NHS WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING. 22 March 2016, 9.30 am am

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1 NHS WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING 22 March 2016, 9.30 am am Lathom North, Lancashire Manor Hotel, Prescott Road Pimbo, Skelmersdale, WN8 9QD 15 minutes to be allocated for questions from members of the public based on agenda items. Item WLCCGB Time Agenda item Action Presenter 03/16/ Welcome Chair 03/16/ Declaration of Interests All 03/16/ Minutes of previous meeting held on 26 January 2016 DR Chair 03/16/ Matters arising - Action sheet DR Chair Communication 03/16/ Chair s update I Chair 03/16/ Chief Officer s update I Mike Maguire Governance 03/16/ BAF and risk register I Paul Kingan 03/16/ Declarations of interest at March 2016 I Paul Kingan Operational Management Section 03/16/ Integrated business report D Paul Kingan 03/16/ Financial plan DR Paul Kingan Consent items 03/16/ Minutes of sub-committees: I Chair - Quality and Safety Committee January and February Executive Committee 12 January 1 March 2016 Other minutes: - Lancashire CCG Network December and January Liverpool City Region NHS Clinical Commissioning Group Alliance (formerly Merseyside CCG Network) January and February West Lancashire Community Safety Partnership January 2016 Other Business 03/16/ Any other business I Chair Date and Time of Next Meeting 24 May 2016, am, tbc I Information Discussion DR Decision Required Members of the governing body will be available after the close of the meeting for informal discussion, time permitting

2 Meeting Title: West Lancashire Clinical Commissioning Governing Body Meeting Time: am Present: Dr John Caine, Chair Mike Maguire, Chief Officer Paul Kingan, Chief Finance Officer/Deputy Chief Officer Dr Adam Robinson, Secondary Care Consultant Claire Heneghan, Chief Nurse Dr Bapi Biswas, GP Executive Lead Dr John (Jack) Kinsey, GP Executive Lead Dr Ros Bonsor, GP Executive Lead Dr Peter Gregory, GP Executive Lead Dr Simon Frampton, GP Executive Lead Greg Mitten, Lay Member Douglas Soper, Lay Member Minutes D R A F T Date: 26 January 2016 Venue: Hesketh with Becconsall Village Community Centre, Hesketh Bank, Lancashire In attendance: Cathy Ashcroft, Executive Assistant Ian Crabtree, Head of Services Policy Information and Commissioning, Lancashire County Council Karen Thompson, Public Health Specialist Lucinda McArthur, Senior Operating Officer Apologies: Mike Kirby, Director of Corporate Commissioning, Lancashire County Council Gill Brown, Chief Executive, Healthwatch Lancashire (in attendance) Agenda Summary of Discussion Item WLCCGB/ 01/16/01 Welcome and apologies for absence John Caine opened the meeting of the West Lancashire Clinical Commissioning Group Governing Body. Introductions were made by the Governing Body to the members of the public present. No questions had been received from the public in respect of the agenda. Apologies for absence were received from the above and noted. Action 01/16/02 Declarations of interests Peter Gregory declared an interest in respect of item 01/16/13. 01/16/03 Minutes of previous meeting held on 24 November 2015 The minutes of the meeting held on 24 November were agreed as an accurate and correct record. The Governing Body: approved the previous minutes 01/16/04 Matters arising The action sheet was updated. Additional items not recorded on the action sheet include the following: Fast track learning fast track plan Claire Heneghan stated that she had been informed by a social work colleague that a meeting had taken place on Friday 22 January between Lancashire County Council (LCC) and NHS England to discuss the current situation and problems with funding and support for discharge. Ian Crabtree was not aware of this but that LCC s position was clear in relation to this, that there is no funding. Graham Urwin and the CCGs have written to say that it was felt LCCs position was unlawful. Graham Urwin is due to meet on 18 February with LCC and Janet Ledward West Lancashire Clinical Commissioning Group Governing Body meeting 26 January 2016 Page 1 of 8

3 will attend for CCGs. Ian Crabtree s position in the minutes stands. More people are in NHS care Calderstones is shutting and felt the budget should transfer to LCC with patients. LCC hold that position with patients leaving Calderstones. Claire Heneghan is concerned that patients with learning disabilities may deteriorate in a hospital environment, other than Calderstones, if they are not supported to return to the community. Ian Crabtree confirmed those individuals are separate and should be resolved separately and asked Claire Heneghan to inform him if this is not happening. Claire Heneghan raised the issue of social workers saying they could not participate in procurement of placements or court of protection. Ian Crabtree assured that this was not the case. Claire Heneghan asked if what seems to be a miscommunication with social workers can be clarified for them by LCC. Ian Crabtree agreed. Ian Crabtree Chair s update Musculoskeletal services a question was raised whether the first gateway in December has determined if MSK services will form part of the procurement process. It has been decided that as the service is undergoing service redesign, it will continue to be monitored until closer to the decision is required. Integrated Business Report a question about progress on contract queries was raised. The contract query on coding covering trauma and orthopaedics is ongoing and subject to review by internal audit. Ophthalmology had been resolved but the quality safeguarding query is outstanding. The Trust, Trust Development Agency and NHS England are aware of this. This will be included in the next report. Paul Kingan COMMUNICATION 01/16/05 Chair s update The report provided members with an update on both strategic and operational issues since the last meeting. John Caine highlighted key areas of interest: Junior doctor strike following the announcement of junior doctor strikes, by the British Medical Association, one strike had taken place on 12 January with two other dates deferred from 26 January and 10 February. To assist patients during the strike period, the CCG had cascaded information on where to find emergency care. Patients whose treatment was postponed due to the strike action will have appointments rebooked as a matter of urgency. Bluebell Lodge opening on 5 January, a unit opened at Southport and Ormskirk Hospital NHS Trust for patients no longer requiring consultant care, but awaiting tests and social care packages or care home beds. The unit will operate for 12 weeks to assist the patient flow through the hospital with a maximum stay of 72 hours for each patient. Clarity is sought to establish the financial impact on the CCG and the pathway from A&E. As patients are transferred internally to the ward and not discharged first, they are still under acute care. A request for a business case for the Executive Committee has been made. GP elections in accordance to the Membership Council s agreement of terms of office for the GP members, three GP positions will require filling from April 2016 following a four-year term of service. This includes the position of chair. There is a three-month period to receive expressions of interest and the details around the process will be discussed at the Membership Council this week. The Governing Body: Noted the content of the report West Lancashire Clinical Commissioning Group Governing Body meeting 26 January 2016 Page 2 of 8

4 01/16/06 Chief Officer s update The report provided members with an update on both strategic and operational issues since the last meeting. Mike Maguire highlighted key areas of interest: Planning guidance the CCG is required to produce two interconnecting plans: Sustainability and Transformation plan and a plan by organisation for Firstly the sustainability and transformation plan footprint for the CCG must be agreed and approved by NHS England. Well North it is anticipated that Well Skelmerdale will have a soft launch in Spring The Ketso tool is helping to gather data from Skelmersdale residents supplementing our analysing quantitative data and we are building detailed maps of community assets. Some partners and CCG representatives will visit Bromley by Bow in London to interrogate a strong example of collaborative working and progress achieved. Lord Mawson will revisit Skelmersdale tomorrow and will spend time in the community, with the Borough Council and CCG. Flooding update in addition to the affect from the Boxing Day flooding to Parbold and Croston areas, Skelmersdale Walk in Centre, Aughton Surgery and a care home in Aughton were also affected with issues continuing until 31 December. This caused issues with the planned extra GP cover in Skelmersdale Walk in Centre. The CCG thanked everyone who was involved in providing assistance and ensuring patient safety IT update the utilisation of the new E-Referral Services has increased from 71% in June to 92% in November since the decommission of the Referral Management Centre. An integrated primary and community care record will be in place by June 2016 followed by progression to phase 2. Innovation funding will enable FLO teleheatlh system to be implemented by early February and the community heart failure service will be the first to use this. The IT Infrastructure has improved greatly with wifi available in most practices. Allocations the government has announced a five-year funding settlement for the NHS to deliver the vision in the Five Year Forward View. Annual funding nationally will rise by 3.8bn in and 8.4bn by In specialised commissioning will receive 7.0% growth in funding, primary care 4.2% and CCGs 3.4%. West Lancashire CCG will receive an additional 3% funding in and 2% in each of the next two years. Musculoskeletal (MSK) services Southport and Formby CCG has commissioned a consultancy agency to review MCAS, physiotherapy and orthopaedic services. The findings will be shared with the Executive Committee in February and Membership Council in March. The new model will be implemented in July The Governing Body: Noted the content of the report The recent case of a child who died in the South East was raised. Out of Hours services do have access to patient records whereas the 111 service do not. There is no shared record between the services reporting the frequency of calls from a patient. An opportunity for full sharing of records via Emis, which would also assist community matrons and district nurses, will be raised with the Membership Council with focus on safeguards around information sharing. The benefits of information sharing between services should be conveyed to patients. Paul Kingan, Bapi Biswas and Claire Heneghan will meet to discuss the risk over gaps in information sharing and consider this for the risk register. West Lancashire Clinical Commissioning Group Governing Body meeting 26 January 2016 Page 3 of 8

5 GOVERNANCE 01/16/07 Board Assurance Framework and Risk Register The Board Assurance Framework (BAF) is a key part of the CCG s governance arrangements. The CCG risk register has been reviewed to reflect the up to date position. The paper went to the Executive Committee on 19 January The CCG Corporate Risk Register includes two risks with a score higher than 15 which appear on the Board Assurance Framework: Risk 44 - the main ICO provider potentially failing to meet required levels of delivery and performance due to a number of issues including service quality, financial outlook and senior staff changes. Risk 8 - the poor level of engagement from the Trust in terms of the quality agenda. Data has not been received although requests are channelled through a single point of contact to ensure the Trust is not overcome with duplicate requests. This issue will be raised at the Quality Surveillance Group meeting in March. A number of high risks were discussed: Risk 29 - the individual patient activity process. There is a financial pressure across the country as some nursing homes and dual status care homes have increased their charges. The Lancashire CCGs are collaborating to manage the issue and achieve more stability. Lancashire County Council and the CCG are currently reviewing their frameworks and looking at fees. Risk 41 financial risk for the CCG taking on specialist services work is taking place across CCGs to manage the bariatric services, as the current tariff does not cover the cost of the service. Risk 45 from the community services re-procurement risk register presented to the Executive Committee refers to the risk of failure to deliver the procurement given the capacity of a small CCG. This register will be appended to the next corporate risk register. Risk 32 capacity to review continuing health care patients. This score has reduced as capacity has increased and reviews are expected to be completed by March Paul Kingan The Governing Body: Noted the report 01/16/08 Declaration of interest register The current declaration of interest register was presented and included two changes. The Governing Body: Approved the revised scheme of delegation. 01/16/09 Appointment of External Auditors and the establishment of an Auditor Panel The Department of Health requires CCGs to appoint their own external auditors by 31 December To enable this to take place an auditor panel must be in place by early 2016 to carry out the procurement and make the appointment. Guidance has been issued around the process and the suggested terms of reference for the auditor panel were discussed. The recommended panel members: Greg Mitten and Doug Soper as independent from CCG members Doug Soper - to chair as current Audit Committee chair Dr Bapi Biswas GP member The procurement process will be discussed and agreed with other chief West Lancashire Clinical Commissioning Group Governing Body meeting 26 January 2016 Page 4 of 8

6 finance officers in Lancashire. The Governing Body: approved the establishment of the Auditor Panel, terms of reference, the chair being the current Audit Committee chair, the membership as stated above and recommend appointment of the external auditors to the Governing Body following the procurement process before December OPERATIONAL MANAGEMENT SECTION 01/16/10 Integrated Business Report (IBR) The report provided summary information on the financial position and activity performance of the CCG to November and the financial positon for December It also included quality and performance analysis for community based targets for Southport and Ormskirk Hospital NHS Trust. Paul Kingan highlighted some key areas within the report: At month 7 the CCG is forecasting a surplus of million in line with the 1% target required by NHS England, however there is still risk of nonachievement of the full surplus. Planned care this is still performing over plan, particularly in trauma and orthopaedics. The increase in A&E attendances since October 2015 was raised. Since 111 had been implemented, the Out of Hours service had experienced a reduction in patient calls with specific areas eg chest infections. Paul Kingan will discuss with other CCGs to establish if this is a widespread issue and if there is a connection with the 111 service. GP referrals, though still high, reduced slightly in November. A small increase in referrals causes a large cost increase for operations. GPs have been asked to consider alternatives to referring patients to hospital if clinically safe to do so. The CCG has a high rate of arthroscopy with a questionable limited value to patients. The policy has been rewritten and will be presented at the policy group in February. Both MCAS and physiotherapy waiting times have reduced. Claire Heneghan reported on the key quality areas of performance within the report: A correction to the data confirms only one case of MRSA attributable to the Trust in April as the case in July was attributable to community. The C. Difficile appeals process continues. The three cases of C. Difficile infection in November were within the Trust s monthly target. Three wards are currently closed due to noro virus infection Aaron Crest Care Home had also closed to new patients due to the same virus. Claire Heneghan will discuss public health s infection control input and a regular presence within the CCG with Ann Smith, head of services. The Lancashire CCG Network is currently discussing the memorandum of understanding. Ambulance turnaround time the group were informed of an incident regarding potential long waits. It is felt that the long turnaround time for ambulances is partly due to the design of the A&E department at Southport and Ormskirk Hospital NHS Trust and the crew logging process. A letter will be sent to NWAS by John Caine to highlight the incident. Karen Thompson has received an urgent care utilisation report which could be used to support any further discussion. It is important for the Trust s Systems Resilience Group to be informed also. Improved Access to Psychological Therapies (IAPT) - currently data presents the CCG as an outlier. Lancashire Care Foundation Trust has changed to a new system of tracking progress which could be affecting Paul Kingan Claire Heneghan John Caine West Lancashire Clinical Commissioning Group Governing Body meeting 26 January 2016 Page 5 of 8

7 the data. Very few CCGs have met the 50% recovery rate. Psychologists have recently been diverted to support other areas which could also have affected the data. Friends and Family test the numbers of those patients responses are so small and not significant enough to have a meaningful discussion. The Trust is considering how to improve participation in the test. Mixed sex accommodation a contact query has been raised. Sickness levels are still high as is agency spend. This may impact on morale and wider quality issues as vacancy numbers are also high. Increases in pressure ulcer reporting continues. As West Lancashire CCG is an associate commissioner, contract queries are raised via Southport and Formby CCG, the main commissioner. There is a concern that the impact of the contract queries could be reduced when managed through a third party. The unanswered contract queries will be raised at the contract meeting next week. Greg Mitten commended the work of Healthwatch in ensuring the patient voice is heard. They have published a series of reports on inspection and view in care establishments from a non-clinical view point and work with the homes to improve standards. A review of retrospective continuing healthcare cases is ahead of trajectory and should be complete by September The Governing Body: Noted the performance to date and the actions in place to improve performance. 01/16/11 Equality and Inclusion Annual Report The Equality and Inclusion Annual Report demonstrates how the CCG is meetings its legal requirements by ensuring commissioned services do not discriminate. This report had been discussed at the Executive Committee. Paul Kingan outlined the areas which the report covered and the grading system used to determine which level the CCG has achieved compliance. The outcome is a combination of developing and achieving. Lucinda McArthur, who had been involved with the panel, confirmed that a lessons learned meeting will take place this week and felt that further improvements will be developed for the next report. Provider websites had been reviewed to show the current position of each in terms of the NHS Equality Delivery System. Paul Kingan will ascertain the reason Aintree University Hospital NHS Foundation Trust does not achieve all of the requirements. Paul Kingan The Governing Body: Approved the Equality and Inclusion Annual Report and it will be uploaded to the website. 01/16/12 Commissioning Policy Development Update and ratification of Statement of Principles, Decision Making Framework and Exceptionality Policy The paper, which had been to the Executive Committee, was a result of pan- Lancashire working on commissioning policies and related underpinning documents. Three documents were presented for approval and an update provided on the remaining work which is procedural specific. All CCGs should provide input and further intervention specific policies are expected soon. West Lancashire Clinical Commissioning Group Governing Body meeting 26 January 2016 Page 6 of 8

8 The Governing Body: Approved the three documents. 01/16/13 Integrated Community Services update report Peter Gregory declared an interest in this item. As the item was for information only, no action was required. Jackie Moran provided an update of the procurement process to date. Since the community services transferred to Southport and Ormskirk Hospital NHS Trust, integrated care had not been delivered as evidenced in gateways and targets not met. A decision was made at the Membership Council to reprocure community services. Engagement has taken place with a large number of ICO staff. The procurement process includes input from patients, ambulance, third sector, social services who have met to establish what is needed from services. The CCG is procuring separately and not with Southport and Formby CCG. The aim is to mobilise by April The scope has changed slighting with an additional Lot which includes: Walk in Centres, intermediate care beds, AVS and Out of Hours services. A financial envelope has been developed and the Membership Council are signed up. Unopened bids have been received which will go through a competitive dialogue process. Greg Mitten commended the team for their work and for including the third sector in engagement sessions. A separate session for the CVFS was requested to discuss individual providers. The Governing Body: noted the report and ratified the decisions made at the Membership Council. CONSENT ITEMS 01/16/14 Minutes of sub-committees: The minutes from the following meetings were noted by the Governing Body: - Quality and Safety Committee November Claire Heneghan will reinvite Trust clinical leads to the committee for specific items, requiring minimal time in their schedules. - Audit Committee December Executive Committee 10 November - 5 January 2016 Other minutes: - Lancashire CCG Network October and November Merseyside CCG Network November and December System Resilience Group November and December Health and Wellbeing Board October West Lancashire Community Safety Partnership October 2015 The attendance level and importance of the System Resilience Group was questioned. This meeting will be essential as the Strategic Transformation Partnership has been stood down. The Governing Body: Noted the papers. Other business 01/16/15 Any other business Greg Mitten reported that domestic violence funding is changing. A plan B is required should current potential solutions fail. This could be a major issue over next 12 months. West Lancashire Clinical Commissioning Group Governing Body meeting 26 January 2016 Page 7 of 8

9 Meeting closed at am Date and time to next meeting: 22 March 2016, am, tbc West Lancashire Clinical Commissioning Group Governing Body meeting 26 January 2016 Page 8 of 8

10 Agenda item no: WLCCGB West Lancashire CCG Governing Body meeting Action sheet Action Lead Date required by Action completed 09/15/09 Integrated Business Report New action: Mike Maguire and Dr Bapi Biswas will attend the next Stroke Operational Group New action: Need to request Lisa Hunt to attend the Stroke Operational Group Mike Maguire and Dr Bapi Biswas Mike Maguire 22 March March 2016 Dr Bapi Biswas will attend the next Stroke Operational Group and speak to those delivering the service. Ongoing. The data on the new dedicated stroke unit will be shared when received. 09/15/07 Board Assurance Framework New action: the lack of response to the outstanding quality issue letter will be escalated to Ann Marr and the Trust chair. 01/16/04 Matters arising Fast track learning fast track plan. Claire Heneghan raised the issue of social workers saying they could not participate in procurement of placements or court of protection. Ian Crabtree assured that this was not the case. Claire Heneghan asked if what seems to be a miscommunication with social workers can be clarified for them by LCC. 01/16/04 Matters arising Integrated Business Report. An update on the contract queries will be included in the next report. Mike Maguire 22 March 2016 The Collaborative Commissioning Forum will address the quality issues. This is made up of various organisations, hence the need for the overarching action plan to address all organisations outstanding actions. Ian Crabtree 22 March 2016 Paul Kingan 22 March 2016 Page 1 of 2

11 01/16/06 Chief officers update. Flooding update. The CCG thanked everyone who was involved in providing assistance and ensuring patient safety and an official letter will be sent to all involved. 01/16/07 Board Assurance Framework and Risk Register. Risk 45 the community services reprocurement risk register will be appended to the next corporate risk register. 01/16/10 Integrated Business Report (IBR) Since 111 had been implemented, the Out of Hours service had experienced a reduction in patient calls with specific areas eg chest infections. Paul Kingan will discuss with other CCGs to establish if this is a widespread issue and if there is a connection with the 111 service. 01/16/10 Integrated Business Report (IBR) Claire Heneghan will discuss public health s infection control input and a regular presence within the CCG with Ann Smith, head of services. 01/16/10 Integrated Business Report (IBR) Ambulance turnaround time - A letter will be sent to NWAS to highlight the delays in ambulance turnaround times with regards to a specific incident. Mike Maguire 22 March 2016 Paul Kingan 22 March 2016 Paul Kingan 22 March 2016 Claire Heneghan 22 March 2016 John Caine 22 March 2016 Page 2 of 2

12 WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY REPORT DATE OF BOARD MEETING: 22 March 2016 Agenda number: WLCCGGB 03/16/05 TITLE OF REPORT: Chair s Update BRIEFING POINTS: Does this report / its recommendations have implications and impact with regard to the following: A. Commissioning Board s Aims and Objectives 1. Quality (including patient safety, clinical effectiveness and patient experience) please outline impact No 2. Commissioning of hospital and community services please outline impact No 3. Commissioning and performance management of GP Prescribing please outline impact No 4. Delivering Financial Balance please outline impact No 5. Development of the commissioning group as a commissioning organisation please outline impact Yes B. Governance 1. Does this report: provide the Commissioning Board with assurance against any of the risks identified in the assurance framework (identify risk number) have any legal implications promote effective governance practice 2. Additional resource implications (either financial or staffing resources) Yes Yes 3. Health Inequalities Yes 4. Human Rights, Equality and Diversity Requirements No 5. Clinical Engagement Yes 6. Patient and Public Engagement Yes REPORT PREPARED BY: REPORT PRESENTED BY: Meg Pugh, head of communication and engagement Dr John Caine, Chair Chair s Update West Lancashire Clinical Commissioning Group Governing Body Meeting 22 March

13 WEST LANCASHIRE CLINICAL COMMISSIONING GOVERNING BODY CHAIR S UPDATE PURPOSE 1. This report provides an update on both strategic and operational issues of interest to governing body members in the months since the last meeting. ISSUES ARISING Rally Round 1. We worked with West Lancashire CVS (Council of Voluntary Services) to fund Rally Round locally in West Lancashire. 2. Rally Round is an online platform which allows anyone to create a support network for themselves or someone who needs help. It manages and logs day to day tasks on a todo list and allows for the support network around an individual to network with each other through texts and notifications. 3. Rally Round allows anyone to help themselves or another they care for to live a better live. For more information, please visit 4. The platform will be launched in West Lancashire next month, with promotional activity planned in order to highlight the benefits to the local community. Move More 5. As part of our Macmillan project, we launched a fitness programme to help people living with and beyond cancer become more active. 6. A joint initiative between the CCG, Macmillan Cancer Support, Southport and Ormskirk Hospital NHS Trust and NHS, Move More helps people with a diagnosis of cancer to find effective ways to stay active, no matter where they are on their cancer journey, including those who have since completed treatment. 7. Move More offers individually tailored activity programmes and sets personal goals which have a lasting impact on well-being. People can work on their fitness individually or in a group setting. Classes take place weekly in the physiotherapy department at Ormskirk Hospital. We published a story on our website with further information. GP elections 8. As mentioned in more detail in my board report in January 2016, three GP positions, including the role of chair of the CCG, will require filling from April Voting in the GP elections commenced last week (14 March) 10. The Local Medical Council (LMC) will be overseeing the process. 11. The CCG expects successful candidates to be notified early in April 2016, with confirmation at the Council of Members meeting on 27 April Chair s Update West Lancashire Clinical Commissioning Group Governing Body Meeting 22 March

14 Recommendation 12. Members are asked to note the content of the report. Dr John Caine Chair March 2016 Chair s Update West Lancashire Clinical Commissioning Group Governing Body Meeting 22 March

15 Agenda item no: WLCCGB 03/16/06 WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY REPORT DATE OF MEETING: 22 March 2016 TITLE OF REPORT: Chief Officer s Update BRIEFING POINTS: Does this report / its recommendations have implications and impact with regard to the following: A. Commissioning Board s Aims and Objectives 1. Quality (including patient safety, clinical effectiveness and patient experience) please outline impact No 2. Commissioning of hospital and community services please outline impact Yes 3. Commissioning and performance management of GP Prescribing please outline impact No 4. Delivering financial balance please outline impact No 5. Development of the commissioning group as a commissioning organisation please outline impact No B. Governance 1. Does this report: provide the Commissioning Board with assurance against any of the risks identified in the assurance framework (identify risk number) have any legal implications promote effective governance practice 2. Additional resource implications (either financial or staffing resources) Yes No 3. Health Inequalities Yes 4. Human Rights, Equality and Diversity Requirements No 5. Clinical Engagement Yes 6. Patient and Public Engagement Yes REPORT PREPARED BY: REPORT PRESENTED BY: Meg Pugh, head of communication and engagement Mike Maguire, Chief Officer Chief Officer s Update West Lancashire Clinical Commissioning Group Governing Body Meeting 22 March

16 Purpose WEST LANCASHIRE CLINICAL COMMISSIONING GOVERNING BODY CHIEF OFFICER S UPDATE 1. This report provides an update on both strategic and operational issues of interest to governing body members in the months since the last meeting. Planning guidance 2. In terms of the requirements for the operational plan for 16/17, we have met all submission deadlines requested by NHS England. We continue to progress with any further refinements or additional analysis for the 16/17 operational plan that is requested of us. We have chosen as an organisation to draw together a written narrative that will outline our priorities for the year ahead. This will be a lighter version of the strategic plan we published last year. This document, currently in draft will be presented to the next Governing Body for approval. 3. All of this work will form year one of the STP (Sustainability and Transformation plan) for which we now understand more, although it is worth noting that further guidance is awaited. There is now agreement that the footprint for the STP with be Lancashire and South Cumbria. This plan will encompass a number of local delivery plans, one of which will relate to West Lancashire. Reflecting our boundary with Mersey and our patient flow, we have agreed to be an associate to the STP for Liverpool City Region. There is commitment to ensure a clear read across between STPs which is positive. We have meetings planned with relevant colleagues to progress discussions that will result in the narrative for our local delivery plan to which our annual strategic plan and our clinical strategy Building For The Future will form the basis. 4. The Better Care Fund plan for 2016/17 has been drafted and submitted NHS England for review. The plan will be finalised at the end of April, including sign off from the local Health and Wellbeing Board. Well North 5. Later this month, the CCG and some partners involved in Well North will be visiting Bromley by Bow, London as a strong example of what can be achieved by the community and agencies working together towards a common goal. This visit is to allow us to witness firsthand the potential and possibilities, and understand the principles that supported the progress. 6. The CCG, along with other partners, hosted a second immersion visit for Lord Andrew Mawson (Chair, Well North) and Sam Tunney (Chief Executive, Well North) on 27 January. This provided the opportunity to further explore town centre developments (including taking a walk around the town centre), spend time with some primary school children to hear their views and input and also more time with third sector organisations. 7. With an official launch planned for spring, we have in the meantime (since last Governing Body) presented to the following groups: the Ecumenical Clergy Lent Study Event and the West Lancashire Children & Young People s Mental Health Group. If any members of the public have a forum where they would like information on Well Skelmersdale to be shared then again, please contact the CCG via myview@westlancashireccg.nhs.uk 8. Other work on this project continues, including in depth work with the local community and partners and also the recent opportunity to meet with other Well North sites to hear their learning and discuss opportunities that may be suitable locally for Well Skelmersdale. Chief Officer s Update West Lancashire Clinical Commissioning Group Governing Body Meeting 22 March

17 Neighbourhood learning 9. We teamed up with Edge Hill University to deliver four half day workshops aimed at supporting everyone to build inner strength to meet their challenges of life, and support others to do the same. 10. With an initial focus on anyone living and working in Skelmersdale, these workshops were offered free of charge and looked at issues such as: understanding resilience, the importance of you and addressing how to connect with those who are isolated in a community. Community health services procurement 11. Our community health services procurement continues to progress, following the initial decision to procure made by our board and membership of local GP practices in July February 2016 marked the completion of the Pre-Qualification Questionnaire (PQQ) evaluation stage. A PQQ is completed and submitted by all potential bidders interested in delivering the service locally, which are then evaluated by the CCG. 13. Following a stringent evaluation process of the information and evidence provided, four bidders have been invited to have further discussions with the CCG. This is known as the Invitation to Participate in Dialogue (ITPD) stage of the procurement. 14. Lancashire Care NHS Foundation Trust, Optum Health Solutions (UK) Ltd, Virgin Care Services and Bridgewater Community Healthcare NHS Foundation Trust have been invited to have further discussion with the CCG about community health services. 15. Optum Health Solutions (UK) Ltd and Virgin Care Services have been invited to have further discussion with the CCG about urgent care services 16. The CCG will now embark on a period of in depth dialogue and following the submission of final tenders, the successful bidder(s) will be chosen in September The successful bidder(s) will begin delivering the services locally in April The CCG has involved several local stakeholders in this process in various ways. The CCG s website has a dedicated community health services page under the have your say tab, which continues to be updated with information such as stakeholder briefings, infographics showing the timeframes and information on how members of the public/patients can share their views and experiences. 19. This procurement process is subject to national procurement legislation which requires CCGs to enable all NHS and private providers to compete. All bidders are evaluated against set criteria and those providers that were successful have therefore been invited to have further discussions with the CCG. Recommendation 20. Members are asked to note the content of the report Mike Maguire Chief Officer March 2016 Chief Officer s Update West Lancashire Clinical Commissioning Group Governing Body Meeting 22 March

18 WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY REPORT DATE OF MEETING: 22 March 2016 Agenda item no: 03/16/07 TITLE OF REPORT: Risk Register & Governing Body Assurance Framework BRIEFING POINTS: Outlines key risk areas Does this report / its recommendations have implications and impact with regard to the following: A. Commissioning Board s Aims and Objectives 1. Quality (including patient safety, clinical effectiveness and patient experience) please outline impact No 2. Commissioning of hospital and community services please outline impact No 3. Commissioning and performance management of GP Prescribing please outline impact No 4. Delivering Financial Balance please outline impact No 5. Development of the commissioning group as a commissioning organisation please outline impact Part of governance arrangements B. Governance please outline impact 1. Does this report: provide the Commissioning Board with assurance against any of the risks identified in the assurance framework (identify risk number) have any legal implications promote effective governance practice Provides overview and updates on all strategic and operational risks 2. Additional resource implications (either financial or staffing resources) Yes Yes No 3. Health Inequalities No 4. Human Rights, Equality and Diversity Requirements No 5. Clinical Engagement No 6. Patient and Public Engagement No REPORT PREPARED BY: REPORT PRESENT BY: Elizabeth Dalton, CSU Corporate Governance & Risk Manager Paul Kingan, Chief Finance Officer Corporate Risk Regsiter & Board Assurnace Framework West Lancashire Clinical Commissioning Group Governing Body 22 March

19 Risk Register & Governing Body Assurance Framework Introduction The Board Assurance Framework (BAF) is a key part of the CCG s governance arrangements. It is the principal way by which the CCG holds itself to account; it helps to clarify and quantify risks that could compromise delivery of our strategic objectives. The CCG Risk Register has been reviewed to reflect the up to date position as at 11 March 2016 A separate risk register has been created in respect of the community services re-procurement exercise. This is discussed on a regular basis as part of the Community Procurement Programme Board meetings. The Clinical Executive will receive updates on the Community Re-procurement on a regular basis. Board Assurance Framework The CCG Corporate Risk Register includes two risks with a score higher than 15 and are therefore are on the Board Assurance Framework. One risk relates to the main ICO provider potentially failing to meet required levels of delivery and performance due to a number of issues including service quality, financial outlook and senior staff changes. A further risks in relation to lack of engagement of providers in the quality agenda remains on the Board Assurance Framework. Although the CQPG has been reinvigorated by the Trust Executive, engagement from the Trust has been poor and the attendance from Trust Clinicians and GPs has been sporadic. Delivery Risk 41 Increasing financial risk in relation to the CCG taking on specialist services cocommissioning and the associated budget remains a high financial risk to the CCG and an action plan is being developed. In terms of risk 44 in relation to the ICO, the CCG is working closely with Southport and Formby CCG and Southport and Ormskirk NHS Hospitals Trust on the clinical and financial sustainability of patient services going forward. The governing body will be kept informed as this work progresses. In relation to the other risk in this area Quality, Innovation, Productivity and Prevention (QIPP) schemes continue to be developed and a QIPP dashboard is being populated to monitor and report progress against identified schemes. The risk remains on the register in order to ensure focus on delivery of QIPP targets. The CCG is currently now achieving 79% of its QIPP target however additional schemes have been identified and work is underway to quantify the potential savings. Given the current situation the overall risk rating for Delivery is Amber, however this is under constant review as more data on the in-year position for QIPP and financial position becomes available. Engagement An existing risk in relation to the lack of engagement of providers in the quality agenda remains at a risk score of 16. Although the CQPG has been reinvigorated by the Trust Executive, engagement from the Trust has been poor and the attendance from Trust Clinicians and GPs has been sporadic. This risk is included on the Board Assurance Framework and the overall risk rating for Engagement in now Red. Corporate Risk Regsiter & Board Assurnace Framework West Lancashire Clinical Commissioning Group Governing Body 22 March

20 Contracts The main issues in relation to this element remain the risk to the CCG managing the financial position. A finance plan is in place for the overall allocation and the CCG is still forecasting a surplus position for 2015/16. However this is being closely monitored and the CCG and NHS England are aware that any further material financial risks will impact on delivery of the full 1.4m surplus target. A new risk has been identified in relation to the introduction of charges for the anti-coagulation service during 2016/17. The risk is a medium risk to the CCG at the current time. Given the current situation the overall risk rating for contracts is Green, however this is under constant review as more data on the in-year position becomes available. Operational Systems There are currently no risks in relation to operational systems. Recommendations The Governing is asked to note that the Risk Assessment Form and Guidance documents have been reviewed and amended. The Integrated Assurance Framework has also been reviewed and it is recommended that the inclusion of risks aligned to the achievement of critical outcomes which score 12+ are included on the Governing Body Assurance Framework with effect from the May 2016 submission. A copy of the revised documentation is included for review by the Clinical Executive The Governing Body is asked to note the board assurance framework and corporate risk register and continue to support the risk management arrangements. Paul Kingan Chief Finance Officer March 2016 Corporate Risk Regsiter & Board Assurnace Framework West Lancashire Clinical Commissioning Group Governing Body 22 March

21 West Lancashire Clinical Commissioning Group Governing Body Assurance Framework 14/03/2016 Assurance Framework 2015/16 - V4.0 March /16 Critical Outcome TEAM Delivery - Failure to Deliver CCG Service Priorities MM LEAD DIRECTOR RESIDUAL RISK RATING ASSURANCE STATUS (overall) 16 RED 16 Engagement - Failure to Engage Effectively with Stakeholders Contracts - Failure to effectively manage contracts to ensure high quality services Operational Systems Dr SF (Comm) Dr JK (Clinical) Dr BB PK 16 RED Green Amber Assurance Status Key: Green Complete Amber On track Red Off target NB: where there is more than 1 risk relating to a key objective the higher of the risk ratings will be shown on the summary sheet Page 1 of 5

22 West Lancashire Clinical Commissioning Group Governing Body Assurance Framework 14/03/ /16 Delivery - Failure to Deliver CCG Service Priorities EXEC LEAD: MM Risk ID (Link to Risk Register) Principle Areas of Risk Initial Risk Rating (LxC) Key Controls Assurance on Controls Gaps in Control Gaps in Assurance Level of Assurance Key actions Target Date for Completion of Key Actions Lead Officer Current Risk Rating (LxC) Status These are the specific areas where failure will risk a critical outcome Processes and plans in place or actions being taken to mitigate risk in principle areas Internal or external reporting arrangements that provide assurance to the Governing Body that controls are effective Areas where controls are not in place or are ineffective Areas of insufficient evidence to assure the Governing Body that controls are being effective Must state either None Limited Significant Full Key actions being taken to mitigate the risk Colour indicates current status of principle risk area RED = off track AMBER = on track GREEN = completed 44 Risk of main ICO provider failing to meet required levels of delivery and performance due to a number of issues including service quality, financial outlook and senior staff changes. 20 (5x4) Discussions at Quality Committtee, discussions with Chair of hospital and Board to Board meetings. Achievement of contract performance targets. CCG continues to meet regularly with the Trust at a number of meetings (around quality and contractual performance), as well as a dedicated health economy wide group which meets regularly and looks at clinical and financial sustainability of services going forward. This includes NHS England, the TDA and fellow CCG commissioners. This work has been given a high priority in each organisation. Performance data often retrospective and time lag exists. Queries and letters not responded to on time. Some services difficult to performance monitor on timely basis e.g Community Services Limited A finance risk summit has been set up with next meeting on 8th January. There are also regular biweekly meetings of the Trust sustainability programme which involves all key stakeholders. The risk score will likely stay the same until longer term solutions are found PK 16 (4x4) RED Page 2 of 5

23 West Lancashire Clinical Commissioning Group Governing Body Assurance Framework 14/03/ /15 Engagement - Failure to Engage Effectively with Stakeholders EXEC LEAD: Dr SF (Comm) Dr JK (Clinical) Risk ID (Link to Risk Register) Principle Areas of Risk Initial Risk Rating (LxC) Key Controls Assurance on Controls Gaps in Control Gaps in Assurance Level of Assurance Key actions Target Date for Completion of Key Actions Lead Officer Current Risk Rating (LxC) Status These are the specific areas where failure will risk a critical outcome Processes and plans in place or actions being taken to mitigate risk in principle areas Internal or external Areas where controls are reporting arrangements not in place or are that provide assurance to ineffective the Governing Body that controls are effective Areas of insufficient evidence to assure the Governing Body that controls are being effective Must state either None Limited Significant Full Key actions being taken to mitigate the risk Colour indicates current status of principle risk area RED = off track AMBER = on track GREEN = completed 8 Lack of engagement of providers in the quality agenda leading to a lack of understanding and consistency between partners regarding outcomes of specific schemes. 12 (C4 x L3) CQPG has been reinvigorated but Trust Executive engagement from the Trust has been poor New meeting is in place to engage Trust clinicians with GPs. JC attends on our behalf. CQPG Separate single item QSGs have taken place to focus trust on quality issues More detailed requirements of funding and scheme outcomes are being stipulated Separate meetings with other providers have taken place to iron out quality issues Regular feedback of new op forum to membership under chairman s update Engagement of trust staff with GPs in our membership and FTFT events Limited Continued emphasis on the quality agenda at the QSG meetings and with formal letters between the CCG and S&OHT on these issues JM 16 (C4 x L4) RED Page 3 of 5

24 West Lancashire Clinical Commissioning Group Governing Body Assurance Framework 14/03/2016 Risk ID (Link to Risk Register) Principle Areas of Risk Initial Risk Rating (LxC) Key Controls Assurance on Controls Gaps in Control Gaps in Assurance Level of Assurance Key actions Target Date for Completion of Key Actions Lead Officer Current Risk Rating (LxC) Status These are the specific areas where failure will risk a critical outcome Processes and plans in place or actions being taken to mitigate risk in principle areas Internal or external Areas where controls are reporting arrangements not in place or are that provide assurance to ineffective the Governing Body that controls are effective Areas of insufficient evidence to assure the Governing Body that controls are being effective Must state either None Limited Significant Full Key actions being taken to mitigate the risk Colour indicates current status of principle risk area RED = off track AMBER = on track GREEN = completed None Identified. Lower ranked risks are shown on the risk register Page 4 of 5

25 West Lancashire Clinical Commissioning Group Governing Body Assurance Framework 14/03/ /15 Operational Systems EXEC LEAD: PK Risk ID (Link to Risk Register) Principle Areas of Risk Initial Risk Rating (LxC) Key Controls Assurance on Controls Gaps in Control Gaps in Assurance Level of Assurance Key actions Target Date for Completion of Key Actions Lead Officer Current Risk Rating (LxC) Status These are the specific areas where failure will risk a critical outcome Processes and plans in place or actions being taken to mitigate risk in principle areas Internal or external Areas where controls are reporting arrangements not in place or are that provide assurance to ineffective the Governing Body that controls are effective Areas of insufficient evidence to assure the Governing Body that controls are being effective Must state either None Limited Significant Full Key actions being taken to mitigate the risk Colour indicates current status of principle risk area RED = off track AMBER = on track GREEN = completed None Identified. Lower ranked risks are shown on the risk register Page 5 of 5

26 West Lancashire CCG Risk Register Active Risk Register No. Date Added Lead Description Controls Score Overall Risk Score Change Action Plan (AP) Updates Status of AP Link to BAF C L R A G 7 BAF Theme: Delivery PJ Failure to deliver service priorities to plan including QIPP targets Monitoring of QIPP linked into financial reporting system CSU support for comms, finance and business intelligence Strategic Partnership Board (SPB) (6 key priorities agreed) National reporting on assurance established. Q1 -Q4 assessment completed with full assurance received Cross reference QIPP programme to redesign programme. Continuously refresh assumptions around QIPP programme outcomes and embed services. QIPP strategy established for 15/16 and operational delivery detail now being developed. Matrix designed to monitor impact of QIPP and assist redistribution of resources. QIPP outcomes clarified and plan amended accordingly Improvement in systems being maintained with on-going scrutiny. Currently predicting 79% delivery of QIPP as at January 2016 New project management system (Aspyre) will assist the CCG in project managing QIPP schemes and measuring their financial impact. Residual risk Last Risk Review Date Moderate BAF Theme: Engagement JM/LC Lack of engagement of providers in the quality agenda leading to a lack of understanding and consistency between partners regarding outcomes of specific schemes. CQPG has been reinvigorated but Trust Executive engagement from the Trust has been poor New meeting is in place to engage Trust clinicians with GPs. JC attends on our behalf Separate single item QSGs have taken place to focus trust on quality issues More detailed requirements of funding and scheme outcomes are being stipulated Separate meetings with other providers have taken place to iron out quality issues Regular feedback of new op forum to membership under chairman s update Engagement of trust staff with GPs in our membership and FTFT events Continued emphasis on the quality agenda at the QSG meetings and with formal letters between the CCG and S&OHT on these issues. Moderate

27 No. Date Added Lead Description Controls Score Overall Risk Score Change Action Plan (AP) Updates Status of AP Link to BAF C L R A G 23 BAF Theme: Delivery CW Children being discharged from CAMHS too early at 16 when they should remain with service until 18. Leading to risk of no services being received when child needs it safeguarding issue transition into adult service where staff are not trained to provide an age appropriate service, inappropriate placement of children on adult mental health ward. Eating Disorder specification for extended service to support 16+ with BMI<17.5 agreed with LCFT and CSU funding flowing. (Service delivery commenced 25 Feb 2015) Safeguarding issue investigated - learning and actions agreed and discussed. Lancashire wide Transformation Plan for CYP emotional health and wellbeing will address age range of CAMHS (0-25 service by 2020) New Eating Disorders model to be developed for Lancashire in line with National Guidance - West Lancs preference for all age service. (no transition) Transformation Plan has been assured for Lancashire. Lancashire North and Fylde and Wyre CCGs will be piloting new service model for eating disorders. West Lancashire detailed plans and actions for Eating Disorders support, development and roll out of pilot learning discussed with LCFT team Residual risk Last Risk Review Date Moderate BAF Theme: Contracts PJ Running costs outstrip available resources Consideration being given to how to achieve 2015/16 running costs target Develop plan to achieve running cost target for 2015/16 Requirements reviewed as and when vacancies arise. Maintaining an on-going review of running costs. Resources have been freed up by not replacing staff like for like. Moderate BAF Theme: Delivery JM Lack of a Referral Management Centre Strategy Engagement made with the National C&B2 Team. New strategy developed to move away from RMC and move to C&B2. New project structure developed with clear TOR for groups therein. Regular feedback to Executives at least once per month on how this project is performing Implementation and rollout plan developed and updated e-referral manager in post S&F tie in confirmed Choose and book programme board taking place DOS compiled by CCG Alternative options are being sought for services supported by RMC i.e. podiatry, gastroenterology etc. Regular feedback to Executives at least once per month. E-referral duties will remain in staff post on a permanent basis to ensure bedding in of project. Moderate

28 No. Date Added Lead Description Controls Score Overall Risk Score Change Action Plan (AP) Updates Status of AP Link to BAF C L Continued scrutiny of CSU R A G Broadcare data. Residual risk Last Risk Review Date 29 BAF Theme: Delivery PJ IPA process - financial instability, increasing costs, and assurances on quality of assessments Reviews of high cost complex cases. Examining the information MLCSU sends to CCG. Undertaking further training for GPs on process. Participation at IPA Programme Board meetings Undertake reviews and complete training for GPs on process. CCG scrutinising the accuracy of the financial forecast produced by the CSU Developing new commissioning processes in partnership with CSU and CCS. Development of new commissioning processes. The CCG has accepted the CSU's QIPP proposal - this will increase the capacity of the CSU IPA team and the frequency of case reviews. The CCG's investment is anticipated to be more than offset by the savings made. Following the recent procurement of the CHC Framework Agreement the CCG is anticipating a significant increase in the weekly rates care homes charge (the median increase across Lancashire is 10.5%) Moderate BAF Theme: Delivery PJ/CH Patients in receipt of NHS funded care potentially at risk of harm as their health and care needs may not be addressed due to gaps in CSU commissioned to manage CHC process. the commissioning of the CHC Monthly exception reporting care homes from service in respect of care planning CSU. Quarterly reporting on CHC from CSU and case management. Lack of capacity in CHC team resulting in routine reviews behind scheduled The review process is due to be completed and work with the In view of a 16-20% increase in chosen provider will commence demand for CHC assessments the within the month. West CSU Board has made additional Lancashire CCG and BWD are funding available to procure the the first CCG areas to be support of an external nursing targeted, reviews are expected company to assist in the to be completed by end March complete CHC reviews In light of the addition resources the risk is reduce to moderate. Moderate

29 No. Date Added Lead Description Controls Score Overall Risk Score Change Action Plan (AP) Updates Status of AP Link to BAF C L R A G Residual risk Last Risk Review Date 33 BAF Theme: Delivery CH / JR Decisions taken on referrals into MASH not informed by relevant health information and potential therefore that harm and risks not fully recognised leading to poorer outcomes for children/families and vulnerable adults. No agreement for the on-going funding of the Lancashire multiagency safeguarding Hub (MASH). Insufficient health contribution will impact on timeliness of information sharing and decision making and may result in poorer outcomes for children and adults at risk. Interim funding for 2wte band 7s and 1wte admin has been made available until Options paper currently being developed which will make recommendations for future commissioning of health service contribution to MASH Options paper to safeguarding collaborative and CCG on future commissioning of health contribution to MASH CCG/ AT/ PH agree future funding of health s contribution Procure service Awaiting outcome of options paper. 12 month funding agreed for a MASH service manager to coordinate across organisations. Long Term options still to be agreed Low BAF Theme: Delivery CH / JR Statutory health assessments for children looked after are not undertaken within statutory timescales and may result in the child not achieving their full potential as individual health needs not identified and addressed in a timely manner. Service specification in place with LCFT which requires them to co-ordinate the health assessment process and to quality assure assessments. S&O community paeds commissioned to undertake initial health assessments and adoption medicals for children 0-18 years. Health visiting and school nursing service specifications include the requirement for services to undertake statutory review assessments. Contract query being issued with LCFT re uptake and timeliness of review assessments. LCFT have put in place action plan to address issues CSU leading work stream on CLA to include developing preferred option for implementing PbR. will Improvement in administrative include recommendation of processes has seen an central LCC/ health admins improvement in the timeliness system. Reporting to Lancashire of assessment. Data still subject Children's and Maternity to scrutiny and regular commissioning network with final reporting received from report by March 16. To ensure LCC/LCFT CLA assessments integral to public health spec for HV/SN. Low

30 No. Date Added Lead Description Controls Score Overall Risk Score Change Action Plan (AP) Updates Status of AP Link to BAF C L R A G Residual risk Last Risk Review Date 35 BAF Theme: Delivery CH / LE Services users are potentially at risk of harm due to unlawful Pan Lancashire action plan in place with LCC deprivation of liberty within being bench marked against national plan hospital care home and supported held by NHS England. MCA/adult leads of living following the Cheshire West CCGs providing training to CSU staff on DoLS. Judgement in March 2014, Seek assurance that the care and treatment plans for CCG commissioned packages of care for individuals lacking capacity to consent have been reviewed and where a DoLs is identified full exploration of alternative ways of providing care/treatment have The CLA work stream continues been undertaken to enable the and the overall performance least restrictive option of care. continues to be monitored for Seek assurance from care homes sustainability. No change to risk where there are CHC funded score. patients that DoLs applications have been made or are in the process of being authorised. CCG to determine which service is best placed to be commissioned to case manage CHC patients residing in their own homes and supported tenancy to ensure compliance with Cheshire West recommendations. Medium /High BAF Theme: Delivery PJ/JM Lack of commissioning policies to drive individual patient funding decisions. Existing legacy policies being utilised Develop a new suite of policies. The CCG needs to establish clear governance arrangements for adopting polices and needs to engage in a work stream (either in conjunction with the work in Greater Preston and Chorley and South Ribble CCGs with which there is an offer of engagement, or in conjunction with county wide work being promoted by the CSU, or by designating its own officers) to develop a suite of robust and up to date policies. Continual review of commissioning policies is being undertaken. Awaiting updates from Pan Lancashire work Medium /High

31 No. Date Added Lead Description Controls Score Overall Risk Score Change Action Plan (AP) Updates Status of AP Link to BAF C L R A G Residual risk Last Risk Review Date 38 BAF Theme: Delivery MM Inability to deliver corporate objectives as a result of Lancashire County Council (LCC) budget cuts impacting on CCG in terms of LCC service provision and the reduction in capacity and knowledge and relationships with key stakeholders. Meeting with LCC to understand impact of cuts Ensure partnership arrangements are robust CCG is in regular contact with LCC over the financial impact. A senior officer from LCC attends the governing body meetings to provide any updates. The CCG is also working collaboratively across Lancashire as part of the BCF and Healthier Lancashire work with LCC and the other CCG s. Any jointly identified risks are being identified and monitored, including the impact of budget cuts. Medium /High BAF Theme: Delivery JM Patient safety issues in relation to the cardiology services at Southport and Ormskirk Trust having a significant backlog of follow up patients not being offered appointments Alternative provider commissioned to resolve backlog Urgent cases have appointments but the majority are still be have their appointments made Cost of the alternative provision is rising and needs to be managed. Detail of discussions with the provider is still not clear and needs to be confirmed. New consultant has been appointed jointly between LH&C and S&OHT Medium BAF Theme: Delivery PK Increasing financial risk in relation to the CCG taking on specialist services co-commissioning and the associated budget 2015/16 will be about preparation and transition to establish understanding and controls Action plan need developing as likelihood that financial risk will increase as April 2016 approaches. Issue around bariatric is still not resolved. A solution is being worked up across CCG s in Merseyside and Lancashire. This is being managed via the Lancashire Collaborative Commissioning Board of which the CCG is a member. Still remains a high financial risk to the CCG. The NHS will provide a procurement proposal and project plan in March This will likely be on a North West Medium

32 No. Date Added Lead Description Controls Score Overall Risk Score Change Action Plan (AP) Updates Status of AP Link to BAF C L R A G Residual risk Last Risk Review Date 42 BAF Theme: Contracts PJ Failure to Achieve Financial Balance 2015/16 Robust financial controls (ledger) and budget setting Some budget holders assigned Budget allocation agreed by DoH for 2015/ Continuous monitoring of financial position. Successful implementation of QIPP schemes Maintaining an on-going review of financial position. Pressures on planned care budgets need careful monitoring as potentially very significant. Moderate BAF Theme: Delivery MM/LM Reduced services provision leading to increase demand on NHS services as a result of 4M cut in public health funding in Lancashire Chair of HWN Board has written to the Secretary of State on behalf on the Board Lancashire Health & Wellbeing Board to have discussion to determine what it will mean for the future of Public Health. Chair of HWN Board to write to the Secretary of State on behalf on the Board That any soft evidence on the impact of local authority cuts should be forwarded to Director of Public Health LCC Cabinet took a paper considering the impact of scaling back to statutory services. This is an area that we are monitoring in terms of LCC decisions and resulting impact. Continue to monitor any impact through comments received by the CCG. Liaison with LCC commissioning leads to ensure CCG exec and Membership are briefed on updates regarding mobilisation of newly awarded contracts. The Council has reserves for 2 years which helps to mitigate against various service budget cuts in the near future. High

33 No. Date Added Lead Description Controls Score Overall Risk Score Change Action Plan (AP) Updates Status of AP Link to BAF C L R A G Residual risk Last Risk Review Date 44 BAF Theme: Delivery PK Risk of main ICO provider failing to meet required levels of delivery and performance due to a number of issues including service quality, financial outlook and senior staff changes. Discussions at Quality Committee Discussions with hospital chair and Board to Board meetings CCG continues to meet regularly with the Trust at a number of meetings (around quality and contractual performance), as well as a dedicated health economy wide group which meets regularly and looks at clinical and financial sustainability of services going forward. This includes NHS England, the TDA and fellow CCG commissioners. This work has been given a high priority in each organisation. A finance risk summit has been set up with next meeting on 8th January. There are also regular bi-weekly meetings of the Trust sustainability programme which involves all key stakeholders. The risk score will likely stay the same until longer term solutions are found. The CCG and other key stakeholders continue to work on wider acute hospital service sustainability as part of the Strategic Transformational Planning Process (STP). High BAF Theme: Delivery JM/KT Failure to deliver the adult community services procurement. Governance framework and project plan established, including programme-level risk register Frequent discussions at Community Services Programme Board where risk register for the programme is discussed and mitigating actions agreed. The main risks include resource capacity, which have actions in place to mitigate as far as possible. Moderate BAF Theme: Contracts JM/MM Increasing financial risk in relation to the CCG receiving charges for hospital Anti-coagulation Service in 2016/17. This service has previously not been charged for separately. We are unable to identify which patients are within the therapeutic rage for ICO provided service. Contractual process for 16/17 will mitigate the financial risk. The hospital has a monitoring system DAWN and CCG do not have access to this system for Secondary Care New To arrange access with ICO in to DAWN monitoring system. The hospital did not identify this through Code of Conduct practice. So there will be no charge this year i.e. 16/17. However, potential for charging next year - 17/18. Moderate Green Amber Red Status Of Action Plan Key Complete On Track Off Target

34 West Lancashire Clincial Commissioning Group - Risk Assessment Matrix Likelihood Rare Unlikely Possible Likely Almost Certain 5 Catastrophic 5 (Moderate) 10 (High) 15 (Extreme) 20 (Extreme) 25 (Extreme) Consequence 4 Major 4 (Moderate) 8 (High) 12 (High) 16 (Extreme) 20 (Extreme) 3 Moderate 3 (Low) 6 (Moderate) 9 (High) 12 (High) 15 (Extreme) 2 Minor 2 (Low) 4 (Moderate) 6 (Moderate) 8 (High) 10 (High) 1 Negligible 1 (Low) 2 (Low) 3 (Low) 4 (Moderate) 5 (Moderate)

35 West Lancashire CCG Risk Register CLOSED Risks - as at Risks removed from the active register Lead Description Controls Overall Risk Score Action Plan (AP) Updates Link to BAF C L R A G The Central Support Unit (CSU) do Continue to manage on 1 not the have the capacity i) Regular discussion with CSU Regular liaison with CSU KW a week by week basis BAF Theme: /capability to ensure the CCG can regarding the on-going position maintained. during transition fulfil statutory duties Operational Systems ii) CSU seeking specialist advice to address gaps in service offer ii) CCG have contracted specialist support directly in short term Score Maintain contract for specialist cover in the interim Development of suite of policies. Interim specialist staff recruited by CSU for health and safety, fire and risk management. Robust CSU support now in place Status of AP Residual risk Low Inspections completed and reported to Audit Committee. No significant issues Development of suite of policies nearing completion 2 BAF Theme: JW Impact of shortfall in recruitment to i)good liaison with CSU regarding the CSU in terms of specific support gaps in recruitment posts Continue to manage on a week by week basis Embedded team is now fully established and residual issues regarding hub functions are resolved Low Operational Systems When vacancies arise any short term pressures are covered 3 BAF Theme: Contracts/Deliv ery JM The business intelligence information provided by the CSU is insufficient for the CCG to make informed decisions. Monitoring of key performance indicators inc resilience & recovery planning. i) KPIs are agreed and monitored for each contract. Quality Improvement Committee collecting information from various data streams ii) Direct feedback reports from secondary providers re trends iii) Informal GP sharing iv) Lead Nurse in post Data flows are established but still not yet embedded. Non specific gaps as follows: i) Lack of clarity of future role of NHSE in managing and influencing the system Establish clarity of reporting activity arrangements - quality processes now working well Feedback to CSU on the areas that we require making more robust. Ongoing review Jan 15 Low/ Moderate

36 4 BAF Theme: KW Limited GP capacity to the CCG results in increased management i) Specific GP portfolios supported costs and/or limited involvement in by CCG managers local meetings and groups Planned improvements to communications pathways to improve efficiency, Planned improvements to communication pathways to improve efficiency. Ongoing development of engagement strategy will target better use of GP capacity Facing the Future Together has produced a strategy Risk Closed Jan 15 Low/ Moderate Operational Systems/ Engagement ii) Planning of GP engagements to ensure maximum benefit for CCG On-going development of engagement strategy will target better use of GP capacity. Continue watching brief 5 BAF Theme: PJ 2013/14 Financial shortfall possible due to: i) On-going verbal assurances regarding the system wide allocation issues Regular dialogue and updates on a weekly basis CCG confident of operating within budget for 2013/24 Low Contracts /Delivery i) Reduction in allocation following redefinition of specialised services may compromise ability to meet contract costs i) Disaggregation of budgets from CLPCT ii) Agreement with Chorley and Gtr. Preston CCGs regarding reallocation of resources Lancs wide agreement achieved regarding allocation for 2013/14 Status reduced to low for this financial year 6 BAF Theme: PJ Limit on running costs resulting in lack of flexibility to manage staff shortages in financial dept. i) Establishment is considered appropriate to meet current needs Regular monitoring of staffing levels and capacity Finance team fully established Low Operational Systems ii) Staff encouraged to work flexibly to ensure adequate cover Examine development of matrix working to mitigate impact of staff shortages No current pressures status remains satisfactory Continue watching brief Risk reduced to low 9 BAF Theme: Engagement MM (KW) On-going pressure from MPs and interested parties to provide information Websi8te & Media Coverage. Public Board Meetings & joint networking. Patient Participation Groups Patient Focus Groups Mg View Group Co-ordination of information flow between key stakeholder groups needs improving For 2013/14 only Additional target group contacts obtained via AGM and on-going engagement work. Contacts continue to be gathered for the stakeholder database. Stakeholder Database established and MP relationship good at present time Risk Closed Jan 15 Moderate

37 10a BAF Theme: JM Unclear system and process to ensure the CCG receives critical timely information relating to SUIs. i) Existing systems established in providers for management of SUIs. Increase understanding of existing structures & systems within commissioning and providers Information flow arrangements agreed Contracts/ Operational Systems ii) Handover meetings in place Establish systems to ensure appropriate information flows and governance arrangements are in place Chief Nurse and Quality Assurance Manager now in post Low 10a BAF Theme: Contracts/ Operational Systems JM Individual Funding Request and Continuing Healthcare Requests involving WL patients. (REPLACED WITH RISK 29) i) Existing systems established for management of IFRs & CHRs Ensure appropriate data is in place for IFRs and CHCs so that the CCG can appropriately monitor process and performance Information flow arrangements need to ensure adequate data regarding IFRs and CHRs. Low/ Moderate 10b BAF Theme: Contracts/ OP Systems 11 BAF Theme: Delivery/ Contracts/ Operational Systems JM KW Lack of nursing input into quality, safeguarding and SUI operational systems Ability to manage the gap in knowledge transfer during the transition process from PCT to CCG i)development of robust quality to identify gaps ii) Regular reporting to Quality Committee of safeguarding/sui and all quality metrics i) attendance at transition/closedown group ii) Handover meetings scheduled iii) Legacy document re. service/agency specific knowledge & contacts Link with Chief Nurse from neighbouring CCG to ensure links re SUIs Advertisement for additional nursing/quality posts in process Maintain contacts with PCT, services and other agencies during and after transition Maintain broader overview of developments to avoid unexpected problems Chief Nurse and Quality Assurance Manager now in post Reduce risk to low Issues relating to knowledge transfer have now been resolved and no new issues have been raised. Risk reduced to low Low Low 12 BAF Theme: Operational Systems KW Lack of CCG business continuity plan i) Currently linked to PCT continuity and recovery plans Develop CCG specific continuity and recovery plans in liaison with partners and stakeholders CSU Business Continuity Plan now received and both plans circulated to all relevant parties Low 13 JW Managing the demands of the Local Area Team (LAT) regarding the performance of CCG contracted services i) Established links with LAT Develop open culture with LAT regarding performance issues Continuing dialogue current relationship is very positive. Low BAF Theme: Contracts/ Delivery/ Engagement ii) Agreement with LAT regarding CCG Annual Plan Ensure strong links with other CCGs is maintained Status remains Seeking to improve data satisfactory around quality of GP services

38 14 JW Possible breaks in continuity of i) Comprehensive database of contracted services during and post contracts in place transition On-going verification of data relating to all contracts during transition All contracts now in place and any transition issues resolved Low BAF Theme: Contracts/ Delivery ii) PCT support to ensure all contracts are handed over to plan 15 BAF Theme: Contracts/ Delivery JW Inherited risk from PCT- Lack of governance in the Brief Therapy Support Services. i) Issues being investigated by former CL PCT CCGs CCG have fully investigated the issues. Any issues have been resolved and sound governance arrangements are in place Low 16 BAF Theme: Operational Systems KW Potential impact on delivery of corporate and legal responsibilities arising from pressures on capacity. Links to No. 21 i) CCG fully established with clearly defined roles ii) Matrix working principles established Robust prioritization process to be developed in relation to key priorities Time management and resilience training to be developed to embed effective working practices New risk added December 2013) Prioritisation for 2014/15 needs to be progressed. Moderate (Risk closed as relates to 2013/14) iii) PDP process in place 1-1 process in place. 17 BAF Theme: Contracts/Oper ational Systems 18 BAF Theme: Operational Systems CH MM iv) Informal staff and senior team meetings Failure of the CSU and hosted services to provide robust i) Hosted Services in place arrangements for meeting statutory duties relating to safeguarding. Reduced prescribing capacity due to Lancashire Area Team (LAT) having no process in place to authorise practice based nonmedical prescribers (NMP) to have prescription pads ii) CSU proposals Letter sent to LAT requesting they establish standard operating procedures for registering new NMP with the prescription pricing division and implementing the required checks prior to issuing prescriptions PDR process about to commence for 2014/15 Hosted Services proposals considered via Chief Nurse is now Lancs CCG Chairs leading in this area. network no agreement yet reached CSU proposals via CCG managers meeting no agreement yet reached Multi CCG task and finish group to be established To monitor LAT s response to letter sent Multi CCG task and finish group has been established. Chief Nurse attends. Draft Safeguarding Policy received and awaiting approval at next quality committee. Processes now in place. Risk mitigated and closed. New Risk added Awaiting LAT response as at Low/ Moderate Low 19 BAF Theme: Operational Systems JM Inform Chorley and South Ribble CCG (host CCG) and request they Failure to maintain equipment discuss issue at contract meeting asset register by Lancashire re incident reporting and Teaching Hospitals for equipment informing the CSU immediately issued re complex packages of care so investigation can be undertaken Network Director contacted to discuss procedure. Issue to be raised with CSU. Ensure procedure reviewed with regard to incidents where CSU needs to be informed. CSU seeking to procure new equipment asset and maintenance system. The CCG is progressing this issue with the CSU Jan 15. Risk removed from register on

39 20 PJ BAF Theme: Contracts/ Delivery 21 BAF Theme: Operational Systems PJ Not achieving financial balance in 2014/15 RISK IS DUPLICATE OF 26 SO CLOSED Potential impact of 10% Reduction in running cost allocation from 2015/16 i) Financial system to take corrective action as required i) Current position on running costs known ii) Plan for 15/16 being prepared Financial plan in draft Risk added Low Plan for 15/16 being prepared Cost allocation plan being prepared for 2015/16 Risk removed as incorporated into Risk 25 Low/ Moderate 23 CMC The Oxygen Service provided by Southport and Ormskirk Hospital Trust has a waiting list of existing patients to be reviewed 1)Monthly review meetings with nurse specialist 2)Bi monthly meeting With senior team 3)Process map September Meeting Trust to provide paper of up to date activity and To continue with controls risk. Low 4)Review Spec in August 24 BAF Theme: Engagement MM Lack of Engagement with NHS England Primary Care Teams Regular meetings between chief officer and deputy primary care lead at LAT Primary care issues raised at CCG and LAT quarterly assurance meeting Chief officer has regular 1:1s with chief executive of LAT Issue compacted with merger of NHS England Area Teams. Significant issues Concerns continue in arising from 1:1s relation to capacity to between chief officers fulfil any cocommissioning and LAT to be reported to the requirements. Decision governing body within being made by the the Chief Officers Membership Council Report as from July early January 2015 over 2014 the level of Cocommissioning the CCG wished to take on. Jan 15. Moderate 26 BAF Theme: Contracts PJ Failure to Achieve Financial Balance 2014/15 Robust financial controls (ledger) and budget setting. Some budget holders assigned. Budget allocation agreed by DoH for 2014/ Continuous monitoring of financial position. Successful implementation of QIPP schemes On-going review of financial position Jan 15. Risk removed from register on Moderate

40 28 BAF Theme: Delivery KT Uncertainty of future of CCG affecting ability to plan long term 5 year plan finalised & submitted. Strategic Partnership in place. Governing Body development workshop on strategic position held year plan submitted and feedback received. Risk reduced from (4x3) 12 to (3x3) due to potential political impact Facing the future together (FtFT) transformation programme in place. Outcome of Gateway 1 resulted in RAG Rating of Red / Amber. Letter and Gateway Report sent to S&O Trust outlining the current position. Second Gateway is scheduled for March Update Jan 15. Risk removed from register on Risk around delivery of FFT remains on register. Moderate 30 BAF Theme: Operational Systems PK To review all feedback Lack of approval/ from circulation of Risk added July IM&T strategy agreed in principle Strategy with partner by CCG. implementation of an IM&T organisations prior to full Strategy has been circulated to Strategy implementation. partner organisations. Strategy being Strategy approved at Each member practice has an presented to governing November 2014 GB agreed programme plan body for formal adoption in November. Moderate 31 BAF Theme: Operational Systems CH Limited assurances on nursing home issues, -potential Safeguarding issues not identified Receive information via the CSU on all incidents reported in nursing homes. Incident dashboard being developed. Chief nurse attends RADAR meeting with local authority Regular attendance at Safeguarding Adult Board meetings. Chief nurse meets fortnightly with safeguarding team Southport & Ormskirk Trust to amend Policy to ensure staff report incident relating to Nursing Home patients. Awaiting confirmation that this has been done Risk added July Risk can now be closed as process strengthened in relation to care homes. Moderate 37 BAF Theme: Delivery PJ Provider has given formal notice to CSU (28 day standard NHS Contract) re patient on Sec 3 MHA as unable to meet patient's needs. Vulnerable patient, risk of absconding risk to self and others as well as a risk of self-harm. Provider has duty of care to patient. CSU and provider meetings taking place The CSU IPA team are responsible for placing patients on behalf of the CCG. CCG to ascertain from the CSU IPA team why there have been a delay and when will they source a more suitable placement for the patient. Risk added October 2014 Request made to the CSU IPA team in relation to this new incident. CSU have stated that they have no concerns regarding the safety of this patient but are working with the provider to resolve. Identified Risk now Closed Jan 15. Medium /High

41 39 BAF Theme: Delivery MM/JM Inappropriate placement of individual learning disability patients following Learning Disabilities Enhanced Support Service (LD ESS) being transferred to CCGs as a result of CCG not having the expertise in this area. Further discussion at CCB meeting July 15 Update - No progress with this issued risk unchanged. Lead manager in post with a focus on LD - Risk Closed - Jan 2016 Medium \High 22 BAF Theme: Operational Systems PK Implementation of the new IT system at S&O as it may affect the delivery & quality of health services Monitoring of performance and quality metrics for all metrics so any changes can be identified. Updates on implementation going to SPB. Contract penalties for nonsubmission of data On-going monitoring of performance & quality metrics. CCG IT lead obtaining a status report. Data checks have been done and the CCG is now satisfied that the new system has bedded in appropriately. Risk Closed - Jan 2016 Moderate

42 Agenda item no: WLCCGB 03/16/8 WEST LANCASHIRE CLINICAL COMMISSIONING GROUP BOARD REPORT DATE OF BOARD MEETING: 22 March 2016 TITLE OF REPORT: Declaration of Members Interests - Update BRIEFING POINTS: To record the declared interests of the members of West Lancashire Clinical Commissioning Governing Body Does this report / its recommendations have implications and impact with regard to the following: A. Commissioning Board s Aims and Objectives 1. Quality (including patient safety, clinical effectiveness and patient No experience) please outline impact 2. Commissioning of hospital and community services please outline No impact 3. Commissioning and performance management of GP Prescribing No please outline impact 4. Delivering Financial Balance please outline impact No 5. Development of the commissioning group as a commissioning Yes organisation please outline impact Will provide the commissioning board and commissioning group with practical experience of implementing good governance practices B. Governance please outline impact Yes 1. Does this report: provide the Commissioning Board with assurance against any of the risks identified in the assurance framework (identify risk number) have any legal implications promote effective governance practice The report promotes good governance practices. It provides a summary of the declared interests of members. Since the register was first presented to the governing body additional posts have been recruited to. 2. Additional resource implications No (either financial or staffing resources) 3. Health Inequalities No 4. Human Rights, Equality and Diversity Requirements No 5. Clinical Engagement No 6. Patient and Public Engagement No REPORT PREPARED BY: REPORT PRESENTED BY: Cathy Ashcroft, Governing Body secretary Paul Kingan, Chief Finance Officer Declaration of members interests West Lancashire Clinical Commissioning Group Governing Body Meeting 22 March

43 WEST LANCASHIRE CLINICAL COMMISSIONING GROUP BOARD DECLARATION OF MEMBERS INTERESTS - UPDATE BACKGROUND 1. The purpose of this report is to record the declared interests of the members of West Lancashire Commissioning Governing Body. 2. The register was updated in March 2016 to provide an up to date position of declarations of interest for the members of the Governing Body. ACTIONS 3. The Governing Body is asked to: a. note the declared interests of its members Declaration of members interests West Lancashire Clinical Commissioning Group Governing Body Meeting 22 March

44 REGISTER OF INTERESTS AT MARCH 2016 Name Date Position / Role Potential or actual area where interest could occur Dr J Caine * Chair GP partner: Parbold Surgery Wife employed by Southport and Ormskirk NHS Hospital Trust as a paediatric nurse in A&E. Dr B S Biswas * GP executive lead Partner Beacon Primary Care Wife is a family planning nurse employed by Blackpool GUM, which provides local services via Local Authority. Practice subscribes to OWLs. LES provider anticoagulation and minor operations. Dr S Frampton * GP executive lead GP Partner at Ormskirk Medical Practice providing clinical and business management roles. Dr J Kinsey * GP executive lead Partner in Parbold surgery, 4 The Green, Parbold WN8 7DN (3 days per week) Shareholder (30%) in Mednostic Solutions Ltd. o Diagnostic provider (osteoporosis Dexa scanning) o Weight loss services o Sports science Owner, director and shareholder (70%) of JPK medical Ltd Medical Consultant for Pharmacovigilance at Ayrton Saunders Ltd Macmillan GP resigned position at West Lancashire CCG Primary care medical educator and programme manager for Manchester postgraduate Deanery as an educator at Preston GP appraiser carry out appriasals on other GPs for NHS England Out of hours provider work for OWLS CIC Ltd as independent practitioner for GP services in West Lancashire. Wife works as Macmillan upper GI cancer nurse specialist at Aintree NHS Foundation Trust. Wife is a shareholder (30%) and coowner of JPK medical ltd. Declaration of members interests West Lancashire Clinical Commissioning Group Governing Body Meeting 22 March

45 Paul Kingan Chief finance officer Douglas Richard Lay member Soper audit and governance Greg Mitten Lay member patient and public involvement Adam Robinson Secondary care doctor Brother in law co-owner and director shareholder (30%) of Mednostic solutions ltd (family members) Nil Nil Chief Officer, West Lancashire Community for Voluntary Services Director Lancashire Association of CVS (Charity). Director One Lancashire (Voluntary position - Charity) Chair of One West Lancs -strategic partnership. (Voluntary position). Chair Lancashire West LAG (RDPE) Board (Voluntary position) Member Governing Body Hilldale Primary School Wife (Dierdre Mitten) is project director of Skelmersdale Food Initiative Charity. (family member interest) Deputy chair at Salford Royal Foundation Trust Michael Maguire Chief officer Nil Dr R Bonsor* GP executive GP partner and GP Trainer at Beacon lead Primary Care Ormskirk and Skelmersdale. Director of Barbonel services company. Fundraising for Lancashire Defibrillator Campaign Chair of local 30 th Ormskirk Scout Group. Fundraiser for West Lancashire Defib Group, Chair a personal friend (Personal and friend). Ambassador for Twinkle House Charity Skelmersdale, is a personal friend. Director or Home Instead a personal friend. Practice performs minor surgery, vasectomy, anticoagulation and family planning services and the 5 per head proactive cover scheme. Husband is a consultant in Accident and Emergency at Whiston Hospital (family member interest). Declaration of members interests West Lancashire Clinical Commissioning Group Governing Body Meeting 22 March

46 Claire Heneghan Chief Nurse Nil Dr Peter GP executive Gregory* lead Practice nurse clinician is partner of the local manager of the Older Adult Mental Health team (Professional relationship interest). Partner at Parkgate surgery Director of OWLs Brother is a fellow of AQUA (family member interest) Provide minor surgery at practice. *As agreed at the Governing Body meeting on 28 January 2014, please note that all principal GPs in West Lancashire are default members of the Out of Hours service. Declaration of members interests West Lancashire Clinical Commissioning Group Governing Body Meeting 22 March

47 NHS West Lancashire Clinical Commissioning Group Declaration of interests - members This form is required to be completed in accordance with the CCG s Constitution and section 14O of The National Health Service Act 2006, the NHS (Procurement, Patient Choice and Competition) regulations 2013 and the Substantive guidance on the Procurement, Patient Choice and Competition Regulations. Name.. (BLOCK CAPITALS) Position within or relationship with, the CCG or NHS England. I hereby declare my interests as follows: Type of interest Details Personal interest or that of a family member, close friend or other acquaintance? Role and responsibilities held within member practices Membership of any GP provider organisation holding or seeking to hold CCG contracts Membership of the Operating Board of such organisations Directorships, including non-executive directorships held in private companies or PLCs Ownership or partownership of private companies, businesses or consultancies likely or possibly seeking to do business with the CCG and/or NHS England Declaration of members interests West Lancashire Clinical Commissioning Group Governing Body Meeting 22 March

48 Share holdings (more than 5%) of companies in the field of health and social care A position of authority in an organisation (eg. Charity or voluntary organisation) in the field of health and social care. Any connection with a voluntary or other organisation contracting for NHS services. Research funding/grants that may be received by an individual or any organisation in which they have an interest or role Interests in pooled funds that are under separate management (any relevant company included in this fund that has a potential relationship with the CCG must be declared) Any interests in relation to the CCG s Enhanced Services Review Any other role or relationship which the public could perceive would impair or otherwise influence the individual s judgment or actions in their role within the CCG and/or with NHS England. Any other interests Declaration of members interests West Lancashire Clinical Commissioning Group Governing Body Meeting 22 March

49 To the best of my knowledge and belief, the above information is complete and correct. I undertake to update as necessary the information provided and to review the accuracy of the information provided regularly. I give my consent for the information to be recorded in a formal Register of Interests, a public document which will be published on a quarterly basis and available for inspection upon request by the general public. Signed: Date: Please complete and return to: Cathy Ashcroft, Governing Body secretary, West Lancashire CCG Declaration of members interests West Lancashire Clinical Commissioning Group Governing Body Meeting 22 March

50 WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERING BODY REPORT DATE OF BOARD MEETING: 22 March 2016 Agenda item no: WLCCGB 03/16/09 TITLE OF REPORT: Integrated Business Report BRIEFING POINTS: This report provides summary information on the financial and activity performance of West Lancashire Clinical Commissioning Group for January 2016 and a financial position for February Quality and performance analysis is also provided for community based targets and for the Southport and Ormskirk Hospitals. Does this report / its recommendations have implications and impact with regard to the following: A. Commissioning Board s Aims and Objectives 1. Quality (including patient safety, clinical effectiveness and patient Yes experience) please outline impact The report outlines quality and performance issues relevant to the CCG and describes key actions to address these. 2. Commissioning of hospital and community services please outline impact The report includes financial and activity information in relation to commissioned services and highlights areas of risk and actions. 3. Commissioning and performance management of GP Prescribing please outline impact 4. Delivering Financial Balance please outline impact Yes The report summarises the financial position of the CCG and highlights areas of financial risk. 5. Development of the commissioning group as a commissioning organisation please outline impact This report will support the CCG in developing clear and credible plans. B. Governance please outline impact 1. Does this report: provide the Commissioning Board with assurance against any of the risks identified in the assurance framework have any legal implications promote effective governance practice Links to financial risks. 2. Additional resource implications (either financial or staffing resources) 3. Health Inequalities Yes Links to health outcomes framework (all five domains) 4. Human Rights, Equality and Diversity Requirements No 5. Clinical Engagement No 6. Patient and Public Engagement No REPORT PREPARED BY: Paul Kingan, Chief finance officer Yes No Yes Yes No Integrated Business Report West Lancashire Clinical Commissioning Group Governing Body meeting 22 March 2016

51 West Lancashire Clinical Commissioning Group Integrated Business Report March 2016 (Reporting Period January 2016) 1 P age

52 TABLE OF CONTENTS 1 Executive Summary 3 2 Financial Position 4 3 QIPP 7 4 Planned Care: Referrals 8 5 Planned Care: ereferrals Service 9 6 Planned Care: Acute Contract 10 7 Unplanned Care: Acute Contract 12 8 Prescribing 13 9 Lancashire Care Foundation Trust (LCFT) Activity Quality and Performance a WL CCG Performance Dashboard 17 b Southport & Ormskirk hospitals NHS Trust Urgent Care Performance Dashboard 21 c Southport & Ormskirk Hospitals NHS Trust Planned Care Performance Dashboard 22 d Southport & Ormskirk Hospitals NHS Trust Wide Performance Dashboard 23 e Areas of Under-Performance 24 f Patients Waiting by Weeks 26 g CCG Outcomes Indicator Set 28 h Friends & Family Test 29 i Safety Thermometer Complaints a West Lancashire Complaints 30 b GP Comments, Concerns & Issues with Healthcare Providers Serious and Untoward Incident Reporting Wrightington, Wigan & Leigh Contract Performance Group 32 2 P age

53 1. Executive Summary This report provides summary information on the activity performance of West Lancashire Clinical Commissioning Group for January 2016 and a financial position as at February Quality and performance analysis is also provided for community based targets and for Southport and Ormskirk Hospitals NHS Trust. CCG Position Highlights OVERALL POSITION CCG delivery of financial duties CCG forecast DEMAND GP referrals Other referrals PLANNED CARE Total planned care PBR UNPLANNED CARE Total unplanned care PBR PRESCRIBING Prescribing Budget Footprint CCG CCG CCG CCG CCG CCG CCG CCG Key Performance Indicators YTD NHS Constitution indicators Footprint RTT 18 Weeks wait (admitted) CCG A&E 4 hours CCG Cancer Waits 62 days CCG Ambulance Category A Calls CCG Other key targets Friends and Family CCG MRSA attributable to CCG CCG C. difficile CCG Cancer 14 day urgent target breast CCG Key information from this report NHS West Lancashire CCG As at February 2016 the CCG is forecasting a surplus of 1.463m, in line with the 1% target ( 1.463m) required by NHS England. However, the pressures on hospital budgets mean that the CCG s entire contingency reserve has been deployed. Indicative performance to the end of January 2016 against the planned care element of all contracts is over plan by 2.5m. The performance over the same period against the planned care element of the Southport and Ormskirk contract only is over plan by 354k. Indicative performance to the end of for January 2016 against the unplanned care element of all contracts is under plan by 476k. Unplanned care performance for the same period against the Southport and Ormskirk Hospital contract is under plan by 603k. A simple forecast to the end of the year, based on the figures above, would indicate an overspend on hospital budgets of 2.2m. This is incorporated into the financial position in this report. Performance issues The CCG has again under achieved on Ambulance - All Category A call out indicators. The annual trajectory for MRSA cases is zero and this was breached in April at S&O Trust with 1 case. Public Health England has been informed. There have been no further cases reported for rest of the year to date. S&O Trust is above trajectory for C. difficile indicator with 29 cases YTD. There were 4 cases at this Trust in January. The Trust is challenging the derivation of these cases. 3 P age

54 2. Financial Position The following table summarises the financial position for West Lancashire CCG at Month /16. Table 1 NHS West Lancashire CCG Financial Position as at Month /16 Year to Date Full Year Budget Expenditure Variance Budget Forecast Forecast Variance Acute services Acute 68,611 70,302 1,691 75,003 76,848 1,845 Ambulance services 2,705 2, ,951 3, Sub-total Acute Services 71,316 73,112 1,796 77,954 79,913 1,959 Mental Health Services Mental Health 9,824 9, ,712 10, Learning Difficulties Sub-total Mental Health Services 10,595 10, ,553 11, Community Health Services Community 13,046 12,990 (56) 14,257 14,196 (61) Sub-total Community Services 13,046 12,990 (56) 14,257 14,196 (61) Continuing Care Services Individual Packages 8,136 8,095 (41) 8,855 8,810 (45) Funding Nursing Care (64) 1, (70) Sub-total Continuing Care Services 9,060 8,955 (105) 9,863 9,748 (115) Primary Care Services Primary - Local Enhanced Services ,013 1, Urgent Care 2,803 2, ,077 3, GP IT Prescribing 17,219 17, ,785 19, Sub-total Primary Care Services 21,397 22, ,394 24, Other Budgets/Reserves Running Costs 2,197 2,197-2,397 2,397 (0) NHS Property Services 1, (242) 1, (264) Other Corporate Costs (28) (31) Other Programme Services (10) (11) Seasonal Resilience Non Recurrent Schemes (557) (608) Contingency (671) (732) Reserves 2,963 2,040 (924) 2,809 1,801 (1,008) Sub-total Other Programme Services 8,943 6,510 (2,433) 9,365 6,711 (2,654) Total - Commissioning services 134, ,358 (1) 146, ,385 (1) Planned Surplus 1,341 - (1,341) 1,463 - (1,463) Grand Total 135, ,358 (1,342) 147, ,385 (1,464) 4 P age

55 As at Month 11 the CCG has a year to date underspend of 1.341m, which is forecast to increase to 1.463m by the end of the financial year. This is consistent with the delivery of a 1% surplus as required by NHS England. Key points to note are: Acute Services Month 10 activity monitoring information reveals forecast overperformance in excess of 1.8m. This is being driven by elective care particularly in specialities such as Trauma & Orthopaedics, Breast Surgery, Ophthalmology and Clinical Physiology. Analysed by provider, the most significant forecast pressures are with Aintree University Hospital NHS Trust ( 779k), Ramsay Healthcare ( 495k) and Wrightington, Wigan and Leigh NHS Trust ( 397k). The CCG has now allocated the 270k Breast Surgery reserve to those hospital contracts that are experiencing increased activity following the cessation of the service at Southport and Ormskirk Hospitals NHS Trust. Despite this, performance for the specialty across all contracts is significantly above plan with the forecast currently indicating an increase in activity on 2014/15 levels of 21% ( 170k). Partially mitigating the above is a significant forecast underspend at Southport at Ormskirk Hospitals NHS Trust ( 1.247m), driven in part by underperformance in non-elective activity. Additionally an allowance for the application of penalties ( 500k) and deductions relating to CQUIN ( 300k) have been factored into this figure. Mental Health Due to demand pressures Lancashire Care Foundation Trust has been unable to manage the level of unplanned care within its existing bed stock. It has therefore been necessary to utilise additional capacity from the independent sector. The resulting costs have been shared on an equitable basis across Lancashire CCGs and are reflected in the overspend shown above. Individual Care Packages The latest forecasting data received from Midlands and Lancashire CSU indicates an overspend of 384k which is attributable to pressures on the Continuing Care budget. Offsetting this is a correction to the 2014/15 position whereby the total value of packages is now expected to be materially lower than that included in the final accounts. Additionally the CSU has presented a proposal to Lancashire CCGs which seeks investment in additional capacity in the IPA service. This will enable the CSU to implement a number of QIPP schemes that are expected to reduce costs, for example the more effective management of patients with 1:1 nursing needs. West Lancashire CCG has agreed to this proposal. Prescribing The December forecast received from the NHS Business Services Authority shows a projected overspend of 533k, which represents a significant deterioration of 330k on the previous month. This increase is representative of a national trend this month the pan-lancashire movement alone is 3.2m. The forecast is however now more consistent with the increase in year to date expenditure when compared to the same period last year (5.6%). Non Recurrent Schemes The CCG is required to set aside 1% of its programme allocation for these. The largest element of this ( 529k) is the CCG s contribution to the national risk pool (and associated assessment costs) to settle continuing care retrospective cases relating to periods prior to the inception of the CCG. The remainder supports a number of transformational schemes, many of which will no longer require the level of funding originally allocated for 2015/16. Other Budgets/Reserves Within this figure are resources set aside for items such as the allocation of 5/head of population on a Practice footprint to fund initiatives within Primary Care and investment in Community Respiratory and Community IV schemes. These are being moved to operational budgets as and when required. Contingency The CCG is holding 0.5% of its allocation as a contingency (as per NHS England s 2015/16 Business Rules). Given the pressures on Acute Services, the entire contingency has already been deployed 5 P age

56 to deliver a forecast financial position for Month 11 that achieves a 1% surplus. Additionally the CCG will now have to delay certain planned investments in order to deliver this surplus. The CCG s annual budget at Month 11 is m. This is derived from the following allocations: Table Opening Programme Allocation 139,385 Opening Running Cost Allocation 2,397 Return of 2014/15 Surplus 1,442 BCF 2015/16 2,442 GP IT Funding 358 ETO/DTR Funding 444 Waiting list validation & improving operational processes 5 Eating Disorders and planning 63 Tier 3 Specialised Commissioning Responsibility Transfers 919 Extended/seven day access 231 Liaison Psychiatry 50 Mental Health CAMHs - Transformational Allocation Quality Premium award 81 CEOV and non-rechargeable services allocation adjustment (271) Extended/7 day access 146 Total resources (as at Month 11) 147,849 In addition to its duty to deliver a 1% surplus the CCG has other financial responsibilities: Better Payment Practice Code (BPPC) The Better Payment Practice Code requires the CCG to aim to pay valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. The CCG s target is for 95% of invoices (both by value and volume) to be paid within this criteria. Table 3 shows the 2015/16 cumulative performance against these requirements: Table 3 NIS Cumulative Target Performance to date Value 95% Volume 95% On Target for Year 9nd Non-NIS Value 95% Volume 95% Cash Management The CCG must not utilise more cash than it has available, both on a monthly and annual basis. It has to manage its cash flow accordingly whilst ensuring there are sufficient funds available to pay suppliers and meet the BPPC targets listed above. Table Maximum Cash Drawdown 2015/16 146,393 YTD Cash Drawdown 118,926 CHC Risk Pool Contribution 235 YTD Oxygen and Prescribing 17,352 Cash Available for Remainder of Year 9,880 6 P age NHS England has issued the CCG with a Maximum Cash Drawdown (MCD) for 2015/16 of m

57 3. QIPP Each year the CCG is faced with balancing the rising demand for hospital activity with a finite amount of financial resource. Therefore the CCG seeks to negotiate the best value for money it can achieve from its contracts, whilst also seeking to achieve Quality, Innovation, Productivity and Performance (QIPP) gains. These savings maybe either cash releasing or non-cash releasing but need to have a recurrent effect if the CCG is to see a sustainable financial benefit. 14 QIPP schemes have been identified for 2015/2016 and a description, expected savings, confidence levels, current indicative savings and project status for each are shown in the table below. ID Scheme Name Description Expected Savings Likelihood of savings being delivered Likely Savings k % k Commissioning Toolkit Current Status QP01 NEL - AVS LNK - savings from admissions avoided % 626 A Task QP02 Musculoskeletal Redesign Project Savings from referrals, inpatient and follow-ups avoided % 50 A QP03 Choose & Book Savings from inappropriate referrals avoided 46 50% 23 A QP04 BCBV Savings from reduction in outpatients as a result of improving first to follow-up ratios 0 50% 0 R Emphasis on First to Follow-Up with Trust not yet agreed. QP05 Prescribing Savings from prescribing % 566 G QP06 Dressings / Medicines Management Savings from the closer management of dressings % 80 G QP07 CCG running costs Required savings from running costs % 252 G QP08 CCS Reduction in CHC placement costs % 272 G QP09 Complex care panel Savings in complex cases % 120 G QP10 Calderstones Reduction in LD case costs 65 0% 0 R QP11 WLHP Recharge to other commissioners for WLHP activity % 150 G QP12 LCFT Discontinuation of investment in NR LCFT Dementia schemes % 60 G QP13 Estates Reduction in the costs of running estates and better utilisation % 100 G QP14 VFM car parking Reduction in the costs of parking at WLHP from September % 40 G QP15 FLO TeleHealth Reduction in avoidable referrals 57 80% 46 G Total 3,011 79% 2,385 The figures shown in the table above will continue to be refined and updated as further analysis of supporting data is carried out and the schemes are improved & developed over time. 7 P age

58 4. Planned Care: Referrals DUE TO PROBLEMS WITH THE DATA, THIS WILL BE UPDATED IN NEXT MONTH'S REPORT. 8 P age

59 5. Planned Care: ereferrals Service (previously Choose & Book) The latest E-RS utilisation data for NHS West Lancashire CCG practices drop to 83.5% in December 2015 and increased to 94.2% for January Ongoing training and support in the use of e-rs has continued, providing training for further new users and supporting current users in additional understanding of the service and updated information about providers that are available on e-rs. Users are also encouraged and shown how to use SharePoint to access information about services available on the e-rs. The need to standardise referral forms and referral processes for services that are not available on e-rs has been identified as practices are using differing forms and submitting them in different ways. A number of services have been identified to date and work to agree referral forms that integrate with EMIS Web has commenced. A number of forms have been agreed with services and distributed to practices with further forms being developed or awaiting agreement prior to distribution. Use of Generic NHS accounts to use to refer to services not available on Choose and Book is increasing slowly. Work to support the NHS West Lancashire Choice / e-referrals in Mental Health project continues and meetings with the service to agree referral forms to include referral criteria, required information and how referrals can be submitted have been arranged. Support and training for the PARTNERS2 project has been provided with clinical and document templates now available on the 3 practice clinical systems taking part in this work and Erica Thomson who is working on the project for Lancashire Care able to access the required clinical systems. Work to secure access to the e-rs Training Environment to support service configuration and ongoing training continues, the next steps are to achieve integration with the Training Environment and a referring and provider clinical system. GP with Special Interest (GPwSI) services continue to be supported. The process for uploading waiting times etc. into in to Unify2 for diagnostic services has been developed and the documentation for Dr Sharma s Gastroscopy service has now been agreed and finalised, and training for its use has commenced with the service manager now trained and administrative staff training arranged. Work on the procurement of EMIS Web Extended is progressing with current work concentrating on ensuring the most appropriate configuration that meets the needs of the services while also meeting Information Governance requirements is established. EMIS Web Extended will replace ipm Lorenzo to enable all GP with Special interest services to be directly bookable via the NHS e-referral Service, and enable the sharing of patient s medical records to provide safer care. 9 P age

60 6. Planned Care: Acute Contract All Providers Performance at month 10 against the planned care element of the contract is shown below in table 2a. This shows the planned care element of the contracts is over plan by 2.5M While the greatest variance is seen in DC POD, the greatest specialty level variance at a single provider is OPPROCs in 110: Trauma & Orthopaedics at Southport and Ormskirk (262K). Table 2a: Month 10 Planned Care All Providers Point of Delivery Activity 2015/16 Cost 2015/16 Plan Actual Variance Plan Actual Variance DC 11,908 13,068 1,160 8,403,489 9,214, ,676 EL 2,002 2, ,538,703 5,915, ,868 ELXBD , ,465 37,956 OPFA 22,359 22, ,396,551 3,471,320 74,769 OPFUP 49,533 52,640 3,107 4,567,933 4,942, ,690 OPPROC 17,553 21,310 3,757 3,028,389 3,770, ,443 DIAGNOSTIC IMAGING 9,286 9, , ,175 31,310 Grand Total 113, ,430 9,039 25,928,438 28,377,150 2,448,712 Southport and Ormskirk Hospitals NHS Trust Performance to month 10 against the planned care element of the contract is shown below in table 2b. This shows the planned care element of the contract is over plan by 354K.The most significant variance is in OPPROC POD. As commented above the most significant variance within the OPPROC POD is 110: Trauma and Orthopaedics ( 262K). Specialties 330: Dermatology and 304: Clinical Physiology are also over plan by 134K and 106K respectively. Table 2b: Month 10 Planned Care at Southport and Ormskirk Hospitals Point of Delivery Activity 2015/16 Cost 2015/16 Plan Actual Variance Plan Actual Variance DC 7,603 7, ,448,723 4,535,079 86,356 EL ,382,793 2,369,365-13,427 ELXBD ,226 84,396 45,169 OPFA 13,529 11,937-1,592 2,051,208 1,819, ,911 OPFUP 30,421 31, ,808,882 2,961, ,073 OPPROC 12,887 14,897 2,010 2,274,164 2,676, ,488 DIAGNOSTIC IMAGING 6,499 5,385-1, , ,652-87,754 Grand Total 72,096 72, ,526,403 14,880, ,994 All Other Providers Performance to month 10 against the planned care element of the contract is shown below in table 2c. This shows the planned care element of the contract is over plan by 2M. This over performance is primarily seen in DC and EL PODs ( 724K & 390K respectively). Table 2c: Month 10 Planned Care at All other Providers Provider Activity 2015/16 Cost 2015/16 Plan Actual Variance Plan Actual Variance Wrightington, Wigan & Leigh 10,142 12,462 2,320 3,073,292 3,678, ,520 Ramsay Operations (UK) 8,299 9,823 1,524 2,526,759 2,950, ,923 Aintree University Hospitals 6,654 8,825 2,171 1,379,356 1,853, ,550 Lancashire Teaching Hospitals 2,534 3, , , ,571 St Helens and Knowsley Hospitals 2,810 3, , , ,278 Royal Liverpool and Broadgreen Hospitals 5,499 5, ,228,787 1,325,725 96,938 Other Providers 5,357 6,491 1,134 1,937,454 2,162, ,940 Grand Total 41,295 49,795 8,500 11,402,035 13,496,754 2,094,719 *Includes points-of-delivery as per Tables 2a and 2b 10 P age

61 Key Risks and Actions Overview The significant shift of activity to providers other than Southport & Ormskirk NHS Trust has settled down. Southport & Ormskirk Trust is currently below plan for outpatient first attendances, both financially and through activity, but above the elective plan overall particularly in outpatient procedures, day cases and follow-up appointments which is mainly T&O (see note below). Orthopaedic Activity A large part of the financial overspend on planned care relates to orthopaedic activity. An audit is taking place led by MIAA to investigate the underlying reasons for the increased activity. The CCG has requested detailed information in respect of the waiting list to ascertain whether average waiting time reductions are driving this trend. Breast Services Due to the closure of Breast Services at this Southport & Ormskirk NHS Trust from September 2014, activity for this specialty has shifted to Aintree, Wrightington, Wigan & Leigh Trust and St Helens & Knowsley Trust. The expenditure on this activity at these hospitals is proving higher than the activity and funding related to Southport & Ormskirk Hospital Trust. 11 P age

62 7. Unplanned Care: Acute Contract All Providers Performance for month 10 against the unplanned care element of the contract is shown below in table 3a. Overall the unplanned care element of the contract is under plan by 476K. This is caused by significant under performances in NEL POD which is 532K under plan. Also please see below for variances for Southport and Ormskirk Hospitals Foundation Trust. Table 3a: Month 10 Unplanned Care at All Providers Provider Activity 2015/16 Cost 2015/16 Plan Actual Variance Plan Actual Variance Accident and Emergency 25,575 25, ,807,366 2,986, ,068 Non-Elective Short Stay 1,157 1, , ,751-20,618 Non-Elective 7,671 7, ,425,195 12,892, ,390 Non-Elective Excess Beddays 3,314 3, , ,594 88,328 Non-Elective Non-Emergency 1,104 1, ,895,958 1,926,721 30,763 Non-Elective Non-Emergency Excess Beddays ,243 76,657-28,586 Non-Elective Same Day Emergency Care , , ,876 Non-Elective Threshold Adjustment ,970-35,970 Grand Total 39,977 40, ,372,129 19,895, ,282 Southport and Ormskirk Hospitals NHS Trust Performance for month 10 against the unplanned care element of the contract is shown below in table 3b. Overall the unplanned care element of the contract is under plan by 603K. This is largely due to an under-performance in NEL 300: General Medicine which is 570K under plan. Table 3b: Month 10 Unplanned Care at Southport and Ormskirk Hospitals Provider Activity 2015/16 Cost 2015/16 Plan Actual Variance Plan Actual Variance Accident and Emergency 20,332 20, ,235,589 2,371, ,578 Non-Elective Short Stay , ,306-56,770 Non-Elective 6,203 5, ,561,733 9,965, ,443 Non-Elective Excess Beddays 2,811 3, , ,457 44,332 Non-Elective Non-Emergency 1,011 1, ,627,701 1,634,960 7,259 Non-Elective Non-Emergency Excess Beddays ,739 46,954-12,785 Non-Elective Same Day Emergency Care , , ,096 Grand Total 32,005 31, ,191,587 15,588, ,925 All Other Providers Performance for month 10 against the unplanned care element of the contract is shown below in table 3c. Overall the unplanned care element of the contract is over plan by 127K. The most significant variations are general overperformance at Aintree University Hospitals which is 93K over plan, general over-performance at Royal Liverpool and Broadgreen Hospitals which is 97K over plan and general under-performance at Wrightington, Wigan and Leigh which is 73K under plan. Table 3c: Month 10 Unplanned Care at All Other Providers Provider Activity 2015/16 Cost 2015/16 Plan Actual Variance Plan Actual Variance Wrightington, Wigan & Leigh 3,567 3, ,747,955 1,674,658-73,296 Aintree University Hospitals 1,209 1, , ,275 93,040 Lancashire Teaching Hospitals 959 1, , ,760 16,961 Royal Liverpool and Broadgreen Hospitals , ,585 96,656 St Helen's & Knowsley Hospitals NHS Trust , ,507 39,520 Other Providers 1,105 1, , ,399-46,237 Grand Total 7,972 8, ,180,543 4,307, ,643 *Includes points-of-delivery as per Tables 3a and 3b 12 P age

63 Key Risks and Actions Unplanned care is currently under performing in both activity and financially against plan. There is some evidence to show that the financial shift from Southport & Ormskirk Hospitals Trust is being offset by increases at other providers particularly at Aintree. Southport & Ormskirk Trust Non Elective admissions are lower than the previous year; however there have been 384 patients seen in the GP Assessment Unit (GPAU) who would previously have been counted as an admission but are no longer included in these figures. These patients are now counted using a local non-pbr tariff. We are currently checking planning trajectories for the last quarter of the financial year to ensure that they accurately represent activity levels. 8. Prescribing In order to address the West Lancashire CCG Medicines Management duties as defined by the National Prescribing Centre s Medicines Management Competency Framework, West Lancashire CCG has set up a Medicines Management Committee (MMC). The MMC s remit encompasses all systems, policies and procedures designed to ensure the safe, secure and cost-effective use of medicines. A summary of prescribing costs for December 2015 is shown below. The CCG is currently forecasting a cost growth of 5% in 2015/16 based on the figures as at December This is a 1.86% increase from the 3.14% forecast reported in October % List Size Growth (APU Dec 15 v Dec14) % Growth (Forecast Outturn v 14/15 Spend) Current YTD Spend per APU (15/16) Total Spend for Previous Year (14/15) Current YTD Spend Previous YTD Spend Growth (Forecast Outturn CCG (15/16) (14/15) v 14/15 Spend) WEST LANCASHIRE 17,787, ,149, ,401, % 889, % P age

64 9. Lancashire Care Foundation Trust Contract Activity The contract value for Lancashire Care Foundation Trust (LCFT) mental health services is 9.7m. The LCFT contract is for a range of mental health services such as rehabilitation, community mental health teams, hospital liaison, memory assessment, CAMHS and child psychology and prison in-reach. Below is activity for compared with the previous year. *RITT Contacts not available for 14/15 Activity Total Q1 Q1 Total Q2 Q2 Total Q3 Q3 Total Q4 Q4 TotalYear to Date Metric CCG Apr 15 May 15 Jun 15 Jul 15 Aug 15 Sep 15 Oct 15 Nov 15 Dec 15 Jan 16 Adult Inpatient 28 Day ReAdmissions WLCCG Adult Inpatient 90 Day ReAdmissions WLCCG Adult Ward Occupied Bed Days WLCCG , , , ,192 Adult/PICU Ward Admissions WLCCG Adult/PICU Ward Discharges WLCCG CCTT Teams - Accepted Referrals WLCCG CCTT Teams - Contacts WLCCG , , , ,098 CCTT Teams - Rejected Referrals WLCCG CMHT Contacts WLCCG , , , ,526 CMHT Referrals WLCCG Community Restart Teams - Accepted Referra WLCCG CRHT Face to Face Contacts - 18 to 65 WLCCG ,902 CRHT Face to Face Contacts - Below 18 WLCCG CRHT Face to Face Contacts - Over 65 WLCCG CRHT Teams - Referrals WLCCG CRHT Telephone Contacts - 18 to 65 WLCCG ,237 CRHT Telephone Contacts - Below 18 WLCCG CRHT Telephone Contacts - Over 65 WLCCG Criminal Justice Liaison - Contacts WLCCG Eating Disorder Service - Contacts WLCCG Eating Disorder Service - Referrals WLCCG EIS: New EIS Patients in Year - VSMR 5378 WLCCG EIS: Unclustered EIS Patients not seen for 8 WLCCG Hospital Liaison Contacts WLCCG Hospital Liaison Referrals WLCCG MAS Teams - Referrals WLCCG Older Adult (Dementia) Inpatient Ward Admis WLCCG Older Adult (Dementia) Inpatient Ward Discha WLCCG Older Adult (Dementia) Ward Occupied Bed D WLCCG Older Adult (Functional) Inpatient Ward Admi WLCCG Older Adult (Functional) Inpatient Ward Disch WLCCG Older Adult (Functional) Ward Occupied Bed WLCCG ,080 PICU Ward Occupied Bed Days WLCCG PICU Wards - Transfers In WLCCG RITT Contacts WLCCG RITT Referrals WLCCG New Format of Above Report Data previously reported as Older Adult Liaison, is now being reported as Hospital Liaison. The Intermediate Support Team activity for Older Adults (Dementia and Functional) is now being reported under one service line, and is now called the Rapid Intervention and Treatment Team (RITT). The change to RITT has led to extra referrals being within year to date reporting, which is due to this team s activity also covering Care Home Liaison, which has previously not been reported. 14 P age

65 9a Care Programme Approach (CPA) follow- up within 7 days The proportion of eligible patients who are followed up within 7 days is one of the performance measures on which the CCG will be monitored by the Local Area Team. The Tables below show current West Lancashire performance. % Successful Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Q1 Q2 Q3 Q4 to date 15/16 NHS West Lancashire CCG 66.7% 100.0% 100.0% 83.3% 90.9% 100.0% 100.0% 100.0% 80.0% 100.0% #DIV/0! #DIV/0! 94.1% 90.5% 94.4% 100.0% 93.4% Total Figure - 8 CCGs 94.9% 96.0% 97.5% 95.8% 95.2% 96.4% 97.9% 95.5% 95.8% 97.8% #DIV/0! #DIV/0! 96.1% 95.7% 96.3% 97.8% 96.3% January performance is on target; the numbers each month are relatively small and for January there were 5 patients which have all had a follow up. The low numbers are a potential risk, if one patient is to breach then it is more likely we would fail the target; previous quarters have only had few patients which have breached yet we have not met the target. 9b IAPT Performance Summary of Key Performance for January This report is provided in a revised format as discussed last Contract meeting. The detail is provided in the attached excel spreadsheets. This report focuses on the key performance areas and exceptions. Prevalence Prevalence Monthly Target Jan-16 January YTD Entered Treatment YTD Variance YTD Prevalence Met (%) YTD Variance (%) Year End Trend NHS BLACKBURN WITH DARWEN CCG % % 0.01% 15.02% NHS EAST LANCASHIRE CCG % % 0.27% 15.38% NHS CHORLEY AND SOUTH RIBBLE CCG % % 1.12% 16.37% NHS GREATER PRESTON CCG % % 1.14% 16.37% NHS WEST LANCASHIRE CCG % % -0.47% 14.45% NHS FYLDE & WYRE CCG % % -0.78% 14.03% NHS LANCASHIRE NORTH CCG % % -0.35% 14.59% Prevalence in month was met CSR in January. The failure of other teams to meet this target is attributed to the major incident. In those areas staff were required to support other services. Cumulative prevalence has not been met in W Lancs, Fylde and Wyre and N Lancs. Preston and Chorley South Ribble continue to exceed cumulative prevalence target significantly. This has a negative impact on ability to deliver against waiting times and recovery. All teams have recovery plans in place to meet prevalence target of 15% by 31 st March This includes offering taster sessions and prioritising welcome calls over other activity. 15 P age

66 Recovery Following discussion at previous CCG Performance Meeting service has introduced measures to exclude data for patients with severe presentations as measured by PHQ 9 (20 and above) and GAD 7 (15 and above). This is consistent with approach taken in other IAPT services. Indicatice Recovery 2015/16 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Recovery is continuing to improve in some areas such as E Lancs, Chorley South Ribble and West Lancs,. The Learning is being applied to the other areas. In Lancaster there was a high dropout rate. This may be attributed to long waiting times. Major incident may have also increased drop out and impacted on recovery across service. 9c IAPT Data Quality The CCG has been informed of data quality issues with the IAPT minimum dataset developed in house by Lancashire Care Foundation Trust (LCFT). Following a recommendation from NHS England in 2014, LCFT services implemented a nationally recognised data collection and reporting system called Laptus, and made their first submission using this system to the Health & Social Care Information Centre (HSCIC) in July The new codes generated by this system are not yet fully understood by the Business Intelligence Team at LCFT, and the interpretation of the final results by NHS England has impacted upon our performance standards for Access rates, Recovery Rate and Waiting Times. The CCG has asked LCFT to rectify this problem as swiftly as possible and liaise with the HSCIC to correct earlier submissions of data. 16 P age

67 10. Quality and Performance 10a West Lancashire CCG Performance Dashboard Metric Preventing People from Dying Prematurely Cancer Waiting Times Reporting Level Q1 Q2 Q3 Q4 YTD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar % Patients seen within two weeks for an urgent GP referral for suspected cancer % of patients seen within 2 weeks for an urgent referral for breast symptoms West Lancashire CCG West Lancashire CCG RAG G G G G G G G G G G Actual 95.41% 95.15% 95.71% 95.90% 94.19% 94.69% 96.70% 95.39% 97.78% 94.70% Target 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% RAG G G G R G R G G G R Actual 97.06% 94.87% % 92.31% 96.77% 92.00% 94.44% 94.74% 97.87% 91.18% Target 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% % of patients receiving definitive RAG G R G G G G R G G G G treatment within 1 month of a cancer diagnosis West Lancashire CCG Actual 98.41% 95.52% % 97.50% 96.67% 96.72% 94.74% 96.61% 98.11% 97.96% 97.15% Target 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% % of patients receiving subsequent RAG G G R R G G G R G treatment for cancer within 31 days (Surgery) West Lancashire CCG Actual % % 90.00% 88.89% % % % 83.33% % Target 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% % of patients receiving subsequent RAG G G G G G R G G G G G treatment for cancer within 31 days (Drug Treatments) West Lancashire CCG Actual % % % % % 95.45% % % % % 99.51% Target 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% of patients receiving subsequent RAG G G G G G G G G G G G treatment for cancer within 31 days (Radiotherapy Treatments) West Lancashire CCG Actual % % % % % % 95.83% % % % 99.47% Target 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% % of patients receiving 1st definitive RAG R R G G G G R G R G R treatment for cancer within 2 months (62 days) West Lancashire CCG Actual 83.33% 80.00% 86.36% 88.24% 85.19% 88.00% 81.82% 87.50% 82.14% 85.00% 84.52% Target 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% % of patients receiving treatment for RAG G G G G R G R G G G cancer within 62 days from an NHS Cancer Screening Service West Lancashire CCG Actual % % % % 80.00% % 88.89% % % % Target 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% % of patients receiving treatment for cancer within 62 days upgrade their priority West Lancashire CCG RAG Actual % 76.19% % 81.82% % % 90.00% % 87.50% 92.31% 91.60% Target G 95.55% G 95.27% 17 P age

68 Ambulance Category A calls responded to within 19 minutes Category A (Red 2) 8 Minute Response Time Category A Calls Response Time (Red1) West Lancashire CCG West Lancashire CCG RAG R R R R R R R R R R Actual 85.32% 92.40% 88.91% 88.63% 87.26% 87.99% 89.44% 85.30% 89.19% 78.10% Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% NORTH WEST RAG R G G R G R R R R R R AMBULANCE Actual 93.28% 96.38% 95.87% 94.56% 95.11% 94.60% 94.08% 91.99% 92.68% 89.85% 93.72% SERVICE NHS TRUST Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% West Lancashire CCG RAG R R R R R R R R R R Actual 57.30% 68.70% 64.97% 60.63% 56.04% 59.62% 60.89% 60.04% 56.64% 51.80% Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% NORTH WEST RAG R G G G G R R R R R R AMBULANCE Actual 72.12% 79.43% 78.17% 75.96% 75.42% 74.87% 72.45% 68.45% 69.48% 63.49% 72.67% SERVICE NHS TRUST Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% RAG R R R R R R R R R R Actual 45.45% 70.80% 71.88% 54.55% 56.25% 65.63% 57.69% 66.67% 55.88% 48.60% Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% NORTH WEST RAG R G G G G G G R R R G AMBULANCE Actual 71.22% 81.55% 79.80% 79.29% 77.65% 78.42% 75.86% 73.41% 74.95% 69.29% 76.07% SERVICE NHS TRUST Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% R 87.07% R 59.52% R 59.41% Helping People to Recover from Episodes of Ill Health or Following Injury Emergency Re-admissions Emergency Re-admissions within 30 days of discharge RAG West Lancashire CCG Actual 11.12% 11.97% 13.39% 11.35% 12.06% 10.86% 11.06% 10.32% 13.15% 11.68% Target 18 P age

69 Ensuring that People Have a Positive Experience of Care EMSA Mixed sex accommodation breaches - All Providers Mixed Sex Accommodation - MSA Breach Rate West Lancashire CCG West Lancashire CCG RAG R G G G G R R R R R R Actual Target RAG R G G G G R R R R R R Actual 29.94% % 57.11% 60.92% % % 0.00% Target Referral to Treatment (RTT) & Diagnostics Referral to Treatment RTT (Incomplete) G West Lancashire CCG 95.56% 92.00% 92.00% Referral to Treatment RTT (Incomplete with decision to admit) West Lancashire CCG 93.64% Referral to Treatment RTT (New RTT Periods) Referral to Treatment RTT - No of Incomplete Pathways Waiting >52 weeks Referral to Treatment RTT (Admitted) Referral to Treatment RTT (Adjusted Admitted) Referral to Treatment RTT (Non-Admitted) % of patients waiting 6 weeks or more for a diagnosic test West Lancashire CCG West Lancashire CCG West Lancashire CCG West Lancashire CCG West Lancashire CCG West Lancashire CCG RAG G G G G G G G G G G Actual 95.32% 95.20% 95.19% 95.06% 95.04% 95.01% 95.66% 96.30% 96.04% 97.18% Target 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% RAG Actual % 94.62% 92.46% 93.18% Target RAG Actual Target RAG G G G G G G G G G G Actual Target RAG R R G G G G G G G R Actual 87.25% 89.84% 91.73% 91.12% 91.69% 92.95% 92.30% 92.49% 93.45% 89.35% Target 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% RAG R G G G G G Actual % % % % % % Target 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% RAG R G G G G G R G G G Actual 94.63% 95.62% 95.33% 95.26% 95.62% 95.51% 93.88% 95.29% 96.51% 96.04% Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% RAG G G G G G G G G R G Actual 0.46% 0.29% 0.29% 0.51% 0.57% 0.32% 0.67% 0.40% 1.05% 0.27% Target 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% G G 91.25% 90.00% 90.00% G % 90.00% 90.00% G 95.34% 95.00% 95.00% G 0.49% 1.00% 1.00% - 19 P age

70 Treating and Caring for People in a Safe Environment and Protect them from Avoidable Harm HCAI Number of MRSA Bacteraemias Number of C.Difficile infections West Lancashire CCG West Lancashire CCG RAG R R R R R R R R R R R YTD Target RAG G G G R G G G G G G G YTD Target Accident & Emergency 4-Hour A&E Waiting Time Target (Monthly Aggregate for Total Provider) 12 Hour Trolley waits in A&E SOUTHPORT AND ORMSKIRK HOSPITAL NHS TRUST Activity LANCASHIRE TEACHING HOSPITALS NHS FOUNDATION TRUST SOUTHPORT AND ORMSKIRK HOSPITAL NHS TRUST WRIGHTINGTON, WIGAN AND LEIGH NHS FOUNDATION TRUST WRIGHTINGTON, WIGAN AND LEIGH NHS FOUNDATION TRUST LANCASHIRE TEACHING HOSPITALS NHS FOUNDATION TRUST RAG R G G R R G R R R Actual 94.07% 97.18% 95.42% 94.85% 94.44% 95.97% 93.69% 91.26% 90.39% Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% RAG R R G G G R R R R R Actual 92.69% 93.96% 95.86% 95.51% 95.83% 92.44% 91.55% 91.41% 87.56% 92.94% Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% RAG G G G G R G G R R Actual 97.54% 98.47% 97.68% 98.00% 94.07% 96.80% 95.03% 93.27% 93.64% Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% RAG G G G G G G G G G G Actual Target RAG G G G G G G G G G G Actual Target RAG G G G G G G G G G G Actual Target R 94.12% 95.00% G 96.04% 0 0 Activity GP Written Referrals Other Referrals for First Outpatient Appointments Total Referrals (MAR) West Lancashire CCG West Lancashire CCG West Lancashire CCG RAG R R R R R R R R R R R YTD Target 2,133 4,455 6,721 9,133 11,127 13,451 15,945 18,284 20,569 23,065 25,657 27,655 23,065 RAG R R R R R R R R R R R YTD Target 983 1,961 2,944 4,066 5,106 6,185 7,298 8,387 9,392 10,507 11,572 12,614 10,507 RAG R R R R R R R R R R R YTD 3,814 7,434 11,338 15,462 18,998 22,871 26,612 30,430 34,027 37,828 37,828 Target 3,116 6,416 9,665 13,199 16,233 19,636 23,243 26,671 29,961 33,572 37,229 40,269 33, P age

71 10b Southport & Ormskirk Hospitals NHS Trust Urgent Care Performance Dashboard STROKE UPDATE - SQU06: % stroke patients spending 90%+ time on a stroke unit data refreshed from Sep 66.7% to 59.1% and Oct 65.6% to 53.8% 21 P age

72 10c Southport & Ormskirk Hospitals NHS Trust Planned Care Performance Dashboard 22 P age

73 10d Southport & Ormskirk Hospitals NHS Trust Wide Care Performance Dashboard 23 P age

74 10e Areas of Under-Performance A number of areas of underperformance are reported to end of January 2016 ytd; the detail below is presented by indicator for each of these areas with actions identified as required and on-going, seeking to improve performance. Direction of travel of performance against indicator from previous reporting period is provided to demonstrate if performance is deteriorating. Indicator: Ambulance category call outs CCG Target: 95% (All Cat A) 75% (Red 1) Current Performance 75% (Red 2) 78.10% 51.80% 48.60% Direction of travel Forecast Current Issues: All Categories A calls responded to within 19 mins performance has decreased to 78.10% this month for our CCG, NWAS performance is under the 95% target at 89.85% for this month. The Performance of Category A Red 1 callouts has decreased since the previous 48.60% and is still under target. The Performance of Category A Red 2 callouts has decreased since the previous 51.80%, this trend is consistent with almost all of the CCGs within Lancashire for January Improvement Plans: Crew clear times have not improved at Southport District General Hospital, there were 51 over 60Mins and >30Mins has decreased to 15. Indicator: 4hr A+E Waiting Time Target Current Performance - Lancashire Teaching Target: 95% Current Performance Southport+Ormskirk Current Performance WW+L 90.38% 87.55% 93.64% Direction of travel Forecast Current Issues: The current target of 95% is not being achieved by any of the above Trusts Improvement Plans: S & O. The Trust has now recruited a new Consultant for Sundays to improve weekend discharges and to plan for the week ahead. Root Cause Analysis shows this is due to poor flow and late discharges. The Trust is developing a clinical service strategy which will aim to redesign all pathways taking account of previous advice from NHSE s Emergency Care Intensive Support Team. Indicator: Stroke: % Stroke patients spending 90% time on Stroke Unit S&O Target: 80% Current Performance 55.7% Direction of travel Forecast Current Issues: The Trust again failed the standard for % Stroke patients on Stroke Unit. The main reason for the breaches is again related to bed availability due to pressures across the Trust. They failed to achieve target even with the Improvement Plan below. Improvement Plans: Despite the move to a smaller unit, the Trust is still experiencing problems. Further actions have been identified to improve performance. Indicator: Cancer: % patients receiving 1 st definitive treatment within 2 months (62 days) Target: 85% Current Performance 84.5% Direction of travel Forecast Current Issues: Performance for the month of January was above target and the ytd position has improved.there were 3 breaches at S & O in January. Improvement Plans: S & O continue to carry out RCAs on breaches and apply learning. 24 P age

75 Indicator: Mixed sex accommodation breeches S&O Target: 0 Current Performance YTD 38 YTD Direction of travel Forecast Current Issues: The Trust failed the standard for unjustified mixed sex accommodation with another 11 breaches in January. Incorrect Trust reporting is apparent which came to light in September 2015 and has since been corrected; this has been communicated with the CCG s. Improvement Plans: They all related to ITU patients. A joint decision has been made by the Chief Exec and Chief Operating Officer to prioritise this area. The Director of Nursing and Quality is capacity planning to prioritise the movement of patients within the ITU. Indicator: MRSA Bacteraemia S&O Target: 0 Current Performance 1 YTD Direction of travel Forecast Current Issues: The Trust annual target was zero for the year however there was a case in April therefor the Trust has failed the target and will do for the remaining months of the year. There have been no further cases since April. Improvement Plans: Improvement in MRSA pathway compliance is a continued focus of attention for the Trust. Indicator: C.difficile S&O Target: 36 (annual Target) 3 Cases per Month Current Performance 34 YTD Direction of travel Forecast Current Issues: Southport and Ormskirk Trust annual target is 36 cases for the year i.e. an average of 2/3 cases per month. There were 4 cases in January which is within the monthly target, YTD performance is still over target. Improvement Plans: ^The Trust is applying learning from the RCAs. Indicator: Staff Sickness Absence S & O Target: 4% Current Performance 6.14% Direction of travel Forecast Current Issues: The Trust has had some issues with Staff Sickness for the current Financial Year. It has not achieved this target for the last 12 months Improvement Plans: A full review of the sickness policy has taken place. The new policy will go to JNC in March and managers now have the lead in managing their own staff absence. This new approach involving HR support to managers in dealing with absence, rather than managing sickness centrally has focused initially on long term sickness. During March this will extend to cover short term sickness as well. Support to staff wellbeing at work will continue through the Health and Wellbeing department. 25 P age

76 10f West Lancashire CCG Patients Waiting To understand how many patients were still waiting for procedures or outpatient appointments, the numbers of patients waiting for all in-completed pathways for all trusts has been included in the graph below. More detailed reports on RTT waiters are available via Aristotle spotlight reports. For the Lancashire footprint there are 5,925 patients with an incomplete complete pathway who are waiting over 18 weeks for January. The table below shows the top 5 highest number of breaches by provider for January 2016 for our CCG. All of the top 5 are over the 92% target; when drilling into the specialties there are some variances within each of the Trusts. 26 P age

77 Southport & Ormskirk, when drilling down into the data each speciality performance has reached the target % within 18wks which equates to so there are 41 patients currently waiting over 18 weeks of 688 overall waiters for this Trust Aintree has 1 specialty under the 92% compliance target; Respiratory Medicine there s 14 waiters over 18wks of a total of 56 waiters for Respiratory Medicine. Wrightington, Wigan and Leigh have 0 specialties under the 92% compliance target for incomplete pathways. Royal Liverpool & Broadgreen have a total of 23 waiters over 18wks out of a total of 259 waiters. There are 3 specialities under the 92% target; Trauma & Orthopaedics with 9 patients of 38, General Surgery with 4 patient out of 48 and Ophthalmology with 6 patients out of 70. Lancashire Teaching has a total of 11 waiters over 18wks out of a total of 150 waiters. There are 4 specialities under the 92% target; Neurology with 2 waiters out of a total of 12 and Plastic Surgery with 1 waiter out of a total of 10, Urology with 2 patients out of a total of 10, General Surgery with 4 patients of a total of 25 waiters overall. Conclusion The previous waiting times problems at Southport & Ormskirk Hospitals Trust seem to have been rectified according to January Data 27 P age

78 10g CCG Outcomes Indicator Set The Health & Social Care Information Centre (HSCIC) published data for 1 new indicator within the CCG Outcomes Indicator set since the last report. Details of this indicator and West Lancashire CCG s performance and position are provided below Hip fracture: care process composite indicator Only 40% of West Lancashire CCG patients suffering a hip fracture received all 9 of the agreed best practice standards in This concerning performance ranks the CCG 197 out of 211 CCG s, with the national average being 64%. Refreshed data for this indicator will be available nationally in December 2016 however; the CCG will raise this issue immediately with relevant providers at the earliest contract review and quality review meetings. CCG Outcomes Indicators Domain 3: Helping people to recover from episodes of ill health or following injury 3.18 Hip fracture: care process composite indicator % 197 out of 211 New indicator Dec-16 Of people with hip fracture, the percentage who receive all nine of the agreed best practice standards 28 P age

79 10h Friends & Family Test Friends and Family data for January 2016 has not been published by NHS England in time for inclusion within this report. A further update will be provided in next months integrated business report when this information becomes available. 10i Safety Thermometer On one day each month hospital trusts are required to check to see how many of their patients suffered certain types of harm whilst in their care. This measure is known as the safety thermometer. The safety thermometer looks at four harms: pressure ulcers, falls, blood clots and urine infections for those patients who have a urinary catheter in place. This helps Trusts to understand where they need to make improvements. The table below shows the percentage of patients who did not experience any of the four harms in the Trust(s) during the 12 month period March 2015 to February Safety Thermometer - February 2016 Trust Southport & Ormskirk NHS Hospitals Trust Wrightington, Wigan & Leigh NHS Foundation Trust Aintree University Hospitals NHS Trust Royal Liverpool & Broadgreen University Hospitals NHS Trust Lancashire Teaching Hospitals NHS Foundation Trust St Helens & Knowsley Hospitals NHS Trust Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Trajectory from previous month 98.0% 97.8% 98.9% 98.5% 98.9% 97.9% 97.0% 95.4% 95.0% 94.1% 93.5% 93.1% 99.5% 99.4% 97.9% 98.6% 97.9% 99.3% 99.5% 97.2% 94.6% 95.5% 95.3% 94.2% 97.6% 97.7% 99.4% 98.5% 98.6% 98.2% 97.9% 94.8% 94.4% 94.4% 93.9% 94.0% 97.3% 97.8% 97.1% 97.8% 97.8% 97.3% 98.0% 96.1% 95.1% 94.6% 94.6% 96.2% 98.4% 98.2% 98.6% 97.6% 96.8% 98.8% 98.7% 95.5% 95.9% 96.4% 95.7% 93.8% 98.3% 98.8% 98.5% 98.3% 99.1% 99.0% 98.2% 96.9% 95.0% 95.0% 95.3% 96.0% - Score more than 5% lower than previous month - Score lower than previous month but within 5% - Score equal to or higher than previous month 29 P age

80 11. Complaints 11a West Lancashire Complaints There has been one new contacts received by MLCSU on behalf of West Lancashire CCG in February An MP letter about treatment of a patient through Mental Health Services after they moved from Ormskirk to Blackpool. Two PALs enquiries were closed during February. There were no breaches of the 40 day target for resolution for complaints as no complaints were closed during this month. 11b GP Comments, Concerns & Issues with Healthcare Providers There were 51 complaints, comments and concerns copied to the CCG from GP s across West Lancashire in February 2016, 26 of which related to information governance and diagnostic test results being sent to the wrong practice. There were a further 21 concerns received regarding delayed or incomplete diagnostic test results being sent. The charts below summarise the trends/themes of comments and complaints over the last 12 month period. Themes & trends will continue to be monitored & reported against on a monthly basis, and raised providers through the contract and quality monitoring process as appropriate. 30 P age

81 12. Serious Untoward Incidents 3 new StEIS incidents were reported in February involving West Lancashire CCG registered patients and 1 StEIS incident was closed. Four RCA reports were due in February of which 1 was received within the 60 days time limit and 3 relate to pressure ulcer incidents and will form part of a combined pressure ulcer report. There has been only 1 new serious incident reported by a West Lancashire Nursing Home and 1 incident was closed by the Contracts Team. As at 29 February 2016, 64 StEIS incidents remain open involving WL CCG patients, the majority of these are from Southport & Ormskirk Hospitals Trust (52 in total) and the highest reported incidents remain pressure ulcers with 34 incidents currently open. The quality and timeliness of RCA reports produced by Southport and Ormskirk NHS Trust have improved to a degree over the last couple of months. Unfortunately this improvement is unlikely to be sustainable from April when a significant staff member within the team will transfer to a new role. This issue together with the theme highlighted in last month s IBR around the failure of this provider to escalate deteriorating patients have been tabled for discussion in the Quality Surveillance Group. 31 P age

82 13. Wrightington, Wigan & Leigh Contract Performance Group & Contract Monitoring Group Developments. A clinically led Outpatient pathway redesign has been initiated at the Trust. The CCG requested overview of the project plan. RAID (Rapid, Assessment, Interface & Discharge) Team-Wigan Borough CCG has agreed to continue funding this scheme as it has demonstrated significant savings in terms of bed days (19/day). The service will expand to include children as well as adults. The CCG will work with the Trust to develop appropriate targets. Theatre upgrades at WWL have affected capacity of the Business Unit. Extra work has been undertaken at weekends to ensure demand is met and limit the impact on waiting lists. There has also been an increase in demand for emergency cancer procedures. An Emergency Response Team was established in November to review deteriorating patients within WWL. Following an investment of 2.1m to improve staffing levels, Wigan Borough CCG have requested that the Trust provide evidence of how this has impacted on patient outcome Quality concerns: Ambulance handover times have breached targets for a number of months, 3.8% of handovers exceeded a 30 minute wait in Quarter 3. A hospital liaison officer is now in post and significant improvements in handover times are expected in coming months. The 4 hour target in AED was not achieved (93.99% in Q3, 89.77% Jan. cf 95% target). 260 Falls reported by the Trust in Q3 cf target of 195. To provide assurance; in line with national guidance all moderate and severe falls undergo an RCA and are reported to the Executive Scrutiny Committee. In quarter 3 the Trust breached the 62 day cancer target (93.12% cf 95% target). Cancer leads will be invited in March to discuss the strategic planning. 2 breaches re mixed sex accommodation occurred in January, totalling 3 for 2015/16. WWL reported 1 Never Event in year. This was categorised as misplaced naso or orogastic tubes and occurred November Level 2 Safeguarding training is only at 8.3% within the Trust and has been added to the risk register and an action plan developed. 32 P age

83 WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY REPORT DATE OF BOARD MEETING: 22 March 2016 TITLE OF REPORT: Draft Financial Plan 2016/17 BRIEFING POINTS: Does this report / its recommendations have implications and impact with regard to the following: A. Commissioning Board s Aims and Objectives 1. Quality (including patient safety, clinical effectiveness and patient experience) please outline impact WLCCGB 03/16/10 The CCG s QIPP programme aims to promote and increase the quality of services to patients. 2. Commissioning of hospital and community services please outline impact The CCG s QIPP programme includes collaborative schemes that seek to integrate acute and community healthcare. 3. Commissioning and performance management of GP Prescribing please outline impact The CCG has an active QIPP programme for prescribing. 4. Delivering Financial Balance please outline impact This report sets out the financial plan for the CCG in 2016/17. Delivery of this plan, including the QIPP programme, is key to achieving recurrent financial balance for the CCG. 5. Development of the commissioning group as a commissioning organisation please outline impact B. Governance please outline impact 1. Does this report: provide the Commissioning Board with assurance against any of the risks identified in the assurance framework (identify risk number) have any legal implications promote effective governance practice Risk of not achieving financial balance 2. Additional resource implications (either financial or staffing resources) 3. Health Inequalities 4. Human Rights, Equality and Diversity Requirements 5. Clinical Engagement The delivery of the financial plan requires clinical engagement to deliver the commissioning programme, QIPP schemes and to help manage demand in the health economy. 6. Patient and Public Engagement The financial plan supports the CCG s commissioning programme which includes a number of schemes that have involved patient and the public from their inception. REPORT PREPARED BY: REPORT PRESENTED BY: Paul Kingan, Chief Financial Officer Paul Kingan, Chief Financial Officer Financial Plan 2016/17 West Lancashire Clinical Commissioning Group Board Meeting - 22 March 2016

84 DRAFT NHS West Lancashire CCG Financial Plan 2016/17 Contents: (1) Introduction (2) The Financial Context (3) Financial Strategy of the CCG (4) 2016/17 Resource Allocation (5) Financial plan & budget-setting methodology 2016/17 (6) CCG Budgets (7) Financial Risks (8) Balance Sheet Items (9) Financial Governance (10) Next Steps (11) Recommendations Financial Plan 2016/17 West Lancashire Clinical Commissioning Group Board Meeting - 22 March

85 Executive Summary The purpose of this paper is to set out the first cut financial plan for 2016/17. The key messages to note are as follows: A challenging financial position anticipated in 2016/17 during a time of flat funding and very limited financial headroom. This financial plan is consistent with the finance sections of the CCG s commissioning strategic plan and the financial plan submitted to the Local Area Team on 2nd March 2016 (section 1.1). The CCG is developing a Right Care programme approach which underpins a number of schemes and will be instrumental in identifying additional QIPP to mitigate uncovered financial risk (section 2). The CCG is planning to deliver its statutory financial duties in 2016/17, including a 1% surplus mandated by NHS England (section 3). NHS England guidance specifies that the 1% nonrecurrent spend is to create a risk reserve and therefore should remain fully uncommitted. Spending during the year against the 1% non-recurrent reserve will be subject to approval by NHS England. The CCG has no new recurrent funds available for investment in 2016/17 except for those that were pre committed in 2015/16. This predominantly relates to third sector, community IV and community respiratory. In addition the CCG must deliver its QIPP target to maintain recurrent financial balance in to 2016/17 (section 3). The extra 3% growth in recurrent allocations (section 4) has been applied to a range of funding issues (including budget pressures from 2015/16 see section 5). The CCG is planning to increase its mental health spend by 3.0% as mandated by NHS England. The CCG QIPP requirement is just over 3.8m in 2016/17 and the draft QIPP plan will need refreshing following the 2016/17 contract round and agreement of the prescribing budget (See section 5). This is a significant increase on previous years QIPP plans. A high level budget summary is provided (section 6) which summarises the application of CCG funds for 2016/17 described in section 5. The financial risks are described in section 7. This includes risk in respect of QIPP, national tariff, and underlying activity in respect of healthcare contracts. Significant effort and focus will be needed to ensure that the QIPP target remains on track to deliver. The CCG will need to plan for additional QIPP and cost saving measures during the year to mitigate uncovered financial risks of around 1.5m (7.3). The recommendations are made in section 11. This includes a key recommendation to approve the first draft 2016/17 revenue income and expenditure budget for NHS West Lancashire CCG, in the knowledge that budgets will require further revisions in April and May following the 2016/17 contract round. Financial Plan 2016/17 West Lancashire Clinical Commissioning Group Board Meeting - 22 March

86 NHS West Lancashire Financial Plan 2016/17 1. Introduction 1.1 As part of its statutory duties, NHS West Lancashire is required to approve its financial plan from the 1 April 2016 for the financial year ending 31 st March This financial plan is consistent with the CCG s 2016/17 Strategic Plan and the financial plan submitted to the Lancashire Local Area Team (NHS England) on 2nd March This report describes the financial planning and budget-setting approach for 2016/17: It provides an understanding of how NHS West Lancashire CCG will apply resources to meet the requirements of the planning framework 5 Year Forward View (which ensures the safety, quality and consistency of existing services) as well as meeting the challenges of QIPP, service re-design, the commissioning landscape and the NHS transition programme over the next year as we implement the Better Care Fund. 1.3 The CCG has used directions and guidance from the Department of Health and NHS England to inform its mandated investments such as tariff adjustment and CQUIN (commissioning for quality) payments. The CCG has also used local knowledge to inform its financial planning assumptions e.g higher than national average growth in continuing care activity. 1.4 The summary operational financial plan is included in section 6. This provides an overview of the CCG finances in 2016/17 and outlines where the 2016/17 CCG funding has been initially allocated. 2. The Context 2.1 The financial year 2015/16 has been a challenging year for the CCG with a very tight financial position, both for programme spend and running costs /17 is an important year as the CCG not only needs to continue with its commissioning plan but also complete a significant service redesign programme by re-procuring Community Services for West Lancashire. This will deliver the vision set out in the Facing the Future strategy. However, given the timescales involved in following procurement processes, mobilising services and embedding new ways of working, the financial benefits of this will not be realised in 2016/ We are developing high impact prevention programmes investing in prevention and early access to treatment, rather than dealing with the consequences and cost of unidentified and untreated mental health, with the aim of Right Care. The Right Care programme underpins a number of schemes and will be instrumental in identifying additional QIPP. Financial Plan 2016/17 West Lancashire Clinical Commissioning Group Board Meeting - 22 March

87 2.4 The Better Care Fund value for 2016/17 is 7.4m for West Lancashire CCG. The Better Care Fund has been created from existing healthcare budgets, in addition to budgets paid for by Local Authority (section 256) funding. There are no new funding streams available to cover this. That is why it has been very important to work closely with providers to identify appropriate services that could form part of a section 75 pooled fund with the over-arching aim of ensuring integrated service provision as we go forward. 2.5 The CCG is mindful that financial risks will emerge during the next year as the health system meets the challenges of relatively flat funding, QIPP targets, national mandate requirements, achieving Parity of Esteem and the Transforming Care agenda and growing activity pressures. 2.6 Although the CCG is forecasting to achieve its financial balance in 2016/17, financial pressure has been brought forward from 2015/16 which is directly related to: (a) The growth in planned care particularly in the area of Trauma and Orthopaedics around MSK. MSK will be a key component of the QIPP programme in 2016/17. (b) Continuing healthcare costs and high cost packages of care which without control will grow in 2016/7. (c) An increasing trend in prescribing over-spends which will represent a significant financial risk in 2016/17. These pressures are discussed in section In 2016/17, the QIPP challenge for the CCG is set at 3.8m. The CCG is working through its current schemes to confirm deliverability and address any gaps that still remains and consequent schemes to be identified. 2.8 NHS contracts with providers are to be signed by the end of March In collaboration with health economy partners, the CCG is providing financial and practical support to a sustainability review that seeks to find a long term solution to the financial issues experienced by Southport and Ormskirk Hospitals NHS Trust. Sharing financial risk is an important part of the strategy to be negotiated in 2016/17 as it will give the CCG, its partners and providers a period of headroom to manage demand in the health economy. Failure to manage demand will create a serious financial challenge to be addressed by the CCG and the wider health economy, particularly as we plan for significant change in respect of the Better Care Fund. 3. Financial Strategy of the CCG 3.1 The CCG must achieve its statutory financial duties by operating within its capital, cash and resource limits, as well as its running cost allowance. Its commissioning resource limit for 2016/17 has been set at m. In addition to this, the CCG s running cost allowance is 2.370m and the CCG also receives a transfer of funding in relation to the Better Care Fund that was previously held by NHS England. This relates to section 256 agreements and will form part of the pooled budget transfer to the Council. When this is taken into account, the total CCG recurrent allocation is m. When the return of surplus (from the previous year) is added to this amount, it gives a total allocation of m. Financial Plan 2016/17 West Lancashire Clinical Commissioning Group Board Meeting - 22 March

88 3.2 The CCG plans to deliver a balanced financial position whilst meeting national and local targets and service priorities through a strategy of: (a) Delivering the required surplus of 1% for each year. (b) Setting aside 1% recurrent funds ( 1.4m) for a non-recurrent risk reserve as per NHSE mandated guidance. Approval for spending of the 1% non-recurrent monies during the year will also be subject to approval by NHS England. (c) Setting aside 754,000 as a contingency reserve, 0.5% of total budget (as mandated). (d) Delivering, through commissioner QIPP and provider CRES schemes, the level of cash releasing savings and productivity gains required to achieve sustainable financial balance whilst preserving or improving service quality (e) Operating within our designated running costs allowance of 2.4m (f) Adopting a risk-based approach to financial planning, assessing and quantifying the risk of deviation from planned levels of income, expenditure or savings to inform risk management and mitigation (g) Ensure value for money and cost effectiveness in everything we do bench-marking products and services. (h) Delivery of the NHS West Lancashire CCG Strategic Plan 3.2 The CCG has developed planning trajectories for activity and finance over a 5 year time-frame. The key significant assumption is that non-elective hospital activity can be contained to current levels by treating patients in the community before they require urgent hospital treatment. This is a key facet of the CCG s Facing the Future Together collaborative programme and is discussed in more detail in the CCG s commissioning strategic plan. 3.3 The CCG does not have any recurrent investment funds available to invest in new services, except for recurrent activity growth, cost pressures and relatively limited service developments. The current financial climate means that the CCG will need to dis-invest from services which are not cost effective and re-invest in services in more appropriate settings that demonstrate value for money. Any funding implications to support strategic initiatives will need to be identified from the following funding sources: (a) Reducing costs in current service budgets and re-deploying resources to other health priorities where appropriate (b) Stopping or reducing services where clinically appropriate and re-deploying the resource in to other health priorities (c) Utilising non-recurrent funds to pump prime schemes and to cover double running costs during service re-design (only if recurrent savings can be identified). Schemes will need the approval of the Local Area Team before non-recurrent funding can be accessed. (d) Utilising freed up resources that accrue in the future from service-redesign initiatives. 3.4 It is vital that the 3.8m QIPP programme is delivered on a cash releasing basis to ensure financial balance. Any deviation from this target will mean that cash savings will need to be made from other areas of the CCG s commissioning budget by generating under-spends where possible. Financial Plan 2016/17 West Lancashire Clinical Commissioning Group Board Meeting - 22 March

89 /17 Resource Allocation /17 CCG allocations were published in December NHS West Lancashire CCG received growth funding of 4.337m, equivalent to 3.05% of recurrent allocations. 4.2 The application of CCG resources for 2016/17 is discussed in the sections below. 4.3 The CCG s increase in allocation for 2016/7 was 3.05%. Within this year s baseline funding includes a number of non-recurrent allocations (totalling 1.0m) from 15/16 that has now been included within the CCG s baseline. These include ETO funding ( 444k), GPIT ( 358k) and CYP MH funding ( 238k). There is also the waiting list target for EIP services which will be funded through the MH block income deflator ( 150k). The new funding formula means the CCG is slightly above target (1.52%), meaning that it should be due less resources (relative to the CCG average) in the future. Although given the pace of change over the next several years, this will only have a very small impact on the future funding allocation. 4.4 A summary of the CCG s allocation for 2016/17 is as follows: m Programme Baseline Allocation Growth Uplift 3.05% Running Cost Allowance Return of Surplus Total Allocation Approach to Budget-setting 2016/ The CCG will set commissioning budgets based on its initial financial plan as set out in this document. Further budget revisions will be required as more relevant information is available e.g the outcome of contractual agreements. 5.2 Budgets have been set within the overall commissioning resource envelope of million and to deliver the required control total surpluses of 1%. The CCG has recently submitted comprehensive financial plans for 2016/17 to NHS England. These plans will form the basis on which the CCG s internal budgets are set. In formulating these plans, each current budget has been adjusted for: Known cost pressures Anticipated increases in demand Impact of QIPP schemes Provider inflation and efficiency requirements The outcome of commissioning intentions/contract negotiations Financial Plan 2016/17 West Lancashire Clinical Commissioning Group Board Meeting - 22 March

90 5.3 A review has been applied across budget lines. Funding issues and requirements have been evaluated as follows: (a) Surplus brought forward from 2015/16 & surplus target 2016/17: The CCG is currently assuming that the target surplus for 2015/16 is returned in 2016/17. This is 1.44m. NHS planning guidance as part of 5 Year Forward View requires the CCG to deliver a 1% nonrecurrent surplus in year. This is 1.509m for the CCG in 2016/17. (b) 2015/16 Budget Pressures: The budgets include out-turn pressures totalling c 2.0m from 2015/16. A large part of the overspend is around planned care specifically on orthopaedics ( 716k) and the growth in MSK. A proportion of this pressure ( 306k) relates to mental health schemes due to start at the end of 15/16, as well as volume pressures on continuing healthcare costs ( 382k). The balance of pressures largely relates to other commissioning services. Work is on-going to address the underlying causes of these financial pressures, both through the work on QIPP and active cost control as part of budgetary management. The CCG will operate a rigorous programme management approach in delivering its commissioning plan objectives. Underlying activity trends will be monitored closely so that any deviations from plan can be corrected quickly. (c) 2016/17 inflation/deflation: The plan reflects the inflation and deflation assumptions in the NHS planning framework. For Healthcare Services a PbR/non-PbR cost inflation uplift of 3.1% has been applied to healthcare contracts. This includes a one-off adjustment in relation to the effect of changes to pensions. There is also an efficiency factor of 2.0% applied. In addition there is an adjustment to specific prices to reflect the anticipated increase in contributions to the clinical negligence scheme for trusts (CNST). The CNST uplift is equivalent to a 0.7% uplift on national prices. The net inflation figure is 1.7m when taken across all areas of commissioning spend (1%). (d) 2.5% CQUIN Financial Plan 2016/17 West Lancashire Clinical Commissioning Group Board Meeting - 22 March

91 The CCG has made provision for 2.5% CQUIN in 2016/17. This means that total CQUIN across all healthcare contracts is approximately 2.5m. Providers will need to demonstrate that they have achieved the CQUIN targets before they receive the full 2.5% CQUIN from commissioners. (e) Demand growth: The Plan includes 2.7m for demand growth in 2016/17. This can be summarised as follows: Commissioning Area Amount m % Growth Acute 1.6m 2.0% Continuing Care 0.3m 4.0% Prescribing 0.8m 4.0% Total 2.7m The planning assumption for all other budgets is that activity will be contained within budgets and that demand management in respect of QIPP schemes will be delivered e.g Facing the Future Together programme. In the above table, the acute growth of 2% is offset by QIPP schemes that aim to contain demand to a flat trend ie 0%. A number of these schemes are currently part of the contract negotiation with providers, as well as schemes to reduce costs of medicines prescribing. (Please see QIPP section (g).) (f) Commissioning intentions: The CCG s commissioning intentions, together with the Trust s code of conduct requests (e.g activity counting and classification changes) are currently being negotiated through the contract discussions. Any financial impact associated with this will have to be contained as part of the cost pressures, activity growth and QIPP assumptions contained in this plan. Work is currently on-going within the CCG Executive to identify and prioritise funding for recurrent schemes. This includes dis-investing from certain schemes and re-investing in CCG priorities. As mandated by NHS England, the CCG will ensure that it spends an extra 3.0% in 16/17 on mental health to ensure the parity of esteem agenda. (g) QIPP challenge 2016/17: The CCG s QIPP requirement for 2016/17 is 3.883m. The programme consists of a diverse range of schemes, thereby reducing the risk of nondelivery. Risks are mainly around the level of activity that can be successfully deflected from secondary care, however the CCG s programme management approach will ensure that each scheme is monitored very closely and corrective action will be taken where necessary. Financial Plan 2016/17 West Lancashire Clinical Commissioning Group Board Meeting - 22 March

92 Further changes and revisions to the QIPP plan are expected as we work with partners to implement schemes and clarify savings assumptions. The current schemes identified for QIPP will take significant effort and focus to ensure they remain on track to deliver the full 3.8m savings. Transactional Productivity and Contractual Efficiency Savings Prescribing (570) Right Care Right Value (265) Outpatient attendance reductions (165) Estates review (100) Contract coding challenges (375) Packages of Care Review (325) Transformational Service Re-design and pathway Changes MSK Redesign (including MCAS) (449) LD Discharges to community placements (375) COPD (340) Primary Care (Care Homes) (125) IT Strategy Schemes (60) Other Non Elective Schemes (384) Community Gynaecology Service (50) Community Dermatology Service (50) Revised IPA System (250) Total QIPP (3,883) (h) 1% non-recurrent funds in 2016/17: The 2016/17 financial plan has set aside 1% of recurrent funding for non-recurrent expenditure purposes (as per national guidance). NHS England guidance specifies that the 1% non-recurrent spend is to create a risk reserve and therefore should remain fully uncommitted. Spending during the year against the 1% nonrecurrent reserve will be subject to approval by NHS England. 6. CCG Budgets 6.1 CCG budgets will continue to be refined through the year to reflect updates eg in year allocations, confirmation of migration to/from specialist services, contract settlements. Financial Plan 2016/17 West Lancashire Clinical Commissioning Group Board Meeting - 22 March

93 6.2 The table below shows planned CCG expenditure by high level budget line. Total /17 Resource Resource Revenue Resource Limit ( 000) 150,641 Income and Expenditure TOTAL Total /17 Plan Acute services Acute contracts -NHS (includes Ambulance services) 74,418 Acute contracts - Other providers (non-nhs, incl. VS) 5,103 Acute - Other 550 Acute - Exclusions / cost per case 254 Acute - NCAs 1,271 Sub-total - Acute services 81,596 Mental Health services MH contracts - NHS 10,739 MH contracts - Other providers (non-nhs, incl. VS) 107 MH - Other 105 MH - Exclusions / cost per case 1,593 Sub-total - MH services 12,544 Community Health Services CH Contracts - NHS 9,911 CH Contracts - Other providers (non-nhs, incl. VS) 792 CH - Other 748 CH - Exclusions / cost per case 611 Sub-total - Community services 12,062 Continuing Care services Continuing Care Services (All Care Groups) 7,260 Local Authority / Joint Services 1,038 Free Nursing Care 975 Sub-total - Continuing Care Services 9,273 Primary Care services Prescribing 19,126 Community Base Services 882 Out of Hours 2,949 Sub-total - Primary Care services 22,956 Other Programme services GP IT Costs 519 NHS Property Services re-charge (excluding running cost) 1,017 Voluntary Sector Grants / Services 14 Social Care 2,442 Other CCG reserves 1,161 Other Programme Services 958 1% Non Recurrent - uncommitted funds 1,468 Sub-total - Other Programme services 7,579 Total - Commissioning services 146,010 Running Costs CCG Pay costs 1,637 CSU Re-charge 435 NHS Property Services re-charge / CHP Charges 52 Running Costs - Other Non-pay 246 Sub-total - Running costs 2,370 Contingency 754 Total Application of Funds 149,134 Surplus/(Deficit) 1,507 Financial Plan 2016/17 West Lancashire Clinical Commissioning Group Board Meeting - 22 March

94 6.3 The CCG will shortly be assigning Budget Holders to individual Cost Centres to ensure the operational delivery of these plans. 7. Financial Risks 7.1 The plans are based on the forecast healthcare contracts for 2016/17 as well as forecast out-turn position for other key budgets (e.g drugs). It should be noted that these reflect a number of pressures around prescribing, healthcare contracts and continuing/complex care, together with assumptions around overall levels of QIPP delivery. Further pressures may emerge or existing pressures worsen during the year. 7.2 The list of the material risks and cost pressures in 2016/17 can be summarised as follows: Full Risk Value 15 '000 Probability of risk being realised 15 % Potential Risk Value 15 '000 Proportion of Total 15 % Commentary 15 Risks CCGs 0.3% reduction in efficiency requirement ( 289k) plus Acute SLAs % 327 NEL marginal rate increase ( 147K) Community SLAs - Mental Health SLAs - Continuing Care SLAs % 50 Financial risk associated with expiry of CHC Framework QIPP Under-5elivery 1, % 875 Performance Issues 1, % 888 Impact of 1.5% overperformance on Acute Services Primary Care - Prescribing % 116 Impact of 2.5% variance Running Costs -.CF - Other Risks - TOTAL RISKS 4,033 56% 2, % 7.3 The CCG has a 0.5% contingency reserve to cover financial risks associated with over-spending. This equates to 754,000. Clearly this is not enough to cover the potential risks identified above at 2.3m. In terms of the acute SLA risk ( 327k), the CCG received support in 15/16 from NHS England as part of the 150m national support for the enhanced tariff option, this funding was 444k. However this is expected to be within CCG allocation baselines for 16/17. This year s funding settlement reflects the challenging financial position in the provider sector as well as the tariff settlement and funding rules surrounding the transformation programme. They are a substantial part of NHS increases which are aimed towards the provider sector. So despite the contingency reserve, the potential for unmitigated financial risks could be around 1.5m (with still more to be identified). The CCG will need to proactively plan for additional QIPP early in the financial year to guard against downside risk. 7.4 There are further, as yet un-quantified risks that add to the pressure on budgets as follows: Financial pressure within the health economy as providers are facing financial deficits in 2015/16 and increasing for 2016/17. Financial Plan 2016/17 West Lancashire Clinical Commissioning Group Board Meeting - 22 March

95 Potential financial pressures that are driven by further reductions in council budgets and the knock on effect to CCGs. Running cost pressures associated with widening the CCG commissioning agenda (e.g primary care and specialist commissioning) and the pressure it puts on existing CCG capacity. High cost packages of care and personal budgets which have a bigger financial impact for smaller CCGs as it is more difficult to spread risk. The potential to manage and reduce costs may be outside of the CCG s control. The alleviation of pressures will require the support of partner organisations, including GP s and the Local Authority. The net risk position is dependent upon how the risk materialises, this could significantly impact the delivery of the 1% surplus requirement. 7.5 Within the financial plans, provision has been made to cover the financial impact of activity growth in acute, tertiary and continuing health care. However, if the growth in these services exceeds the levels planned, the CCG will face further pressures and the financial gap will increase. 8. Balance Sheet/working capital Items 8.1 This section provides an overview of the balance sheet items including cash, creditors, debtors and capital. These will be managed corporately by the CCG for 2016/17. (a) Cash is a key resource and must be managed efficiently and effectively to ensure the CCG can meet all of its financial obligations without interruption. The CCGs will be given a cash limit each year which is linked to their revenue and capital resource limits, and have a statutory duty to remain within their cash limit. Therefore, cash must be managed efficiently to ensure that the CCG has adequate cash to meet its needs for each month and for the whole year. Ineffective drawdown of cash from the National Commissioning Board is uneconomical for the Treasury and so penalties can be imposed. (b) Creditors and Better Payment Practice Code: All NHS organisations have an administrative duty to conform to the Better Payment Practice Code and as such should pay their undisputed invoices within 30 days of receipt of a valid invoice or receipt of goods. Regular monitoring of creditor invoices should be undertaken to ensure potential disputes are highlighted at an early stage for resolution. The Late Payment of Commercial Debts (Interest) Act 1998 applies to the NHS and therefore any late payments can result in non-nhs bodies claiming interest. During 2015/16 the CCG has maintained the progress achieved in its target of paying over 95% of invoices within 30 days remains fully compliant. 9. Financial governance 9.1 The CCG has established financial systems, processes and procedures to ensure the CCG and its staff can manage their financial responsibilities effectively. All CCG officers and staff have a responsibility for helping the CCG to manage income, expenditure and assets properly and need to follow the principles laid down in these documents to fully protect the interests of the CCG and to protect themselves against Financial Plan 2016/17 West Lancashire Clinical Commissioning Group Board Meeting - 22 March

96 possible criticism or even disciplinary action. These documents apply to all CCG staff, including bank, agency and contract staff. 9.2 Current governance arrangements will ensure that the CCG operates in a transparent and open manner, observes the principles of the NHS Constitution, Standards of Public Life (Nolan principles) and equality laws. It is anticipated that systems and processes will be in place in accordance with required timetables. 10. Next Steps 10.1 Following approval by the governing body, an analysis at individual budget level will be prepared and distributed to budget-holders and governing body members of the CCG. Budget changes from the plan presented here for 2016/17 will be highlighted as they arise. Any budget amendments arising from this update will be updated as subsequent movements to the approved budget and reported through the CCG sub-committees. 11. Recommendations The Governing Body is recommended to: Note the challenging nature of the financial plan for 2016/17 in particular the requirement to deliver a QIPP plan totalling 3.8m. Note there is only very limited investment available based on schemes that were pre-committed in 2015/16. Note the requirement to identify and develop additional QIPP schemes early in 2016/17 to guard against the significant financial risks that exist over the next 12 months. Note the requirement to use Right Care approach to identify ongoing savings to mitigate uncovered financial risk. Note that the financial plan is based on the best available knowledge of allocations and financial commitments at the present time. Budget assumptions may change during the year based on final contractual agreements and revisions to financial assumptions. Approve the initial 2016/17 revenue income and expenditure plan for NHS West Lancashire CCG. Paul Kingan March 2016 Chief Finance Officer Financial Plan 2016/17 West Lancashire Clinical Commissioning Group Board Meeting - 22 March

97 Minutes Quality and Safety Committee Venue: Boardroom, Hilldale, Ormskirk Date & Time: Tuesday 26 January 2016 at pm Attendees: Mr G Mitten Chair Dr J Kinsey GP lead for safeguarding Dr R Bonsor GP clinical lead Mrs J DeBacker Practice manager Mrs J Moran Head of quality, performance and contracting Mrs K Thompson Public health consultant Apologies: Dr S Featherstone Director of nursing (in attendance) Mr R Gillies Medical director (in attendance) Mrs C Heneghan Chief nurse Mrs J Rollinson Head of safeguarding In attendance: Miss C Ashcroft Executive assistant Mrs A Lumley Primary care nurse development lead Mrs A Sathiyanathan Quality assurance manager Mrs L Elliott Lead nurse for safeguarding adults and mental capacity act Ms G Brown Chief executive of Healthwatch Mrs L Burton Designated lead nurse for safeguarding children Ms Anita Watson Lead nurse in prevention of infection control, Lancashire County Council Agenda Summary of Discussion Item CCGQIC 01/16/1 Welcome and apologies for absence Greg Mitten welcomed the members of the quality and safety committee to the meeting. The apologies above were relayed. Lead 01/16/2 Declaration of interest There were no declarations of interest raised which were pertinent to the agenda. Members will raise any relevant declarations of interest as each item is discussed. 01/16/3 Minutes from the previous meeting on 24 November 2015 The notes from the previous meeting were approved as a correct record of the meeting. 01/16/4 Matters arising action sheet The action sheet was updated. 01/16/5 Patient Quality, Performance, Safety and Experience a. Quality assurance update - CCG Jackie Moran provided a verbal update on quality assurance. A discussion had taken place at the governing body meeting around a clear pathway for requesting information from the Trust, to ensure they are not overcome with identical requests. A stakeholder action plan is required. A collaborative commissioning forum has been established to understand what the quality issues are, which involves the CQC, NHS England and CCGs to achieve joined up working. Any questions for the forum should be relayed through Quality and Safety Committee 26 January 2016 Page 1 of 5

98 Agenda Item CCGQIC Summary of Discussion Jackie Moran or Claire Heneghan. Claire Heneghan will also ask the Trust to come to the executive committee to discuss maternity quality issues. A discussion on the effectiveness of the 111 service took place at the governing body where public opinion had been sought. Healthwatch s methods of compiling public opinion were commended, eg the Mum test in care homes. Gill Brown confirmed that Healthwatch had worked with 111 the previous year and found that patients felt they had been directed to the correct place. Claire Heneghan has stepped down from the Trust s quality committee as she felt her presence gave approval of items discussed, although her role was only to as an observer. It was suggested it be useful for Gill Brown to attend the next oversight meeting in March. b. Quality workplan - final Allison Sathiyanathan provided the final workplan including dates for papers to be presented. The following changes will be made: Primary care update will be added on a quarterly basis. Safeguarding will be reported on a quarterly basis, can be brought forward and include mental capacity act. The HCAI reports will be put back one month. Sign up to safety pledges reviewed every six months. A new service redesign manager will prove additional support for DoLs. The workplan will be brought back to the next meeting. c. Serious incidents monthly report The purpose of this report produced by the CSU is to learn lessons from reported serious incidents, which are looked at by the serious incident review group and escalated with themes identified. The new layout for this monthly report was approved. As at 31 December, 65 StEIS incidents remain open, of which 34 relate to pressure ulcers from Southport and Ormskirk Hospital NHS Trust which will be reported collectively in a separate report. Most of these pressure ulcers were reported between April and June 2015, but continue to occur. Southport and Formby CCG have formerly requested a copy of the report the pressure ulcers continue to occur. Alison Lumley is linked into issues including care homes. The throughput on open StEIS by provider will be looked into. Gill Brown commented that timeliness of reporting of StEIS is crucial and questioned why they are not being reported. This will be raised with the GP operational forum who are dealing with pathology quality issues and will be included in the Serious incident report in future. d. Serious incident group terms of reference The terms of reference of the new serious incident review group set up by Southport and Formby CCG were discussed. Clinical input from West Lancashire CCG is limited with Allison Sathiyanathan attending. Meeting documentation is now sent out to West Lancashire clinicians a week in advance to enable them to provide input to the meeting. Allison Lead CH AS Quality and Safety Committee 26 January 2016 Page 2 of 5

99 Agenda Item CCGQIC Summary of Discussion Sathiyanathan will speak to Claire Heneghan to gain her comments on the terms of reference. e. Complaints and issues Patient complaints are collated by the CSU who produce a monthly report. The CCG and CSU are working to update the format of this report. A very small number of complaints are received by the CSU. In relation to GP complaints Allison Sathiyanathan complemented the customer relations manager from Lancashire County Council, Ian McGoway, who provides prompt solutions to complaints. GP complaints include 34 cases of diagnostic test results being sent to the wrong GP practices by St Helens and Knowsley. This should be easy to solve by contacting the pathology quality manager. This issue should improve when electronic ordering commences. f. Friends and family report Grahame Moore informed the group of the background to the report. The friends and family survey started in 2013 in a few clinical areas and has been rolled out to other areas over the years. Last month NHS England published comprehensive datasets for each of the new areas and the report has been amended. Accordingly, the response rate in October 2015 for A&E was very low at 4% against the national average of 12%. For the North West Ambulance Service, Patient Transport services have an indicative low response rate, but this is above the national average. However, the See and Treat response rate is lower than the national average rate. 98% of patients would recommend community services to family and friends, although the staff response rate was very low in October The response rate for the GP survey in West Lancashire was above the national average, with a very low level not recommended responses achieved. g. Patient experience report and plan A story had been received via the diabetes services, having been volunteered by the patient. Having been diagnosed with multiple sclerosis the lady had become morphine and insulin dependent, becoming household and overweight. Her goal was to lose weight and reduce her dependence on medication and social care. She received support from her family, voluntary sector organisations, her housing association, General Practice and community health services. In under two years she no longer needs morphine, now manages diabetes by diet alone, has lost over 15 stone in weight, regained her mobility and no longer requires social care visits. These changes have given her back her life and reduced her requirements on both health and social care services. She is now volunteering and helping others make the changes she was able to. The lady stated we cannot change everything in our lives, but when there is something we can change you never know where it will lead and she thanked all of the community services who had supported her. All data will be brought together for future reports. The terms of reference for the Patient Experience Group had been circulated. Lead AS h. Health Care Acquired Infection update Anita Watson provided an update on infection control. There are 27 cases Quality and Safety Committee 26 January 2016 Page 3 of 5

100 Agenda Item CCGQIC Summary of Discussion of C. Difficile to the end of December, which is within the cumulative trajectory of 34. All the C. Difficile cases should be reviewed and not just those attributed to the Trust which they are appealing against. There are no trajectories for MRSA as there is a zero target; there have been 2 cases, 1 apportioned to Southport and Ormskirk Hospital NHS Trust and the other to the community. There is currently a local outbreak of norovirus affecting three wards and one care home which have been closed. Possible links are being looked into. An outbreak meeting will take place tomorrow. A meeting is required with Claire Heneghan to review the IPC support to the CCG. i. Sign up to safety pledges Since the previous meeting, Claire Heneghan and Alison Lumley had produced the safety pledges. There is evidence for each pledge and this will be reviewed in the future. An update will be provided every six months. Practices report to the NSRL with their significant issues. The Trust s pledges can be looked at and any future provider would need to sign up to the pledges. The committee: agreed to the current pledges and for them to be reviewed on a six-monthly basis. j. Lancashire County council Care Home Quality Improvement Projects Alison Lumley is on this group which is proactive in Lancashire care homes and have put systems in place to support them. One system is for sharing good practice and support across all homes, with the CQC linking with the group to provide details of their inspection process. Safeguarding are trying to strengthen the relationships with care homes. Lead 01/16/6 Governance and Performance a. CQUIN / other incentive schemes This item was deferred. b. Internal audit (MIAA) Quality report This item was deferred. c. Policy assurance Serious Incident policy The final policy contains updates from safeguarding and takes into account suggestions made by Billi Lam during the recent MIAA audit. This is a combined policy and procedure to reduce repetition. Dr Ros Bonsor requested that a procedure for the dissemination of learning from serious incidents be included. 01/16/7 Any other business Provider representation at future meetings Joanna Stark had suggested attending future meetings of the committee. It was agreed that it would be a more beneficial use of limited time for Joanna and other Trust representatives to attend by invitation to discuss specific items. Greg Mitten relayed a story about a road traffic accident where an ambulance had taken a significant time to arrive. Gill Brown had experienced a similar Quality and Safety Committee 26 January 2016 Page 4 of 5

101 Agenda Item CCGQIC Summary of Discussion case caused by delayed turnaround time at the Trust s A&E department. It was confirmed to the group that at the prior Governing Body meeting it was agreed that a letter be sent to NWAS to highlight this issue. Lorraine Elliot raised Prevent basic awareness which had been circulated to the CCG to read and provide confirmation. Alison Lumley will check that this has been actioned and results will be provided. Louise Burton confirmed that safeguarding financial arrangements have been agreed and the memorandum of understanding is being worked on by Jean Rollinson. Lead AL Date and time of the next meeting Tuesday 23 February at 1.30 pm, Boardroom, Hilldale, Ormskirk 01/16/06 The meeting was not quorate from this item onwards. Quality and Safety Committee 26 January 2016 Page 5 of 5

102 Minutes Quality and Safety Committee Venue: Boardroom, Hilldale, Ormskirk Date & Time: Tuesday 23 February 2016 at pm Attendees: Mr G Mitten Chair Mrs C Heneghan Chief nurse Dr J Kinsey GP lead for safeguarding Mrs J DeBacker Practice manager Mrs K Thompson Public health consultant Apologies: Mr S Featherstone Director of nursing (in attendance) Mr R Gillies Medical director (in attendance) Ms G Brown Chief executive of Healthwatch (in attendance) Mrs J Moran Head of quality, performance and contracting Dr R Bonsor GP clinical lead In attendance: Miss C Ashcroft Executive assistant Mrs A Lumley Primary care nurse development lead Mrs A Sathiyanathan Quality assurance manager Mrs L Elliott Lead nurse for safeguarding adults and mental capacity act Mrs L Burton Designated lead nurse for safeguarding children Ms Anita Watson Lead nurse in prevention of infection control, Lancashire County Council Mrs C McCabrey Service redesign manager Agenda Summary of Discussion Item CCGQIC 02/16/1 Welcome and apologies for absence Greg Mitten welcomed the members of the quality and safety committee to the meeting. The apologies above were relayed. Greg Mitten confirmed the discussion from the previous meeting where it was agreed that Simon Featherstone and Rob Gillies would only be asked to discuss specific items at future meetings and not attend every meeting given their current priorities. The Collaborative Commissioning Forum (CCF) will take forward quality issues with the Trust from West Lancashire and Southport and Formby CCGs. Lead 02/16/2 Declaration of interest There were no declarations of interest raised which were pertinent to the agenda. Members will raise any relevant declarations of interest as each item is discussed. 02/16/3 Minutes from the previous meeting on 26 January 2016 The notes from the previous meeting were approved as a correct record of the meeting with two corrections: Louise Butler s name corrected to Burton. Lancashire County Council Care Home Quality Improvement Projects One system is for sharing good practice and support across all homes, with the CQC linking with the group to provide details of their inspection process. The proposal to cancel the two quality meetings on 22 March and 24 May was accepted, allowing committee members to attend the procurement days. Ongoing quality items will be addressed via the CCF and contracting meetings. Quality and Safety Committee 23 February 2016 Page 1 of 5

103 Agenda Item CCGQIC Summary of Discussion Any new quality issues will be raised at contracting meetings and the weekly Executive Committee meetings. Lead 02/16/4 Matters arising action sheet The action sheet was updated. 02/16/5 Patient Quality, Performance, Safety and Experience a. Integrated business report (IBR) Claire Heneghan referred to the report and confirmed that the MRSA figures for the Trust should be corrected from 2 cases to 1 case as the second case was attributed to the community and the C. Difficile trajectories should be examined. Contract queries are still in place. Ward closures have slowed down after the noro virus and flu viruses, which are also affecting care homes. It was agreed that areas of concern in the IBR will be reflected in the committee s workplan on a quarterly basis. Despatches are looking at the ambulance service in different areas of the country and comparing monitoring and evaluation of performance. GP practices which wish to complain about the ambulance service or wider issues, can use the GP complaints address, which will be publicised in the GP Bulletin. Specific issues with the ambulance service experienced by local GPs were raised, including the appropriateness of one case where the first responder was the fire brigade and others where arguments took place with the GP over the appropriate destination. Claire Heneghan will discuss with Jackie Moran who can raise the cases discussed at the Blackpool ambulance meetings as lead commissioners. The responses to the complaints need to be shared with the GPs and Allison Sathiyanathan will strengthen the process in terms of policy and procedure. AS AS CH/JM AS b. Quality assurance update - CCG Claire Heneghan provided a verbal update on quality assurance. At the Lancashire Quality Surveillance Group, Linda Ward had presented the Royal College of Obstetrics and Gynaecology s report on maternity services at Southport and Ormskirk Hospital NHS Trust. As Claire Heneghan could not attend the Lancashire Quality and Safety Improvement meeting Allison Lumley attended and outlined the purpose of the group. An assurance framework for infections is in place and the meeting includes patient experience. The meeting is a forum for both providers and commissioners learning and sharing with Linda Ward feeding back on many areas. Alison Lumley will feedback on future meetings. An internal quality away day will take place on 26 February, where the priority areas will be agreed along with the leads to take them forward. Claire Heneghan will feedback on the outcomes of the quality away day. CH The next Single Item Quality Surveillance meeting takes place on 8 March. c. Quality workplan - final amended Allison Sathiyanathan provided the final workplan. It was agreed that this Quality and Safety Committee 23 February 2016 Page 2 of 5

104 Agenda Item CCGQIC Summary of Discussion plan will continue to evolve. Changes noted included: The quality strategy review will be moved from December to March. The ambulance service as discussed earlier in the notes. The plan will be discussed at the quality away day as the plan must remain flexible to accommodate changing priorities and additional items. The cancellation of the March and May meetings will also need to be taken into account when updating the plan. d. Serious incidents monthly report One of the purposes of this report produced by the CSU is to ensure are learnt from reported serious incidents, which are looked at by the Serious Incident Review Group and escalated with themes identified. Allison Sathiyanathan attends the Group with Southport and Formby CCG. Only one new StEIS incident was reported in January involving a West Lancashire patient. As at 31 January, 62 StEIS incidents remain open including 34 pressure ulcers incidents. An overarching action plan for pressure ulcers has been requested from the Trust, with all current incidents remaining open until this has been received. After which time one overarching pressure ulcer incident will remain open for each CCG. Recurrent themes identified include the inconsistent escalation of deteriorating patients by junior doctors and processes not being followed when using vital PAC ( a digital system for early warnings when patients are deteriorating). With similar cases being reported there appears to be no lessons learned. A representative from the Trust has been invited to the next meeting where the issues will be raised. This will be raised at the next Executive Committee as a hot topic. e. GP complaints and issues In January, there were 15 complaints, comments and concerns from GPs, 12 of which related to diagnostic test results sent to the wrong practice raising information governance issues. f. Patient complaints and issues Patient complaints are collated by the CSU who produce a monthly report. The CCG and CSU have updated the format of the monthly and quarterly reports. The updated version for January will be distributed after the meeting. Lessons learnt from these complaints have been requested by the CCG but due to staff shortages at the CSU there has been a delay in their collection. g. West Lancashire exception report The report highlights nursing care and independent sector mental health providers. This is for information and is addressed under safeguarding as a monthly agenda item. h. Lancashire screening performance review January 2016 The review was provided for information. It had been presented at the Overview and Scrutiny Group. Greg Mitten queried if the report should be presented for discussion and not just information. Clarification will be provided at the next meeting. Lead AS AS CH Quality and Safety Committee 23 February 2016 Page 3 of 5

105 Agenda Item CCGQIC Summary of Discussion i. Safeguarding activity report Lorraine Elliot and Louise Burton highlighted the key areas in the report: At the time of writing the report there were no care homes being managed under the QIP process, one home will soon be placed on the process, a meeting is planned in March. An adult learning review has been commissioned for Briarwood rest home and soon to presented to the Lancashire Safeguarding adults board, the lessons learned are similar to other adult learning review findings involving care homes. An action plan is to be put into place to ensure agencies respond accordingly. The potential risks around patients in receipt of personal health budgets was raised due to a lack of case management arrangements in place for these patients. The CSU have appointed a safeguarding and quality lead and the safeguarding team intend to work closely with the CSU to ensure there is safeguarding representation within this work stream. Transforming lives agenda was discussed in relation to patients in Calderstones hospital requiring the CCG to make a court of protection application prior to discharge into a DoL. Delays in the system can impact on patients remaining in hospital for longer than they need to and exposing them to further risks. An MCA media resource and e-book will be launched next week to provide MCA learning on websites. This will be shared with all organisations to include on their websites. OFSTED inspection Lancashire Children s services the report produced in November 2015 is concise but covers a vast area. The outcome was found to have serious failures in service to children. The areas which failed were outlined. During the investigation three children died in unrelated incidents, they were open cases receiving services as children in need. Investment had been made and a Lancashire Improvement Board established. Ofsted also reviewed the effectiveness of the LSCB which was graded as good having recognised that the board was meeting its statutory responsibilities. NHS England have commissioned the roll out of CCG commissioning compliance benching marking tool in line with revised statutory and the revised guidance: promoting the health and wellbeing of looked after children. The safeguarding team has attended workshops and will complete the self-assessment on behalf of the CCGs with feedback planned at an event on the 29 April. The completed assessment will be shared at a future committee. A case study was shared with the committee in respect of a young person experiencing child sexual exploitation (CSE). The young person had been supported and assessed by DETER (CSE multi-agency team) highlighting the role of the health practitioner in achieving a positive outcome. j. CQC recommendation update overarching action plans Claire Heneghan had met with Michelle Creed and Debbie Fagan where it was agreed that a summary of cross-cutting themes were needed and not separate action plans for each department. A request to the Trust for a summarised document has been made. It was suggested that the Lancashire Healthwatch representative be invited to the Quality Surveillance Group meeting. This will be discussed with Michelle Creed and if it is not possible, comments will be requested from Gill Brown to be Lead LB Quality and Safety Committee 23 February 2016 Page 4 of 5

106 Agenda Item CCGQIC presented at the meeting. Summary of Discussion k. NICE guidance update Care of dying adults in the last days of life Carol McCabrey has only recently taken over end of life and therefore the guidance will return to the next meeting. Lead CMcC 02/16/6 Governance and Performance a. Corporate risk register Agreement will be sought as to whether the register is required to be present at this forum, as it is already presented at the two committees and the governing body. Lorraine Elliot has identified an additional risk around safeguarding and will liaise with Claire Heneghan around including the item. The report can be circulated with the minutes. AS CA 02/16/7 Any other business Any quality items needing to be raised before the next meeting should be directed to the Executive Committee or the Contracting meeting. Date and time of the next meeting Tuesday 22 March CANCELLED Tuesday 26 April at 1.30 pm, Boardroom, Hilldale, Ormskirk Tuesday 24 May CANCELLED Tuesday 28 June at 1.30 pm, Boardroom, Hilldale, Ormskirk Quality and Safety Committee 23 February 2016 Page 5 of 5

107 West Lancashire CCG Clinical Executive Committee Action and Notes 19/01/16 Attendees Discussion and Decisions Adam Robinson - Secondary Care Consultant Bapi Biswas GP Executive Lead Claire Heneghan Chief Nurse Debbie Dobson - Practice Manager Doug Soper Lay Member Greg Mitton Lay Member Jack Kinsey GP Executive Lead Jackie Moran - Head of Contracting, Performance and Quality Jo DeBacker Practice Manager Joanne Kane Admin Officer John Caine Chairman Mike Maguire Chief Officer Nicki Watson - Contracts Manager Peter Gregory - GP Executive Lead Simon Frampton GP Executive Lead This week s actions Due Date Responsible officer RAG Apologies Ros Bonsor - GP Executive Lead Declaration Interest of Bapi Biswas declared an interest in Item 9a Concordia Mobilisation. Peter Gregory declared an interest in Item 9 Contracts Procurement. Greg Mitten declared an interest in Item 9 Contracts Procurement. All GPs declared an interest in Item 9 Contracts Procurement. 1

108 Notes from previous meeting GP Elections The notes from 5 January were agreed as a correct record. Paul Kingan presented information regarding GP elections, in accordance with the WLCCG constitution the position of Chair and two Exec members are due to be voted on. Paul asked that the Exec Committee formally agree the process prior to seeking expressions of interest. Discussion followed on the process which will be facilitated by the Local Medical Committee (LMC). A Membership advisory panel will be formed to make decisions on who will stand for election. Following on from comments today a paper will be circulated to the Membership prior to discussion at the next Membership Council. Paul will liaise with the LMC for advice on proceeding with the election. Formal Ratifications IBR Appointment of new auditors Equality and inclusion report Commissioning Policies IBR Paul Kingan presented the IBR for comment before this goes to the Governing Body on 26 January. The financial position again remains tight. The IBR highlights the overspend on Acute planned care. Bluebell Lodge has not impacted on figures yet. Overall WLCCG will achieve the expected target. Jackie Moran gave an update on the performance, it is likely that mental health and 2

109 Ambulances will need to a focus in the future. Appointment of new auditors WLCCG like all other CCGs are able to make select their own auditors. The requirements are still under consideration but a local panel may be required to appointment new auditors. This will be discussed at the Governing Body on January 26. Equality and inclusion report Paul presented the statutory Equality and inclusion report for Exec Committee comment prior to this being taken to the Governing Body next week. WLCCG has a mix of green and amber grades, learning will be taken into account from the grading panel and it is expected that the new band 7 role will also help to improve future grading. Commissioning Policies Lucinda McArthur updated from the Commissioning Policy sub group. Final drafts were presented again for approval prior to Governing Body; previous comments from the Exec Committee have been taken into account. Anthony Sudell - Consultant in Public health, LCC will be leaving soon, discussion followed on whether this could impact on the support provided to WLCCG. Lucinda will report back to the committee following the next network meeting. The Exec members then voted to approve all 3

110 the policies presented, they will now be taken to the Governing Body for ratification. Healthier Lancashire Paul Kingan presented information on the governance structure of Healthier Lancashire. There followed a long discussion on where West Lancashire fits into Healthier Lancashire, including which work streams WLCCG would benefit from being involved in and which would be less appropriate to the area. It was agreed that further clarity on what associate means would be beneficial to direct where WLCCG should seek to be involved. BAF and Risk Register Paul Kingan presented the BAF and latest Risk Register prior to the Governing Body meeting next week. There are 18 risks registered, 2 appear on the BAF, these are now different risks than before. It was noted that the Community procurement is a composite risk on this register but also holds its own register, at a future date this may be reviewed and possibly be taken to the Governing Body separately. AOB Claire Heneghan raised Transforming Care - Caulderstones as an AOB following attendance at a CTR. An issue regarding doubt over who is the responsible commissioner is halting progress for a patient. Claire asked the Exec Committee to consider approving funding without prejudice to resolve 4

111 the issue. Discussion followed on this, however it was agreed that legal advice needs to sought before the Exec Committee can make a decision. Advice from MLCSU will be obtained regarding the legal aspect of the case Claire Heneghan Mental Health Dementia Briefing Acute Therapy Service Two papers were presented on behalf of Ros Bonsor and Catherine Webster, the first a dementia briefing which included an issue with increased waiting times to the Memory Assessment Service (MAS). The second regarding funding of the Acute Therapy Service (ATS). One suggestion to alleviate the MAS issue was the use of a care home diagnosis pro forma. It was noted that while the pro forma may not impact greatly on MAS, it could be included in a standard 5 per head template. Another suggestion was for follow up appointments to take place at practices instead of MAS. A further aspect within the briefing was the development of assistant, associate and advanced practitioner roles. Due to the tight deadline for submission it was agreed WLCCG should not pursue due to capacity. Discussion also followed on suggested guidance for consulting with violent patients. Peter Gregory highlighted that guidance omitted advice for situations when a patient is actually violent and this should be included before issuing the document. The second paper for consideration was the 5

112 ATS, the Exec Committee was asked to consider roll out the service across the area, further information to understand the cost saving and on activity was requested. Contract/ Procurement Concordia Mobilisation Update Endoscopy Paper Contracts Procurement Paper Concordia Mobilisation Update Bapi Biswas declared an interest in the Concordia item. The chair decided that the interest was significant but not fundamental. Bapi was allowed to take part in the discussion but not vote. An update was given on progress made by Concordia to mobilise the Tier 2 Cardiology service. WLCCG has raised concerns regarding the mobilisation plan. Jackie Moran is writing a paper which will be taken to the Governing Body next Tuesday. Following this Jackie will update the Exec Committee on the way forward. Endoscopy Paper Jackie presented a paper and updated spec for AQP for direct access Endoscopy. Jackie thanked Adam, John and Jack for their advice regarding the changes made. The members were asked to approve the spec prior to advertising on contracts finder, a vote took place and this was approved. Contracts Procurement Paper Jackie Moran presented a paper setting out a number of contracts which are due to expire in The Exec Committee was asked to consider each in turn. Before each was 6

113 considered the Exec Committee was asked to declare any interest, the declarations of interest are recorded at the beginning of each contract discussion. OWLS Peter Gregory and Jack Kinsey declared an interest in this item. The chair of the meeting was passed to Mike Maguire. The chair decided that Peter Gregory s interest was fundamental and Peter should not take part in the discussion or any vote. Peter was therefore asked to leave the room for this item. The chair decided that Jack Kinsey s interest was significant but not fundamental. Jack was allowed to take part in the discussion but not vote. Discussion followed on the OWLs, Out of Hours (OOH) and the Acute Visiting Service (AVS) contract. Jackie reminded the committee that these are all included in Lot 2 of the Community Procurement and as such suggested they could be extended for 12 months. The members voted to extend the contract for 12 months. West Lancashire Health Partnership No interests were declared in this contract. Jackie gave an update to the Exec Committee on the current situation with the WLHP. The 7

114 issue regarding the directorship remains unresolved and the contract has not been novated to the Trust yet. The Exec Committee was asked to agree rolling the contract on, all agreed. Queenscourt Hospice No interests were declared in this contract. There followed a detailed discussion on the contract and what the funding provides for the local population. There is a need to consider whether funding to the Third Sector is equitable and if funding could be available to other third sector organisations for example those that provide bereavement counselling or palliative care. A vote took place, it was agreed to extend the contract for 12 months subject to review within this period. GP Enhanced Services Anti Coagulation Shared Care Drugs Phlebotomy Support to Rehabilitation Units Treatment Room Vasectomy Diabetes Cataract All GPs and Practice Managers declared an interest in various aspects of this item. The 8

115 chair decided that the interest was fundamental and all GPs and Practice Managers should not take part in the discussion or any vote of the contracts they had an interest in. All GPs and Practice Managers were therefore asked to leave the room as each contract was discussed that they had declared any involvement with. Discussion focused on Phlebotomy and Treatment rooms in particular as there is still a need to understand how they could be improved across the neighbourhood, it was suggested that there is further work to be done as part of community service. All agreed to extend the contract subject to reviewing how they are organised. Discussion then turned to Anti Coagulation, Diabetes and Cataract. Feedback on the service provision was reported to be good, the members voted to roll these on. Support to rehab units was discussed briefly with recognition that WLCCG will continue to work to provide equity of access across the patch. The remaining contracts were agreed to roll over. Tier 2 This covered contracts for Minor Surgery, Gastroscopy and Opthalmology which were then considered. Those members present who had not declared an interest voted to extend 9

116 these contracts. Voluntary Sector Greg Mitten declared an interest in this item. The chair decided that the interest was fundamental and Greg should not take part in the discussion or any vote. Greg was therefore asked to leave the room for this item. Discussion followed on the third sector contracts, the Exec Committee agreed that these should be extended but with the proviso that notice will be given that contracts will be subject to review. Further information on activity and outcomes from Action for Blind was requested to be brought to the next Exec meeting. WLCCG will look to carry out a bigger piece of work to understand further what the services provide for the funding and services must demonstrate value for money. Heart Failure Service The pilot is due to expire in September, the Heart Failure team report that they deal with more than heart failure. Activity data has been requested. Again this was agreed to extend, this will be returned as will Cardiology and Dermatolgy. All the contract recommendations discussed today at Exec will go to the Governing Body on 26 January. 10

117 Confidential Lancashire Community Equipment STP Planning Pan Paul Kingan updated the Exec Committee on the outcome of a procurement process for Community Equipment. This will be discussed at the Governing Body. Agreement will be sought to proceed with the selected bidder. Lucinda presented slides on the Strategic Transformation Planning. At present an agreed footprint is required for submission on 29 January. There was discussion on the geography of WLCCG and how this causes complexity in planning. The meaning of associate was considered and the work streams that sit under the Liverpool City Region and the Pan Lancashire region were then looked at. There is a proposed summary that is due to be submitted. Following this there will be further work to progress a transformation plan. Draft Membership Agenda Discussion followedon the draft agenda, this will be amended accordingly prior to circulation. Wrap up 11

118 West Lancashire CCG Clinical Executive Committee Action and Notes 02/02/16 Attendees Discussion and Decisions Adam Robinson - Secondary Care Consultant Bapi Biswas GP Executive Lead Claire Heneghan Chief Nurse Jack Kinsey GP Executive Lead Jackie Moran - Head of Contracting, Performance and Quality Jo DeBacker Practice Manager Joanne Kane Admin Officer John Caine Chairman Mike Maguire Chief Officer Amanda Gordon- Service Redesign Peter Gregory - GP Executive Lead Simon Frampton GP Executive Lead Doug Soper Lay member Lucinda McArthur Senior Operating Officer Leslie Jones Public health speciality registrar Michelle Sage- Admin support Joanne Kane- Admin support Anne-Marie Bridge- Admin support This week s actions Due Date Responsible officer RAG Apologies Greg Mitton Lay Member Debbie Dobson - Practice Manager Declaration Interest of Peter Gregory declared an interest in Item 6 Primary Care Development Notes from previous meeting The notes from 19 th January 2016 were agreed as accurate. 1

119 Update on new Exec arrangements Mike Maguire updated the members on the new executive committee meeting format. Roles and descriptions have been revised, with changes to the timekeeper role, a new role summariser has been added this is primarily to sum up and provide closure. Papers for submission are now to be put into one page visual summary known as Infographics, Smita Shetty has trailed this and will be supporting members with training if required. SharePoint link to the executive e- meeting page which includes pipeline, declaration of interest submissions and executive library will be sent out via , the executive committee meeting folder v drive will continue to run alongside. There is an opportunity at 11am for clinical and managerial leads to book satellite meetings. The members agreed to go forward with the new arrangements. Strategic/service redesign MSK Redesign Update Mike Maguire and Amanda Gordon presented the current situation with the service and how they would like to progress the service. Currently MSK is run separately from MCAS with MCAS being integrated with orthopaedics. This generates an overspend on orthopaedic procedures. There is no system for triage and reduction of waiting times. The current IT solutions run differently between MSK/MCAS and they do not integrate. The way forward would be to integrate both services to initiate a 2

120 one stop shop for diagnostics this would then generate an appropriate treatment plan to include the use of self-management in the form of APPS and websites. Referrals would be preferred through e-referral and Ramsay Health has agreed to work alongside to minimise direct referral to them. The new title for the service is to be JOINT HEALTH and it is hoped that all changes needed will be introduced by June Concerns were raised as to what would happen if the changes weren t introduced by June 2016 and to provide an update on the progress in 4 weeks time. Acute Therapy Service Mike Maguire updated on a recent meeting with LCFT regarding the service. It was noted that the service has provided great benefit to the mental health service in West Lancashire and has shown to reduce admission rates and cost savings, but LCFT have asked for additional funding to continue the service. It was agreed that in order to retain good staff and the benefits of the service that WLCCG are committed to the continuation of the service with LCFT and Healthier Lancashire and they would expect the service to be cost neutral. Decisions from e- meeting Agenda item 4 Decisions from e-meeting working from home was unable to be tabled today due to technical issues with SharePoint. 3

121 Operational Staff Wellbeing Review Lucinda McArthur introduced Leslie Jones, Public Health Speciality Registrar, Lancashire County Council. Leslie is wishing to carry out an audit report on individuals health and wellbeing. The audit would consist of a 20 selfassessment, focus group and then a full evaluation and response. It was agreed that this should go ahead and that it should involve all staff within the WLCCG to include the executive team. Brookside Flats Claire Heneghan updated on the current position with the 5 flats paid for by WLCCG, the local authority who pay for the carers have wished to pull out of the arrangement for the past 12 months. The flats are not being utilised to their full potential. After discussion it was agreed and passed by the committee to give notice on the flats and reallocate the budget to be used for community rehabilitation elsewhere. Hot Topic Primary Care Development Peter Gregory declared an interest in this item, but did not leave the room as at this stage there is no vote taking place. Following on from the Membership Council meeting on 28 January there was a lengthy discussion on the role of general practice and how this could develop in future. General themes of quality, access and 4

122 sustainability were covered. Possible federation of practices was touched upon, however this was not discussed in detail as this would be Membership Council led. A&E Walkround Claire Heneghan and Charlotte McAllister carried out a walkround of A&E on Monday 1 February They reported that the unit was quiet with no waiting ambulances. It was highlighted that West Lancashire GPs appear to be sending patients direct to A&E for ECGs as there is currently no service for this in primary care. Data/evidence was requested from the committee to back this up. WLCCG are no going through the single point of access and using the bed manager. It was agreed that Claire would send a letter to the Trust to declare that we are happy to use the single point of access. Wrap up 5

123 West Lancashire CCG Clinical Executive Committee Action and Notes 09/02/16 Attendees Discussion and Decisions Adam Robinson - Secondary Care Consultant Anne-Marie Bridge- Admin support Amanda Gordon- Service Redesign Bapi Biswas GP Executive Lead Claire Heneghan Chief Nurse Doug Soper Lay member Greg Mitton Lay Member Jack Kinsey GP Executive Lead Jackie Moran - Head of Contracting, Performance and Quality Joanne Kane- Admin support Jo DeBacker Practice Manager John Caine Chairman Leslie Jones Public health speciality registrar Michelle Sage- Admin support Mike Maguire Chief Officer Peter Gregory - GP Executive Lead Simon Frampton GP Executive Lead This week s actions Due Date Responsible officer RAG Apologies Lucinda McArthur Senior Operating Officer Debbie Dobson - Practice Manager Paul Kingan- Head of Finance Declaration Interest of Greg Mitton declared an interest under item 6 walking away from diabetes The chair decided this was significant. Greg Mitton left the room and did not take part in the debate. Notes from previous Amended item hot topic Peter Gregory 1

124 meeting Strategic/service redesign declared an interest. The chair decided this was significant. Peter Gregory stayed in the room, no vote was taken. Item 2. Heart Failure Team Jackie Moran and Claire Heneghan recently met with Liverpool Community Heart Failure team who reported a considerable rise in additional patients. This increase is impacting on West Lancashire and the Heart Failure Team. The heart failure team have asked for more investment in staffing (2 band 6 nurses and a health care assistant). Jackie advised the members a further meeting will take place with the heart failure team on 7 th March and asked the member for some steer. It was agreed to park this item for now and discuss this in conjunction with community cardiology item 3 Item 3. Community Cardiology Concordia tier 2 cardiology service, has been tabled at both executive committee and the governing body meetings. Jackie informed the members that NHS WLCCG has now send a formal letter to Concordia informing them the contract has ceased. The recent walkround ( Southport ) A+E by Claire Heneghan and Charlotte McAllister highlighted that patients are attending A+E for diagnostic cardiology ECGs. A discussion took Extend the PDS (pilot) to BB/JMo 2

125 place as to whether it was possible to extend the PDS pilot and give them the diagnostic quota Concordia would have received. It was agreed to review community cardiology and heart failure data, work on the clinical specs with a view to extending the pilot to September. September subject to clinical specs. Update the executive committee at a future date Operational Item 4. Finance Update Mike Maguire updated the members. Paul Kingan is currently working on the financial plan and will update the executive committee members in due course Item 5. Action for blind contract Jackie Moran updated the members, discussing the model and financial aspects. Jackie reported that Action for Blind cannot gain permission to access the ophthalmology patient waiting areas in the hospital. The members felt overall that AFB would benefit from support from the CCG, and that the funding should remain. Greg Mitten will liaise with AFB to assist facilitate change. Item 6. Walking away from diabetes: Greg Mitton declared an interest The chair decided this was significant. Greg Mitton left the room and did not take part in the debate. Jackie Moran and Amanda Gordon updated the members on the current focus of the service, what is currently on offer and the financial aspects. The members were asked Funding will remain and Greg Mitten to liaise with Action for Blind to support and assist them in making some changes JMo/GM 3

126 how best to take this forward. The members agreed this should now be worked up to a stronger proposition. Amanda will be attending the Skelmersdale Food Initiative (SFI) later today. A progress update will be tabled at a future executive committee meeting. ` JMo/AG Greg Mitton rejoined the meeting. Item 8. Upcoming Exec 16, 23 feb and 1 march Jackie Moran asked the members to review the upcoming executive meeting agendas. 16 th February will be the combined programme board / executive development. There will be no programme board meeting on 1 st March some suggestions from the members were to table the following: VCFS ( 3 rd sector ) GP membership development/ succession health inequalities This is a live item Item 9. IAPT and Dementia Live item JMo Dementia - Jackie Moran is currently working on the first draft. Population data was Data prevelance rates AG 4

127 discussed since there has been an increase in the demographic. Amanda Gordon will look at the data prevelance rates. Dementia will be tabled at the GP membership meeting to share figures with practices and discuss using the dementia toolkit once again to compare data. GP membership agenda item IAPT Ros Bonsor gave an overview of how the service is running at present. They are reaching targets and showing good results. Item 10. Zika Virus letter All members verified they had received and subsequently read the information on Zika Virus Item 11. Action Logs Red Mike Maguire will take responsibility to clean up the action log and return this to the executive committee meeting on 1 st March Hot Topic Item 12. Hot Topic - Output of health summit Mike Maguire gave a verbal update to the executive committee members. Mike to update reds action log. Bring back to executive meeting 1 st March Mike Maguire Wrap up 5

128 West Lancashire CCG Clinical Executive Committee DRAFT Action and Notes 23/02/16 Attendees Discussion and Decisions Adam Robinson - Secondary Care Consultant Anne-Marie Bridge- Admin support Bapi Biswas GP Executive Lead Claire Heneghan Chief Nurse Greg Mitton Lay Member Jack Kinsey GP Executive Lead Jackie Moran - Head of Contracting, Performance and Quality Jo DeBacker Practice Manager Debbie Dobson - Practice Manager John Caine Chairman Michelle Sage- Admin support Mike Maguire Chief Officer Peter Gregory - GP Executive Lead Simon Frampton GP Executive Lead This week s actions Due Date Responsible officer RAG Apologies Lucinda McArthur Senior Operating Officer Paul Kingan- Head of Finance Doug Soper Lay member Bapi Biswas- GP Executive Lead Declaration Interest of NONE Notes from previous meeting The notes from the previous meeting were agreed as accurate. 1

129 Strategic Issues Item 2. Primary Care Development Mike Maguire updated the members. A new role reporting to Jackie Moran (to assist with primary care development and the facing the future expectations) will go out to advertisement in the next couple of weeks. 5 per head: John Caine discussed the possibilities of aligning GP practices with care homes in order to improve patient care and quality of care. John Caine presented survey data and information on the Sheffield model to members, a discussion on cost, structure, transition and funding followed. Adam Robinson suggested looking at the Salford care homes GP practice model, a multi displinary team which covers all the patients in care homes in the Salford area. John asked the members to consider if this is worth pursuing, it was agreed that if the principal is right, to look further at the findings and take to the GP membership to discuss further. Feedback from group work: Jackie Moran informed the members that both Smita Shetty and Chris Russ are currently looking at primary care, out of hours extended access and GPs. A further update will be given at a later date. John Caine discuss costs, funding, structure, evidence based, transition, resource allocation and models that work to the GP membership tomorrow JC 2

130 Operational Item 3. Community Stroke update WLCCG funding around technology for stroke recovery. Mike Maguire reported good progress of: Biometrics, bespoke developed by occupational health and physiotherapist to aid severe stroke patients recovery to improve daily life. X Box Kinnect functionality for less disabled stroke patients exercise and tracking software. FES baseline assessment and lets patients see their potential (including foot drop patients). Ipads have speech therapy applications (accredited programmes) this is proving very useful but currently there is an issue with infection control and the indestructible cases. Endoscopy sign off (Infographic) Mike Maguire presented the infographic and updated the members. This has been out to advert for any provider who would meet the criteria. Only one application was made from Care UK mobile endscopy unit. This was successful 3

131 and the mobile unit will be located in areas with high cancer prevelance. Due to the size and weight of the mobile unit, Care UK are waiting to see which sites are suitable to locate the mobile unit. Once this has been confirmed it will be opened up on the choose and book system. Intermediate care 2016/17 Charlotte McAllister asked the clinical executive for decision on the way forward with regard to the Intermediate Care Beds at Aaron Crest, supported by Manor primary Care practice, currently block funded by WLCCG. The Members agreed to rollover the contract for the same period as the original contract (5 months), but that after that period interested parties would be invited to bid for the contracts. E Meeting papers Notes and actions from the last meeting were agreed as accurate. Draft membership agenda was agreed. SU to safety agreed. Re drafted SUI policy was signed off. Hot Topic LH letter Challenge from Southport Trust. Mike Maguire 4

132 explained the content of the letter received from the Trust interim chief Lisa Hunt. Having sought legal advice, WLCCG has drafted a formal response. 2 letters will be sent out tomorrow to Southport Trust a response to the challenge and a further letter informing the Trust as to the result of their PQQ submission. The GP membership and the CCF members will be briefed tomorrow A formal response to the challenge from Southport Trust will be drafted and sent out together with a letter informing the Trust as to the results of PQQ selection process. Brief the GP membership and CCF members JMO/MM Wrap up 5

133 West Lancashire CCG Clinical Executive Committee Action and Notes 01/03/16 Attendees Discussion and Decisions Adam Robinson - Secondary Care Consultant Anne-Marie Bridge- Admin support Bapi Biswas GP Executive Lead Claire Heneghan Chief Nurse Greg Mitton Lay Member Jack Kinsey GP Executive Lead Jackie Moran - Head of Contracting, Performance and Quality Jo DeBacker Practice Manager Debbie Dobson - Practice Manager John Caine Chairman Michelle Sage- Admin support Mike Maguire Chief Officer Peter Gregory - GP Executive Lead Simon Frampton GP Executive Lead Ros Bonsor GP Executive Lead Lucinda McArthur Senior Operating Officer Paul Kingan Head of Finance This week s actions Due Date Responsible officer RAG Apologies Doug Soper Lay member Declaration Interest of NONE Notes from previous meeting Amendments Add Ros Bonsor to apologies, Add IG Handbook and Subject Access Request were accepted 1

134 Strategic Issues Item 3 SharePoint System Refresh Joanne Kane gave an overview of SharePoint and how to access and make comments on papers held on e-meeting section. Version control is held for all documents. It was suggested that comments made should be linked to the specific item and it was agreed that this should be looked into. Link comments to specific items Operational Item 4 Quality Discussion Jack Kinsey and Alison Sathiyanathan gave an overview of the quality of STEIS reporting from Southport & Ormskirk Hospital Trust. They highlighted how reports are not being followed up effectively and that there is a lack of learning from the outcomes. They raised the problems with VitalPAC, which is a system used by the Trust to record patient observations, this has been highlighted in several reports as showing failings, but it does not appear to being addressed. A Quality Surveillance Group (QSG) meeting is due to take place on Tuesday 8 March 2016 and it was agreed that this would be the forum to present a strategy and escalation plan. This would be agreed outside of this meeting. Jack Kinsey will attend also as a clinical representative. Strategy & Escalation plan to be agreed before QSG Meeting Item 5 Financial Plan 2016/17 Paul Kingan gave a presentation of the financial plan for 2016/17. He gave an 2

135 overview of the financial situation including projected overspend and QIPP savings and how this will affect the CCG in the coming year. E-Meeting Item 7 Exec Change of Venue Reminder given to check the change of venues due to the Board Room being used for competitive dialogue meetings. Item 8 Lancs Mutal Aid Agreement Approved. Item 9 Action Log Reds The action log has now been fully updated and the is available on SharePoint. This will be discussed next week. Hot Topic Issues Arising from the PQQ Process Outcome The West Lancashire GPs are due to meet on 2 March 2016 and although the meeting was to discuss the federation it was felt that the GP execs would be approach and questioned as to the outcome of the PQQ this would be a difficult meeting, but Peter Gregory advised he would try his best to keep to the original agenda. It was felt that the majority of questions from the public would be on Friday after local newspapers were published. It was advised 3

136 Wrap up that all staff refer any queries to Meg Pugh or ask them to consult the West Lancashire CCG website 4

137 Lancashire CCGs Network Minutes Thursday, 17 December 2015, Meeting room 231, Preston Business Centre, Watling Street Road, Fulwood, Preston, PR2 8DY at 9.30 am Present In Attendance Mr Andrew Bennett, Lancashire North CCG Mr David Bonson, Blackpool CCG Dr Chris Clayton, Blackburn with Darwen CCG (Chair) Dr Amanda Doyle, Blackpool CCG Dr Alex Gaw, Lancashire North CCG Dr Michael Ions, East Lancashire CCG Mrs Karen Sharrocks, Chorley and South Ribble and Greater Preston CCGs Mr Mike Maguire, West Lancashire CCG Mrs Debbie Nixon, Blackburn with Darwen CCG Dr Tony Naughton, Fylde & Wyre CCG Mr Peter Tinson, Fylde and Wyre CCG (Vice Chair) Mr Carl Ashworth, Strategic Locality Lead, Fylde and Wyre CCG, Senior Executive - Transformation Mr Paul Kingan, Chief Finance Officer West Lancashire CCG Mrs Linda Riley, Director of Delivery, Midlands and Lancashire CSU Mrs Jill Truby, Lancashire CCGs Network Mr Harry Catherall, Blackburn with Darwen Council Dr Sakthi Karanunthi, County Council 1 Welcome, apologies and declarations of interest Dr Clayton opened the meeting and welcomed everyone. Apologies for absence were received from Dr Bangi, Dr Patel, Dr Caine and Mrs Ledward. There were no declarations of interests. 2 Local Authorities Combined Local Authority Mr Harry Catherall, CEO Blackburn with Darwen Council and Dr Sakthi Karunanithi, Director of Public Health and Wellbeing, Lancashire County Council were in attendance to discuss the proposed combined local authority. Dr Clayton asked that the following be considered during discussion: What health would want from a Lancashire combined authority Lancashire identity and leadership for change Public sector efficiencies, releasing investment for Lancashire Clarity on investment in social care Standardised social care offer Health prevention strategy Standardised PH support Buy in from local politicians to impact of health system changes Minutes of Lancashire CCG Network 26 November 2015

138 What health can offer the Lancashire combined authority More efficient NHS, greater levels of integrated out of hospital care Shared briefing on health and social care funding Lancashire whole programme of reform focussed on four communities integrated care models Inward investment in Lancashire to make significant difference to Lancashire population Improved health delivering economic growth and development Partnership with Unis, research, business Sort out duplication between acute providers Mr Catherall opened discussion by providing background information on the formation of a Lancashire Combined Local Authority. 15 councils are looking to combine together, Lancashire County, 12 borough councils, and the two unitary councils of Blackpool and Blackburn with Darwen on key initiatives. Wyre council was the only authority not proceeding. Mr Catherall explained that individual councils would still have their own autonomy but it would mean that they would work together on bigger strategic issues such as economic development and Health and Social care. Currently a scheme of governance and constitution is being presented to authorities for approval. A public consultation process will take place in the new year. It is hoped that this will see all public sectors working together with the aim of making Lancashire a better place to live and work. Conversations were taking place to explore the current footprints of the Health and Wellbeing Boards and reviewing areas where they could work together. There was agreement that there was a need to demonstrate to the Government how much we can do, but also a need to demonstrate it has to be better than the alternative. In relation to Wyre, Mr Catherall confirmed that the door remains open to engage Wyre and to give them an opportunity to join. If during the public consultation the community says yes, then the council may have to reconsider its position. Dr Clayton conveyed congratulations on what has been achieved in such a short time and thanked both Mr Catherall and Dr Karanuthi for their attendance. 3 Minutes of Network meeting held 26 November 2015 The minutes of the meeting held on 26 November 2015 were agreed as an accurate record. 4 Matters arising and action sheet Dr Clayton sought and obtained confirmation that the actions from the previous meeting were either complete or in hand. Public Health governance Public Health Directors to be invited to attend the January meeting to support discussion. 6 Minutes from other meetings The draft minutes from the CCB meeting held on 1 December 2015 were noted for information. 7 Any other business Outcome of respiratory clinical network proposal Dr Clayton updated members on the feedback from the consultation around the proposal to set up a Lancashire Clinical Respiratory Network. Following discussion it was suggested that this could be best placed under the Healthier Lancashire work programme for taking forward. Minutes of Lancashire CCG Network 17 December 2015

139 Transforming Care Dr Ions agreed to take forward the issue of LCC discharging patients with Learning Disabilities in inpatient beds. Mrs Nixon agreed to share documentation from Blackburn with Darwen CCG. ACTION: Mrs Nixon to share information from Blackburn with Darwen. EPRR and Cumbria s recent major incident Mr Bennett gave a verbal summary on the recent major incident due to heavy rainfalls up in north Lancashire and Cumbria and the involvement of Lancashire North CCG. Collaboration had taken place between the CCG, NHS England, hospital services, out of hours, GP surgeries, local authorities and other local services. Tasks were able to be divided accordingly. Further information will be shared with CCGs once de-brief is complete. Access to Morecambe also became difficult due to both bridges being closed. Mrs Riley reported that she would be meeting with the local authority to understand any gaps in business continuity in nursing and residential homes. There had also been a knock on effect in other areas such as St Michael s on the Fylde where all lines of communication were down. EPRR A request had been received from Colin Kelsey following the EPRR Assurance process to move this along following the recent heavy rainfalls in the North of the county. Mrs Nixon shared a document that had jointly been produced between Blackburn with Darwen and East Lancashire CCGs regarding CCGs responsibilities. Mrs Nixon offered to co-ordinate a similar system on a pan Lancashire basis as there would be benefits in collaborating. Mrs Riley reported that the CSU was well placed to provide silver command. Dr Clayton concluded that there was a will to take forward a Lancashire conversation and through the Network will arrange conversations a) with ourselves and then b) NHS England. An officer from South Cumbria CCG would be invited to join the initial conversation. ACTION: Initial conversation with CCGs EPRR leads. Then arrange a meeting with NHS England and Colin Kelsey. Mr Bennett to invite an officer from South Cumbria CCG to join initial conversation. Minutes of Lancashire CCG Network 17 December 2015

140 Lancashire CCGs Network Minutes Thursday, 28 January 2016, Meeting room 253, Preston Business Centre, Watling Street Road, Fulwood, Preston, PR2 8DY at 9.00 am Present In Attendance Mr Andrew Bennett, Lancashire North CCG Dr Chris Clayton, Blackburn with Darwen CCG (Chair) Dr Alex Gaw, Lancashire North CCG Dr Michael Ions, East Lancashire CCG Mrs Jan Ledward, Chorley and South Ribble CCG and Greater Preston CCG Mrs Debbie Nixon, Blackburn with Darwen CCG Dr Tony Naughton, Fylde & Wyre CCG Dr Dinesh Patel, Greater Preston CCG Mr Peter Tinson, Fylde and Wyre CCG (Vice Chair) Mr Carl Ashworth, Strategic Locality Lead, Fylde and Wyre CCG, Senior Executive - Transformation Mr Iain Crossley, Chorley and South Ribble CCG and Greater Preston CCG Mr Andrew Harrison, Chief Finance Officer, Fylde & Wyre CCG Ms Kirsty Hollis, Acting Chief Finance Officer, East Lancashire CCG Mr Paul Kingan, Chief Finance Officer West Lancashire CCG Mr Gary Raphael, Chief Finance Officer, Blackpool CCG Mrs Jill Truby, Lancashire CCGs Network Mrs Lucinda McArthur, West Lancashire CCG (item 6) Dr Sakthi Karunanithi, County Council (item 6 onwards) Mr Jim Bluett Duncan, MIAA (item 6) Mr Keith Bowman, MIAA (item 6) Ms Sam Nicol, Healther Lancashire (item 8) 1 Welcome, apologies and declarations of interest Dr Clayton opened the meeting and welcomed everyone. Apologies for absence were received from Dr Bangi, Dr Doyle, Mr Bonson, Dr Caine, Mr Maguire, Mr Parr, Mr Youlton and Mrs Riley. There were no declarations of interests. 2 Minutes of previous meeting held 17 December 2015 The minutes of the meeting held on 17 December 2015 were agreed as an accurate record. 3 Matters arising and action sheet Dr Clayton sought and obtained confirmation that the actions from the previous meeting were either complete or in hand. 4 Minutes from other meetings The draft minutes from the Collaborative Commissioning Board held on 12 January were received for information. Mr Tinson highlighted two areas: stroke and vascular services for noting. Minutes of Lancashire CCG Network 28 January 2016