update on capacity, performance and quality since the permanent move.

The permanent move of Ivory Ward was approved by the Board in September 2017. The rationale for relocation had been extensively discussed. In summary, the Mile End site offered a number of advantages in caring for older people who often have co morbid physical health problems and may be frail. There are facilities offering acute care on site and the presence of other older person’s wards has allowed cross cover by experienced staff.

2. Key considerations

2.1 2.1.1

Quality, Performance and Capacity There are a number of measures which are routinely reported which can be interrogated in order to gain assurance on quality and effectiveness. These include data on; Delayed Transfers of Care (DTOCs), mixed sex accommodation breaches, serious untoward incidents, complaints, bed occupancy, average length of stay (ALOS) and readmission within 28 days and data on these is presented below.

3. 3.1.1

Mixed sex accommodation There have been no mixed sex accommodation breaches since the reconfiguration of Ivory Ward.

4. 4.1

4.1.2

4.1.3

4.1.4

DTOCs The Trust have a downward trend on all DTOCs and this is mirrored with MH Older People. As there are such small numbers, any increase in numbers of unique patients has to be treated with caution.

From April to November 2017 (inclusive) there was one unique patient per month who was a DTOC, except for September and October which accounted for 4 patients for each month. Cumulatively over this period, this amounted to 14 patients compared to 31 for City and Hackney and 38 for Tower Hamlets.

There is an agreed process for managing DTOCs which involves London Borough of Newham and this focus has reduced DTOCs overall.

There are currently zero DTOCs to report on for Older People in January 18 for Newham CCG.

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5. 5.1

5.1.2

5.1.3

Bed occupancy Since the permanent move, Newham CCG has seen a decrease in bed base for the older adults (functional mental health) cohort, as agreed by the Board.

There have not been any adverse results due to this since the permanent move, The normal occupancy level on Leadenhall Ward (Tower Hamlets) the ward is around 85-87% and the average length of stay is reducing to 26 days. The occupancy of the ward has recently increased to 91% in January 18 as a result of a spike in admissions during the Christmas period. On Columbia Ward the occupancy levels remain healthy at below 80% and average length of stay is also decreasing below the mean of 65 days. Readmissions also remain low.

This data demonstrates that the reduction in bed base is sufficient to meet Newham’s needs.

Graph 1: Leadenhall occupancy and ALOS

Graph 2: Columbia occupancy and ALOS

6. 6.1

Readmissions There have been no readmissions within 28 days for this patient cohort since April 2017.

Graph 3: Readmissions within 28 days

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7. 7.1

7.2

Serious incidents and complaints Since the move, there have been two serious incidents relating to care and treatment. One incident is yet to be reported on and the other has already been shared with the CCG including action on lessons learned.

There has been one formal complaint by a Newham service user since the transition. The main theme of the complaint related to patient focus/staff attitude and clinical management and although the complaint was not upheld, learning was taken forward by ward staff during their business meetings to reflect on the case and share learning.

8. 8.1

8.1.1

8.1.2

Patient and carer engagement ELFT have now consulted with wider stakeholders about the permanent move and have written to anyone who has used the service in the last year as well as their relatives. This invited any patient and/or carer to feedback on the plans for a permanent move and seeking their comments and concerns.

Due to this communication, one couple contacted ELFT to discuss this further and the Newham Borough Director met with them to outline the proposals. No further comments were received.

ELFT’s Friends and Family Survey for both Columbia and Leadenhall remain high at 100% of users recommending services.

9. 9.1

9.1.2

9.1.3

Conclusion Following the implementation of the permanent reconfiguration of the Ivory Ward, there do not appear to have been any adverse events due to the move.

There is sufficient capacity in the re-designed accommodation to accommodate Newham patients without breaching the 85% occupancy threshold and male and female patients can be accommodated by the flexibility of ‘swing beds’ in both wards.

There has been no material negative impact on the quality of care for patients due to the move, indicating that quality has not been affected.

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newham ccg board part i meeting...2.35pm integrated quality and performance report 17 approval f...

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