Progress report from the Quality, Risk and Safeguarding Committee

Date of committee: 21st February 2019

Key Achievements A summary report was provided on the NHS Long Term Plan and the potential links to the work of the Committee. It was agreed that each section within the plan should be mapped to the work of the Committee in order to understand the areas of focus and steer, and provide topics for future development sessions. This should be a joint development session for QRS with Greater Nottingham CCGs in April/May. An update was provided on the Nottinghamshire Integrated Care System (ICS) Workforce Workstream. The committee agreed that the report provided positive assurances however workforce is still the single biggest risk to the system. The ICS workforce risk (Risk 5) was reviewed and it was agreed that in order to capture the risk in its entirety it would need to be broken down into 6 separate risks. The Patient Story was presented to the Committee for sign off, which focussed on the good example of Community Nursing both holistically and psychologically. It was agreed that once additional information was included it would be taken to Governing Body. An update was provided on Enhanced Healthcare in Care Homes (EHCH). The Committee were informed that this was a priority area within the Long Term Plan and as such workload will increase. A development session will be taking place on 26th February, bringing together partners across the whole system, understand what is/isn’t currently working and how do we improve. Nottinghamshire has been identified as a good area which can be built on. The Quality Performance Report was received. The Gifts and Hospitality Policy was approved. The Annual report was approved. Issues Actions The lack of contracting representation at the Committee meetings continued to be raised.

Elaine Moss to discuss this with Mick Cawley.

Risks Actions Risk 5 (Workforce): There is significant risk to the delivery of the workforce change and as such it has been requested to split into a number of more distinct risks. Risk 7 (EMAS): The committee were in agreement that patient experience is being affected, however the quality of the service can only be effected by tackling the current EMAS performance. It was suggested that, as a performance issue, this risk should now be overseen by the Finance, Performance and Turnaround Committee. Risk 23 (ULHT): It was agreed to maintain the rating at its current level until assurance from the lead commissioners is provided.

Andrea Brown to work with Sue Bowskill to split out Risk 5. Elaine Moss/Eleri De Gilbert to discuss suggestion of moving risk to FPT at the next Governing Body meeting.

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Minutes of the Meeting in Common of the NHS Mansfield and Ashfield CCG and Newark and Sherwood Quality, Risk and Safeguarding Committees

Minutes of Meeting held on 20 December 2018

Meeting Room 3, Birch House

Present: Eleri de Gilbert (Chair) Lay Member, NHS Mansfield & Ashfield CCG & NHS Newark and

Sherwood CCG Ruth Lloyd Head of Corporate Governance, NHS Mansfield & Ashfield CCG

and NHS Newark & Sherwood CCG Dr Nigel Marshall Clinical Advisor, NHS Newark & Sherwood CCG Sue Barnitt Head of Quality and Adult Safeguarding, NHS Mansfield & Ashfield

CCG and NHS Newark & Sherwood CCG Val Simnett Rosa Waddingham

Designated Nurse Children’s Safeguarding, Nottinghamshire CCGs Deputy Chief Nurse, NHS Mansfield & Ashfield CCG and NHS Newark & Sherwood CCG

Sally Bird Coral Osborn Nick Judge Mary Hodgeon

Head of Infection and Prevention Control, Nottinghamshire CCGs Senior Prescribing (North) and Governance Advisor on behalf of Mid and South Notts CCGs Continuing Healthcare Quality Assurance Manager, NHS Mansfield & Ashfield CCG and NHS Newark & Sherwood CCG PPEC representative, Newark and Sherwood CCG

CCG Staff In attendance: Fay Bradley (minutes) Apologies: Elaine Moss David Ainsworth Jane Brady Donna Nussey Grace Kinsey Sharon Garratt Desiree Kelly

PA to the Chief Nurse, NHS Mansfield & Ashfield CCG and NHS Newark & Sherwood CCG Chief Nurse and Director of Quality and Governance, NHS Mansfield & Ashfield CCG and NHS Newark & Sherwood CCG Director of Primary Care, NHS Mansfield & Ashfield CCG and NHS Newark and Sherwood CCG Associate Designated Nurse Children’s’ Safeguarding, Nottinghamshire CCGs Quality and Safety Manager – Care Homes, NHS Mansfield & Ashfield CCG and NHS Newark & Sherwood CCG Quality and Safety Manager – MH & LD, NHS Mansfield & Ashfield CCG and NHS Newark & Sherwood CCG Quality and Safety Manager – Secondary Care, NHS Mansfield & Ashfield CCG and NHS Newark & Sherwood CCG Patient Experience Manager, NHS Mansfield & Ashfield CCG and NHS Newark & Sherwood CCG

QRC/18/93 Welcome and introductions The Chair welcomed participants to the meeting and a round of introductions were made.

QRC/18/94 Apologies Apologies were noted as above.

QRC/18/95 Declarations of interest

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All members confirmed that their declaration of interests were as detailed on the register. No other declarations of interest were made.

QRC/18/96 Minutes of the meeting held on Thursday 18 October 2018 The minutes of the meeting held on 18 October were taken as an accurate record of discussions.

QRC/18/97 Matters arising (not elsewhere on the agenda) Action Log QRC/18/83 – It has been clarified that the sepsis patient story discussed previously cannot be changed from the original presentation at the SFHFT Board meeting, therefore as this does not link into the CCGs sepsis outcomes the team are looking into other sepsis patient stories. QRC/18/86 – A response from lead commissioners for ULHT has not been received querying their recording of Risk 23.

• ACTION: Sue Barnitt to chase lead commissioners for a response. QRC/18/89 – It was agreed that a full review of the TOR would be premature given the restructuring of the CCG and the likelihood of a shared committee in the near future. As such a full review of TOR will be undertaken at that point. However it was agreed an amendment to the Committee Terms of Reference (ToR) is required, which clarifies that where decisions have an impact on finance and/or performance this will need to be taken through Finance, Performance and Turnaround Committee for sign off before Governing Body. Following this amendment the ToR was agreed.

QRC/18/98 Committee Workplan The committee workplan was provided for noting only. It was agreed that the topics for discussion at next month’s deep dive meeting would be EMAS AQI and Mental Health/Learning Disability indicators.

QRC/18/99 Controlled Drugs (CD) Annual Report and Medicines Safety Officers (MSO) Annual Report A report was provided noting the work undertaken in relation to Controlled Drugs and Medicines Safety Officers by the CCGs during 2017-2018. Controlled Drugs There are a number of legal requirements in regards to controlled drugs that are supported and monitored by the CD leads and medicines management team on behalf of 6 Nottinghamshire CCGs. The team ensure that any incidents are reported to the CD Accountable Officer and that links are made into the intelligence network. When compared to last year the volume and expenditure of controlled drugs has decreased, in line with the national picture. Areas that have been focussed on include quality, care homes and incident reporting. The committee was informed that drug volumes in care homes are being reviewed, as well as reviewing patient prescriptions to ensure prescriptions are only being given where necessary. It was noted that controlled drugs was not part of the monthly Care Home data reporting.

• Action: Sue Barnitt to pick up controlled drugs reporting as part of the monthly care home report with Donna Nussey.

The report was noted by the committee. The Chair commented that the report highlighted a great deal of very positive improvements as a result of the work of the

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team and asked that the committees thanks be shared with the team Medicines Safety Officers Medicines Safety remains a global and national priority with an aim to reduce the level of severe avoidable harm related to medications by 50% over the next 5 years. In addition research indicates that many patients may be dying as a consequence of medication errors; 5-10% of all hospital admissions are medicines related and two thirds of medicines related hospital admissions are preventable. Ensuring that these national priorities are implemented locally are a critical part of the MSO network and also a core function of all the CCGs prescribing and medicines management teams work streams. The committee was informed that MSOs are currently reviewing all patients on high strength/high volume, and are supporting care homes to decrease inappropriate antibiotic prescribing for UTIs with the ‘To dip or not to dip’ tool. The report was noted by the committee.

QRC/18/100

Smoking at the Time of Delivery Update The Committee were informed that an update had been received by the Governing Body, and this committee will now be expected to monitor SATOD on a quarterly basis. SATOD will also be built into the quality indicators to ensure alignment.

• ACTION: Fay Bradley to add SATOD to the forward work planner. It was noted that funding for the roll out of the ‘Love Bump’ media campaign had been approved, and Primary Care colleagues would be taking this forward in the new year.

QRC/18/101 Quarterly CHC Update The CHC Oversight Group provided a quarterly highlight report providing an initial update on the integration of CHC delivery into the Mid-Notts CCGs, performance in relation to the CHC quality premiums and current risks for the service. The committee was informed that quality premium performance has fallen below target. It has been identified that these are linked to a backlog of learning disabilities assessments compounded by the initial lack of CHC nurse assessor capacity in the learning disabilities team. In order to ensure continuous delivery of the 28 day target the Mid-Notts CHC team have developed an action plan. Assurance was given that improvement will be seen by Quarter 4, with the expectation that the trajectory will be met. The Chair advised that this risk had not been raised previously and asked that the CHC Oversight Group (sub group of QRSC) seeks assurance around performance and provides update reports and escalates issues to this committee .

• ACTION: Action plan to be RAG rated. CHC oversight group highlight report to provide additional assurance at next QR&SG committee around QP performance

The committee were made aware of a risk to patient level data in regards to the archiving of historic patient information and CHC assessment records that are held on a G-Drive owned and managed by Nottingham CityCare. Assurance has been provided that the information is being held correctly, and that as the information owner is CityCare they are responsible for this data. This along with any emerging CHC risks are on an issues log monitored by the CHC Oversight Group and any

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issues will be escalated to this committee if required.

QRC/18/102 Patient Story The committee were in agreement that the EOL patient story that was presented for review, after previously being presented at the EOL programme board did not provide enough detail or link to strategic objectives, and therefore could not be taken to January’s Board Meeting. The story needs to be reframed and more clarity and context included. It was suggested that the story should show both the patient journey previously and what the patient journey now looks like. It should also make reference to Single Point of Access and include a clinical EOL perspective. • ACTION: Patient experience team to review and update the EOL story.

QRC/18/103 Flu – Care Homes and Secondary Healthcare Sue Barnitt reported that there was a robust and standardised approach/process in place across mid Notts and Greater Notts CCGs to respond to reported flu cases. Care homes have been asked to record both staff and residents that have received a flu vaccination. To date only 25% of nursing homes have returned flu vaccination uptake data as part of monthly quality monitoring submissions. Uptake for both residents and staff is variable across providers however it is of note that very few staff are reported to have received flu vaccinations to date. An update was provided for both SFHFT and NUH, noting that both secondary care providers aim to achieve 75% of frontline staff vaccinated by 28th February 2019. Recommendations were as follows:

1. Working group involving CCG primary care, quality and IPC teams to look at how high risk cohorts of patients may be identified and vaccinations offered.

2. Quality team to continue to monitor monthly quality monitoring data submissions from nursing homes and understand in more detail barriers impacting on low uptake.

3. Seek assurance from SFHFT re offering of Influenza Vaccination Programme for eligible women receiving maternity care from SFHT.

4. Continue to monitor NUH progress against CQUIN 1c target The report was noted by the committee.

QRC/18/104 Harwood Close Evaluation The committee were provided with a report on the patient experience of the practice merger and relocation of Harwood Close and Ashfield Medical Centre, and the Underwood branch site closure. Significant communication and engagement activity has been undertaken ahead of the merger and site closure; patient surveys have on the whole provided positive feedback and no significant negative social media reports had been noted. It was suggested that the ongoing telephone access issues highlighted by the Kings patients was not directly linked to the site closure or practice merger. Work is ongoing with the two practices, and the patient participation groups are very involved. The chair thanked the Primary Care team for the report. She commented that the Jacksdale feedback was evidence of the huge efforts of the Director and his team with the local community and its leaders. She however expressed disappointment regarding the very low numbers of responses from Kings, with those having replied expressing concerns around access and availability of appointments. She asked

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that consideration in future be given to greater involvement from PPGs to get more feedback and that in the meantime the access issue be referred back to QPMRG for consideration The report was noted by the committee.

QRC/18/105 Underwood Closure Evaluation Discussed as part of QRC/18/105 – Harwood Close evaluation.

QRC/18/106 Report from EQIA Sub Group The committee were informed that a total of 40 EQIA were completed during quarter 2. In addition the Alliance EQIA have drafted a shared joint sign off process, shared stage 1 EQIA, stage 2 EIA and stage 2 QIA. Once agreed, these can be used instead of existing single organisation forms for shared projects to avoid duplication of work across the system. This will be agreed by the Alliance before the end of the year. Each form will need approval from the Better Together Transformation Board, however this committee were happy to endorse and support the joint process.

QRC/18/107 Quality Performance report The IPR exception report and Quarter 1 Dashboard were provided to the committee for oversight and assurance. The Dashboard includes all providers of note including those where we are associate commissioners. Sue Barnitt provided the quality performance highlights:

• Increase in cases of C.Diff noted across the wider system. Many cases are reported as unavoidable and where lapses in care are identified these are acted upon and action plans developed. Some early indications of inappropriate prescribing across primary care which has been flagged with medicines management teams and individual practices. M&A CCG have seen double the community acquired cases when compared with the same time period as last year whereas N&S have seen a general increase in total cases. Paper to be presented to QRSC in early 2019 detailing concerns regarding increase in incidence.

• SFHT, NUH, NHCT, ULHT, EMAS and NEMS remain below the appraisal compliance target of 95%. As winter pressures begin to take hold it is likely that compliance may remain static.

• SFHT, NUH, NHCT, ULHT, EMAS remain below the standardised target of 4.2% for staff sickness. As winter pressures begin to take hold it is likely that compliance may remain static or deteriorate for some providers.

• GP uptake of Learning Disability Health Checks is variable across localities, with some practices making good progress and others showing limited improvements. Average compliance for each CCG is just under 25%.

Sue Barnitt reported that there was limited data for ULHT last month, due to their different reporting cycle.

• ACTION: Dashboard to be provided as an excel spreadsheet rather than an Adobe file at future meetings in order that members can interrogate the data more easily.

Sue Barnitt added that additional indictors can be added to the Dash Board as and when required.

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Review of Quality Risks Risk 5 (Risk to service change due to workforce) – As a commissioning/primary care representative was not at this meeting, the risk could not be fully discussed. It was agreed it would be brought back to the next meeting for discussion. Risk 7 (EMAS) – It was agreed to maintain the rating at its current level. Risk 23 (ULHT) – As discussed under item QRC/18/97, Sue Barnitt is currently awaiting a response from lead commissioners. Until a response has been received it was agreed to maintain the rating at its current level.

QRC/18/108 Safeguarding Assurance Group Highlight Report The committee were provided with a report from the Safeguarding Assurance Group. Val Simnett noted that a county public health commissioner has been added to the group membership Val Simnett reported that a public health representative had presented proposals for a regional adoption agency for Notts and Derbyshire and new medical advisor roles. There are issues regarding capacity to provide assessments of prospective adoptive parents within current GP contracts. A detailed paper has been produced; the committee were in agreement that Val Simnett should consult with David Ainsworth before the paper is presented at an Executive level meeting.

• ACTION: Val Simnett to discuss the proposed regional adoption agency paper with David Ainsworth before presenting it at an Executive level meeting.

The report was noted by the committee. The committee were in agreement that the Safeguarding records review paper should be discussed under the confidential section of the agenda.

QRC/18/109 Policy approval The committee were in agreement this section should be discussed under the confidential section of the agenda.

QRC/18/110 Business Continuity Plan The committee were in agreement this section should be discussed under the confidential section of the agenda.

QRC/18/111 Corporate Governance highlight report The committee were informed that mandatory training figures are showing an improvement. We are working to adopt an internal dashboard to mirror that in place for providers and provide greater assurance and oversight of compliance rates. Ruth Lloyd added that there was a need to have control of contracted staff in order to instruct that mandatory training is completed before staff commence in their post, and continues to work with HR to put this in place. Monthly face to face IG sessions will be running from February as well as Governing Body safeguarding training. Review of Corporate Risks Risk 15 (Mandatory Training) – It was agreed that the risk would need to be re-written to ensure the risk is captured correctly.

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• ACTION: Ruth Lloyd to work with Sue Bowskill to re-write risk 15.

Ruth Lloyd reported that based on HSE Best Practice and in regards to the office risk assessment, a health and safety manual will be worked up with assistance from 360 assurance. The manual will be brought to this committee for review once complete. Ruth Lloyd added that the GDPR action plan had now been through the assurance process. The action plan will come back to this committee for review.

• ACTION: Ruth Lloyd to share GDPR action plan.

QRC/18/112 Any Other Business There was no further business for discussion.

QRC/18/113 Agreement of the escalation of new risks or issues and key messages to the Governing Bodies or other Committees

• Controlled Drugs (CD) and Medicines Safety Officers (MSO) reports provided positive messages

• SATOD update – Love Bump and Primary Care work • CHC issues – trajectory to deliver Q4 • Flu – praise provider staffing vaccinations

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Progress Report from the

Clinical Effectiveness Committee

Date of committee: 21 February 2019

Key Achievements • AGREED to receive case studies / pilots to provide clinical critique and endorse as appropriate.

Briefing list will be presented every month to help provide focus and priorities for PCNs.

• APPROVED implementation of change in the gynaecology post-menopausal bleed pathway. The strategy aimed to revise the current care of patients with post-menopausal bleeding in order that they can be reassured and assessed in a routine way within primary care to identify the cause of their bleeding. This would reduce the patient referrals to Sherwood Forest Hospitals and streamline the gynaecology pathway.

• APPROVED the end of life documentation. • DISCUSSED the Member Practice Agreement. The Agreement was approaching its biennial

renewal date of May 2019 and had been refreshed to reflect the changing landscape in relation to Primary Care Networks.

• NOTED the CCGs feedback, featuring an update on quality and performance, finance, ICS and

the CCG consultation. Issues Actions Concern expressed that there may be individual GPs who lacked the expertise to undertake gynaecological examinations and needed further supervision, training or support.

An offer of training and supervision to be included in ‘Snippets’ communication to practices.

Concern expressed in regard to attendance and behaviour at the PLT.

Letter to be distributed to all practices highlighting observations and professional conduct, requesting the practice acknowledge, sign and return.

Risks Actions No risks to raise.

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Minutes of the Meeting in Common of NHS Mansfield and Ashfield and NHS Newark & Sherwood Clinical Commissioning Group

Clinical Effectiveness Committee

Held on Thursday 17 January 2019, 1.00-5.00pm

Meeting Rooms 2/3, Birch House Present: David Ainsworth Director of Primary Care Dr Thilan Bartholomeuz Clinical Chair, Newark and Sherwood CCG Dr Doug Black Chairman NEMS Community Benefit Services Ltd Chairman EM Affiliated Commissioning Committee Honorary (Consultant) Assistant Professor, University of Nottingham, School of Medicine Michael Cawley Chief Finance Officer Jonathan Cummins Practice Manager, Middleton Lodge Lucy Dadge Chief Commissioning Officer Dr Subash Das GP, Sherwood Medical Partnership Dawn Jenkin Consultant in Public Health Dr Hilary Lovelock GP, Brierley Park Medical Practice Dr Gavin Lunn Clinical Chair, Mansfield and Ashfield CCG (Chair) Luella Robb Nurse Practitioner, Lombard Medical Centre Dr Milind Tadpatrikar GP, Roundwood Surgery In attendance: Rachel Bradley Executive Assistant to the Chief Officer (minutes) Sarah Carter Interim Director of Turnaround Dr Nigel Marshall Clinical Lead Dr James Mills Clinical Lead, Urgent and Proactive Care Dr Andy Sommers Clinical Lead, Mental Health Dr Stephen Wormall Clinical Referral Advisor

Item Action CEC/19/01 Apologies for absence

Apologies were received from:

• Amanda Sullivan • Vicki Clarke • Ian Jackson • Stuart Poynor

CEC/19/02 Declarations of Interest Declarations of Interest were as reported on the Register of Interest made available at the meeting. It was noted there were no potential or actual conflicts declared in relation to the business to be transacted at the meeting and all present would remain in the meeting at this point.

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Item Action

Ms Jenkin advised that she had been omitted from the Declarations of Interest. Ms Jenkin reported that she was a commissioner of public health services. ACTION: Miss Bradley to liaise with Corporate Governance to request Ms Jenkin be included.

RB

CEC/19/03 Minutes and actions from the Clinical Effectiveness Committee The minutes of the meeting held on 13 December 2018 were agreed as an accurate record of discussion, with the exception of one minor grammatical error. CEC/18/72/Nottinghamshire Citizen Facing Digital Services Strategy – Mr Cawley made reference to the finalisation of the specification and procurement of the system which had been discussed at the last meeting; and queried what the process and implications this had for the CCGs. Mr Cawley stated that it sounded the right thing to do, but as a statutory organisation it needed to be understood what the quality implications were, what the procurement gateways were, if any; and what resource was required. Dr Lunn advised that the presentation contained no procurement or financial content and that the discussion had been centred around the clinical direction. This had been emphasised recently in the 10 Year Plan. Dr Lunn stated that it was currently work in progress and the business case had not yet been presented. Members had endorsed the strategic intention at the last meeting of the Clinical Effectiveness Committee. It was acknowledged that the CCGs would need to navigate through its own governance processes. Dr Bartholomeuz and Dr Macdougall joined the meeting. CEC/18/74/AF ADVANCE Programme: Advancing AF diagnosis and management – Mr Cawley queried reference made to the suggestion that £0.5m be allocated to the prescribing budget in order to fund the programme; and whether this was a statement or an agreement. Dr Lunn advised it was a suggestion and the ‘free offer’ would be worked through in the first instance. It was noted that the committee had approved 10 practices signing-up for implementation of the mobile ECG devices, adopting a phased approach in order to review feedback. There would be close links with Rightcare to look at reducing variation around AF diagnosis.

CEC/19/04 Nottinghamshire Gestational Diabetes Pathway Ms Robb presented an overview of the Nottinghamshire Gestational Diabetes Pathway. The pathway had been approved by the Nottinghamshire ICS Clinical Reference Group on 11 October 2018. The pathway had been subject to Public Health England

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Item Action

Scrutiny through case study approach. Launched on 3 October 2017 in Greater Nottingham the pathway had resulted in achievement of key outcomes. Ms Robb advised members that the presentation included with the papers was the version that had been presented to the ICS Clinical Reference Group and a lot of issues that had been referred to how now been resolved. Members were being asked to endorse the pathway in order to standardise processes across Nottinghamshire. Benefits would include the implementation of one single aligned pathway to ensure all women with Gestational Diabetes were offered follow up care in a consistent way. In addition, it also ensured clarity of responsibility to determine where care should be delivered at different stages of pregnancy. A discussion ensued in respect of appointment waiting times for those women with Gestational Diabetes. It was suggested by some clinical members that this should be reduced to 6 weeks as part of their first appointment for the convenience of the patient. However, some felt that it should be 8 weeks in order to keep the practice nurse and GP appointments separate to provide dedicated time and so it did not ‘get lost’. It was thought that the benefit of any actions could be seen by the 13 week blood test. Ms Jenkin stated that there was an opportunity to provide an impact on lifestyle and suggested that lifestyle services were firmed up as part of the formal pathway to reiterate and remind staff there were services such as weight management to refer into. In response to a comment expressed that the pathway did not feel robust in regard to goals and objectives, Ms Robb stated it was a starting point that worked well in Greater Nottingham. It was noted that some members felt the pathway was excellent. The Clinical Effectiveness Committee reviewed the strategic intentions detailed within the strategy and ENDORSED completion of the Nottinghamshire Gestational Diabetes Pathway.

CEC/19/05 Early Inflammatory Arthritis (EIA) Clinic Mr Wormall presented a pathway which would stream referrals into a dedicated EIA clinic. It was noted that NICE stated that patients with suspected rheumatoid arthritis should be referred to a specialist team and reviewed within two weeks. This was to prevent delay in the initiation of DMARD therapy. The Rheumatology team at Sherwood Forest Hospitals were enabling a dedicated EIA service in 2019. Patients were to be streamed by the MSK hub into these clinics. To enable this process GPs were requested to be aware of the criteria and use the

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Item Action

EIA template that would ensure correct streaming at the MSK hub. Other urgent referrals would not be streamed into the EIA clinic. Mr Wormall reported that the first clinic would be opening in mid-February, subject to the Committee’s approval. It was noted that once a referral was made, it would be triaged. If EIA was suspected, the patient would be referred to the EIA Clinic. Templates would be made available to GPs so that they could order baseline tests in readiness for the EIA Clinic. Members noted that radiography of the hands and feet were included in the list of tests for speeding up the diagnostic process when historically this was not included. Dr Wormall advised that radiography would take place if clinically appropriate, i.e. if synovitis was affecting these joints. It was noted that sometimes radiography may already have been undertaken and therefore it was suggested that if a patient had received radiography within the last 3 months, they could be discluded. ACTION: Dr Wormall to seek advice from the Rheumatology team in respect of timelines for radiography. Mr Ainsworth queried whether the pathway needed to be presented to the Finance, Performance and Turnaround Committee in respect of governance process. Members agreed it would be useful in order to assure the committee in respect of waiting times and ensuring patients were seen with the agreed period. Waiting times would be measured in respect of KPIs. Dr Wormall advised that GPs were good at picking up cases, but the issue was in regard to patients not being seen quick enough for the intervention to make a difference. It was hoped that if patients were seen quickly, A&E attendance and admissions would reduce. Dr Wormall advised that the hub would be reviewing referrals to ensure patients were being referred correctly. Mr Jonathan Cummins joined the meeting. The Clinical Effectiveness Committee APPROVED the EIA pathway to stream referrals into a dedicated EIA clinic.

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CEC/19/06

10 Year Plan Dr Lunn presented a summary of the 10 Year Plan. The importance of cascading the plan via primary care networks was stressed. A Task and Finish Group was suggested to ensure the message was communicated efficiently. Members agreed it was a useful opportunity to start interpreting the plan and strengthen networks.

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Item Action

Members noted that the 10 Year Plan summary would provide a good precis of where the CCGs were against plan and help to build on the foundations built so far. The importance of ensuring connections were right for the hub were stressed. Mr Ainsworth agreed that the key points of the 10 Year Plan needed to continue to be fed to staff as it was easy to forget the aim of the plan and what it needed to achieve. Mr Ainsworth suggested that it would be worth exploring through Communications in respect of whether staff could dial-in to communications via webinar whilst in practice. Ms Jenkin advised that in respect of Public Health there potentially could be big changes following publication of the plan. Ms Jenkin stated that it was encouraging to see the plan restate the commitment for long-term prevention. In response to a query in regard to the role the CCGs would play in regard to drawing up the local plan by April 2019, Ms Dadge advised this was part of the normal annual planning process. It was noted that there was a Planning Group established and work was ongoing. The Clinical Effectiveness Committee NOTED the 10 Year Plan summary.

CEC/19/07 CCG Feedback Mr Ainsworth reported the following: Quarter 4 The CCGs were on track with the delivery of QIPP as at Month 9, but remain under significant pressure. This was mainly due to the amount of activity going into secondary care. Planning Predominantly the CCGs were wanting to build on work already undertaken with the Alliance for system approach in 2019/20 in order that providers could take out the cost and hopefully align incentives. QIPP QIPP project ideas were still required for 2019/20. ACTION: GPs to take the message to their primary care network meetings and feedback to Mr Ainsworth accordingly.

Clinical members

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Item Action

Consultation The consultation for the CCG merger would commence on Monday 21 January with the first wave starting with the Directors and first tier reports. Mr Ainsworth to keep members updated on progress. Reference was made to extended access and GPs asked how this could be made more useful to take demand out of the system. Mr Ainsworth advised that he was making good progress with NEMS and DHU in respect of 111 and increasing extended access this year. For example, NEMS undertaking triage by telephone. Dr Lunn advised that pre-bookable appointments could work, i.e. model for triage with non-urgent patients being seen the next day. The Clinical Effectiveness Committee NOTED the CCG feedback.

CEC/19/08 Identification of New Risks The Clinical Effectiveness Committee identified the following risks with the committee:

• Under significant pressure for Q4, which was already addressed through the Finance, Performance and Turnaround Committee.

• Merger of the CCGs, which would be addressed through the Governing Body.

There were therefore no new risks for the Clinical Effectiveness Committee.

CEC/19/09 Progress Reports of CCG Sub-Committees Progress reports for the following meetings were circulated for information. • Quality, Risk and Safeguarding Committee – 20 December

2018. Dr Marshall reported that at alternate monthly meetings, deep dives were being undertaken in order to assure the committee. In response to a query from Mr Cawley in regard to whether the risks were documented in the Board Assurance Framework, Dr Marshall stated he would need to check.

ACTION: Dr Marshall to confirm that the risks were documented in the Board Assurance Framework. • Mid-Notts Joint Prescribing Group – 20 September and

21 November 2018. There was reduced capacity due to Medicines Management team turnover. They were looking to potentially recruit a technician and pharmacist.

• Cancer Team Meeting – 28 November 2018. It was noted that

NM

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Item Action

a paper was being written for the Governing Body in regard to the suspected data collection issue on the Infoflex system.

• Integrated Performance Report - Mr Cawley reminded members

that the report was considered at Finance, Performance and Turnaround Committee and the Governing Body.

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Schedule of Actions

Agenda ref Action Responsibility Progress

CEC/19/02 Declarations of Interest

Miss Bradley to liaise with Corporate Governance to request Ms Jenkin was included.

RB Completed.

CEC/19/05 Early Inflammatory Arthritis (EIA) Clinic

Dr Wormall to seek advice from the Rheumatology team in respect of timelines for radiography.

SW Completed. The X rays need repeating if older than one year.

CEC/19/07 CCG Feedback

GPs to take the message back to their primary care network meetings in regard to QIPP project ideas.

GPs Progress unknown. Dr Lunn and Dr Bartholomeuz to take to the next Primary Care Network meeting.

CEC/19/09 Progress Reports of

CCG Sub-Committees

Dr Marshall to confirm that the risks relating to the Quality, Risk and Safeguarding Committee were documented in the Board Assurance Framework.

NM Completed. The risks presented are all part of the risk register. Those which score 12 or above are escalated to the Board Assurance Framework – where they are presented and considered by Governing Bodies. QRSC consider all their risks at each meeting, and affirm the mitigating actions.

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Progress Report from the Chair of the Audit Committee

Date of Meeting: 14 February 2018

Key Achievements

The Audit Committee noted the following areas to be highlighted to the Governing Body with regard to the business conducted at the Audit Committee meeting which took place on 14 February 2019.

The risks/issues to be highlighted to the Governing Body are as follows:

• Outline Internal Audit and Counter Fraud Plan 2019/20: The Committee DISCUSSED the Outline Internal Auditor and Counter Fraud Plan which include outline proposals for the provision of Internal Audit services in shadow form from 1 April 2019 for the Greater Nottingham and Mid Nottinghamshire CCGs.

• Head of Internal Audit Stage 2 memo: The Internal Auditor presented the Stage 2 Head of Internal Audit memo which reports on the review of the CCG’s strategic risk management arrangements and operation of the Assurance Framework in the year to date. Stage 2 has oversight of the format and content and reports on the results of the Governing Body survey, the results of which were in line with expectations. The Internal Auditor confirmed that the response rate was higher than in previous years.

• External Audit Plan 2018/19: The Committee welcomed Mr Andrew Cardoza (Mr John Cornett’s successor as External Audit Director for KPMG), along with Mr Sundeep Gill (External Audit Manager). The gentlemen presented the External Audit Plan 2018/19 which was APPROVED by the Committee. The plan details the proposed work to be undertaken for the audit of the CCG’s financial statements for 2018/19. It also outlines the work that needs to be carried out by KPMG to enable value for money conclusions to be reached. The Committee thanked the External Auditors for providing a Plan that was very logical and easy to understand.

• Assurance Framework: The Assurance Framework for Quarter 3 was presented to the Audit Committee and the Committee NOTED that the scoring for both SR1 and SR3 have been reduced whilst SR25 and SR6 have increased.

Risk 14 has been escalated to the Assurance Framework with a revised score increase. The increase, proposed by Finance, Performance and Turnaround Committee, relates to the RTT (Referral to Treatment) standards breach by Sherwood Forest Hospitals.

There is an additional paragraph at section 2.9 of report – Emerging Risks – as consideration should be given to whether there are any emerging risks that require detailing on the Corporate Risk Register.

The Committee AGREED that a new risk relating to ‘identifying staff capacity during the merger process’ would be created and presented to the Governing Body in April.

• Cyber Security: The Committee received ASSURANCE from the Cyber Security progress update presented by the Director of Nottinghamshire Health Informatics Service (NHIS). The Director summarised the technical wording to confirm that anti-virus ‘patches’ had been installed

1 Progress Report MACCG 14.2.19 Audit Committee (FINAL v27.2.19)

on all servers and devices and NHIS had the technology to scan for unpatched devices and to remove these from the network. It was also confirmed that the Wannacry cyber attack in May 2017 was due to a vulnerability because a patch had not been applied.

• Annual Accounts Preparation: The Committee received an update in terms of the CCG’s progress towards the annual accounts preparation for 2018/19 and APPROVED the proposed accounting policies of the CCG.

• Internal Controls - Non-Financial: The Committee received ASSURANCE on the non-financial internal controls for the CCG relating to :

o Conflicts of Interest Quarterly Return; o Whistleblowing Register (Freedom to Speak Up) – nil return; o Gifts and Hospitality Register – nil return; o Suspension of Standing Orders – nil return.

• Internal Controls - Financial: The Committee received ASSURANCE on the financial internal

controls for the CCG relating to the Suspension of Standing Financial Instructions – for which there was a nil return.

• Amendment to Authorised Signatories: The Committee APPROVED the amendment to Authorisation Limits to reflect recent staffing changes and to meet operational need.

• Reports from Governing Body Sub-Committees: The Committee received ASSURANCE from the Progress Reports of the following CCG meetings :

o Primary Care Commissioning Committee – 10 January 2019; o Quality, Risk and Safeguarding Committee - 20 December 2018.

Issues / Risks Corresponding Actions

• Corporate Risk Register:

The Committee AGREED there was no risk on the Corporate Risk Register relating to ‘identifying staff capacity during the merger process’.

• A new risk ‘identifying staff capacity during the merger process’ to be created and presented to the Governing Body in April.

2 Progress Report MACCG 14.2.19 Audit Committee (FINAL v27.2.19)

Information Governance, Management & Technology (IGMT) Committee Highlight Report

18 January 2019

• The Committee received the updated annual work programmes for 2018/19 and 2019/20; both now make reference to GP Information Technology (IT) provision, the Committee’s it oversees and the IT capital bids process.

• The Committee agreed that it will continue to submit an annual report to the Governing Bodies to demonstrate that all delegated responsibilities have been discharged. This report will be extended to incorporate the annual Caldicott Guardian report.

• The inaugural Operational Delivery Group is due to take place during February 2019. The Group will provider Director level oversight for Information Governance, Management and Technology projects and priorities for the six Clinical Commissioning Groups.

• The Committee received the quarter three Information Governance Assurance Report and were advised that the key area of focus is the completion of the project work required to meet the mandatory assertions for the annual Data Security and Protection Toolkit (DSPT) submission. Meeting the 95% Data Security Awareness Training compliance threshold remains a challenge however work is taking place to address this, with classroom based sessions available to staff unable to access the online training module.

• The Committee was advised that there are seven IGMT risks currently documented on the organisational risk register; three of these have been updated since the December 2018 meeting, however, there has been no change to the risk scores and profiles. The identification and management of partnership and system risks remains an area of focus; planned work to ensure that all risks identified within partnership forums are systematically captured and transferred to the risk register is underway.

• The Data Quality Report identified that Nottingham University Hospitals NHS Trust (NUH) Healthcare Resource Group (HRG) four coding (used for identifying national tariff cost) is now above the national average. The Committee commended this improvement.

• The Removable Media Policy was approved subject to additional amendments and clarification around identified areas of ambiguity.

The Information Governance, Management and Technology Committee is managed by Rushcliffe Clinical Commissioning Group (CCG) on behalf of Nottingham West CCG, Nottingham North and East CCG, Mansfield and Ashfield CCG and Newark and Sherwood CCG

Information Governance, Management and Technology Committee RATIFIED Minutes of the meeting held on 04 December 2018, 15:00 – 17:00

Chappell Room, Civic Centre Arnot Hill Park, Arnold, Nottingham NG5 6LU

Present: Sue Sunderland Lay Member (Chair), Greater Nottingham Clinical

Commissioning Partnership Nichola Bramhall Chief Nurse and Director of Quality, Greater

Nottingham Clinical Commissioning Partnership (Caldicott Guardian)

Lucy Branson Corporate Director, Greater Nottingham Clinical Commissioning Partnership

Mick Cawley Chief Finance Officer, Mid-Nottinghamshire CCGs (SIRO)

Andy Hall Director of Performance and Information, Greater Nottingham Clinical Commissioning Partnership

David Heathcote Lay Member, Mid-Nottinghamshire CCGs Dr Mike O’Neil GP Representative, Greater Nottingham Clinical

Commissioning Partnership In attendance: Helen Clark Governance Officer (minutes) Ruth Lloyd Head of Corporate Governance, Mid-Nottinghamshire

CCGs Apologies: Terry Allen Lay Member, Greater Nottingham Clinical

Commissioning Partnership Loretta Bradley Head of Information Governance, Greater Nottingham

Clinical Commissioning Partnership Elaine Moss Chief Nurse and Director of Quality and Performance,

Mid-Nottinghamshire CCGs’ (Caldicott Guardian) Dr Carter Singh GP Representative, Mid-Nottinghamshire CCGs’ Gary Thompson Chief Operating Officer, Greater Nottingham Clinical

Commissioning Partnership, SIRO

Cumulative Record of Members Attendance (2018/19) Name Possible Actual Name Possible Actual Nichola Bramhall 3 1 Sue Sunderland1 1 1 Elaine Moss 3 0 Terry Allen1 1 0 Mick Cawley 3 3 Lucy Branson1 1 1 Gary Thompson 3 0 Andy Hall 3 3 Dr Carter Singh1 1 0 Jaki Taylor2 2 2 Dr Mike O’Neil 3 3 Ruth Lloyd2 2 2 David Heathcote1 1 1 Loretta Bradley2 2 2 1Membership commenced as at December 2018 2Membership ceased as at July 2018

Item Introductory Items

IGMT 18 083 Welcome and apologies for absence Sue Sunderland welcomed everyone to the Information Governance,

Management and Technology Committee and a round of introductions was made. Apologies were noted as above.

IGMT 18 084 Confirmation of quoracy It was confirmed that the meeting was quorate. IGMT 18 085 Declarations of interest for any item on the agenda

No interests were declared in relation to any item on the agenda. The Chair reminded members of their responsibility to highlight any interests should they transpire as a result of discussions during the meeting.

IGMT 18 086 Management of any real or perceived conflicts of interest As no conflicts of interest had been identified, this item was not necessary for

the meeting. IGMT 18 087 Minutes of the meeting held on 20 July 2018

It was agreed that the minutes were an accurate record of the meeting.

IGMT 18 088 Action log and matters arising from the meeting held on 20 July 2018 The action log was reviewed and the following actions discussed:

(a) It was agreed that action IGMT/18/026 and IGMT/18/008 were operational actions that no longer fell within the remit of the IGMT Committee. They will remain on the action log until Lucy Branson has identified an appropriate forum for onward referral.

All other actions were noted as ongoing or complete and there were no further matters arising.

Items for Discussion/Information

IGMT 18 089 Terms of Reference and Forward Work Programme

Lucy Branson presented this item. The following key points were highlighted: (a) The Terms of Reference have been approved by all six Governing

Bodies. (b) Members are asked to be mindful that meetings dates for the remainder

of 2018/19 are being finalised, but it may not be possible to get a full complement of members present at each meeting.

(c) Dates for meetings throughout 2019/20 have been set. (d) It is proposed that lay membership is been bolstered from two members

to three to support the Committee’s ability to provide the desired level of scrutiny and assurance.

(e) An initial work programme has been produced for the remainder of 2018/19 and 2019/20; however, this will need to be further developed as the Committee evolves.

The following points were made in discussion: (f) There is a complex operational delivery meeting infrastructure that

members are keen to understand. (g) It will be the responsibility of the relevant IGMT Committee member to

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Item convert the information discussed at the various operational delivery meetings into an assurance report.

At this point Dr Mike O’Neil joined the meeting. (h) Members are keen to understand where risks related to operational

delivery are escalated to. (i) Members agreed that the forward work programme needs to include; an

annual update on GP IT provision, a policy work programme, and the IGMT Strategy for annual review.

(j) It was also noted that moving forward the quarterly information governance assurance report will include an update on the Data Security and Protection Toolkit and General Data Protection Regulation in a single report.

(k) The forward work programme will continue to develop, and as such, will be included on subsequent agendas for review and input.

At this point Nichola Bramhall joined the meeting. (l) The work plan also needs to align with the Estates and Technology

Transformation Fund (ETTF) cycles to enable the Committee to be sighted on priorities and enable colleagues to respond to short notice requests from NHS Digital to make capital bids.

The Committee:

• RECEIVED the terms of reference and SUPPORTED the proposed increase to lay membership.

• REVIEWED the draft Annual Work Programme for the remainder of 2018/19 and 2019/20.

• NOTED that meeting dates are currently being finalised for 2019/20. ACTIONS:

• Lucy Branson to update the forward programme to include an annual update on GP IT provision, a policy work programme, the IGMT Strategy for annual review and IT capital bid priorities.

• Andy Hall to liaise with Andy Evans regarding bring a paper to the January 2019 meeting to agree the IT priorities to support capital bids.

• Lucy Branson and Mick Cawley to seek approval from the Governing Bodies to increase the lay membership of the IGMT Committee from two to three members.

IGMT 18 090 Operational Delivery Infrastructure Lucy Branson gave a verbal updated regarding the Operational Delivery

Infrastructure. The following key points were highlighted: (a) There is a shared ambition to establish clear arrangements for the

oversight of operational delivery regarding the IT, information management and information governance agendas.

(b) Andy Hall and Lucy Branson will meet with Jaki Taylor, Director of Nottinghamshire Health Informatics Service (NHIS), to test whether the existing NHIS meeting infrastructure relating to cyber security remains fit for purpose, and to identify areas requiring refinement.

(c) The establishment of an IGMT Operational Delivery Group for the six

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Item CCGs will provide assurance to the IGMT Committee that operational workstreams are being effectively managed and delivered.

The following points were made in discussion: (d) Members are supportive of streamlining the existing operational delivery

infrastructure. (e) It was reiterated that there needs to be clear governance around where

risks to operational delivery are reported and at what point they need to be escalated to the IGMT Committee.

(f) Identified gaps in the existing infrastructure will be identified and a report will come back to the January 2019 Committee for review.

The Committee:

• NOTED the verbal update. ACTION:

• Andy Hall and Lucy Branson to meet with Jaki Taylor, Director of Nottinghamshire Health Informatics Service (NHIS), to test whether the existing NHIS meeting infrastructure relating to cyber security remains fit for purpose, and to identify areas requiring refinement.

IGMT 18 091 IGMT Strategy Andy Hall presented this item. The following key points were highlighted:

(a) The CCGs are four years into a five year strategy; it is reviewed annually to ensure it continues to align with national and local priorities.

(b) The strategy reflects local ambition, the work required to meet the CCGs’ obligations in line with national standards and links to emerging Integrated Care System priorities.

(c) When the Local Digital Roadmap was produced, Nottinghamshire was an exemplar and has been more successful than other organisations at attracting capital bids.

(d) As per national requirements the CCGs are obliged to ensure all GP Practices can operate a GP System of Choice (GPSoC) compliant system. In Mid-Nottinghamshire all practices operate a GPSoC compliant system. In Greater Nottinghamshire, 80% of practices use TPP SystmOne system and 20% use EMIS Web.

(e) There is a general trend to move over to SystmOne, as this will allow practices to have shared access to patient records.

(f) There is a national directive to move to a new Health and Social Care Network (HSCN) which will replace the N3 Connection.

(g) The Medical Interoperability Gateway (MIG) has been implemented and enables information to be accessed across the system.

(h) Assistive technology will be implemented where clinical benefit can be identified.

(i) Some of the proposed initiatives have already been implemented as the strategy has come to the IGMT for endorsement later than desired.

The following points were made in discussion: (j) The summary provided by Andy gave context to the strategy, which

members appreciated. (k) Members are keen to see the strategy accompanied by a work plan

reflecting the CCGs’ priorities and the elements of the strategy that the Committee needs to seek assurance on as part of its delegated responsibilities.

(l) Designing a strategy beyond three years into the future is challenging

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Item given the changing health and social care landscape.

(m) Members are keen for an executive summary to accompany the strategy when it is submitted to the Governing Bodies to contextualise what is currently being delivered and the impact this will have on both the patient and the practitioner.

(n) It is suggested that the first output of the Operational Delivery Group (once established) is to summarise the benefits to patients in achieving the strategy.

(o) It is recognised that in some instances, cultural attitudes to technology rather than the technological tools themselves are the obstacle to implementation.

(p) The CCGs have a responsibility to ensure systems are compliant with national standards.

(q) It is recognised that a delay in endorsing the strategy for approval to the Governing Bodies could pose a risk as it is needed to support the capital bids submission to NHS Digital.

The Committee:

• ENDORSED the refreshed IGMT Strategy for submission to the CCGs’ Governing Bodies for approval.

ACTION:

• Andy Hall to liaise with Andy Evans about producing a twelve month work plan to draw out the elements of the strategy that the IGMT Committee is seeking assurance on as part of its delegated responsibilities.

Items for Assurance

IGMT 18 092 General Data Protection Regulation (GDPR) Update Lucy Branson presented this item. The following key points were highlighted:

(a) The paper provides an update on compliance with the requirements of the EU General Data Protection Regulation (GDPR).

(b) To ensure preparedness, implementation plans had been developed using the Information Commissioner’s Office’s ’12 Steps to GDPR Compliance’ guidance.

(c) An overview of the actions taken to date is set out in the report, along with a description of the ongoing ‘business as usual’ activities that will ensure continued compliance.

(d) Key areas of ongoing work relate to the annual data flow mapping and information asset register refresh and the work to continue to embed ‘privacy by design’ principles within commissioning processes.

(e) 360 Assurance conducted an audit of GDPR preparedness and both Mid-Nottinghamshire and Greater Nottingham CCGs’ have received significant assurance, with only a small number of low risk issues identified.

(f) A review of the interim DPO appointment in Greater Nottingham has been completed and it has been agreed that the preferred approach to assignment of this role needs to be aligned across the six CCGs. An options appraisal has been undertaken which recommends that the role is assigned to the Information Governance Leads on a permanent basis.

The following points were made in discussion: (g) The new Data Security and Protection Toolkit is designed to ensure that

organisations’ are GDPR compliant.

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Item (h) The Information Governance Alliance (IGA) is clear that the DPO does

not need to be a member of the Governing Body. (i) The DPO needs to have expert knowledge and the outline of the role

requirement aligns with the Head of Information Governance’s job description.

(j) The allocation of the DPO role to the Information Governance Leads is supported by Committee members.

The Committee:

• RECEIVED the GDPR compliance update; • ENDORSED the assignment of the DPO role to the Information

Governance Leads. Approval will be sought from the Governing Bodies for this role to be formerly assigned on a permanent basis.

ACTION:

• Lucy Branson and Mick Cawley to seek approval from the Governing Bodies to assign the role of the Data Protection Officer to the Head of Information Governance (Greater Nottingham) and the Head of Corporate Governance (Mid-Nottinghamshire).

IGMT 18 093 Cyber Security Update Lucy Branson presented this item. The following key points were highlighted:

(a) The full report has been deferred to a future IGMT Committee meeting. (b) Andy Hall and Lucy Branson will meet with Jaki Taylor at NHIS to sense

check the existing infrastructure around cyber security monitoring. The following point was made in discussion: (c) Members are keen to have complete assurance that all risks identified

through the Root Cause Analysis following the 2017 cyber-attack have been addressed and remaining low risk actions have been subsumed into business as usual workstreams.

The Committee:

• NOTED the verbal update. IGMT 18 094 Data Security and Protection Toolkit Report Lucy Branson presented this item. The following key points were highlighted:

(a) The Data Security and Protection Toolkit is built around the ten national data security standards and will demonstrate organisational compliance with the GDPR.

(b) An overview of the similarities and differences between the new toolkit and its predecessor was provided.

(c) A detailed training needs assessment will be conducted across key roles related to the Information Governance, Information Technology and Data Management agenda.

(d) A significant amount of work has already been undertaken but final steps are required to confirm that the assertions are complete. The number of completed assertions is as expected for this point in the financial year and will continue to increase during the coming months.

(e) An action plan setting out areas where further actions are required prior to year-end is attached to the paper.

(f) 360 Assurance will audit compliance with the toolkit as standard. The Committee:

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Item • NOTED the Data Security and Protection Toolkit Update.

IGMT 18 095 Data Quality Report

Andy Hall presented this item. The following key points were highlighted: (a) The level of coding compliance of major providers is routinely monitored. (b) The level of coding compliance at Nottinghamshire Healthcare NHS

Foundation Trust isn’t as high as that of other providers, but is within the normal range of a mental health provider.

(c) The number of unidentified codes at Nottingham University Hospitals NHS Trust has dropped below 1%, which is a significant improvement on previous performance following the issue of a breach notice.

The Committee:

• NOTED the content of the Quarterly Data Quality Report.

IGMT 18 096 Risk Report Lucy Branson presented this item. The following key points were highlighted:

(a) The consolidated risk report provides a summary of identified IGMT risks.

(b) Two new risks have been identified: • There are identified vulnerabilities on the Citrix platform, which is a

national issue. Mitigating actions are being explored and Jane Godden, Head of Commissioning (Continuing Healthcare and Individual Care Packages) will provide a coordinated response on behalf of all six CCGs.

• There is a risk that the alignment and accessibility of corporate records within Greater Nottingham will be impacted by a delay in the G Drive Project. A project plan and mitigating actions are in place.

(c) Risk GN025, GDPR Preparedness, and GN071, the Records and Information Group not being operational, are proposed for archiving as both have been mitigated.

(d) Work is taking place to ensure there is a consistent and systematic approach to capturing and recording risks across all six organisations, particularly those pertaining to partnership arrangements.

The Committee:

• RECEIVED the risk report; • APPROVED the archiving of risks GN025 and GN 071; • NOTED the work required to ensure that all partnership risks (relevant to

the CCGs) are being systematically captured.

Closing Items

IGMT 18 097 Risks identified during the course of the meeting No risks were identified during the course of the meeting. IGMT 18 098 Any other business There was no other business to be discussed. IGMT 18 099 Date of next meeting:

18 January 2019, 13:30-16:00 Committee Room, Civic Centre, Arnot Hill Park, Arnold, Nottingham NG5 6LU

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