CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BODY MEETING

Transcription

1 Questions from members of the public will be received under Item 4; if submitted in advance in line with the protocol on the CCG s website: cg.nhs.uk/about-us/governingbody-meetings/ CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BODY MEETING Wednesday 6 th September 2017 at 1.30 pm Meeting Rooms 1 and 2, Blackburn Central Library Town Hall Street, Blackburn BB2 1AG A G E N D A Item No: Agenda Item Member Report Responsible PUBLIC PARTICIPATION 1. Chair s Welcome Mr Graham Burgess Verbal 2. Apologies for Absence and Confirmation of Quoracy Mr Graham Burgess Verbal 3. Declarations of Interest relating to items on the agenda Members and attendees are requested to identify any interests relating specifically to the agenda items being considered (see guide below) and inform the Chair and Governing Body Secretary in advance of the meeting. Mr Graham Burgess Verbal 4. Questions from Members of the Public Mr Graham Burgess Verbal PART 1 BUSINESS (APPROXIMATELY 1.30 PM) 5. Minutes of the Meeting Held on 5 th July Extract from Part 2 of the Minutes of the Meeting held on 5 th July 2017 Mr Graham Burgess Attached Attached Matters Arising Action Matrix Mr Graham Burgess Attached 7. Clinical Chief Officer s Report Dr Chris Clayton Attached 8. Chief Finance Officer s Report Mr Roger Parr Attached 9. Contract, Quality and Performance Report Mr Roger Parr/ Mrs Janet Thomas Attached 10. Healthier Lancashire and South Cumbria Sustainability and Transformation Partnership Governance Proposal 11. Healthier Lancashire and South Cumbria Sustainability and Transformation Partnership Development of Shared Decision Making for the Joint Committee of CCGs Dr Chris Clayton Dr Chris Clayton Attached Attached

2 12. Governing Body Assurance Framework Update Mr Roger Parr Attached 13. Replacement Process for the CCG s Accountable Officer 14. Process for Emergency Preparedness, Resilience and Response (EPRR) Assurance Mr Graham Burgess Mr Iain Fletcher Attached Attached FOR INFORMATION 15. Annual Report of the Audit Committee Mr Roger Parr Attached 16. Communication and Engagement Update Mr Iain Fletcher Attached 17. Review of Register of Interests Mr Iain Fletcher Attached 18. Sub-Committees and Groups Minutes Mr Iain Fletcher Attached 19. Any Other Business All Verbal 20. Date and Time of Next Meeting: Wednesday 8 th November 2017 in Meeting Rooms 1 and 2, Blackburn Central Library, Town Hall Street, Blackburn BB2 1AG Mr Graham Burgess Verbal EXCLUSION OF THE PRESS AND PUBLIC That representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section1(2)Public Bodies(Admission to Meetings)Act 1960) PART 2 (APPROXIMATELY 3 PM) A/17 Minutes of Part 2 of the Meeting held on 5 th July 2017 Mr Graham Burgess Attached B/17 B/17.1 Matters Arising Action Matrix Mr Graham Burgess Attached C/17 Pennine Lancashire Clinical Commissioning Groups Confidential Provider Update Mrs Janet Thomas Attached D/17 Joint Commissioning Arrangements Miss Claire Jackson Presentation E/17 General Practitioner Executive Time Commitment Dr Chris Clayton Attached F/17 Any Other Business All Verbal Types of Conflict of Interest Type of Interest Financial Interests Description This is where an individual may get direct financial benefits from the consequences of a commissioning decision. This could, for example, include being: A director, including a non-executive director, or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations; A shareholder (or similar owner interests), a partner or owner of a private or not-forprofit company, business, partnership or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations. A management consultant for a provider; In secondary employment (see paragraph 56 to 57); Page 2 of 3

3 Type of Interest Non-Financial Professional Interests Non-Financial Personal Interests Indirect Interests Description In receipt of secondary income from a provider; In receipt of a grant from a provider; In receipt of any payments (for example honoraria, one off payments, day allowances or travel or subsistence) from a provider In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; and Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider). This is where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. This may, for example, include situations where the individual is: An advocate for a particular group of patients; A GP with special interests e.g., in dermatology, acupuncture etc. A member of a particular specialist professional body (although routine GP membership of the RCGP, BMA or a medical defence organisation would not usually by itself amount to an interest which needed to be declared); An advisor for Care Quality Commission (CQC) or National Institute for Health and Care Excellence (NICE); A medical researcher. This is where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit. This could include, for example, where the individual is: A voluntary sector champion for a provider; A volunteer for a provider; A member of a voluntary sector board or has any other position of authority in or connection with a voluntary sector organisation; Suffering from a particular condition requiring individually funded treatment; A member of a lobby or pressure groups with an interest in health. This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision (as those categories are described above). For example, this should include: Spouse / partner; Close relative e.g., parent, grandparent, child, grandchild or sibling; Close friend; Business partner. Page 3 of 3

4 Subject to approval at the next meeting Item 5 PRESENT: Mr Graham Burgess Dr Chris Clayton Dr Malcolm Ridgway Miss Claire Jackson Dr Penny Morris Dr Zaki Patel Dr Adam Black Dr Preeti Shukla Dr John Randall Mr Paul Hinnigan Dr Nigel Horsfield Mr Dominic Harrison IN ATTENDANCE: Mr Iain Fletcher Mrs Caroline Edwards Mrs Debbie Nixon Mr Steve Winterson Mrs Pauline Milligan CLINICAL COMMISSIONING GROUP (CCG) Minutes of the Governing Body (GB) Meeting held on Wednesday 5 th July 2017 at 1 pm in Rooms 1 and 2, Blackburn Central Library, Town Hall Street, Blackburn, BB2 1AG Chair (Chair) Clinical Chief Officer Clinical Director for Primary Care and Quality Director of Commissioning Operations General Practitioner (GP) Executive Member and Vice Chair GP Executive Member GP Executive Member GP Executive Member GP Executive Member Lay Member Governance Lay Member Director of Public Health, Blackburn with Darwen Borough Council (BwD BC) Head of Corporate Business End of Life Care Lead (Minute Item only) Senior Responsible Officer for Mental Health, Lancashire and South Cumbria (Minute Item only) Director of Engagement, Lancashire Care NHS Foundation Trust (LCFT) Governing Body Secretary Min No: Chair s Welcome The Chair opened the meeting by welcoming all attendees and members of the public Apologies for Absence and Confirmation of Quoracy Apologies for absence had been received in respect of Mr Roger Parr, Deputy Chief Executive/Chief Finance Officer, Dr Geraint Jones, Lay Member Secondary Care Doctor (Retired) and Mrs Janet Thomas, Executive Nurse/Associate Director of Quality and Commissioning. The Chair confirmed that the meeting was quorate Declarations of Interest Relating to Items on the Agenda The Chair reminded Members of their obligation to declare any interest they may have on any issues arising at Committee Meetings which might conflict with the business of BwD CCG. Declarations declared by members of the GB are listed in the CCG s Register of Interests. The Register is available, either via the Secretary to the GB or the CCG website via the following link:

5 Mr Iain Fletcher declared an indirect Conflict of Interest in Agenda Item 12 (Minute ) Assessment and Support for Children and Young People Requiring Ventilation. The Chair reminded members that they should, if appropriate, make a declaration should a conflict emerge during the meeting and these would be recorded against the relevant agenda item Questions from Members of the Public No questions had been received from members of the public End of Life Care Dr Penny Morris introduced Mrs Caroline Edwards who provided an update presentation on the BwD End of Life Care 10 point Implementation Plan finalised in August 2016, which was aligned to the Pennine Lancashire (PL) Integrated Health and Social Care Economy End of Life Care Strategy and the PL Transformation Programme. Mrs Edwards outlined the three priority areas identified to improve End of Life Care across PL and highlighted the work which was ongoing and achievements so far: Priority 1: Communication and Coordinated Care; Priority 2: Reducing Inequalities and Ensuring Equitable Access; Priority 3: Education and Training. It had been identified that the implementation of the priority areas would lead to: Improved Coordinated Care; Consistent and Equal Access to End of Life Care Services; Improved Patient Choice and Improved Quality. Mrs Edwards explained that the impact of the Implementation Plan was measured by the CCGs responsiveness of care to patients wishes. The Department of Health End of Life Care Strategy 2008 stated that most patients would probably like to die at home. In 2017, in BwD, 40% of all deaths occurred in the usual place of residence, which was a slight increase from last year. She added that LCFT data for 2016/17 reported that District Nursing Teams showed that the 97% of their patients who were identified as being at end of life on their caseload died in their preferred place of care. Mrs Edwards outlined next steps for the following 12 month period: Continue to build on and embed current priorities; BwD would continue to work closely with PL partners to promote quality care, effective and efficient services for all; Future priorities would be based on locality wide mapping; New models of care would be explored for service redesign. Questions and answers followed. The Chair thanked Mrs Edwards for her presentation. ACTION: It was agreed that Mrs Edwards would come back to a GB meeting to provide an update on progress next year. Mrs Pauline Milligan to add to the Forward Plan. Mrs Edwards left the meeting. RESOLVED: That the GB noted the content of the presentation. Page 2 of 8

6 Minutes of the Meeting held on 3 rd May 2017 The minutes of the meeting were reviewed and accepted as an accurate record. RESOLVED: That the minutes of the meeting held 3 rd May 2017 were approved as an accurate record Extract of Part 2 of the Minutes of the Meeting held on 3 rd May 2017 The extract of Part 2 of the minutes of the meeting held on 3 rd May 2017 was accepted as an accurate record. RESOLVED: That the Extract of Part 2 of the Minutes of the Meeting held on 3 rd May 2017 was approved as an accurate record Matters Arising/Action Matrix Matters Arising There were no Matters Arising which were not listed on the Action Matrix Action Matrix The Action Matrix was reviewed and the following were noted: Minute / / Suicide Prevention Strategy Mr Dominic Harrison provided a verbal update in response to Dr Malcolm Ridgway s enquiry if there was recorded data which indicated if a person had been accessing Mental Health Services prior to their suicide. Mr Harrison explained that the Suicide Audit Tool used by Local Authorities to complete the Suicide Audit collected information specifically related to Mental Health Services. There were five sections within the audit tool where details about an individual s mental health could be obtained from a range of difference sources. The data was obtained from the Coroner, Primary Care, Secondary Care and Mental Health Services. Mr Harrison added that data from the last BwD Suicide Audit in indicated that 28% of individuals had a depressive illness diagnosed prior to their death; 7% of those individuals were diagnosed with anxiety and phobia and 7% were also known to have misused alcohol (not necessarily at the time of suicide). However, 35% of individuals had either missing or unknown data in relation to their mental health. Mr Harrison concluded that, currently, from the data available, the majority of individuals in the BwD Borough who die by suicide do not have an existing mental health diagnosis. Questions and answers followed. Minute / / Stroke Update It had been agreed at the June Development Session that Stroke Services would be added to the agenda of the next Executive Team to Team Meeting with East Lancashire CCG. Minute / / Cancer Performance Update The Chair reported back on his action, which was related to the national shortage of Consultant Radiologists and reminded members that it had been agreed to write collectively to appropriate Colleges to request an increase in training slots. Members noted that the joint letter was due to be signed off this week. Minute / Intermediate Care Re-provision Dr Chris Clayton reported that conversations with BwD BC about future plans and risk share provision were ongoing and the GB would be updated accordingly. Page 3 of 8

7 Clinical Chief Officer s Report Dr Chris Clayton presented his report and highlighted the following items: Department of Health: o Secretary of State Message to NHS Staff; o NHS Cyber Attack; o Accountable Care Systems. Care Quality Commission: o Appointments. Lancashire and South Cumbria: o Joint Committee of CCGs. Pennine Lancashire: o Together a Healthier Future Programme. Good News: o PL Cancer Commissioning Team. Questions and answers followed. RESOLVED: That the GB noted the content of the report Chief Finance Officer s Report Miss Claire Jackson presented in the absence of Mr Roger Parr. Miss Jackson highlighted key elements of the report. The CCG was reporting a year to date surplus of 775k; in line with the 2017/18 plan. Healthcare Commissioning reported a year to date underspend of 108k with a year-end forecast underspend of 152k. Primary Care Services reported a year to date overspend of 118k with a forecast out-turn overspend of 152k. Corporate Services reported a year to date underspend of 10k and a breakeven position is forecast at year end. Miss Jackson outlined the risks and associated mitigating actions. RESOLVED: That the GB noted the content of the report and the overall position of the CCG at the end of May Quality, Innovation, Productivity and Prevention (QIPP) Mr Jackson drew members attention to the CCG s QIPP target of 8.6m in 2017/18. There were banked savings to date with an annual value of 5.7m; leaving 2.9m still to be released. Miss Jackson concluded that there was still a lot of work to be done to meet the QIPP financial challenge for the year. Questions and answers followed. RESOLVED: That the GB noted the in-year and forecast position for the 2017/18 QIPP. Page 4 of 8

8 Contract, Quality and Performance Report Miss Jackson presented the contracting section of the month 1 report in the absence of Mr Parr and then deferred to Dr Ridgway to highlight the key points related to quality and performance. Miss Jackson highlighted the following: LCFT Mental Health Services (page 3): o Psychological Therapies Miss Jackson reported that for those entering treatment the target was not met at month 1; however, the position was now being recovered; o Admission levels to mental health in patient wards were above the number admitted in the previous year; o Out of Area Placements there was a decrease in the number of patients in month 1. East Lancashire Hospitals NHS Trust (ELHT) (page 4): o Elective activity was down against plan but there was an increase in associated spend. The CCG was reviewing the case mix and coding for the activity with the Trust; o Awaiting Treatment Performance was 92.7%. Primary Care (page 5) o Out of Hours there was over performance in relation to GP Advice. Other Significant Contracts (page 7): o North West Ambulance Service (NWAS) there continued to be pressure in the system; o BMI Beardwood there was a reduction in activity. Dr Ridgway highlighted the following: LCFT Mental Health Services (page 3): o Psychological Therapies the CCG hit both targets in month 1. o Memory Assessment Service (MAS) performance was not as good but it was expected that by September 2017 the CCG would be hitting the six week target. Primary Care (page 5): o PL Primary Care Quality Group the group had agreed to utilise the data from the Lancashire Quality Dashboard to generate a PL dashboard and this would be brought to the next meeting of the Primary Care Co-commissioning Committee. LCFT Community Services (page 6): o Referral to Treatment (RTT) (Incomplete) Dr Ridgway reported that the target was not achieved in month 1. There were problems with staff recruitment in the Speech and Language Therapy (SALT) Service and these would be resolved by September Other Significant Contracts (page 7) o RTT (Incomplete) Dr Ridgway reported that the target was not achieved for the CCG in month 1 and this was related to performance at Lancashire Teaching Hospitals NHS Foundation Trust. The CCG was working with the Lead Commissioner to improve the position. o Cancer 2 Week (Breast) Dr Ridgway reported that there were two targets with the standard; one of the targets related to suspected cancer and one was related to cancer symptoms. Both were two week targets. The differences in the targets were being explored. Dr Ridgway concluded that the baselines Community Services Contract had not yet been agreed but agreement was imminent and would be adjusted as soon as it had been agreed. Questions and answers followed. ACTION: Following a request from the Chair, Miss Jackson agreed to raise the GB s concerns with the contract provider that information in relation to the new baselines would not be available to be reviewed until six months into the financial year and this Page 5 of 8

9 should be rectified by next year. RESOLVED: That the GB noted the content of the reports and supported the actions as identified Remuneration and Terms of Service Committee Terms of Reference Mr Iain Fletcher presented the revised Terms of Reference (ToR) for the Remuneration and Terms of Service Committee. Following comments at the last meeting, the ToR had been revised and the changes were listed in section 2.1 (page 1). Questions and answers followed. RESOLVED: That the GB approved the GB ToR Assessment and Support for Children and Young People Requiring Ventilation Mr Fletcher declared an indirect Conflict of Interest in this item due to a close association with an individual who had a non-financial professional interest in a commissioning decision. It was agreed that, due to the nature of the conflict, he could remain in the meeting and take part in discussions. Miss Jackson explained that the paper, which had previously been presented to the Commissioning Business Group (CBG) for discussion, outlined the historical commissioning arrangements for children and young people in BwD to access ventilation services. She outlined the current position and the proposal that a framework approach is implemented in BwD to gradually reduce the current block contract arrangements with the existing provider over time and ensure best quality and practice for packages going forward. Miss Jackson added that the service was a very specialised, involving a small number of patients. She drew members attention to the potential impact, next steps and timescales. Questions and answers followed. RESOLVED: That the GB agreed to ratify the recommendations of the CBG to: i. approved the expansion of the East Lancashire framework of packages of care for children and young people with complex needs including those with ventilation needs to ensure consistency across PL; ii. approved the development of a single PL assessment team for all children and young people with complex needs including those with ventilation needs by bringing together existing teams; iii. agreed to service notice to ELHT regarding the current Community Ventilation Service; iv. approved the submission of a contract variation to LCFT to separate the Complex Needs Nurse role from the Special School Nursing Service as part of the streamlining of the assessment process Joint Pennine Equality and Inclusion (E&I) Strategy 2017/21 Mr Fletcher presented the strategy, which had been developed as part of the joint PL working arrangements. He explained that once the strategy had been agreed by both CCGs it would be uploaded to both websites. Page 6 of 8

10 Questions and answers followed. RESOLVED: That the GB noted and approved the content of the Joint Pennine E&I Strategy 2017/ BwD Local Authority s Declaration on Healthy Weight Mr Harrison presented the national declaration on healthy weight which BwD BC had already approved and signed up to. The report recommended that the CCG also sign up to the declaration, which made a commitment for the GB to support papers which had already been approved by BwD BC and the BwD Health and Well-being Board in relation to physical inactivity and obesity. Questions and answers followed. ACTION: It was agreed that an update on progress would be provided to the GB in six months time. Mr Harrison to oversee. RESOLVED: That the GB: i. noted the content of the report; ii. noted that physical inactivity and obesity is a significant public health issue requiring senior level leadership and commitment from a range of partners and stakeholders, including the CCG; iii. agreed to adopt a joint BwD BC and CCG declaration on healthy weight (Appendix B) Prescribing for Clinical Need Policy Implementation Plan Dr Preeti Shukla provided a verbal update in relation to the Prescribing for Clinical Need Policy which had been in place since 3 rd July There had currently not been any feedback from GPs. Dr Shukla stated that in her own practice patients had been well informed of the policy due to the engagement work carried out by Mrs Julie Kenyon, Senior Responsible Officer for Medicines Commissioning and Mrs Lucie Higham, Communications and Engagement Account Manager. Questions and answers followed. RESOLVED: That the GB noted the content of the update Equality and Inclusion Annual Report 2016/17 Mr Fletcher presented the report for information, which outlined the CCG s progress to incorporate E&I into all the CCG s work. There were no questions. RESOLVED: That the GB noted the content of the report Workforce Race Equality Standard (WRES) Report Mr Fletcher presented a copy of the mandated document, which had to be completed and returned to NHS England by 1 st August There were no questions. On behalf of the GB, the Chair thanked all staff who had participated in the staff awareness Page 7 of 8

11 sessions. RESOLVED: That the GB: i. noted the content of the WRES Equality Standard for publication on the CCG s website and submission to NHS England by 1 st August 2017; ii. noted the actions of WRES will be linked to the current staff forums and Equality Delivery System throughout 2017/ Lancashire Mental Health Acute Reconfiguration and Preferred Option for the Pennine Lancashire Unit Mrs Debbie Nixon attended for this item and provided an overview of the update on the Lancashire Mental Health Acute Reconfiguration and recommendation about the preferred option for the site in PL. Mrs Nixon reminded members that, following a Technical Appraisal Process (TAP) conducted in 2010/11, there was a decision to co-locate the PL site on the Royal Blackburn Hospital site. Mrs Nixon explained that there had been an aspiration for a new build adjacent to the hospital but, due to issues mainly in relation to affordability, it had been agreed by LCFT, supported by the Lead Commissioner for Mental Health Services, that the plans would default to the preferred option of the Royal Blackburn site by 2018/19; to be operational by Questions and answers followed. The Chair thanked Mrs Nixon and Mr Winterson for their attendance and they left the meeting. RESOLVED: That the GB noted the preferred option for the site in PL remained as in the original proposal set out in the Technical Appraisal, at the Royal Blackburn Hospital Sub-Committees and Groups Minutes Mr Fletcher presented the report, which included the minutes of the GB Sub-Committees and Groups for receipt and note by members to inform the GB of delegated and key decisions taken and provide information regarding items of particular interest or potential risk. There were no questions. RESOLVED: That the GB noted the content of the report Any Other Business No further business was discussed Date and Time of Next Meeting The next meeting will be held on Wednesday 6 th September 2017 at 1 pm in Meeting Rooms 1 and 2 Blackburn Central Library, Town Hall St, Blackburn, BB2 1AG. The Chair thanked everyone for their attendance and input and the meeting closed. EXCLUSION OF THE PRESS AND PUBLIC That representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section1(2)Public Bodies(Admission to Meetings)Act 1960). Signed. Chair Date Page 8 of 8

12 Item 5.1 CLINICAL COMMISSIONING GROUP (CCG) Extract from the Minutes of Part 2 of the Governing Body (GB) Meeting held on Wednesday 5 th July 2017 at 3 pm in Rooms 1 and 2, Blackburn Central Library, Town Hall Street, Blackburn, BB2 1AG PRESENT: Mr Graham Burgess Dr Chris Clayton Dr Malcolm Ridgway Miss Claire Jackson Dr Penny Morris Dr Zaki Patel Dr Adam Black Dr Preeti Shukla Dr John Randall Mr Paul Hinnigan Dr Nigel Horsfield Mr Dominic Harrison IN ATTENDANCE: Mr Iain Fletcher Mrs Pauline Milligan Chair (Chair) Clinical Chief Officer Clinical Director for Primary Care and Quality Director of Commissioning Operations. General Practitioner (GP) Executive Member and Vice Chair GP Executive Member GP Executive Member GP Executive Member GP Executive Member Lay Member Governance Lay Member Director of Public Health, Blackburn with Darwen Borough Council (BwD BC) Head of Corporate Business Governing Body Secretary Re-Confirmation of Apologies for Absence and Quoracy Apologies for absence had been received in respect of Mr Roger Parr, Deputy Chief Executive/Chief Finance Officer, Dr Geraint Jones, Lay Member Secondary Care Doctor (Retired) and Mrs Janet Thomas, Executive Nurse/Associate Director of Quality and Commissioning. The Chair confirmed that the meeting was quorate. Re-Confirmation of Declaration of Interests The Chair reminded Members of their obligation to declare any interest they may have on any issues arising at Committee Meetings which might conflict with the business of BwD CCG. Declarations declared by members of the GB are listed in the CCG s Register of Interests. The Register is available, either via the Secretary to the GB or the CCG website via the following link: No declarations of interest were made with regards to items on the agenda at this point. The Chair reminded members that they should, if appropriate, make a declaration should a conflict emerge during the meeting and these would be recorded against the relevant agenda item.

13 A/17 Minutes of Part 2 of the Meeting held on 3 rd May 2017 The Minutes of Part 2 of the Meeting held on 3 rd May 2017 were reviewed and accepted as an accurate record following the correction of a typo in section B/17.1. RESOLVED: That, following the correction of a typo in section B/17.1, the Minutes of Part 2 of the Meeting held on 3 rd May 2017 were approved as an accurate record. B/17 Matters Arising There were no matters arising. B/17.1 Action Matrix Minute E/17 March Acute Visiting Service (AVS) Miss Claire Jackson provided a verbal update. Negotiations had been taking place with the current service provider and a service specification had been agreed within the financial envelope. The service specification would be signed off and the contract would be extended until 1 st September Dr Chris Clayton commended all the work by those involved in reaching an agreement. Minute B/17.1 May Any Other Business Bariatric Services Following discussion regarding the correct forum to discuss Bariatric Services, the Chair agreed to defer the action until September. Minute C/17 May Pennine Lancashire CCGs Confidential Provider Update Dr Malcolm Ridgway confirmed that the Lancashire Safeguarding Children s Board does provide a range of training, including recognising and reporting neglect. C/17 Pennine Lancashire Clinical Commissioning Groups Confidential Provider Update Dr Ridgway presented the report, which provided the GB members with a briefing on new provider performance/quality issues that have occurred since the last meeting. Dr Ridgway drew key issues related to the following to members attention: Questions and answers followed. RESOLVED: That the GB received the report for information purposes. Page 2 of 2

14 Item 6.1 GOVERNING BODY (GB) MEETING - ACTION MATRIX PART 1 Action Origins GB Ref / / Action Owner Due Date Status Stroke Update The Chair requested that the Executive Team (ET) consider the questions and comments posed by members of the GB and produce a report in response to be presented to the appropriate forum for action and then the results reported back to the GB in early Dr Chris Clayton agreed to investigate the current position related to Stroke Services and report back to the next meeting. It was agreed at the June Development Session that stroke would be added to the agenda of the next Executive Team to Team Meeting with East Lancashire CCG. Cancer Performance Update The Chair confirmed that a response had been received from the Chief Officer of Greater Preston CCG, who attends the Cancer Alliance Meetings, which had been circulated to members and suggested that a review of progress regarding the recommendations from the Lancashire and South Cumbria Acute Oncology Review should take place at the end of May. CC September It was agreed at the June Development Session that stroke would be added to the agenda of the next Executive Team to Team Meeting with East Lancashire CCG It was agreed that the Chair would write again to the Chief Officer of Greater Preston CCG in September for an update on progress Intermediate Care Re-provision Following discussion, it was agreed that Mr Steve Tingle/Dr Clayton should begin to consider a long-term strategy for the demand management of the provision of care for the five years GB September In progress. In progress. Discussions underway with Blackburn with Darwen Page 1 of 2

15 beyond Borough Council Dr Clayton/Mr Roger Parr confirmed that ongoing discussions were taking place with BwD Borough Council about future plans and risk share provision. CC/ST July Completed Dr Clayton reported that the conversations with BwD BC were ongoing and the GB would be updated accordingly (iii) Chief Officer Report The Chair referred to the content of section 3.3, which referred to the work on the Fylde Coast being highlighted as an exemplar of good practice and requested that the Executive Team organise a briefing/presentation for the GB outlining what it means to be recognised as an exemplar Communication and Engagement Update Following a request from Dr Patel regarding focused engagement with the Black, Minority and Ethnic (BME) population, Mr Fletcher agreed to ensure that information relating to the breakdown of population diversity and how any engagement issues may be addressed would be included in the next report to the GB Draft Minutes of the Lancashire and South Cumbria Joint Committee Clinical Commissioning Groups The Chair and Dr Clayton agreed to discuss how they could ensure that information from the JCCCG was received at the CCG s GB meetings in a timely manner End of Life Care It was agreed that Mrs Caroline Edwards would come back to a GB meeting to provide an update on progress next year. Mrs Pauline Milligan to add to the Forward Plan Contract, Quality and Performance Report Following a request from the Chair, Miss Claire Jackson agreed to raise the GB s concerns with the contract provider that information in relation to the new baselines would not be available to be reviewed until six months into the financial year and this should be rectified by next year Blackburn with Darwen Local Authority s Declaration on Healthy Weight It was agreed that an update on progress would be provided to the GB in six months time. Mr Dominic Harrison to oversee. Executive Team July In progress. In progress. IF September In progress. GB/CC July In progress. CE/PM 2018 Completed. Added to GB Forward Plan for March 2018 agenda. CJ July In progress. DH Jan 18 Completed. Added to GB Forward Plan for January 2018 agenda. Page 2 of 2

16 GOVERNING BODY MEETING CLINICAL CHIEF OFFICER S REPORT Date of Meeting 6 th September 2017 Agenda Item 7 CCG Corporate Objectives Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care X X X X X X CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality GOVERNOVERNING BODY MEETING X X X X X X X X

17 Clinical Lead: Senior Lead Manager Finance Manager Equality Impact and Risk Assessment completed: Patient and Public Engagement completed: Financial Implications Risk Identified Report authorised by Senior Manager: Decision Recommendations Chris Clayton Iain Fletcher Roger Parr The report is for the information of members only. The report is for the information of members only. The report is for the information of members only. The report is for the information of members only. Chris Clayton The Governing Body is requested to receive this report and to note the items as detailed. Y Report of the Clinical Chief Officer 6 th September 2017 Page 2 of 11

18 CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BODY MEETING 6 TH SEPTEMBER 2017 CLINICAL CHIEF OFFICER S REPORT 1) Introduction This report provides an update on national and local issues of interest to Governing Body (GB) members not covered elsewhere on the agenda, and also provides an indication of where the Clinical Chief Officer s (CCO) efforts have been directed since the last meeting. 2) Department of Health 2.1 NHS Transformation On 19 th July 2017, the Health Secretary, Jeremy Hunt and NHS England Chief Executive, Simon Stevens, announced 325m of capital investment for local projects that will help the NHS to modernise and transform care for patients. Local capital investment schemes in 15 areas of the country have been given the go ahead, with the largest sums being used for urgent care in Dorset, surgery in Greater Manchester and cancer care in Cumbria. Patients will see this investment deliver faster diagnosis for conditions like cancer, easier access to mental health care, expansion of Accident and Emergencies, shorter waits for operations, and more services in General Practitioner (GP) surgeries. The initial funding has been targeted at the strongest and most advanced schemes in the Sustainability and Transformation Partnership (STP) categories, based on an assessment of leadership and service performance. All plans have been developed locally in consultation with the public. The funding was secured in the Budget in March when the government also committed to make further capital investment available in the forthcoming Autumn Statement. Please see Item 5.2 to read more about plans for Lancashire and South Cumbria (L&SC). Further information via: 3) NHS England 3.1 Annual Report and Accounts 2016/17 NHS England has published its Annual Report and Accounts for 2016/17, detailing the work of the organisation over the last year and outlining some of the most significant achievements and challenges. The report sets out the progress made in delivering the NHS Five Year Forward View (FYFV), the 2016/17 Business Plan, and the Government s mandate to NHS England. Report of the Clinical Chief Officer 6 th September 2017 Page 3 of 11

19 Further information via: Prescribing in Primary Care NHS England has published detailed plans, drawn up with GPs and Pharmacists, to cut out prescriptions for ineffective, over-priced and low value treatments. Helping to trim hundreds of millions from the nation s rapidly growing drugs bill will create headroom to reinvest all savings in newer and more effective NHS medicines and treatments. A formal public consultation is being launched on new national guidelines which state that 18 treatments, including homeopathy and herbal treatments, which together cost taxpayers 141m a year, should generally not be prescribed. In addition, the consultation also covers a further 3,200 prescription items, many of which are readily available and sold over the counter in pharmacies, supermarkets, petrol stations, corner shops and other retailers, often at a significantly lower price than the cost to the NHS. The consultation proposes initial action to limit prescribing of products for minor self-limiting conditions which currently cost taxpayers million a year. The products include cough mixture and cold treatments, eye drops, laxatives and sun cream lotions. NHS England is also supportive of restricting the availability of gluten-free foods on prescription, which costs 26m a year, which is currently subject to a Department of Health consultation. These savings form a key building block of the NHS s 10 point efficiency plan contained in the Next Steps on the NHS FYFV, published in March Further information via: NHS Continuing Healthcare Assessment Process NHS England has written to CCG Accountable Officers and Clinical Leaders explaining the actions that CCGs are expected to take to improve the NHS Continuing Healthcare (CHC) process. The letter refers to the reduction in Delayed Transfers of Care (DTOCs) being a key priority for the NHS, with delays needing to reduce from approximately 6,428 per day to 4,080 per day in order to release the needed bed capacity within health systems. It is estimated that resolution of the factors causing delays due to NHS CHC assessment could help free up to a quarter of the total number of beds the NHS is required to release. These delays are primarily within the remit of health to resolve (in collaboration with Local Authority partners) and there is a need to ensure that plans to improve NHS CHC pathways and processes are in place in order to achieve the two key standards required for the Quality Premium for 2017/18. CCGs must ensure that: less than 15% of all full NHS CHC assessments take place in an acute hospital setting; in more than 80% of cases with a positive NHS CHC Checklist, the NHS CHC eligibility decision is made by the CCG within 28 days from receipt of the Checklist (or other notification of potential eligibility). CCGs are expected to take a number of actions, which are outlined in the letter, in relation to these standards during the course of 17/18. Further information via: Report of the Clinical Chief Officer 6 th September 2017 Page 4 of 11

20 3.4 Pre-Exposure Prophylaxis (PrEP) Implementation Trial NHS England and Public Health England (PHE) working with a range of partners and patient groups have announced details of the world s largest single Pre-Exposure Prophylaxis (PrEP) implementation trial to prevent Human Immunodeficiency Virus (HIV) amongst at-risk groups. From September, the IMPACT trial will make PrEP available on the NHS to an estimated 10,000 people who are judged as at-risk by sexual health experts. Clinics in London, Brighton, Manchester, Liverpool and Sheffield are expected to be amongst the first to start enrolling people in the trial, with more joining in October and full implementation across England expected by April Described as a pivotal moment in the fight against HIV by the Chief Executive of the National Acquired Immune Deficiency Syndrome (AIDS) Trust, the initial three year trial will be the largest single study of its type in the world, and will help inform plans to make PrEP more widely available in future by providing crucial information on which patients take PrEP and how they do so. NHS England has committed 10m to the trial, which thanks to a competitive tendering process will cover the entire cost of the drugs involved in the programme, as well as the administration of the trial by the independent St Stephen s Clinical Research group and PHE, as well as covering the costs to sexual health clinics of administering the drug and support trial participants. Further information via: 4) Health Education England 4.1 Stepping Forward to 2020/21: Mental Health Workforce Plan for England 5) L&SC Health Education England (HEE) has published Stepping Forward to 2020/21: Mental Health Workforce Plan for England, which is a fully-researched and considered response to the commitments made in both the Five Year Forward View for Mental Health (FYFVMH), published in February 2016 and Future in Mind, published in March The plan has been developed by HEE, together with its NHS partners, the Royal College of Psychiatrists and other experts in the field of Mental Health Services (MHS). Mental Health is a key priority for HEE. The FYFVMH laid out an ambition to see an additional one million people being treated by MHS by 2021, including 70,000 more children and young people. This is something the whole system is committed to working on to make sure patients get the best possible care. Please see Item 5.2 for more information regarding funding for plans for MHS in L&SC. Further information via: Joint Committee of CCGs Members of the public are invited to observe the Joint Committee of CCGs, which is set to hold its next formal meeting in public on 7 th September 2017 at 1 p.m. in Chorley Town Hall, Market Street, Chorley PR7 1DP. Report of the Clinical Chief Officer 6 th September 2017 Page 5 of 11

21 The Joint Committee of CCGs is made up of GPs and Lay Members from each of the CCGs in Lancashire and South Cumbria. Chief Executives from Lancashire County Council, Blackburn with Darwen (BwD) Borough Council, Blackpool Council, representatives from District Councils, local Healthwatch are not members of the Committee, but attend the meetings. 5.2 NHS Transformation As outlined in Item 2.1, Health Secretary Jeremy Hunt and NHS England boss Simon Stevens announced 325m of capital investment for local projects that will help the NHS to modernise and transform care for patients. In L&SC, East Lancashire Hospitals NHS Trust will receive 5m - 10m to develop Accident and Emergency (A&E) Services. In addition, 5m - 10m of the new capital funding has been earmarked to be used to modernise mental health inpatient services. Dr Amanda Doyle, GP and STP Lead for L&SC has stated that for the L&SC STP to be awarded this funding demonstrates the strength of the partnerships developing across L&SC. This investment will support us to make faster progress on modernising MHS and improving A&E facilities which will help to improve lives for people across our region. As mentioned above, this initial tranche of funding has been targeted at the strongest and most advanced STPs. All plans have been developed locally. Further information via: Primary Care Transformation Project An exciting digital initiative taking place across L&SC has so far seen over 10,000 patients from more than 30 surgeries signing up to use GP online services. The Primary Care Transformation Project is part of a wider programme supporting GP Practices across the region to improve services for local people. The team behind the project has worked with GPs, Practice Managers, Patient Participation Group (PPG) members and patients to promote the use of online services including ordering repeat prescriptions and booking GP appointments from the comfort of homes and on mobile devices. Free support offered to Practices has come in the form of a bundle of technology which includes help with using apps, improving online services available from Practices, advice on setting up and maintaining official Facebook pages and bespoke and very localised PR campaigns to promote online services and support. The team has also assisted PPG groups with holding sessions in surgery waiting rooms to inform and assist patients with the online signing up process. Further information via: surgeries-sign-use-gp-online-services 5.4 Supporting Patients Choice to Avoid Long Hospital Stays Policy Health and social care organisations are working together to improve the way we support patients to avoid long hospital stays by adopting a new policy which has been developed nationally to Report of the Clinical Chief Officer 6 th September 2017 Page 6 of 11

22 create an equal approach for people across L&SC. The aim is to make sure that hospital beds are used for those with a medical need and that people do not spend longer in hospital than they need to. Long hospital stays refers to people who are staying longer than they need to for medical reasons and are fit to leave. It is known that staying in hospital longer than necessary is not good for people; it can cause physical problems, particularly for older people. Hospitals are not the best places for people to remain once their treatment has been completed. It is important that the NHS helps people to get to the right place as soon as possible after a hospital stay, which in most cases will be their own home. At the moment there are too many people who are not able to leave when they are fit to do so. The aim is to improve this and help patients, their families and carers to make appropriate choices in order to avoid these long stays. In order to improve procedures, there is a new joint policy across L&SC for both health and social care to provide equity of treatment. Improvements will include the way we communicate with patients and carers around a persons treatment and care plans that detail what is going to happen, when people are likely to leave hospital, and where people will go at that point. As a general rule, it is believed that people should be discharged from acute hospitals as soon as it is deemed safe and appropriate to do so. It is also important that health and care staff are supported to help patients to avoid long hospital stays. For some people they will not be returning home, either initially or in the longer term, if they have significant health and care needs. For these people we need to work closely with them and their families or carers to help them understand their options. We want to help people and families to make informed decisions about next steps. For more information about what this means to patients, NHS England and Healthwatch England have produced an easy read leaflet which is available here: 6) Pennine Lancashire 6.1 Together a Healthier Future (TAHF) Programme As members will be aware, I have undertaken the additional role of Chief Officer to the Pennine Lancashire (PL) Transformation Programme, which involves taking a lead executive role in supporting the developments of the programme. There are three key strands to the transformation programme and each is led by an individual Senior Responsible Officer; the key strands are Prevention, Joined up Care (Out of Hospital including our Neighbourhoods) and In Hospital Care. Although, there are lead officers working on these areas, they are supported by all of the lead organisations across PL (including the CCGs) and, when the sum of their work comes together, it will set the direction of travel for a new model of care that will be the foundation for an Accountable Care System (ACS) for PL. Ultimately, plans are being developed and we are aiming to be an ACS, in shadow form, by April 2018 and, most likely, into a more formal arrangement by As part of the programme s ongoing commitment to engagement, local residents have been invited to get involved, debate and help shape the future of health and social care in PL at a series of summer engagements. These events continued into August and have been updating people on the TAHF programme s progress and sharing initial ideas about next steps. They follow up on the work carried out over the last year to talk and listen to members of the public via a series of workshops, face to face meetings and on social media. Report of the Clinical Chief Officer 6 th September 2017 Page 7 of 11

23 We ve been delighted with the feedback received at the events so far and hope there is more to come. The feedback we receive will form a crucial part of our plans for what happens next. 6.2 Collaborative Working 7) BwD In PL, the two CCGs (BwD and East Lancashire) have been working more closely together and understanding what commissioning functions we could do once and collaboratively across the area. This includes the sharing of clinical leaders and officers across the two CCGs and an ethos in those relevant areas of working on behalf of PL as opposed to either individual organisation. There are examples of this working really well and the PL Safeguarding Team is one such example. We need to work on bringing together the commissioning processes across this area where it makes sense to do so. This should result in removing any postcode differences in services for patients where there is no sound reason for there being a difference. Many CCG areas across the country are starting to do this and, whilst not merging, they are creating single management teams working for several CCGs including sharing key posts. 7.1 CCG /17 Annual Assessment The CCG annual assessment for 2016/17 provides each CCG with a headline assessment against the indicators in the CCG Improvement and Assessment Framework (CCG IAF). The CCG IAF aligns key objectives and priorities as part of its aim to deliver the FYFV. The headline assessment is confirmed by NHS England s Commissioning Committee. The CCG has received notification that, following a very challenging 12 months, it has maintained its headline rating for 2016/17 as Requires Improvement. The final rating in 2016/17 for CCG Quality of Leadership is Green and the final rating for Finance is Red. The CCG has made significant progress in recovering its finance position for 2017/18. NHS England congratulated the CCG overall on the progress it has made over the last year, particularly the leadership on a PL approach. The CCG has demonstrated active engagement with the STP and alignment of TAHF with the STP. In the three clinical areas, the CCG has been rated as outstanding for dementia and good for mental health. In cancer, the CCG has been rated as requires improvement. This measure is based on four cancer targets and, although the CCG has made progress against these, there is still a great deal of work to do. Overall, the results for the NHS in England in 2016/17 represent an improvement from 2015/16, which is a significant achievement for commissioners and is representative of much hard work during what has been a difficult year. NHS England thanked the CCG for its contribution to delivering the FYFV and its focus on making improvements for local people. Report of the Clinical Chief Officer 6 th September 2017 Page 8 of 11

24 Further information via: / Accountable Officer As members will already be aware, I have recently been appointed as the new Accountable Officer (AO) for the four CCGs across Derbyshire. This represents a substantial opportunity for me personally to take forward all that I have learned in the last few years and take this into a larger role and in a different area. Whilst I am delighted with my new appointment, I am very sad to be leaving BwD, having been a practising GP in the area for many years and leading its CCG since The people and the place will always have a place in my heart as I see so many examples of transformational work and have been privileged to work with so many excellent, passionate and committed people. It is because of this that I know that BwD will continue to go from strength to strength. I thank you all for your continued support both past and present. It has been agreed that my last day of service to the CCG will be on 30 th September Members will note that a paper outlining the replacement process for the CCG s AO role is to be presented later on the agenda at today s meeting Lay Member Term of Office 7.2 Healthwatch Members will be aware that on 1 st June 2016 a succession planning report was presented as an update for members on the option for appointing to the role of the Lay Member. The recruitment process was concluded in 2016 but no appointment was made to the post of Lay Member to replace the Lay Member Nurse Representative. The CCG considered an option to cover this role for a fixed term period. Dr Nigel Horsfield offered to change his role and extend his term of office for 12 months, which the GB approved. On this basis Dr Nigel Horsfield s term of office is due to cease in August 2017 and, following conversations and in line with succession planning and business continuity, Dr Horsfield has indicated he would be willing to extend his time with the CCG in the role of Lay Member for a further two years. This two year extension would be in line with the CCG constitution for Lay Members to hold two consecutive terms of office before stepping down for new recruitment process. This offer was considered by the Executive Team, the Executive GP Leads and Chairman as being acceptable to the organisation and it is reported here to inform the GB of this action Healthwatch BwD is to embark on an exciting new project; gathering the views and experiences of those residents visiting A&E at Royal Blackburn Teaching Hospital. The project will seek to understand residents expectations and discover what their journey is like from admission through to discharge. Along with this, Healthwatch will uncover the reasons why people chose to attend A&E and identify if more could be done in the community to prevent admissions. Report of the Clinical Chief Officer 6 th September 2017 Page 9 of 11

25 7.3 Borough Council Healthwatch will be based in A&E on a weekly basis until the end of January, along with engaging with residents out in the community. Amplify, Healthwatch BwD s young persons project, will be delivering a project alongside this to ensure children and young people are given the opportunity to have their voices heard on their A&E experiences Road Safety 8) Good News The CCG is committed to working collaboratively with Lancashire partners towards a safe transportation system in which people are safe and feel safe on BwD s roads that will benefit our residents, economy and wellbeing. BwD is committed to delivering locally the four toward zero outcomes of the Lancashire Road Safety Partnership: Reduce number, severity and rate of road traffic injuries; Improve, adapt and change attitude and perception of road safety; Reduce rate of fatalities and injuries across road user and age group; Improve community engagement with road safety. Members will be aware that road traffic casualties are a contributor to the health profiles for BwD. 8.1 National Institute for Health and Care Excellence (NICE) Shared Learning Awards 2017 I am pleased to report that BwD Integrated Wellbeing Service was runner up at the NICE Shared Learning Awards 2017, for progress made towards implementing NICE guidance and standards with its Shared Learning. The Wellbeing Service has created a single point of access for all referrals from either professionals (health and wider) or individuals who may require some support or intervention on a wide range of health issues, as well as picking up the wider determinants of health. NICE guidance about behaviour change recommends that programmes should be based upon sound knowledge of community needs and to build on existing skills and resources. In early 2013 the Council, in partnership with the CCG, commenced discussions around how the organisations could take a more systematic approach to self-care and long-term conditions (LTCs) management and deliver a more integrated service to the public a new Wellbeing Service rather than a range of individual service offerings. 8.2 Practice in Management Award I am personally delighted to announce that a BwD GP Practice Manager, and the Practice Manager at my own GP Practice, has been awarded top spot in industry magazine Practice in Management s list of the country s most inspiring Practice Managers. Mrs Ann Neville, Practice Manager at Darwen Healthcare, has been in her role for just three years yet in that time has resolved major problems with patient access introducing more flexibility in appointment structures to meet patient needs, brought in a more practical system for home visits and created a risk register to give preventative advice to patients who might develop diabetes. Report of the Clinical Chief Officer 6 th September 2017 Page 10 of 11

26 9) Meetings Mrs Neville regularly overcomes a number of challenges including working within financial constraints and making sure there are enough appointments to meet patient demand, as well as occasionally dealing with patient complaints and staffing issues. As well as being rated as an outstanding practice by the Care Quality Commission, Mrs Neville and the Practice were finalists in three categories in the prestigious General Practice Awards 2016; Practice Manager of the Year, Nursing Team of the Year, and Diabetes Team of the Year. These awards are dedicated to recognising, highlighting, and rewarding the hard work and innovation that gets carried out every day in surgeries up and down the UK in order to deliver the best possible care to patients. Members may be interested to note the following meetings and events which have taken place during the course of the last two months: Senior Management Team with Accountable Officers Clinical Management and Executive Team Together a Healthier Future Strategic Partnership Board CCG Governing Body Governing Body Development Session Finance Scrutiny Meeting Care Professionals Board Joint Committee of CCGs BwD and ELCCG Chief Officers and Chairs meeting Collaborative Commissioning Board Commissioning Business Group Transformation Steering Group Together a Healthier Future Executive Joint Commissioning Group System Leaders Forum Transformation Steering Group Senate Meeting Pennine Lancashire A&E Delivery Board Joint Committee of CCGs Collaborative Commissioning Board CCG Governing Body Pennine Lancs Programme Executive Team Together a Healthier Future System Leaders Forum New Models of Care Meeting 10) Recommendation The Governing Body is requested to receive this report and to note the items as detailed. Dr. Chris Clayton Clinical Chief Officer 25 th August 2017 Report of the Clinical Chief Officer 6 th September 2017 Page 11 of 11

27 GOVERNING BODY MEETING Chief Finance Officer Report Date of Meeting 6 th September 2017 Agenda Item 8 CCG Corporate Objectives Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity y To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality GOVERG BODGOVERNING BODY MEETING Governing Body Meeting Page 1 of 3

28 Clinical Lead: Senior Lead Manager Finance Manager Equality Impact and Risk Assessment completed: Patient and Public Engagement completed: Financial Implications Risk Identified Report authorised by Senior Manager: Y N/A Mr Roger Parr Mrs Linda Ring N/A N/A N/A See report Mr Roger Parr Decision Recommendations The CCG Governing Body is asked to note the contents of this financial summary and the financial position of the CCG at the end of July Governing Body Meeting Page 2 of 3

29 Executive Financial Summary Month 4 Period Ending 31 st July 2017 Year to Date (YTD) Full Year Forecast Budget Actual Variance Budget Actual Variance Funds Available 82,778 82, , ,290 0 Commissioning 62,073 62, , , Primary Care 17,516 17,563 (47) 52,619 52,769 (150) Corporate 2,443 2, ,069 6, Reserves ,130 3,130 0 Balance ,239 2, Summary Financial Position The CCG is reporting a year to date surplus of 781k which is 35k ahead of plan. The CCG is forecasting to deliver a surplus of 2,346 which is 107k ahead of plan. The CCG is currently holding a 0.5% risk reserve as per national guidance. Commissioned Services Healthcare Commissioning is reporting a YTD underspend of 52k with a year-end forecast underspend of 146k. Primary Care Services are reporting a YTD overspend of 47k with a forecast overspend of 150k mainly from primary care cocommissioning. Prescribing is reporting a YTD breakeven position as no forecast figures have been received from the NHS Business Services Authority at this time. Corporate Services are reporting an underspend of 30k and a forecast year end underspend of 111k Capital A combined bud for hardware replacement of the GPIT estates, provision of mobile working and the upgrade all practices across Blackburn with Darwen CCG to Windows 10 has been submitted by NHS England Lancashire and South Cumbria on behalf of the CCG. The CCG awaits confirmation of this funding. Risks The QIPP target for the CCG is 3.4% of turnover and some schemes are scheduled to come on line during the year. Acute activity levels continue to be a key factor in 2017/18. Schemes are in place to manage demand. Continuing health care and complex packages continues to be a key risk as these are generally high cost and low volume. The CCG continues to closely monitor this area of expenditure. Prescribing expenditure is volatile and is monitored closely by the Medicines Management Team. The prescribing waste scheme commenced in 2016/17 and is expected to make significant savings. QIPP The CCG has actioned 6.2m of QIPP savings to date and is ahead of plan to meet the full year savings of 8.6m. The CCG is currently reviewing services to identify where savings can be made to meet the target. The CCG plans to deliver the full target however there remains a risk of schemes yet to be actioned. Recommendation: The CCG Governing Body is asked to note the contents of this financial summary and the financial position of the CCG at the end of July Governing Body Meeting Page 3 of 3

30 NHS Blackburn with Darwen CCG APPENDIX A Summary Governing Body Report July 2017 Budget to Date 000 Expenditure to Date 000 Variance to Date 000 Annual Budget 000 Annual Forecast 000 Annual Forecast Variance 000 Revenue Resource Limit Confirmed (82,778) (82,778) 0 (250,290) (250,290) 0 Anticipated Total Revenue Resource Limit (82,778) (82,778) 0 (250,290) (250,290) 0 Expenditure Commissioning (Page 2) 79,589 79, , ,856 (4) Corporate (Page 4) 1,292 1, ,551 3, Reserves (Page 4) ,130 3,130 0 Healthcare Sub Total 80,881 80, , , Running Costs (Page 4) 1,151 1, ,518 3, Total Expenditure 82,032 81, , , Surplus/(Deficit) ,239 2, Better Payment Practice Code YTD Value (%) YTD Volume (%) FOT Value (%) FOT Volume (%) Target (%) NHS Non NHS

31 NHS Blackburn with Darwen CCG APPENDIX B Healthcare Commissioning Report July 2017 Budget to Date 000 Expenditure to Date 000 Variance to Date 000 Annual Budget 000 Annual Forecast 000 Annual Forecast Variance 000 Acute Services NHS contracts (includes Ambulance Services) 40,178 39, , , Non NHS Providers 2,298 2, ,995 6, NHS Contract Exclusions / Cost per Case Non Contract Activity ,756 1, Other Sub Total Acute Contracts 43,240 43, , , Mental Health Services NHS contracts 5,306 5, ,647 15,643 4 Non NHS Providers (3) (3) NHS Contract Exclusions / Cost per Case Non Contract Activity Other (1) Sub Total Mental Health Services 5,926 5, ,812 16,812 0 Community Health Services NHS contracts 4,745 4, ,235 14,235 0 Non NHS Providers (20) 1,437 1,458 (21) NHS Contract Exclusions / Cost per Case Non Contract Activity Hospices ,051 1,046 5 Other Sub Total Community Services 5,772 5,790 (18) 17,083 17,099 (16) Total Healthcare Contracts 54,938 54, , , Continuing Care Services Continuing Care 2,325 2,421 (96) 6,786 7,378 (592) Free Nursing Care ,031 1,031 0 Sub Total Continuing Care Services 2,658 2,754 (96) 7,817 8,409 (592) Primary Care Services Prescribing 8,244 8, ,732 24,732 0 Enhanced Services ,411 1,411 0 Primary Care Co Commissioning 7,510 7,579 (69) 23,131 23,281 (150) Out of Hours ,699 1,699 0 Commissioning (1) Other Sub total Primary Care services 17,516 17,563 (47) 52,619 52,769 (150) Other Programme Services Other Non Acute 2,605 2,608 (3) 7,934 7,935 (1) Complex Cases & Individual Funding Requests 1,872 1,924 (52) 5,617 5,771 (154) Sub Total Other Programme Services 4,477 4,532 (55) 13,551 13,706 (155) Surplus/(Deficit) 79,589 79, , ,856 (4)

32 NHS Blackburn with Darwen CCG APPENDIX C Main Healthcare Contracts July 2017 Budget to Date 000 Expenditure to Date 000 Variance to Date 000 Annual Budget 000 Annual Forecast 000 Annual Forecast Variance 000 Acute Contracts Main Provider East Lancashire Hospitals NHS Trust 34,264 34, , , Other Lancashire Providers Lancashire Teaching Hospitals NHS FT 1,748 1,760 (12) 5,245 5,281 (36) Blackpool Fylde & Wyre Hospitals NHS FT University Hospitals Morecambe Bay NHS FT (5) (15) North West Ambulance Service NHS Trust (Block) 2,431 2, ,293 7,293 0 Sub Total Other Lancashire Providers 4,431 4, ,393 13, Greater Manchester Providers University Hospital South Manchester NHS FT Salford Royal NHS FT (29) (88) Royal Bolton Hospitals NHS FT Wrightington, Wigan & Leigh NHS FT Central Manchester University Hospital NHS FT ,463 1, Pennine Acute NHS Trust The Christie NHS FT Sub Total Greater Manchester Providers 1,389 1, ,218 3, Merseyside Providers Royal Liverpool & Broadgreen NHS Trust (27) (80) Sub Total Merseyside Providers (27) (80) Independent Sector Contracts BMI Healthcare (Beardwood, Beaumont, Gisburne) 1,931 1,946 (15) 5,792 5,839 (47) Ramsay Sub Total 2,063 2, ,287 6, Total Acute Contracts 42,202 42, , , Mental Health Contracts Lancashire Care NHS FT (Block) 5,294 5, ,612 15,608 4 Calderstones Partnership NHS FT (Block) Greater Manchester West NHS FT Total Mental Health Contracts 5,305 5, ,644 15,640 4 Community Health Contracts Lancashire Care NHS FT (Block) 4,745 4, ,235 14,235 0 Total Community Health Contracts 4,745 4, ,235 14,235 0 Surplus/(Deficit) 52,252 52, , ,

33 NHS Blackburn with Darwen CCG APPENDIX D Non Healthcare Commissioning Report July 2017 Budget to Date 000 Expenditure to Date 000 Variance to Date 000 Annual Budget 000 Annual Forecast 000 Annual Forecast Variance 000 Other Corporate Costs (Non Running Costs) CSU re charge NHS Property Services re charge ,213 2,213 0 Other Sub Total Corporate Costs 1,292 1, ,551 3, Plan requirements & reserves Reserves ,130 3,130 0 Sub Total Reserves ,130 3,130 0 Running Costs CCG Pay ,619 1,619 0 CSU re charge ,324 1,324 0 NHS Property Services re charge Other (17) Running Costs Reserve Sub Total Running Costs 1,151 1, ,518 3, Surplus/(Deficit) 2,443 2, ,199 10,

34 NHS Blackburn with Darwen CCG APPENDIX E Statement of Financial Position July 2017 Statement of Financial Position July 000 Non Current Assets Property, Plant, Equipment 0 Total Non Current Assets 0 Current Assets Trade and Other Receivables 4,444 Financial Assets 0 Inventory 298 Cash and Bank 143 Total Current Assets 4,885 Total Assets 4,885 Current Liabilities Trade and Other Payables (10,030) Other Liabilities 0 Provisions (1) Borrowings 0 Total Current Liabilities (10,031) Total Assets less Current Liabilities (5,146) Non Current Liabilities Trade and Other Payables 0 Provisions 0 Borrowings 0 Other Liabilities 0 Total Non Current Liabilities 0 Total Assets Employed (5,146) Financed By General Fund (5,146) Revaluation Reserve 0 Donated Asset Reserve 0 Government Grant Reserve 0 Other Reserves 0 Total Equity (5,146)

35 GOVERNING BODY MEETING GOVERG BODGOVERNING BODY MEETING CONTRACT, QUALITY AND PERFORMANCEE REPORT Date of Meeting 06 September 2017 Agenda Item 9 CCG Corporate Objectives Through better commissioning, improve local health outcomes by b addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care x CCG High Impact Changes Delivering high quality Primary Care at scalee and improving access Self-Care and Early Intervention Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality x Clinical Lead: Senior Lead Manager Finance Manager Equality Impact and Risk Assessment completed: Patient and Public Engagement completed: Financial Implications Dr Malcolm Ridgway Directorr of Quality and Performance Mr Roger Parr Chief Financee Officer Mr Roger Parr Chief Financee Officer Mrs Jill Marr Senior Finance Officer Not Required Not Required None identified at this stage Governing Body Meeting 1 Pag e

36 Risk Identified Fluctuating performance and potential impact on the quality of patient care Report authorised by Senior Manager: Dr Malcolm Ridgway Director of Quality and Performance Mr Roger Parr Chief Finance Officer / Interim Deputy Chief Executive Y Decision Recommendations To note the contents of the report and support actions as identified. Governing Body Meeting 2 P age

37 Contract & Information Lancashire Care Foundation Trust (LCFT) Mental Health Executive Summary Month 3 Psychological Therapies Blackburn with Darwen Clinical Commissioning Group (BwD CCG) is required to achieve a minimum 16.8% access rate at the end of 2017/18 for Psychological Therapies. Assessment will be based on a quarterly run rate requirement, with the expectation that the CCG will achieve a rate of at least 4.2% of local prevalence entering services in Quarter 4 of 2017/18, which equates to 826 patients for BwD CCG. It is expected that the number of patients entering into treatment via the existing LCFT and Lancashire Women s Centre (LWC) Core Increasing Access to Psychological Therapies (IAPT) Services, combined with the number of patients entering into treatment via the new LCFT and LWC Integrated IAPT (long term conditions) services will ensure that this target is met at the end of the operating year. In Quarter 1, a total of 856 BwD patients entered into treatment for Psychological Therapies, equating to an access rate of 4.35%, which would meet the Quarter 4 target. This was broken down as follows: 732 patients via the LCFT Core IAPT service; 41 patients via the LCFT Integrated IAPT service; and 83 patients via the LWC Core IAPT service. Data is not yet available for the LWC Integrated IAPT service and this is expected to be reported from September 2017, backdated to April The LWC Integrated service is expected to deliver a further 129 patients per Quarter. Referrals At Month 3, BwD CCG referrals to LCFT Mental Health Services have increased from levels by +48 (+7.1%). Admissions The number of admissions to Mental Health inpatient wards, is below the number admitted in the previous year i.e. 96 in , versus 97 in ( 1, 1%). Including Out of Area Placements (OAPs), BwD CCG patients account for more than BwD CCG s weighted population share of admissions +16 (+20.6%). This is indicative of an above average prevalence of high level mental health need among the BwD population. Bed Days Including Out of Area bed days, BwD CCG patients account for more than Quality & Performance Lancashire Care Foundation Trust (LCFT) Mental Health Executive Summary Month 3 Psychological Therapies The 50% Recovery target was met for BwD CCG in June 2017, with performance at 56.72%, with a year to date (YTD) position of 52.88% (Trust performance: 58.05% in month and 55.48% YTD). The standard for 75% of patients to enter treatment within 6 weeks was met for BwD CCG in June 2017, at 77.33%, with a YTD position of 87.79% (Trust performance, 94.44% in month and 94.97% YTD). The standard for 95% of patients to enter treatment within 18 weeks was also met for BwD CCG in month, at 98.67%, with a YTD position of 99.06% (Trust performance: 99.62% in month and 99.45% YTD). Long internal waits however remain an issue, particularly for high intensity interventions such as Cognitive Behavioural Therapy (CBT), 1 to 1 Psychological Wellbeing Practitioner (PWP) sessions and Counselling. For BwD CCG, as at the end of June 2017 there were 16 patients waiting over 18 weeks for CBT. The Trust is taking action to recover this position. Memory Assessment Service (MAS) The target for 70% of patients to be seen by the Memory Assessment Service (MAS) within 6 weeks was met for BwD CCG in June 2017, at 84.48%, with a YTD position of 42.41% (Trust performance: 70.37% in month and 56.51% YTD). To ensure that the current level of improved performance is sustainable, the Trust, supported by commissioners, is looking to standardise the MAS model across Lancashire. Currently there is significant variation between localities in terms of the diagnostic model, third sector utilisation and the level of post diagnostic support. A best practice group has been set up within MAS to progress this process of standardisation, as well as to identify further efficiencies. Attention Deficit Hyperactivity Disorder (Adult) Concerns remain around waiting times for the Adult Attention Deficit Hyperactivity Disorder (ADHD) service, with 18 week performance for BwD CCG at: 47% for new adult patients (Trust: 40%), and 96% for Child and Adolescent Mental Health Services (CAMHS) Transition patients (Trust: 88%), seen within 18 weeks in Q1. The service continues to prioritise service users transitioning from CAMHS as these patients will already be prescribed medications Governing Body Meeting 3 P age

38 BwD CCG s weighted population share of bed days +755 (+27.1%). Out of Area Placements (OAPs) Mental Health OAPs for 2017/18 year to date are 5 admissions (5.2% of all admissions) and 296 bed days (8.3% of all bed days) for BwD CCG. For both admissions and bed days, these are considerable decreases on the same period last year, when OAPs accounted for 28 admissions (28.9% of all admissions) and 745 bed days (23.9% of all bed days). and therefore require ongoing review. The LCFT Transformation Team has been working closely with the ADHD service and have completed a capacity and demand modelling assessment of the team, which is due to be presented at the LCFT Performance and Quality meeting in September Early learning and improvements from this work have led to an increase in capacity, with an increase in the numbers of patients seen for first appointments in Q1 across Lancashire, at 37, compared to 12 in Q4. In order to further increase capacity and assist in reducing the waiting list, recruitment processes are underway for an additional permanent Band 7 Nurse Prescriber. Governing Body Meeting 4 P age

39 Contract & Information East Lancashire Hospitals NHS Trust (ELHT) Executive Summary Month 3 Activity Variance Variance A&E (including MIU) 1047 ( 7.1%) 123K ( 6.9%) Elective (Ordinary + Day Cases) 18 ( 0.5%) + 92K (+2.5%) Non Elective inc. Non Emerg +82 (+1.7%) + 222K (+2.7%) Outpatients First Attends 486 ( 5.7%) 161K ( 8.3%) Outpatient Follow up Attends +450 (+2.6%) + 32K (+5.0%) Outpatient Procedure New +114 (+5.1%) + 10K (+3.3%) Outpatient Procedure Review 309 ( 6.9%) 21K ( 4.1%) The under trade in planned care (Elective Admissions and Outpatient Attendances/Procedures) which was reported at month 1 as 180K below plan ( 8.0%), was rectified by month 2 activity and a re profiling of the Inpatient (Elective and Daycase) plans. This activity now reports as close to plan: Month 1: 118K ( 5.4%) [ 778 spells/attendances/procedures, 6.6%] Month 2: + 127K (+5.4%) [+961 spells/attendances/procedures, +8.0%] Month 3: 56K ( 2.3%) [ 432 spells/attendances/procedures, 3.4%] Year to Date: 47K ( 0.7%) [ 249 spells/attendances/procedures, 0.7%] Inpatient Care is above plan on cost (+2.5%) from below plan activity ( 0.5%). This is due to Ordinary Elective activity (EL) showing higher costs, with notable shifts in the grouping of spells, towards higher levels of complications/comorbidities. Quality & Performance East Lancashire Hospitals NHS Trust (ELHT) Executive Summary Month 3 A&E 4 Hour Given underperformance nationally against the 95% 4 hour target, NHS England has set a trajectory for 2017/18 for: over 90% of emergency patients to be treated, admitted or transferred within 4 hours by September 2017; the majority of trusts to be meeting the 95% standard by March 2018; and for the NHS overall to meet the 95% standard by the end of the 2018 calendar year. Locally, the 95% 4 hour waiting time target for A&E was not met in June 2017 at East Lancashire Hospitals Trust (ELHT), with in month performance at 84.73%. A 4 hour recovery action plan is being monitored via the A&E Delivery Board. Ambulance Handovers The number of delayed ambulance handovers increased in June 2017, with 349 over 30 minutes, however over 60 minutes decreased to 29, in comparison to 332 over 30 minutes and 45 over 60 minutes in April As previously reported timely availability of medical and surgical beds has impacted on the length of stay in the Emergency Department (ED) and has resulted in delayed first assessments. A rapid handover procedure has been introduced for Urgent Care Centre (UCC) patients and this has seen a rise in the proportion of appropriate patients being taken to UCC. The rapid assessment of treatment process in ED has been reviewed and made more efficient to improve the timeliness of assessment and patient flow to enable an improvement in handover times. Non elective admissions (including non elective non emergency) are close to plan in terms of activity (+82 spells, +1.7%), but above plan in terms of cost: + 222K (+2.7%). As with Ordinary Elective activity, there are notable shifts in the grouping of spells, towards higher levels of complications/comorbidities. This is offset by the under spend in Non Elective (including Non Emergency) Excess Bed Days 239k ( 47.2%). Referral to Treatment BwD CCG patients awaiting treatment at ELHT stands at 7,031 at month 3, which is an increase for the 2 nd consecutive month (6,829 May 17 and 6,786 Apr 17). However, compared to the same month last year, this is a decrease of ( 421, 6%). Governing Body Meeting 5 P age

40 Awaiting Treatment performance (target 92% within 18 Weeks) is stable at 92.6% (Jun 17). 24 patients are currently waiting >36 weeks (of which 0 are > 52 weeks). Governing Body Meeting 6 P age

41 Contract & Information Primary Care Executive Summary Month 3 Out of Hours Compared to last year s Month 3 data, total activity for the Out of Hours service provided by ELMS is slightly under plan YTD by 111 ( 2.3%). Dr Advice continues to over perform: +75 (+5.7%), with Home Visits ( 9, 1.4%) and Primary Care attendances ( 177, 6.2%) under plan. PCC Attends Dr Advice Home Visits Year to date Activity Full Year Forecast Activity 17/18 16/17 Variance Status 17/18 16/17 Variance 2,695 2, % G 10,611 11, % G 1,401 1, % R 5,516 5, % A % G 2,437 2, % G Total 4,715 4, % G 18,565 19, % G Alternative Provider Medical Services (APMS) General Practitioner Contracts The CCG is currently working through a process to deliver APMS contracts for Bentham Road and Waterside aligning with the CCG s agreed Primary Care Strategy. Quality and Outcomes Enhanced Services Transformation (QOEST) The QOEST plan is now in progress. Quarterly Quality and Performance Assurance meetings have now commenced. The next cycle of future planning commences in September. Estates Technology Transformation Fund (ETTF) The West Scheme has now been recommended for the next approval stage to be undertaken by NHSE North although no date for approval has been given at this time. Statu s Quality & Performance Primary Care Executive Summary Month 3 Care Quality Commission (CQC) CQC have now inspected 24 out of 26 practices in BWD. Brookhouse and Shifa surgeries are the only practices waiting for their reports to be published. Out of the 22 reports published, Darwen Healthcare received a rating of outstanding 20 practices have now been rated as Good. Limefield Surgery received their first inspection in October 2016 and was rated as Inadequate However since the visit they have been working hard to improve the identified areas of improvement with the advice and support of the Royal College of Practitioners (RCGP), the CCG and fellow colleagues. The second visit and re assessment took place on 21 st June The practice is currently in receipt of the draft report which they are checking for factual accuracies. The two practices still waiting for their inspections are Waterside and Pringle Street. Both practices have received support and advice from the CCG in preparation for their forthcoming CQC visit which we have been informed should take place soon. Nurse Forum Practice makes Perfect aims to provide training and support for nurses working in general practice. On 13 th July 2017 BWD were the first CCG in the North West to host a workshop delivered by the Public Health England Nurse Clinical Champion. The workshop aimed to increase understanding, confidence and expertise in promoting physical activity for improved outcomes for patients. Dr Malcolm Ridgway briefly outlined Transformation in Primary Care and discussed the importance of the nurse s role during this period. Pennine Lancashire Primary Care Quality Group Continues to meet on a monthly basis to discuss and act upon any concerns within general practice across Pennine Lancashire. The process in place has been developed from the National Trigger tool which includes: Routine Monitoring Monitored through the Dashboard at the GP Quality Group Enhanced Surveillance Individual reports developed by Primary Care Quality Team, meetings with GP Practices. Enhanced Review Multidisciplinary discussion and meetings with GP Practices. Governing Body Meeting 7 P age

42 Contract & Information Lancashire Care Foundation Trust Community Executive Summary Month 3 The process for reporting against variances (+/ 10%) as agreed by Chorley and South Ribble CCG (CSR CCG) contractual lead for LCFT Community Services is for the Trust to provide an exception report in the month following the previous quarter Baseline Proposal The LCFT Performance Team submitted the completed Community Baselines proposal to commissioners on the 5 th July, for review along with answers to various queries raised from the initial submission. It has been identified that a further amendment to the Paediatric Liaison baseline will need to be made due. LCFT are also seeking further clarification from Commissioners as to the data capture and reporting of different referral types. The planned activity figures per service and CCG has been revised to apply the agreed demographic growth per CCG which totals a 0.3% increase across all CCGs. Following further discussions, the Trust are planning to check the CCG activity split against the financial spilt for each service prior to re submitting the baselines back to the commissioners by the end of July. Activity Reporting The LCFT Performance team and the CCGs have signed off the Exception Reporting proposal which aims to give specific guidelines to business managers around exception reporting and will standardise the process across both Community and Mental Health contracts. LCFT will commence exception reporting against reported variances from M4. Quality & Performance Lancashire Care Foundation Trust Community Executive Summary Month 3 Referral to treatment (RTT) Incomplete The 92% 18 weeks referral to treatment (RTT) Incomplete target was met for BwD CCG LCFT Community services patients in June 2017, with performance at 95.6%. Despite meeting the 18 weeks target overall for BwD CCG patients, the target was not met at service level in month for Children s Speech and Language Therapy (SALT), at 90.2% (30 patients over 18 weeks); and the Falls Team, at 0% (1 patient over 18 weeks). LCFT report that significant staffing issues have been the major contributory factor to the poor performance within the BwD Children s SALT services. Recruitment processes however have now been completed and the teams are now fully established. A recovery trajectory is in place and it is expected that 18 weeks RTT will be achieved from August 2017 for the BwD CCG area. As at the end of June 2017, 29 of the 30 BwD patients waiting now have an appointment. The Trust has confirmed that all patients are being prioritised on the basis of clinical need and those waiting are being signposted to self management information or third sector providers. As part of this the service has significantly redeveloped its selfmanagement area of its website in order to encourage active self management and also to reduce inappropriate demand on the service. All Service Users have also been asked to notify the service if there is any change in their condition, so that those patients clinical priority can be reassessed. Governing Body Meeting 8 P age

43 Contract & Information Other Executive Summary Month 3 North West Ambulance Service (NWAS) All Incidents Blackburn with Darwen CCG All Incidents activity provided by the ambulance service at Month 3 is under plan by 4.7%. Performance Line Comparison to Plan Plan Actual Variance & % R1 (% <8 mins) (+27.6%) R2 (% <8 mins) (+1.2%) All Reds (%<19 mins) (+2.6%) Green ( 9.3%) AS ( 63.0%) All Incidents ( 4.7%) Green activity YTD was under Plan [ 382, 9.3%], contributing to All Incident activity underperformance against Plan overall [ 338, 4.7%] for BwD CCG. Lancashire wide none of the Red call targets were met in Month 3. BMI Beardwood + BMI Gisburne Park Total activity is below plan 157K ( 10.7%). BMI Beardwood: 192K ( 14.2%) BMI Gisburne Park: + 35K (+32.6%) Elective Inpatient Care (EL + DC) position at month 3 shows activity 4 spells below plan ( 0.4%) with costs 91K below plan ( 8.9%). Pain Management, General Surgery, Trauma & Orthopaedics and Gynaecology are the key specialties which have underperformed. Only Gastroenterology has over performed to a notable degree Gastroenterology + 14K (+252%) [+35 spells, +260%] Outpatient Care position at month 3, shows activity 180 attendances/procedures below plan ( 4.6%) with costs 50K below plan ( 13.2%). As with Elective Inpatient Care, only Gastroenterology has over performed to a notable degree: Gynaecology + 5K (+62%) [+47 attendances/procedures, +79%] Quality & Performance Other Executive Summary Month 3 North West Ambulance Service Category A ambulance calls In June 2017, none of the three ambulance call targets were met for BwD CCG: with All Red emergency calls to be responded to with 19 minutes performance at 91.30% (91.38% YTD) (against a 95% target); Red 1 (8 minutes) performance at 69.00% (73.90% YTD); and Red 2 (8 minutes) performance at 68.40% (69.40% YTD) (both against a 75% target). In order to assist with ambulance response times, NHS England have announced an Ambulance Response Programme, with a new set of performance targets for ambulance services which will apply to all 999 calls. These measures went live on the 7 th August The programme gives call handlers additional time to assess a call and a new set of questions to help determine the type of response required. The programme also introduces new categories of call: Category 1 (Life threatening injuries and illnesses average response of 7 minutes); Category 2 (Emergency calls average response of 18 minutes); Category 3 (Urgent calls response of 120 minutes (90% target)); and Category 4 (Less urgent calls response of 180 minutes (90% target)). Monitoring against the previous categories will continue to be reported pending availability of data against the new targets. Referral to Treatment 18 weeks (Incomplete) The referral to treatment (RTT) incomplete pathway was not achieved for BwD CCG in June 2017, with performance at 91.14% (against a target of 92%). As previously reported performance at Lancashire Teaching Hospitals Trust (LTHTr) is having the most significant impact on the CCG s overall position, with performance at 81.03% for BwD patients being within 18 weeks (235 patients over 18 weeks). The main pressures are related to: Neurology (additional evening clinics are being run to stabilise capacity and demand); Ophthalmology; General Medicine (for both specialities additional theatre lists are being held and reviewed by surgery teams); and Plastic Surgery (outsourcing of activity is in place). LTHTr, the host CCG and the Sustainability and Transformation Partnerships additionally are working on waiting list initiatives. Cancer 2 weeks for an urgent referral for breast symptoms For BwD CCG, the standard for 93% of patients to be seen within 2 weeks for an urgent referral for breast symptoms was met in June 2017 with performance at 97.78%. For Q however, the standard was not met for BwD CCG with Governing Body Meeting 9 P age

44 performance at 92.75%. Cancer Subsequent treatment for cancer within 31 days (Surgery) For BwD CCG, the standard for 94% of patients to receive subsequent treatment for cancer within 31 days (Surgery) was not met in June 2017 with performance at 93.33%. YTD the target is being met with performance at 97.50%. There was 1 breach attributed to ELHT; due to inadequate elective capacity, with the surgery requiring 3 surgeons due to complexity. The surgery was completed on day 41. Cancer 1st definitive treatment for cancer within 2 months (62 days) For BwD CCG, there was underperformance against the 62 day referral to first treatment standard in June 2017 with performance at 81.58%, against an 85% target. YTD the target is being met with performance at 88.04%. There were 7 breaches leading to the underperformance. 2 breaches related to treatment being delayed due to medical reasons, 1 breach was a patient initiated delay, 3 breaches related to late referrals to tertiary providers and 1 breach was due to a complex diagnostic pathway. Cancer performance continues to be overseen by the Pennine Lancashire Cancer Tactical Group which monitors the delivery of the Cancer Action and Implementation Plan. Governing Body Meeting 10 P age

45 East Lancashire Hospitals NHS Trust: BwD CCG Contract 1 st April th June Appendix 1 Blackburn with Darwen CCG's position at Year to Date EAST LANCASHIRE HOSPITALS NHS TRUST Activity Plan Activity Actual Activity Variance % Variance Cost Plan Cost Actual Cost Variance % Variance A&E (including MIU) Elective (Ordinary + Daycases) Excess Bed Days (Elective) Excess Bed Days (Non Elective Non Emergency) 14,808 13,761 1, % 1.776M 1.653M 123K 6.9% 3,781 3, % 3.637M 3.729M 92K 2.5% % 43,376 20,653 22, % % 32,654 20,726 11, % Excess Bed Days (Non Elective) 1, % 472, , , % Non Elective 4,207 4, % 6.754M 7.029M 275K 4.1% Non Elective Non Emergency % 1.433M 1.380M 52K 3.7% Outpatient First Attends 8,489 8, % 1.931M 1.771M 161K 8.3% Outpatient Follow up Attends Outpatient Procedure New Outpatient Procedure Review 17,581 18, % 642K 675K 32K 5.0% 2,224 2, % 306K 316K 10K 3.3% 4,461 4, % 499K 479K 21K 4.1% Total M M 209K 1.2% Other 7.916M 8.544M 628K 7.9% Adjustments (Residual balance, Dietary Feeds, Anti Coag) 454k 454k Grand Total M M 36k 0.1% Tables Based upon Version 3 of the Contract Monitoring Pivot, updated at 09/08/ P age

46 Appendix 2 All Providers: BwD CCG Contract 1 st April th June Blackburn with Darwen CCG's position at Year to Date ALL ACUTE HOSPITAL PROVIDERS Activity Plan Activity Actual Activity Variance % Variance Cost Plan Cost Actual Cost Variance % Variance A&E (including MIU) Elective (Ordinary + Daycases) Excess Bed Days (Non Elective + Elective) 15,320 14,315 1, % 1.846M 1.721M 125K 6.7% 5,440 5, % 5.554M 5.448M 106K 1.9% 2,411 1,315 1, % 587K 333K 255K 43.4% Non Elective 4,388 4, % 7.148M 7.422M 274K 3.8% Non Elective Non Emergency % 1.564M 1.454M 110K 7.0% Outpatient First Attends 10,772 10, % 2.324M 2.145M 179K 7.7% Outpatient Follow up Attends 23,479 24, % 1.091M 1.126M 35K 3.2% Outpatient Proc edure New 2,306 2, % 319K 333K 13K 4.2% Review 4,695 4, % 533K 525K 8K 1.4% Unspecified % 80K 47K 33K 41.1% Total M M 493K 2.3% Other 8.689M 9.267M 578K 6.7% Grand Total M M 85K 0.3% Tables Based upon Version 3 of the Contract Monitoring Pivot, updated at 09/08/ P age

47 Appendix 3 Referrals to Secondary care 1st April th June 2017 GP Referrals 0.3% versus 16/17 > +5% (above) versus Within 5% versus < 5% (below) versus Specialty GP Referrals Number of Referrals GP Referrals Variance Quantity Variance % (61 days) Referrals per Working Day (63 days) Variance % Cardiology % % Community Paediatrics % % Dermatology % % E.N.T % % General Medicine group % % General Surgery group % % Gynaecology % % Oncology % % Ophthalmology % % Other Specialty group % % Paediatrics % % Pain Management group % % Rheumatology % % Trauma & Orthopaedics % % Urology % % Grand Total % % Subspecialties / Groups General Medicine and Gastroenterology % % Respiratory Medicine % % General Surgery and Vascular Surgery % % Breast Surgery % % 1 General Surgery, Breast Assessment and Vascular Surgery 2 General Medicine, Gastroenterology, Diabetic, Elderly and Respiratory Medicine 3 Pain Management and Anaesthetics 4 Paediatrics, Paediatric Surgery, Paediatric Cardiology, Paediatric Nephrology and Paediatric Respiratory Medicine 5 Community Paediatrics and Community Paediatric Neurodevelopmental Service 6 A&E, Cardiothoracic Surgery, Child & Adolescent Psychiatry, Clinical Genetics, Critical Care Medicine, Clinical Haematology, Endocrinology, Medical Oncology, Neonatology, Palliative Medicine, Radiotherapy, Rehabilitation 13 P age

48 Other Referrals 1.9% versus 16/17 > +5% (above) versus Within 5% versus < 5% (below) versus Specialty Non GP Profess + Other Number of Referrals Non GP Profess + Other Variance Quantity Variance % (61 days) Referrals per Working Day (63 days) Variance % Cardiology % % Community Paediatrics % % Dermatology % % E.N.T % % General Medicine group % % General Surgery group % % Gynaecology % % Oncology % % Ophthalmology % % Other Specialty group % % Paediatrics % % Pain Management group % % Rheumatology % % Trauma & Orthopaedics % % Urology % % Grand Total % % Subspecialties / Groups General Medicine and Gastroenterology % % Respiratory Medicine % % General Surgery and Vascular Surgery % % Breast Surgery % % Referral Type Number of Referrals Variance % (61 days) Referrals per Working Day (63 days) Variance % GP % % Non GP Professional % % Other % % Total % % 1 From GP 2 From non GP professional (e.g. Consultant, Nurse Specialist, Other Practitioner) 3 From non GP other (e.g. Following A&E Attendance or Emergency Admission, Self, Ex Private Patient) 14 P age

49 LCFT Community Contract LCFT: Service Line Activity Against Plan June 2017 Appendix 4 Year to date Activity Full Year Activity Year on Year Comparison Service Line Plan Actual Variance Var % Status^ Plan Forecast 16/17 17/18 Variance Var % Adult Learning Disabilities % % Adult Speech and Language Therapy No Plan 4 4 N/A No Plan % Children's Learning Disabilities % % Children's Nursing No Plan 3 3 N/A No Plan % Children's Speech & Language , % ,545 1, % Children's Occupational Therapy % % Children's Physiotherapy No Plan N/A No Plan % Chronic Fatigue Syndrome No Plan 0 0 N/A No Plan N/A Community Matrons No plan 7 7 N/A No plan % Community Neurological Service No plan N/A No plan % Community Stroke Service , % ,821 1, % Dermatology , % ,471 1, % DESMOND % % Diabetes Specialist Nursing Service % , % District Nursing ,135 1, % ,081 24, % District Nursing (Out of Hours) , % ,366 2, % District Nursing (inc. Out of Hours) ,726 2, % ,447 26, % Falls Team No plan 2 2 N/A No plan % Heart Failure Service No plan 0 0 N/A No plan N/A Intermediate Care ACS , % ,532 2, % 15 P age

50 Year to date Activity Full Year Activity Year on Year Comparison Service Line Plan Actual Variance Var % Status^ Plan Forecast 16/17 17/18 Variance Var % Intensive Home Support , % ,109 8,161 2, % Community IV Service BwD % % Complex Case Management , % , % COPD , % ,375 1, % Rapid Assessment Team , % ,697 4,900 1, % Nutrition & Dietetics No plan 3 3 N/A No plan % Oxygen Service % , % Podiatry , % ,294 4,945 1, % Pulmonary Rehabilitation , % ,071 1, % Treatment Rooms , % , % Treatment Room ,663 2, % ,542 17,663 2, % Ear Care (Treatment Room) % % Healthy Legs (Treatment Room) % % Minor Injury (Treatment Room) % % Ulcer & Vascular (Treatment Room) % % Tissue Viability (Treatment Room) % % Grand Total , % , % Reporting Tolerances Under Plan < 5% Close to Plan > 5% to <+5% Above Plan >+5% ^ Status = change in variance to plan (year to date M3 to M2) % Variance Widened % Variance Narrowed 16 P age

51 Appendix 5 Inpatient Waiting List Inpatient and Daycase Waiting List Source : ELHT Performance Report East Lancashire Hospitals Current Month June 2017 Previous Month May 2017 Specialty 0 <6 Weeks 6 <13 Weeks 13 <20 Weeks 20 + Weeks Grand Total General Surgery % Urology % Breast Care % Orthopaedics % ENT % Ophthalmology % Oral Surgery / Maxillo Facial % Dermatology N/A Medical Oncology N/A Clinical Oncology N/A Surgical Division % General Medicine % Rehabilitation N/A Cardiology % Thoracic Medicine % Nephrology % Medical Division % Gynaecology % Family Care Division % Interventional Radiology N/A Pain Management % Rheumatology % Haematology % Diagnostic & Clinical Support % Grand Total % 0 <6 Weeks 6 <13 Weeks 13 <20 Weeks 20 + Weeks Grand Total Variance %age +/ 17 P age

52 LCFT MH quality measures currently underperforming against target Appendix 6 Ref Indicator Threshold 2017/18 E.B.S.3 CPA: 7 day follow up from psychiatric inpatient care 95% E.H.1 IAPT: seen within 6 weeks 75% E.H.2 IAPT: seen within 18 weeks 95% LQR_6 IAPT: Prevalence Notional Monthly YTD trajectory Annual target 1.25% 3.75% 15.00% IAPT: Recovery 50% E.H.4 Early Intervention Psychosis: seen within 2 weeks 50% Level Apr 17 May 17 June /18 YTD Trust 98.53% 97.13% 97.54% 97.73% BwD 100% 94.74% 100% 97.62% Trust 96.17% 94.36% 94.44% 94.97% BwD 95.59% 91.43% 77.33% 87.79% Trust 99.47% 99.25% 99.62% 99.45% BwD 100% 98.57% 98.67% 99.06% Trust 1.07% 1.35% 1.45% 3.87% BwD 0.74% 1.85% 1.13% 3.72% Trust 55.69% 52.67% 58.05% 55.48% BwD 50.79% 50.82% 56.72% 52.88% Trust 68.97% 83.33% 90.91% 81.52% BwD 85.71% 81.82% 83.33% 83.33% LQR_1 ADHD (Adult): seen within 18 weeks CAMHS Transitions N/A Trust 46% 39% 36% 40% ADHD (Adult): seen within 18 weeks new patients N/A Trust 94% 84% 85% 88% LQR_5 MAS: seen within 6 weeks 70% Trust 47.02% 52.09% 70.37% 56.51% BwD 16.67% 18.97% 84.48% 42.41% 18 P age

53 Ref Indicator Threshold 2017/18 Level Apr 17 May 17 June /18 YTD Unscheduled Care: MHLT assessment within 1 hour of referral from ED N/A Trust 51.19% 47.40% 46.04% 48.31% BwD 96.59% 58.49% 55.56% 68.94% Unscheduled Care: MLHT Assessment within 24 hours from ward referral N/A Trust ELHT site Expected from Q2 LQR_8 Unscheduled Care: All 4 hour breaches where psychiatric assessment was requested N/A Trust ELHT site Unscheduled Care: 4 hour breaches where psychiatric assessment was requested within 2 hours N/A Trust ELHT site Unscheduled Care: 12 hour breaches where psychiatric assessment was requested N/A Trust ELHT site OAPs Out Area of Placements (average) 0 Trust KEY RED Under performance GREEN Achieving AMBER Under Review 19 P age

54 ELHT quality measures currently underperforming against target Appendix 7 Ref Indicator Threshold 17/18 Apr 17 May 17 Jun 17 Jul 17 Aug 17 E.B.5 A&E 4 Hour * 95% 82.72% 84.39% 84.73% 83.95% E.B.7 E.B.S.2 Cancer 2 week breast Cancelled Operations Sep 17 93% 90.90% 94.30% 90.90% E.B.S.4 52 week wait E.B.S.5 Trolley wait Oct 17 Nov 17 Dec 17 Jan 18 Feb 18 Mar 18 YTD E.B.S.7a E.B.S.7b E.B.S.7 Ambulance Handover > 30min Ambulance Handover >60min Missed handover stamps *KEY RED Under performance GREEN Achieving AMBER Under Review 20 P age

55 LCFT Community quality measures currently underperforming against target Appendix 8 Indicator Target Apr May Jun Referral to treatment (RTT) Incomplete (BwD CCG) 84.9% 91.7% 95.6% Adult Learning Disability Service 100% 100% 100% Adult Speech and Language Therapy 100% 100% Children's Occupational Therapy 100% 100% 100% Children s Physiotherapy 100% 100% Children's Speech & Language Therapy 70.2% 81.8% 90.2% Community Respiratory Service 100% 100% Community Stroke Service 100% 100% 100% Continence Service 100% 100% Falls Team 100% 100% 0% Intermediate Care 100% 100% 100% Nutrition & Dietetics 100% 100% Podiatry 100% 100% 100% Pulmonary Rehabilitation 92% 100% 100% 100% Rapid Assessment Team 100% 100% 100% Rheumatology 100% Referral to treatment (RTT) Incomplete (EL CCG) 85.7% 86.8% 84.0% Adult Learning Disability Service 100% 100% 100% Adult Speech and Language Therapy 100% Children's Occupational Therapy 100% 96.8% 96.7% Children's Speech & Language Therapy 83.8% 86.4% 82.4% Community Respiratory Service 100% 100% Domiciliary Physiotherapy 100% 100% 100% Intermediate Care 100% 100% Nutrition & Dietetics 100% 100% Podiatry 100% 100% 100% Pulmonary Rehabilitation 100% Community Stroke Rehabilitation Measures (BwD CCG) Patients assessed with 72 hours of referral 95% Q1: 96.0% FIM/FAM: increase in at least 1 domain at point of discharge 95% Q1: 97.0% 21 P age

56 Indicator Target Apr May Mood screen: patients receiving a mood and anxiety screen 95% Q1: 100% Goal setting: with written goals in place 95% Q1: 100% PROM: improvements in more than one domain 95% Q1: 100% Jun 17 KEY RED Under performance GREEN Achieving AMBER Under Review 22 P age

57 NHS Constitution Appendix 9 23 Page

58 Metric Level Period Target June 2017 Position Year to Date Position Cancer waits 62 days 539: % of patients receiving 1st definitive treatment for cancer within 2 months (62 days) (MONTHLY) 1885: % of patients receiving 1st definitive treatment for cancer within 2 months (62 days) (QUARTERLY) 540: % of patients receiving treatment for cancer within 62 days from an NHS Cancer Screening Service (MONTHLY) 1886: % of patients receiving treatment for cancer within 62 days from an NHS Cancer Screening Service (QUARTERLY) 541: % of patients receiving treatment for cancer within 62 days upgrade their priority (MONTHLY) 1878: % of patients receiving treatment for cancer within 62 days upgrade their priority (QUARTERLY) CCG June % 81.58% 88.04% CCG Q % 88.04% 88.04% CCG June % % 96.77% CCG Q % 96.67% 96.77% CCG June % 93.62% CCG Q % 93.62% NHS Constitution support measures HCAI 24: Number of C.Difficile infections CCG YTD Activity Measures Referral to Treatment (RTT) & Diagnostics 2015: Number of Endoscopy Diagnostic Tests/Procedures 2018: Number of Completed Admitted RTT Pathways 2016: Number of Diagnostic Tests/Procedures (excluding Endoscopy) 2019: Number of Completed Non Admitted RTT Pathways CCG YTD 1,192 1,192 CCG YTD 2,304 2,029 2,029 CCG YTD 9,922 9,922 CCG YTD 7,648 7,201 7,201 Other performance measures EMSA 1067: Mixed sex accommodation breaches All Providers CCG June Referral to Treatment (RTT) & Diagnostics 1839: Referral to Treatment RTT No of Incomplete Pathways Waiting >52 weeks CCG June Episode of Psychosis 2099: First episode of psychosis within two weeks of referral CCG June % 83.33% 75.00% Increasing Access to Psychological Therapies (IAPT) Prevalence Numbers of patients entered treatment for IAPT services (all providers) as a percentage of estimated Prevalence CCG YTD (Apr ) YTD Traj. 1.40% Annual 16.8% 0.97% 0.97% Increasing Access to Psychological Therapies (IAPT) Waiting Times E.H.1: Six week starters as a percentage of Finished course of treatment (all providers) E.H.2: Eighteen week starters as a percentage of Finished course of treatment (all providers) CCG Apr % 98.00% 98.00% CCG Apr % % % 24 P age

59 GOVERNING BODY MEETING HEALTHIER LANCASHIRE AND SOUTH CUMBRIA SUSTAINABILITY AND TRANSFORMATION PARTNERSHIP (STP) GOVERNANCE PROPOSAL Date of Meeting 6 th September 2017 Agenda Item 10 CCG Corporate Objectives Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality Clinical Lead: Senior Lead Manager Finance Manager Equality Impact and Risk Assessment completed: Dr Chris Clayton Mr Roger Parr Mr Roger Parr N/A Patient and Public Engagement completed: Public engagement through STP Communications Team GOVERG BODGOVERNING BODY MEETING Governing Body Meeting Page 1 of 2

60 Financial Implications Risk Identified Yet to be determined Financial Framework and Risk Register has been requested Report authorised by Senior Manager: Y Decision Recommendations The Governing Body is requested to: i. support the establishment of the STP Board for Lancashire and South Cumbria, in line with the explanatory information contained in this report; ii. note that the other aspects of the governance arrangements already exist and the terms of reference for the various groups will need to be refined over time as and when the STP Board becomes fully operational; iii. support a revised Governance structure for Lancashire and South Cumbria STP. Governing Body Meeting Page 2 of 2

61 1. STP Governance Proposed new STP Governance arrangements NHS Trust Boards and CCG Governing Bodies in Lancashire and South Cumbria (L&SC) are asked to support proposals for a refreshed governance arrangement for the L&SC Sustainability and Transformation Partnership (STP). The refresh is needed at this point since the Next Steps on the NHS Five Year Forward View published recently, requested all STPs to establish an STP Board which would enable effective, system wide, decision making and assurance, in order to implement and effectively manage transformation and delivery of the key national and local priorities. The existing governance structure in Lancashire and South Cumbria had been established largely to oversee a large scale transformation programme and the drafting of the Sustainability and Transformation Plan, but, as STPs continue to develop, the arrangements need to enable the L&SC system to move to delivery of the transformation plan, as well as ensure a system wide focus on performance against key clinical priorities and financial control. The proposed governance structure assumes: LDPs will play an active part in the development and delivery work of the policy workstreams Programme Management Group, comprising of STP Execs and SROs of work-streams and LDPs, will oversee the delivery of the overall STP programme plan and advise the STP Board on progress The recommendations of the work-streams can be passed en-route to the STP Board through a number of advisory groups for assurance of clinical priority (Care Professionals Board), economic priority (Finance and Investment Group), operational feasibility (Provider Board), commissioning feasibility (Collaborative Commissioning Board) The current Programme Board be re-established as a Partnership Board, offering the STP Board an opportunity to engage with a wider stakeholder group Local Delivery Partnerships work towards the establishment of Accountable (Integrated) Care systems 2. Accountable Care Blackpool & the Fylde Coast are one of eight first wave Accountable Care Systems (ACS) recently announced by NHS England, but this will extend to the rest of Lancashire & South Cumbria when each local system is ready to meet the requirements set for an ACS. These requirements are detailed in an MOU between NHSE/I and Blackpool and the Fylde Coast ACS. A further MOU is to be established between NHSE/I North and the STP, to describe what needs to be achieved in 2017/18 and the way in which support will be provided to make the fastest possible progress. All L&SC partners need to agree how we will work together to achieve the expectations of the MOUs. STP Governance Arrangements Page 1 of 10

62 Proposed new STP Governance arrangements Objectives of the national MOU with Blackpool and the Fylde Coast are: Make faster progress on reform of urgent and emergency care, primary care, mental health and cancer services Manage improvements within shared financial control total across CCG and provider partners Integrate services and funding within a single health system Act as strong leadership cohort The draft MOU sets out the requirements against each of these objectives: ACSs will be judged by results against specific targets for improving services in the four priority areas (UEC, MH, primary care, cancer) A single control total combining CCG and provider deficits will be set the MOU defines the rules around the expected delivery of the control total, as well as expecting rapid progress on system efficiencies The expectations around developing accountable care are laid out, including effective decision making and governance structure; developing a vertically integrated care system, whilst realising the benefits of horizontal integration for some services The MOU also sets out freedoms and flexibilities available to the shadow ACS on the understanding that the above objectives are achieved, including; Delegated decision rights for primary care and specialised services Streamlined regulation Ability to redeploy attributable NHSE/NHSI staff and funding In parallel, there will also be a Memorandum of Understanding (MOU) covering the whole of Lancashire and South Cumbria, which will encompass a similar set of deliverables, to enable us to align our strategy effectively. This MOU will be established between NHSE/I and the STP Board. The diagram shows the proposed new governance structure. Where formal, collective commissioning decisions are required, following the necessary development work in Local Delivery Partnerships (LDPs) and STP workstreams, they will be identified by the STP Board and referred to the Joint Committee of Clinical Commissioning Groups (JCCCGs), once CCGs have delegated the necessary decision-making powers. STP Governance Arrangements Page 2 of 10

63 Proposed new STP Governance arrangements STP Governance Arrangements Page 3 of 10

64 Proposed new STP Governance arrangements Group Role Reporting relationship STP Board JCCCGs Partnership Board Programme Management Group Care Professionals Board (CPB) Leadership and development of overarching strategy for L&SC Oversight and facilitation of delivery of sustainability, transformation and design of future state, including triple aims Owns MOU - delivery assurance Commissioning strategy approval Scrutiny/assures legality of involvement and consultative processes Delegated decisions Statutory and voluntary stakeholder engagement Socialising work-stream outputs and processes Engine room for STP/ensures programme delivery Oversight of delivery in all STP work-streams LDP programme oversight Clinical assurance on work-stream outputs Assurance on clinical viability of plans Direct to NHSE & NHSI through STP AO Direct to each LDP Board CCG GBs L&SC Health & Well being Board(s) STP Board - advisory STP Board - advisory STP Board - advisory Finance & Investment Group (FIG) Economic assurance on work-stream outputs Assurance on financial viability of plans Assurance on estates strategy STP Board - advisory Provider Board Collaborative Commissioning Board Assurance on operational feasibility of plans Leadership of collective Carter sustainability programmes Oversight of collective QIPP sustainability programmes Oversight of clinical policy & meds management development Assurance on commissioning feasibility of plans STP Board - advisory STP Board - advisory STP Governance Arrangements Page 4 of 10

65 Proposed new STP Governance arrangements 3. Role of the STP Board The STP Board is not a statutory entity, but will be required to ensure delivery of the aims and objectives of the partnership. The STP Board can enable, coordinate and mandate deliverables but it has no formal decision-making powers beyond what each statutory partner is able to bring to the Board, as they seek to align existing strategies and resources. The STP Board will make recommendations on prioritisation of capital and revenue transformation funds, as well as being the single point for system-wide performance appraisal and management. NHSE/I will align their functions with the STP so that the existing regulator/organisational relationships can be developed on a system wide basis. The composition of the STP Board is currently planned as follows: An executive lead from each of the LDPs/ACS (LDP heads) Up to five non-executive/lay members (NEDs) drawn from CCGs and FTs/NHS Trusts A councillor representative from each of the four upper tier local authorities (LA reps) The STP lead and other, interim, STP executives, including officers of NHSE and NHSI A primary care provider representative STP Medical Director Other officers and/or observers in attendance, as required Members of the Board will be expected to lead and deliver the aims and objectives of the STP and use their respective experience and perspectives to ensure delivery as a whole system. They are not there to represent their respective organisations or indeed LDPs. The local authority and primary care members bring the perspective of their constituencies, but will nevertheless also be expected to promote the STP s aims. Draft terms of reference are attached to be approved by the STP Board at its first meeting. 4. JCCCGs The statutory basis of commissioning decisions and the formal requirements of large decisions requiring consultation must be discharged by commissioners. In L&SC the JCCCGs is the means by which L&SC-wide commissioning decisions will be made. The JCCCGs has a substantial interest in the adequacy and integrity of planning and related developmental processes that could lead to formal consultation and therefore has a legitimate and important role in scrutinising and assuring the work of the STP Board in relation to the commissioning part of the agenda. With the advent of the STP Board there is a need to develop a strong and effective relationship between this and the JCCCGs over the next six months, as the STP Board becomes operational. STP Governance Arrangements Page 5 of 10

66 Proposed new STP Governance arrangements 5. Programme Management Group This is a management group comprising of Senior Responsible Officers for the policy and enabling workstreams, LDP programme directors and STP executives. Its job is to ensure that the programme of work for the STP is delivered in line with the expectations of the STP Board. It will essentially be the engine room of the STP. 6. Partnership Board (Previously the Programme Board) The existing Programme Board will become a Partnership Board and will oversee transformation, whilst ensuring that a wide range of stakeholders and partners across the system are connected with developments and progress with delivery of STP/national priorities. 7. Statutory scrutiny and partnership arrangements The current roles of the Overview and Scrutiny Committees and Health and Well-being Boards do not change. Both the STP Board and the JCCCGs are expected to have a strong relationship with these bodies. It is proposed that these arrangements are reviewed during March Next steps for Governing Bodies and Boards Governing Bodies and Boards are asked to support the establishment of the STP Board for Lancashire and South Cumbria, in line with the explanatory information contained in this report. They are also asked to note that the other aspects of the governance arrangements already exist and the terms of reference for the various groups will need to be refined over time as and when the STP Board becomes fully operational. 9. Recommendations All partners are asked to support a revised Governance structure for Lancashire and South Cumbria STP. STP Governance Arrangements Page 6 of 10

67 Proposed new STP Governance arrangements Appendix 1 - Summary draft terms of reference for the STP Board Scope 1. Leadership and oversight of arrangements to deliver the aims and objectives of the partnership- the triple aims of improvements in population health and well-being and improved services within the resources available to the partner organisations. 2. Enabler of effective whole system working among the partner organisations. 3. Jointly with NHSE and NHSI, support partners in the on-going delivery of the NHS Constitution standards and five year forward view (FYFV) Aims 4. The aims of the Partnership are to: Foster and enable effective collaborative working among partner organisations across L&SC to achieve the triple aims of improved population health and better services delivered within the available resources Ensure that the legal, consultative and equality requirements associated with strategic change are effectively discharged with local stakeholders and populations Act as the catalyst and coordinator for innovation and change across health and care services to better meet the needs of our population Develop strategic plans and ensure coordination of clinical and managerial leadership activities Be the focus of accountability processes in relation to whole health and social care system performance and financial management Objectives 5. The objectives of the Partnership are to: Improve the health of our population, with a strong focus on prevention and self-care Improve the clinical and social effectiveness of services focused on patient outcomes, effective use of resources and value for money Improve the efficiency of existing services so that resources can be released to fund service developments To increase the proportion of health expenditure on services delivered outside of hospital to support people better to manage their long term conditions in a community setting Develop proposals for and implement an Integrated (Health and Care) Strategic Commissioning (ISC) function Facilitate and support the development, within Local Delivery Partnership areas (LDPs), of Accountable Care Systems that are able to deliver effective and efficient integrated care services and ensuring that, in the first instance, Blackpool and the Fylde Coast delivers in line with national requirements and timescales Integrate performance assessment processes across commissioners and providers in health and care services to enable them to be held responsible for delivery of the sustainability and transformation agenda STP Governance Arrangements Page 7 of 10

68 Proposed new STP Governance arrangements Responsibilities/powers 6. The STP Board has no statutory or formal regulatory powers, but it has been established to ensure that the collaborative working required to achieve the aims and objectives of the Sustainability and Transformation Partnership, is effectively discharged by all organisations. In particular, the STP Board will ensure that the performance aspects of the sustainability agenda are met, that LDPs implement their aspirations with respect to becoming Accountable Care Systems and that the Lancashire and South Cumbria-wide transformation programme is well-designed and effectively delivered. 7. Alignment of NHSE and NHSI functions with STP aims and objectives enables the development of whole system assessment processes led by the STP Board and involving Local Delivery Partnerships/Accountable Care Systems (LDPs/ACSs). The requirement placed on organisations within LDPs/ACS is that they begin the journey to join up provider and commissioning functions amenable to incorporation into ACSs and contribute to STPwide workstream developments. They will ensure that local perspectives influence strategy and policy development, to reflect the full diversity of services across Lancashire and South Cumbria. 8. The STP Board will hold LDPs/ACS accountable for delivery of wider system responsibilities and in partnership with NHSE/I, will support delivery of existing responsibilities for which organisations are formally accountable. 9. The Board will approve the programme of work designed to achieve the aims and objectives of the Partnership and approve mitigation or other corrective action to ensure that milestones and objectives are achieved on time. 10. Ensure that the interface with the Joint Committee of CCGs is constructive and effective, recognising that the Joint Committee is responsible for and has the legal powers to make decisions on changes to services. 11. The Board will also consider and assess, on an on-going basis, the effectiveness of collaborative working in LDPs/ACS and STP overall and recommend action to achieve improvements, if required. 12. The Board will adopt escalation criteria/triggers being developed by NHSE and NHSI for those situations where it has become clear that formal intervention by NHSE or NHSI is required within an individual organisation. 13. The Board will ensure that the resources required for the whole programme of STP work are sufficient and are applied effectively to achieve the STP s aims and objectives. STP Governance Arrangements Page 8 of 10

69 Proposed new STP Governance arrangements Meetings 14. The Board will meet on a monthly basis to consider progress in the implementation of the STP s aims and objectives and approve any mitigation measures and other action required to assure success, in line with the approved programme. 15. Information relating to the following main processes will inform the Board as and when it is necessary and available, having regard to the timetable and milestones of the STP programme: Development of Lancashire and South Cumbria-wide strategy and policy as currently planned within the policy and enabler workstreams Development of options/option appraisal for proposals to implement STP strategy Development of the programme of work to support a legally complaint public consultation process where it is required Support proposals for FYFV delivery plans/assurance of the same Delivery of NHS Constitution standards in each LDP/ACS Delivery of performance and financial targets in each LDP/ACS Assessment of strategic Risks, Assumptions, Issues and Dependencies (RAID) in relation to the effectiveness of collaborative/system working and development of proposals to mitigate them as part of the Board Assurance process 16. A Register of Interests will be maintained for the Board and any conflicts of interest managed at each and every meeting in relation to the agenda. Membership 17. Membership comprises: The nationally appointed STP lead An executive lead from each LDP/ACS Up to five Non-Executives/Lay Members appointed from among the existing NHS organisations for their experience and knowledge Local authority nominated councillor representatives from each of Lancashire County Council, Cumbria County Council, Blackburn w Darwen Council and Blackpool Council STP executives, including officers from NHSE and NHSI who are part of the STP Executive Team A Primary Care provider professional representative STP Medical Director Other officers in attendance as required 18. All members are expected to uphold and support the vision, aims and objectives of the Partnership and will bring perspectives from their organisations/ldps, to ensure that Lancashire and South Cumbria-wide strategy and policy reflects the diversity of the region and can be implemented within each of the different parts of the STP. 19. The STP lead is responsible for the effectiveness of the STP Board. STP Governance Arrangements Page 9 of 10

70 Proposed new STP Governance arrangements Quorum 20. The STP Board will be quorate when more than half of the membership is present including at least one from each of the following groups LDP leads Non-executive directors Local authority representatives STP executives Clinicians 21. Decisions will normally be agreed on a consensus basis, but where an individual believes that it is important for there to be a recorded vote and the chairman agrees, a majority decision should be taken by a vote of all the members of the Board present at the meeting. Review of Terms of Reference 22. These terms of reference will be reviewed and if required amended in March 2018, in line with the developing national and local STP agenda. Version draft v.02 2 August 2017 STP Governance Arrangements Page 10 of 10

71 GOVERNING BODY MEETING HEALTHIER LANCASHIRE AND SOUTH CUMBRIA SUSTAINABILITY AND TRANSFORMATION PARTNERSHIP (STP) DEVELOPMENT OF SHARED DECISION MAKING FOR THE JOINT COMMITTEE OF CLINICAL COMMISSIONING GROUPS (JCCCG) Date of Meeting 6 TH SEPTEMBER 2017 Agenda Item 11 CCG Corporate Objectives Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality GOVERG BODGOVERNING BODY MEETING Governing Body Meeting Page 1 of 2

72 Clinical Lead: Senior Lead Manager Finance Manager Equality Impact and Risk Assessment completed: Patient and Public Engagement completed: Financial Implications Risk Identified Report authorised by Senior Manager: Y Dr Chris Clayton Mr Roger Parr Mr Roger Parr N/A Public engagement through STP Communications Team Yet to be determined Financial Framework and Risk Register has been requested Dr Chris Clayton Decision Recommendations The Governing Body is requested to: i. Note that the Joint Committee of CCGs was established by the Lancashire and South Cumbria CCGs in December 2016 to facilitate effective and defensible shared decision making in support of the STP. ii. Note the expectations of national regulators for the evolution of shared decision making in this fasttrack STP. iii. Consider and approve the requested delegations for joint decision-making through the JCCCG for 2017/18, as described in Appendix 1. iv. Note that further delegations are likely to be requested in future around areas described in Appendix 2. v. Request that the JCCCGs reviews and strengthens the STP guiding principles for decision-making. vi. Note that CCG leaders have agreed to produce a Commissioning Development Strategy during the autumn of 2017 and this will be presented to Governing Bodies in due course. Governing Body Meeting Page 2 of 2

73 LSC STP Part 1 Governing Body paper FINAL Lancashire and South Cumbria STP Paper for CCG Governing Bodies Development of Shared Decision Making for the Joint Committee of CCGs 1. Purpose of the paper In the light of the publication of the Five Year Forward View Next Steps (March 2017), and the required establishment of the Lancashire & South Cumbria Sustainability and Transformation Partnership (STP), this paper puts forward proposals to the Governing Bodies of the 8 Lancashire & South Cumbria CCGs for the development of shared decisionmaking that will: enable effective shared decision making on agreed STP-wide priorities; give CCG Governing Bodies assurance on appropriate governance arrangements and confidence to delegate decision-making authority to the Joint Committee of CCGs; provide a consistent framework which also supports and clarifies decision-making in local accountable systems (Local Delivery Partnerships) and neighbourhoods. The organisations making up the Lancashire and South Cumbria STP have established a number of work-streams with the expectation that these will bring forward proposals requiring collective decision making by commissioners. For this reason, this paper requests the approval of each Governing Body to delegate a number of decisions that will need to be taken in 2017/18 and which may include a process leading to formal public consultation. This paper has been revised following an earlier opportunity for feedback from Governing Bodies the requested delegations, as set out in Appendix 1, have been adjusted to take account of the comments received. 2. Joint Committee of CCGs (JCCCGs) Early in 2016, NHS England required health and care organisations across geographical footprints to come together to agree five year Sustainability and Transformation Plans. Through the development of their plans, the partners were expected to demonstrate high levels of capability for joint working and shared decision making to address the identified gaps in health and well-being; care and quality; and finance and efficiency. Consequently, the 8 CCGs in Lancashire and South Cumbria established a Joint Committee, in line with legal advice on effective joint decision-making. The terms of reference of the Joint Committee (see Appendix 3) have been incorporated within the Constitution of each CCG. These terms of reference set out the types of decision that could be delegated to the Joint Committee, but not the specific decisions. In the light of the role of the Sustainability and Transformation Partnership described within the Five year Forward View the next steps, CCG Governing Bodies are now being asked to support an extension of delegated decision-making into the JCCCGs to make what are expected to be some important collective decisions during 2017/18. 1

74 LSC STP Part 1 Governing Body paper FINAL The JCCCGs was established in December 2016, and since then the committee has maintained commissioning oversight of the developing STP programme. Blackburn with Darwen CCG is represented by Mr Graham Burgess and Dr Chris Clayton on the JCCCGs. The role of the JCCCGs is to undertake the implementation of policies, specifications and new care models being generated by the work-streams that will require formal agreement by CCG Governing Bodies. The work-streams are: Acute & specialised services Urgent & emergency care Primary care Regulated care Population health & prevention Adult mental health & dementia Children s & young people s mental health & well being Learning disabilities & autism Enabling work-streams such as Digital, Workforce, Estates, Finance, leadership & OD To ensure effective decisions on issues requiring a collective approach across the STP, the Joint Committee terms of reference propose that decision-making on specified priority areas be formally delegated to the JCCCGs. In future, it is possible that the STP Board could also make recommendations for agreement of the outputs of the work-streams to the JCCCGs for consideration obviously within the scope of approved delegations. It is vital to emphasise that decisions coming to the JCCCGs for approval will do so after extensive development and consultation in each of the local areas in Lancashire and South Cumbria. 3. Requests for Delegated Decision making in 2017/18 Each of the STP work-streams has a Senior Responsible Officer (SRO). They have set out specific requests for a delegated decision(s) to the Joint Committee together with a rationale for the request and a statement about the expected impact on local health communities. Such requests have been split into two main groupings. Appendix 1 describes those decisions where SROs are requesting delegation for JCCCGs action during 2017/18. Appendix 2 describes those areas where further requests for delegation may be made in coming months in the meantime, SROs will wish to keep the Joint Committee fully up to date on progress. 4. Guiding Principles and Criteria for Decision Making There is a clear purpose in asking the Lancashire and South Cumbria CCGs to make some decisions together. This is because: We believe joint decision-making will give confidence to patients and the public that local NHS and local government organisations are able to work well together; 2

75 LSC STP Part 1 Governing Body paper FINAL It enables us to demonstrate how we will deliver a clinically and financially sustainable health and care system consistently and fairly across Lancashire and South Cumbria; It allows us to set out the common commissioning policies, care standards and outcomes we believe every patient should expect when they need local health and care services; We intend to reduce unnecessary variations in performance and outcomes and tackle inequalities in health; We must demonstrate that we have drawn on the latest evidence and advice for the configuration and development of local clinical services. The Terms of Reference for the Joint Committee of CCGs sets out a number of guiding principles for joint decision making: Guiding principles Healthier Lancashire and South Cumbria will adhere to the following principles: People and patients come first delivering parity of esteem and outcomes fairness and timeliness of access to support. Delivering a clinically and financially sustainable health and care system across Lancashire and South Cumbria ( L&SC ). Clinically-led, co-design and collaboration across L&SC Health & Care System delivering integrated support. Aligning priorities across Local Health and Care Systems and organisations managing sovereignty and risk. Prioritised effort on greatest benefit improving quality and outcomes efficiently and effectively. Ensuring Value for Money. Doing things right and doing the right things. Alignment of effort and resource twin citizenship of staff for L&SC and local levels. Built upon innovation, international evidence and proven best practice. Subsidiarity with clear framework of mutual accountability. Following previous Governing Body feedback, however, it is recommended that the JCCCGs reviews and strengthens these principles, alongside the developing evaluation criteria that will be used to support decision-making. 5. Risks and proposed mitigations There are identifiable risks associated with the requested delegations. Individual CCGs will wish to be confident that these are mitigated satisfactorily as the JCCCGs begins to address a more formal work plan and the system learns how to take effective collective decisions. Conversely, there are risks to all the CCGs in not taking important STP-wide decisions together. Risk The JCCCGs is presented with unclear evidence or rationale to support a recommendation. Work-stream is unable to produce sufficient evidence against the 5 national tests for reconfiguration proposals. Mitigation The JCCCGs will request the STP work-stream (and STP Board) to undertake additional analysis and evidence gathering before accepting the recommendation. Reconfiguration Tests to be a key element in the formal business cases developed to recommend major changes. 3

76 LSC STP Part 1 Governing Body paper FINAL JCCCGs supports a recommendation for investment which an individual CCG believes it cannot afford Delegated decision making arrangements do not create sufficient assurance and accountability for individual Governing Bodies. Inadequate understanding of the role of the JCCCGs with patients, public and NHS staff. Use STP financial framework developed by the Finance Investment Group (FIG) and approved by the STP Board. Framework to be used to assess proposals, create transitional funding arrangements, and agree pace of change and share risks. STP lead to commission a collective Internal Audit review on behalf of all 8 CCGs of the developing delegated decision making arrangements during 2017/18. STP communications & engagement strategy to ensure clear communication routes into local organisations, representative groups and networks. 6. Communications and Engagement A key attribute of an effective joint decision making approach will be to demonstrate effective communications and engagement across the STP, between the STP and local delivery footprints and between the STP and local organisations, CCG member practices, representative groups and networks. In receiving a number of requests for delegated decision making, CCGs are asked to support a two-way process of communication between the Joint Committee of CCGs and each Governing Body. This will be a critical area of learning and development during the remainder of 2017/ Commissioning Development in the STP Commissioning leaders from each CCG and NHSE met on 30th August 2017 to consider the priorities for commissioning development in the STP. It was agreed that current commissioning arrangements will need to evolve in the light of the 5 Year Forward View and that a strategy for Commissioning Development needs to be developed and agreed during the autumn of This will encompass: Collective commissioning how commissioners will take decisions together to address common priorities across the STP Local Delivery Partnerships how commissioners will support the development of accountable care arrangements in the 5 local health and care communities. Integrated commissioning how CCGs will work with other key partners including Local Government, NHS England and Midlands and Lancashire CSU to align priorities and resources 4

77 LSC STP Part 1 Governing Body paper FINAL 8. Recommendations The Governing Body is requested to: i. Note that the Joint Committee of CCGs was established by the Lancashire and South Cumbria CCGs in December 2016 to facilitate effective and defensible shared decision making in support of the STP. ii. Note the expectations of national regulators for the evolution of shared decision making in this fast-track STP. iii. Consider and approve the requested delegations for joint decision-making through the JCCCG for 2017/18, as described in Appendix 1. iv. Note that further delegations are likely to be requested in future around areas described in Appendix 2. v. Request that the JCCCGs reviews and strengthens the STP guiding principles for decision-making. vi. Note that CCG leaders have agreed to produce a Commissioning Development Strategy during the autumn of 2017 and this will be presented to Governing Bodies in due course Dr Chris Clayton Clinical Chief Officer August

78 LSC STP Part 1 Governing Body paper FINAL Appendix 1 - Proposed delegated decisions across STP work-streams during 2017/18 Work stream Delegated decisions Rationale for requesting delegation 1 Commissioning To ratify agreed set of Lancashire & South Cumbria wide clinical & prescribing commissioning and prescribing policies policies Alignment of decision making across L&SC with consistent application of an ethical framework and evidence base to support decision making Impact on local health economies Makes a standard offer to population across STP 2 Stroke To consider recommendations on the number of hyper acute sites required to meet the agreed specification for stroke services and on any proposed consultation process National and regional Delivers consistent offer outlier for stroke outcomes. for populations across Unexplained and unwanted Lancashire and South significant variation across Cumbria and reduces the pathway. Requires variations in outcomes consistent implementation 3 Adult Mental Health & Dementia To agree a revised Operating Model for implementation of nationally prescribed Mental Health & Well being strategy (MH Five year Forward View) including investment and resources, outcomes & standards at local and STP level Nationally defined delivery Delivers consistent offer plan with STP level for populations across accountability for delivery Lancashire and South requires collective plan for Cumbria and reduces consistent implementation variations in outcomes 4 Learning Disabilities To agree option for commissioning of CCG acute learning disability inpatient services Anticipated urgency of commissioner action upon LD in patient services Delivers consistent offer for populations across Lancashire and South Cumbria 6

79 LSC STP Part 1 Governing Body paper FINAL Appendix 2 - Work-streams where current actions may lead to requests for further delegated decisions during 2017/18 Work stream Current actions underway Rationale for requesting future delegation 1 Acute and Specialised Services To agree intended prioritisation of action, commencing with clinically fragile services; pathology, radiology and other diagnostic services; and urgent & emergency care, including A&E To agree consultation & engagement plan for co design of options and option appraisal, prior to formal consultation on service reconfiguration To agree evaluation criteria against which options would be assessed To launch formal consultation process To take decisions on the outcome of consultation process Scrutiny of process and assurance of adherence to legal requirements change will be across L&SC system therefore need consistent & standard scrutiny process Impact on local health economies Shifts point of control of process from LDP to STP level but with corresponding shift of assurance that all interdependencies are recognised and all local views are considered in light of these 2 Urgent and Emergency Care 3 Children & Young People s Mental Health and Wellbeing Ensuring alignment with outputs and time table for A&E review under A&SS work stream: To agree Urgent and Emergency Care Delivery plan for 17/18 to review current UEC system against national plan requirements To agree defined responsibilities of STP, LDP and A& E delivery boards and governance structure within the UEC delivery plan To agree process, specification and evaluation criteria against which designation of UTCs and walk in centres will take place To agree consultation & engagement plan for co design of options and option appraisal To agree Annual transformational plan To agree Annual business/delivery plan To agree key products to support delivery (eg consultation exercise material, service redesign plans& specifications, options appraisals) To agree products to offer system oversight Scrutiny of process and assurance of adherence to legal requirements change will be across L&SC system therefore need consistent & standard scrutiny process Scrutiny and sign off of system wide plan for implementation of national service requirements Shifts point of control of process from LDP to STP level but with corresponding shift of assurance that all interdependencies are recognised and all local views are considered in light of these Impact of action and investment will vary across economies to deliver consistent standard population offer 7

80 LSC STP Part 1 Governing Body paper FINAL Work stream Current actions underway Rationale for requesting future delegation 5 Adult mental health & dementia 6 Transforming Care (Learning disabilities) To approve case for change for STP wide MH commissioning function To agree business cases for specific developments in line with the MHFYFV including primary care and IAPT models To agree revised Operating Model for implementation of nationally prescribed Transforming Care programme including operational delivery and strategic commissioning roles, investment and resources, outcomes & standards To agree option for Commissioning of CCG acute learning disability inpatient services Impact on local health economies Nationally defined delivery Delivers consistent offer plan with STP level for populations across accountability for delivery Lancashire and South requires collective plan for Cumbria and reduces consistent implementation variations in outcomes Nationally defined delivery Delivers consistent offer plan with STP level for populations across accountability for delivery Lancashire and South requires collective plan for Cumbria and reduces consistent implementation variations in outcomes Anticipated urgency of commissioner action upon LD in patient services 8

81 LSC STP Part 1 Governing Body paper FINAL APPENDIX 3 JCCCGs Terms of Reference Title Healthier Lancashire and South Cumbriaa (HLSC): Terms of Reference (TORs) : Joint Committee of the Clinical Commissioning Groups (JCCCG) Responsible Person Date of Approval Approved By Author Date Created Date Last Amendedd Version Review Date Independent Chair 8 th December 2016 Joint Committeee of the Clinical Commissioning Groups Amanda Doyle 18 th April st December st December 2017 Publish on Public Website Yes Noo The version of the policy posted on the intranet must be a PDF copy of o the approved version Constitutional Document Requires an Equality Impact Assessment Yes Yes Noo Noo Amendment History Version Date Changes Updated to standardise all TORs within HLSCC The Purpose of the Joint Committee of the Clinical Commissioning Groups The NHS Act 2006 (as amended) ( the NHS Act ), was amended through the introduction of a Legislative Reform Order ( LRO ) to allow Clinical Commissioning Groups (CCGs) to form joint committees. This meanss that two or more CCGss exercising commissioning functions jointly may form f a joint committee as a result of the LRO amendment to s.14z3 (CCGs working together) of the NHS Act. Joint committees are a statutory mechanism which gives CCGs C an additional option for undertaking collectivee strategic decision making. Whilst NHS England (NHSE) will make decisionss on Specialised Commissioning separate from a joint j committee, as such decisionss cannot be delegated to a CCG or a joint j committee of CCGs; they can still make such decisions collaboratively withh CCGs. Although the Healthier Lancashire and South Cumbria Programmee (HLSC) will affect services commissioned by the Specialised Commissionin ng function of NHSE it has been decided that decisions on those services will be undertaken on a collaborative basis. This will allow sequential decisions to be undertaken allowingg clarity of responsibility but also recognising the linkage between the two decisions. Individual CCGs and NHSE will still always remain accountable for meeting their statutory duties. The aim of creating a joint committeee is to encourage the development of strong collaborative and integrated relationships and decision-making between partners. 9

82 LSC STP Part 1 Governing Body paper FINAL 1.5 The Joint Committee of Clinical Commissioning Groups ( JC CCGs ) is a joint committee of: NHS Blackburn with Darwen CCG; NHS Blackpool CCG; NHS Chorley & South Ribble CCG; NHS East Lancashire CCG; NHS Fylde & Wyre CCG; NHS Greater Preston CCG; NHS Lancashire North CCG; NSH West Lancashire CCG. With NSH Cumbria CCG invited to be an associate member of the JC CCGs with no voting rights. 1.6 The primary purpose of the JC CCGs is decision making on pertinent Lancashire and South Cumbria wide commissioning issues that arise from the Programme. 1.7 In addition, the JC CCGs will meet collaboratively with NHSE to make integrated decisions in respect of those services within the Programme which are directly commissioned by NHSE. 1.8 The Programme - Health leaders across the Healthier Lancashire and South Cumbria area have collectively committed to change the way certain elements of health care are provided to the local population to deliver the highest quality of care possible within the resources available. The work of the Programme is designed to deliver key clinical standards consistently across the patch so that all people receive the highest possible care and best outcomes. The relevant clinical work streams which the JC CCGs will consider under the Programme are: Acute and Specialized Urgent & Emergency Care Mental Health Population Health Model Population Integrated locality Delivery Model 1.9 Currently for those people who do need in-hospital treatment care can be variable in terms of outcomes because not all hospitals or services meet the agreed clinical quality standards, the hospitals are competing to provide the same services in a health economy that is constrained by both finance and capacity, particularly certain elements of the workforce, to deliver services at the levels required. From the work carried out to date, it is clear that it is not sustainable to carry on without changing the way health services are delivered both regionally and locally HLSC will establish a Programme Board to oversee the development of agreed clinical quality standards, a feasibility analysis looking at the implications of implementing these standards, a clinical case for change, a financial case for change and a model of care. 10

83 LSC STP Part 1 Governing Body paper FINAL 1.11 Guiding principles: The Healthier Lancashire and South Cumbria Programme is proposing to adhere to the following principles as a minimum: People and patients come first delivering parity of esteem and outcomes fairness and timeliness of access to support. Delivering a clinically and financially sustainable health and care system across HLSC. Clinically-led, co-design and collaboration across HLSC Health & Care System delivering integrated support. Aligning priorities across Local Health and Care Systems and organisations managing sovereignty and risk. Prioritised effort on greatest benefit improving quality and outcomes efficiently and effectively. Ensuring Value for Money. Doing things right and doing the right things. Alignment of effort and resource twin citizenship of staff for HLSC and local levels. Built upon innovation, international evidence and proven best practice. Subsidiarity with clear framework of mutual accountability. 2. Statutory Framework 2.1 The NHS Act which has been amended by LRO 2014/2436, provides at s.14z3 that where two or more clinical commissioning groups are exercising their commissioning functions jointly, those functions may be exercised by a joint committee of the groups. 2.2 The CCGs named in paragraph 1.5 above have delegated the functions set out in Schedule 1 to the JC CCGs. 3. Role of the JC CCGs 3.1 The role of the JC CCGs shall be to carry out the functions relating to decision making on pertinent Lancashire and South Cumbria wide commissioning issues that arise from the Programme. 3.2 In relation to Acute and Specialised Services - The JCCCG will collaborate with NHSE, on that which is theirs to commission in relation to aspects as yet to be agreed, but leading is the delivery on an agreed HLSC strategy aligned to national conditions. 3.3 In relation to Urgent and Emergency Care (UEC) The JCCCG will ensure that national standards are delivered and that there is in place an agreed UEC model developed against theses with all interdependencies mapped and considered. 3.4 Mental Health The JCCCGs will recognise that this programme encompasses all ages and people with learning disabilities. Decisions will relate to the development of parity of esteem and delivery of national strategies. This will be done through clarity of relevant pathways and understanding what the potential reconfiguration aspects are to then agree JCCCG decisions and local decisions. 3.5 In relation to Prevention and Population Health Model The JCCCG will provide strategic input into the delivery of a Prevention and Population Health Model to the member CCGs across the region. This will enable the member CCGs to make local decisions in alignment with the regional strategic objective. 11

84 LSC STP Part 1 Governing Body paper FINAL 3.6 This includes, but is not limited to, the following activities: Determine the options appraisal process; Determine the method and scope of the engagement and consultation processes; Act as the formal body in relation to consultation with the Joint Overview and Scrutiny Committees established for this Consultation by the relevant Local Authorities; Make any necessary decisions arising from a Pre-Consultation Business Case (and the decision to run a formal consultation process); Approve the Consultation Plan; Approve the text and issues on which the public s views are sought in the Consultation Document; Take or arrange for all necessary steps to be taken to enable the CCG to comply with its public sector equality duties; Approve the formal report on the outcome of the consultation that incorporates all of the representations received in response to the consultation document in order to reach a decision; Make decisions about future service configuration and service change, including but not exclusively relating to the work on consolidation and the reconfiguration of Acute Services across HLSC, taking into account all of the information collated and representations received in relation to the consultation process. This should include consideration of any recommendations made by the Programme Board or views expressed by the Joint Health Overview and Scrutiny Committee or any other relevant organisations and stakeholders. 3.7 At all times, the Joint Committee, through undertaking the decision making function of each member CCG will act in accordance with the terms of their constitutions. No decision outcome shall impede any organisation in the fulfillment of its statutory duties. 4. Geographical Coverage 4.1 The JC CCGs will comprise those CCGs listed above in paragraph 1.5 and cover the Lancashire and South Cumbria region. 4.2 NHS England Specialised Commissioning will also be involved through a collaborative commissioning arrangement. 4.3 The Joint Committee will have the primary purpose of decision on pertinent Lancashire and South Cumbria wide commissioning issues that arise from the Programme. 5. Membership 5.1 Membership of the committee will combine both Voting and Non-voting members and will comprise of: Voting members: The two individuals appointed to represent each of the member CCGs, subject to such voting being in compliance with paragraph 7 below on Voting. (Whilst the JC CCG does not require a clinical majority the CCG members should ensure it consists of clinicians, lay members and executives.) 12

85 LSC STP Part 1 Governing Body paper FINAL 5.3 Non-voting attendees: The Independent Chair of the Joint Committee; A vice chairman to be elected from the membership of the JC CCGs by the members and who will retain their voting rights. The Senior Responsible Officer for the Programme; The Assistant Director NHS England Specialised Commissioning will be invited to each meeting in a non-voting capacity; A Healthwatch representative nominated by the local Healthwatch groups; Such representation from the Combined and/ or Local Authorities as the JC CCG deems appropriate. The Clinical Lead for the Programme The Lead for the Prevention and Wellbeing Programme The Chairs of: The Care System Design Board Finance and Investment Group Programme Director and Chair of the Programme Management Group. 5.4 Committee members may nominate a suitable deputy when necessary and subject to the approval of the Chair of the Joint Committee. All deputies should be fully briefed and the secretariat informed of any agreement to deputise so that quoracy can be maintained. 5.5 No person can act in more than one role on the Joint Committee, meaning that each deputy needs to be an additional person from outside the Joint Committee membership. 6. Meetings The Joint Committee shall adopt the standing orders of Blackpool CCG insofar as they relate to the: a) notice of meetings b) handling of meetings c) agendas d) circulation of papers e) conflicts of interest Notice of Meetings and the Business to be transacted (1) Before each meeting of the JCCCG, a written notice specifying the business proposed to be transacted shall be sent to every member of the JCCCG and every member practice of the Group at least six clear days before the meeting. (2) No business shall be transacted at the meeting other than that specified on the agenda, or emergency motions allowed under Standing Order 3.8. (3) Before each public meeting of the Governing Body a public notice of the time and place of the meeting, and the public part of the agenda, shall be displayed on the Group s website at least three clear days before the meeting 13

86 LSC STP Part 1 Governing Body paper FINAL 7. Voting 7.1 The Joint Committee will aim to make decisions by consensus wherever possible. Where this is not achieved, a voting method will be used. The voting power of each individual present will be weighted so that each party (CCG) possesses 12.5% of total voting power. 7.2 It is proposed that recommendations can only be approved if there is approval by more than 75%. 8. Quorum 8.1 At least one full voting member from each CCG must be present for the meeting to be Quorate. 9. Frequency of Meetings 9.1 Frequency of meetings will usually be monthly, but as and when required 10. Meetings of the Joint Committee 10.1 Meetings of the Joint Committee shall be held in public unless the Joint Committee considers that it would not be in the public interest to permit members of the public to attend a meeting or part of a meeting. Therefore, the Joint Committee may resolve to exclude the public from a meeting that is open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time Members of the Joint Committee have a collective responsibility for the operation of the Joint Committee. They will participate in discussion, review evidence and provide objective expert input to the best of the knowledge and ability, and endeavor to reach a collective view The Joint Committee may call additional experts to attend meetings on an ad hoc basis to inform discussions The Joint Committee has the power to establish sub groups and working groups and any such groups will be accountable directly to the Joint Committee Members of the Joint Committee shall respect confidentiality requirements as set out in the Standing Orders referred to above unless separate confidentiality requirements are set out for the Joint Committee in which event these shall be observed. 14

87 LSC STP Part 1 Governing Body paper FINAL 11. Secretariat Provisions 11.1 The Programme Director (supported by the Programme Management Group) will act as secretariat to the Committee to ensure the day to day work of the Joint Committee is proceeding satisfactorily. The membership will meet the requirements of the constitutions of the 8 Lancashire CCGs The agenda and support papers will be circulated by 5 working days prior to the meeting Papers may not be tabled without the agreement of the Chair Minutes will be taken by the support officer and distributed to the members within 7 working days after the meeting Minutes will be available to be published in the public domain unless there are discussions which need to be recorded confidentially - in which case there will be recorded separately and will not be made public Agenda and papers to be agreed with the Chairman 7 working days before the meeting All papers agreed by the Chairman should be received by the Administrator 7 working days in advance of the meeting. 12. Reporting to CCGs and NHS England 12.1 The Joint Committee will make a quarterly written report to the CCG member governing bodies and NHS England and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives. 13. Decisions 13.1 The Joint Committee will make decisions within the bounds to the scope of the functions delegated The decisions of the Joint Committee shall be binding on all member CCGs, which are: Blackburn with Darwen CCG; Blackpool CCG; Chorley & South Ribble CCG; East Lancashire CCG; Fylde & Wyre CCG; Greater Preston CCG; Lancashire North CCG; and West Lancashire CCG. With Cumbria CCG invited to be an associate member of the JC CCGs with no voting rights All decisions undertaken by the Joint Committee will be published by the Clinical Commissioning Groups 14 Review of Terms of Reference 14.1 These terms of reference will be formally reviewed by Clinical Commissioning Groups set out in paragraph 15.2 at least annually, taking the date of the first meeting, following the year in which the JC CCG is created and may be amended by mutual agreement between the CCGs at any time to reflect changes in circumstances as they may arise. The power to add Cumbria CCG as a full member with voting rights to the JC CCGs is delegated to the JC CCGs itself. 15. Withdrawal from the Joint Committee 15.1 Should this joint commissioning arrangement prove to be unsatisfactory, the governing body of any of the member CCGs or NHS England can decide to withdraw from the arrangement, but has to give six months notice to partners, with new arrangements starting from the beginning of the next new financial year. 15

88 LSC STP Part 1 Governing Body paper FINAL 16. Signatures Blackburn with Darwen CCG Blackpool CCG Chorley & South Ribble CCG East Lancashire CCG Fylde & Wyre CCG Greater Preston CCG Lancashire North CCG West Lancashire CCG 16

89 LSC STP Part 1 Governing Body paper FINAL Schedule 1 - Delegation by CCGs to Joint Committee A. The following CCG functions will be delegated to the Joint Committee of CCGs ( the JC CCGs ) by the member CCGs in accordance with their statutory powers under s.14z3 of the NHS Act 2006 (as amended). s.14z3 allows CCGs to make arrangements in respect of the exercise of their functions and includes the ability for two or more CCGs to create a Joint Committee to exercise functions. The delegated functions relate to the health services provided to the member CCGs by all providers they commission services from in the exercise of their functions. B. The Lancashire and South Cumbria Change Programme ( the Programme ) focuses on achieving clinical quality standards in the services listed below provided by the NHS Trusts named above. As part of this work it is necessary to consider interdependencies between these services and any other services that are affected. The relevant services are: a. All elements of the Programme, including the Case for Change, evaluation criteria, options, communications plan and such like. b. Such other services not set out above which the CCG members of the JC CCGs determine should be included in the programme of work. C. Each member CCG shall also delegate the following functions to the JC CCGs so that it can achieve the purpose set out in (A) above: a. Acting with a view to securing continuous improvement to the quality of commissioned services in so far as these services are included within the scope of the Programme. This will include outcomes for patients with regard to clinical effectiveness, safety and patient experience to contribute to improved patient outcomes across the NHS Outcomes Framework b. Promoting innovation in so far as this affects the services included within the scope of the Programme, seeking out and adopting best practice, by supporting research and adopting and diffusing transformative, innovative ideas, products, services and clinical practice within its commissioned services, which add value in relation to quality and productivity. c. The requirement to comply with various statutory obligations, including making arrangements for public involvement and consultation throughout the process. That includes any determination on the viability of models of care pre-consultation and during formal consultation processes, as set out in s.13q, s.14z2 and s.242 of the NHS Act 2006 (as amended) ( the Act ) d. The requirement to ensure process and decisions comply with the four key tests for service change introduced by the last Secretary of State for Health, which are: Support from GP commissioners; Strengthened public and patient engagement; Clarity on the clinical evidence base; Consistency with current and prospective patient choice. e. The requirement to comply with the statutory duty under s.149 of the Equality Act 2010 i.e. the public sector equality duty. 17

90 LSC STP Part 1 Governing Body paper FINAL f. The requirement to have regard to the other statutory obligations set out in the new sections 13 and 14 of the NHS Act. The following are relevant but this is not an exhaustive list: 13C and 14P - Duty to promote the NHS Constitution 13D and 14Q - Duty to exercise functions effectively, efficiently and economically 13E and 14R Duty as to improvement in quality of services 13G and 14T - Duty as to reducing inequalities 13H and 14U Duty to promote involvement of each patient 13I and 14V - Duty as to patient choice 13J and 14W Duty to obtain appropriate advice 13K and 14X Duty to promote innovation 13L and 14Y Duty in respect of research 13M and 14Z - Duty as to promoting education and training 13N and 14Z1- Duty as to promoting integration 13Q and 14Z2 - Public involvement and consultation by NHS England/CCGs 13O - Duty to have regard to impact in certain areas 13P - Duty as respects variations in provision of health services 14O Registers of Interests and management of conflicts of interest 14S Duty in relation to quality of primary medical services g. The JC CCGs must also have regard to the financial duties imposed on CCGs under the NHS Act 2006 and as set out in: 223G Means of meeting expenditure of CCGs out of public funds 223H Financial duties of CCGs: expenditure 223I - Financial duties of CCGs: use of resources 223J - Financial duties of CCGs: additional controls of resource use h. Further, the JC CCGs must have regard to the Information Standards as set out in ss.250, 251, 251A, 251B and 251C of the Health & Social Care Act 2012 (as amended). i. The expectation is that CCGs will ensure that clear governance arrangements are put in place so that they can assure themselves that the exercise by the JC CCGs of their functions is compliant with statute. j. The JC CCGs will meet the requirement for CCGs to comply with the obligation to consult the relevant local authorities under s.244 of the NHS Act and the associated Regulations. k. To continue to work in partnership with key partners e.g. the local authority and other commissioners and providers to take forward plans so that pathways of care are seamless and integrated within and across organisations. l. The Joint Committee will be delegated the capacity to propose, consult on and agree future service configurations that will shape the medium and long terms financial plans of the constituent organisations. The Joint Committee will have no contract negotiation powers meaning that it will not be the body for formal annual contract negotiation between commissioners and providers. These processes will continue to be the 18

91 LSC STP Part 1 Governing Body paper FINAL responsibility of Clinical Commissioning Groups and NHS England under national guidance, tariffs and contracts during the pre-consultation and consultation periods. m. The JC CCGs is given the specific power to make Cumbria CCG a full voting member of the JC CCGs, including approving appropriate amendments to the ToR for such specific purpose, when it determines that to be appropriate. D. The role of the JC CCGs shall be to carry out the functions relating to decision making on pertinent Lancashire and South Cumbria wide commissioning issues that arise from the Programme. This includes, but is not limited to, the following activities: Determine the options appraisal process; Determine the method and scope of the engagement and consultation processes; Act as the formal body in relation to consultation with the Joint Overview and Scrutiny Committees established for this Consultation by the relevant Local Authorities; Make any necessary decisions arising from a Pre-Consultation Business Case (and the decision to run a formal consultation process); Approve the Consultation Plan; Approve the text and issues on which the public s views are sought in the Consultation Document; Take or arrange for all necessary steps to be taken to enable the CCG to comply with its public sector equality duties; Approve the formal report on the outcome of the consultation that incorporates all of the representations received in response to the consultation document in order to reach a decision; Make decisions about future service configuration and service change, taking into account all of the information collated and representations received in relation to the consultation process. This should include consideration of any recommendations made by the Programme Board or views expressed by the Joint Health Overview and Scrutiny Committee or any other relevant organisations and stakeholders. At all times, the Joint Committee, through undertaking the decision making function of each member CCG will act in accordance with the terms of their constitutions. No decision outcome shall impede any organisation in the fulfillment of its statutory duties. Schedule 2 - List of Members from each Constituent CCG 19

92 GOVERNING BODY ASSURANCE FRAMEWORK GOVERNING BODY MEETING Date of Meeting 6 th SEPTEMBER 2017 Agenda Item 12 CCG Corporate Objectives Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care Y Y Y Y Y Y CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality GOVERG BODGOVERNING BODY MEETING Y Y Y Y Y Y Y Y Y Governing Body Meeting Page 1 of 5

93 Clinical Lead: Senior Lead Manager Finance Manager Equality Impact and Risk Assessment completed: Patient and Public Engagement completed: Financial Implications Risk Identified Report authorised by Senior Manager: Y DR CHRIS CLAYTON MRS CLAIRE MOIR N/A N/A N/A N/A WITHIN THE REPORT MR ROGER PARR Decision Recommendations The Governing Body is asked to: Note the contents of the report Review the Governing Body Assurance Framework Risks Governing Body Meeting Page 2 of 5

94 1. Introduction NHS BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BODY MEETING WEDNESDAY 6 th SEPTEMBER 2017 GOVERNING BODY ASSURANCE FRAMEWORK 1.1 The purpose of this report is to present the CCG s Governing Body Assurance Framework for review. The report also provides an update on the findings of a Mersey Internal Audit Agency Assurance Framework benchmarking review, and, updates members on progress with the completion of the Annual Risk Appetite toolkit exercise. 2. Background 2.1 The CCG is required to have in place a system of internal control that supports the achievement of the organisation s strategic aims and objectives. The GBAF is a key document which links the corporate objectives to risks, controls and assurances and is the main tool that the Governing Body uses to discharge its overall responsibility for internal control. 2.2 The GBAF is designed to ensure the requirements of the annual reporting arrangements i.e. the Annual Governance Statement (AGS) are met and that principal risks to the CCG achieving its Objectives are managed appropriately. 3. Corporate Objective Risks 2017/ There are currently 6 risks held on the CCG s GBAF: CO1.1: There is a risk that ineffective commissioning decisions will prevent the CCG from achieving its corporate objectives, improving health and reducing inequalities CO2.1: System-wide capacity issues may emerge that prevent the delivery of the CCG's plans and priorities CO3.1: Failure to effectively manage demand, activity and cost pressures across the health system may impact on the CCG delivering its financial targets CO4.1: The local health economy may not be sustainable unless there is a programme of change CO5.1: There is a risk that providers delivery poor quality care and do not meet standards and outcomes CO6.1: Clinical workforce capacity is challenged across the system Governing Body Meeting Page 3 of 5

95 4. Review of GBAF Risks 2017/8 4.1 All GBAF risks have been reviewed by the risk owner and there are no changes to report in risk ratings. 5. Update on Corporate Objective Risks 5.1 The Governing Body has delegated authority to the Pennine Lancashire Quality Committee for the management of risks of the CCG s Corporate Risk Register (CRR). Significant work has been undertaken to develop a joint risk management report between Blackburn with Darwen and East Lancashire CCG and this is presented for review by the PLQC on a monthly basis. 5.2 The following risks are held by both CCGs; further work is underway to either align the risk ratings, or provide a rationale as to why the risk ratings are different for each CCG on the jointly held risks : 95% Accident and Emergency 4 hour standard 62 day cancer target Ambulance performance Initial Health Assessments for Looked After Children Performance against financial targets Lack of inpatient beds for Children and Young People with Mental Health Issues The outcome of this work will be presented to the September 2017 PLQC meeting. 6. Mersey Internal Audit Agency (MIAA) Assurance Framework Opinion Benchmarking 6.1 The CCG s Audit Committee has received the latest benchmarking report issued by MIAA which provides general observations based on its review of 54 CCG s Assurance Frameworks. 6.2 The findings of the report have been reviewed against the CCG s GBAF which has recently received an assurance rating of green from MIAA on its structure, engagement and quality/alignment. 6.3 However, areas for improvement, based on the benchmarking review have been identified including strengthening the associated action plans and timescales to support the gaps and actions on controls. Work is currently underway to support this, and any associated changes to the GBAF will be reported to the Governing Body. 7. Annual Risk Appetite Exercise 7.1 The CCG s Governing Body undertakes an annual exercise based on The Good Governance Institute s toolkit for testing risk appetite. Governing Body Meeting Page 4 of 5

96 7.2 This requires each member to select a level of risk from 0 (avoid), 1(minimal), 2 (cautious), 3 (open), 4 (seek) and 5 (mature) against the following elements: Financial/Value for Money Compliance/Regulatory Innovation/Quality/Outcomes Reputation 7.3 The results are currently being collated and the findings will be reported at the next Governing Body meeting. 8. Recommendations 8.1 The Governing Body is asked to: Note and discuss the contents of the report Review the Governing Body Assurance Framework Risks Claire Moir Governance, Assurance and Delivery Manager 29 th August 2017 Governing Body Meeting Page 5 of 5

97 NHS Blackburn with Darwen Clinical Commissioning Group Governing Body Assurance Framework 2017/18 PAGE 9

98 Governing Body Assurance Framework 2017/8 : NHS Blackburn with Darwen CCG MENU Corporate Objective Corporate Objective 1: Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities Risk Ineffective commissioning decisions may prevent the CCG from achieving its corporate objectives, improving health and reducin g inequalities CO1.1 Initial Current Target Risk Owner Claire Jackson Likelihood Possible Possible Unlikely Financial / VFM Severity Major Major Major Compliance / Regulatory Level Innovation / Quality / Outcomes Date Apr-17 Sep-17 Apr-18 Reputation Controls The CCG has submitted its operational plan for 2017/18 to NHS England. Routine contract monitoring of delivery against these plans will be undertaken (Integrated Business Report, contract and performance meetings) The CCG's Plans developed in conjunction with Health and Wellbeing Board and the Integrated Strategic Needs Assessment (ISNA). Health and Wellbeing Strategy also informs CCGs plans and local health issues and significant barriers to improving health and reducing inequalities CCG Governing Body receives assurance and progress updates on implementation of its annual plans Commissioning Business Group and Primary Care Commissioning Committee established with responsibility for developing, approving and monitoring plans and business cases. The CCG has full delegated authority from NHS England to co-commission primary care which enables the CCG to provide a strong focus on local clinical leadership and enable optimal decision making on investment across primary, secondary and community services Use of "Rightcare" metrics to support decision making. Areas for greatest potential opportunities have been reviewed and plans for 3 priority areas submitted to NHS England (MSK, Medicines, Respiratory) Gaps in Controls Fragmentation of the commissioning system may slow down decision making The frequency and timeliness of performance monitoring data varies according to the measure e.g. Potential Years of Life Lost (PYLL) figures are produced annually Assurance CCG Governing Body receives papers and minutes from Commissioning Business Group Monthly Contracting and Finance report update presented to Governing Body Monthly Quality and Performance report presented to Pennine Lancs Quality Committee Minutes of contract and performance meetings External assurance provided through NHS England Improvement and Assessment Framework for 2017/18 CCG's operational plan 2017/18 has been assured by NHS England. A narrative plan for 2017/18 has been submitted to NHS England outlining how the CCG will deliver the national "must do's" The BCF Plan is aligned to Operational Plans 360 degree stakeholder survey findings are reviewed and areas for improvement built into the CCG's commissioning processes Gaps in Assurance Currently limited information on community services, primary care or specialist commissioning plans or performance monitoring information Health outcomes in certain areas are not improving as expected ACTION PLAN Action Assigned to Due Action Description Progress to Date Date Completed An assurance framework/commissioning plan tracker has been Implement process for reviewing the effectiveness of CCG's commissioning developed linked to QIPP/Cases for Change 2017/18 Claire Jackson Review monthly decisions PAGE 1

99 Governing Body Assurance Framework 2017/8 : NHS Blackburn with Darwen CCG MENU Corporate Objective Corporate Objective 2: To work collaboratively to create safe, high quality health care services Risk System-wide capacity issues may emerge that prevent the delivery of the health economy's plans and priorities CO2.1 Initial Current Target Risk Owner Roger Parr Likelihood Possible Possible Unlikely Financial / VFM Severity Major Major Major Compliance / Regulatory Level Innovation / Quality / Outcomes Date Apr-17 Sep-17 Apr-18 Reputation Controls The Pennine Lancashire Health Economy has developed a Health and Social Care Escalation Plan which ensures a continuous cycle of capacity and escalation planning to ensure the position across Pennine Lancashire remains resilient during periods of increased demand Programme Management Office function (which CCG contributes to) is now in place to oversee delivery of Pennine Lancashire transformational plans Lancashire Leadership Forum established by NHS England to support the Lancashire and South Cumbria change Programme (delivery of care in and outside of hospital). NHS Accelerate Programme developed to explore innovative models of care A&E Delivery Board established and meets monthly GP Federation has established the GP Access Fund (GPAF) which is now providing 7 day access Lancashire wide forums established to review system wide capacity issues Assurance Minutes of Pennine Lancashire Clinical Transformation Board External assurance provided through the NHS England Improvement and Assessment Framework assurance Strong relationships and leadership across the health and social care economy A&E Delivery Board (supported by the A&E Delivery Group) meets monthly and is overseeing plans to improve the delivery of urgent and emergency care Gaps in Controls The frequency and timeliness of performance data varies according to the measure e.g. reducing emergency admissions through urgent care data is produced quarterly, but the comparison of performance is made year on year Currently aligning financial deficit to proposed Sustainability and Transformational plans for Lancashire and South Cumbria Gaps in Assurance Health economy-wide Sustainability and Transformational plans/future models of care still developing Pennine Lancashire Local Delivery Plans still developing ACTION PLAN Action Assigned to Due Action Description Progress to Date Date Completed Roger Parr Action to mitigate this risk are currently under review PAGE 2

100 Governing Body Assurance Framework 2017/18 : NHS Blackburn with Darwen CCG MENU Corporate Objective Corporate Objective 3: To deliver financial balance and improve efficiency and productivity Risk Failure to effectively manage the increase in demand, activity and cost pressures across the health system may impact on the CCG delivering its financial targets CO3.1 Initial Current Target Risk Owner Roger Parr Likelihood Likely Likely Possible Financial / VFM Severity Major Major Major Compliance / Regulatory Level Innovation / Quality / Outcomes Date Apr-17 Sep-17 Apr-18 Reputation Controls CCG Governing Body approved budget for 2017/18 including contingency reserves Financial recovery plan submitted to NHS England Demand management initiatives in place ; the CCG is systematically working through the Rightcare process (wave 2 CCG) with delivery partner support; 3 priority areas for greatest potential opportunities have been identified and plans submitted to NHS England Financial plan underpinning strategic plan in place Established budgetary control system Monthly meetings with budget holders Corporate framework including scheme of delegation in place CCG Exec Team assigned responsibilities for QIPP savings programme CCG ET considers overall performance and ensures corrective action taken as required Finance recovery plan monitored through Operational Delivery Group and Executive Team Assurance Demand and activity is monitored throughout the financial year; risk score amended based on the increasing (or decreasing) likelihood that targets will be met Finance and activity plans has been produced for 2017/18 and submitted to NHS England QIPP tracker used to monitor performance against transactional and transformational initiatives. Potential impacts have been quantified and these are monitored and updated on a weekly basis to track actions undertaken and any financial adjustments. The CCG is due to implement a referral quality improvement scheme in September 2017 Commissioning intentions have been developed for 2017/18 and associated contract values agreed with providers Finance and Scrutiny Group meet monthly and receive detailed progress reports on QIPP initiatives Gaps in Controls Continuing to experience underlying growth in activity Impact of schemes/business cases may not be realised immediately Gaps in Assurance CCG's assurance status is rated "red" on finance targets ACTION PLAN Action Assigned to Due Action Description Progress to Date Date Completed Roger Parr Review monthly Continuing to progress QIPP schemes to close financial gap in year 2017/18 on-going Roger Parr Review monthly Utilise Rightcare metrics to identify areas where CCG is an outlier on spend and activity. Regular meetings held with delivery partner on-going PAGE 6 Malcolm Ridgway Sep - Dec 2017 Implementation of referral quality improvement scheme The scheme will be reviewed in December 2017

101 Governing Body Assurance Framework 2017/8 : NHS Blackburn with Darwen CCG MENU Corporate Objective Corporate Objective 4: To deliver a step change in the NHS in preventing ill health and supporting people to live healthier lives Risk The Local Health Economy may not be sustainable unless there is a programme of change CO4.1 Initial Current Target Risk Owner Claire Jackson Likelihood Possible Possible Unlikely Financial / VFM Severity Major Major Major Compliance / Regulatory Level Innovation / Quality / Outcomes Date Apr-17 Sep-17 Apr-18 Reputation Controls System Leaders Forum (SLF) now established with responsibility for overseeing the Together a Healthier Future Transformation Programme The SLF has agreed five key tests that the transformation programme will focus on over next 12 months; each test is scheduled for consideration through the SLF forum System Accountable Officer and Local Leadership (Senior Responsible Officer) arrangements for each element of the change programme identified Clear process for developing Sustainability and Transformational Plans (STP) set out through a series of Solution Design workshops End to End Overarching Timeline for completion set with milestones to monitor progress Resource plan developed External agency providing specialists support to assist in financial modelling (Deloittes) Assurance System Leaders Forum membership includes senior leaders from key organisations (BwD CCG, East Lancs CCG, East Lancashire Hospitals Trust, Lancashire Care Foundation Trust, BwD Borough Council and Lancashire County Council SLF has set the overarching strategic direction for the transformation programme with a key focus on developing plans for new models of care and an Accountable Care System for Pennine Lancashire Senior Responsible Officers from organisations released to support the development of the plans and systems for health and care Gaps in Controls Process to undertake gap analysis and definition of key priorities to be undertaken Resource plan awaiting review by System Leaders Forum Gaps in Assurance Scale of financial challenge and alignment of commissioner/provider plans may impact on delivery of plans Final case for change business case still awaited ACTION PLAN Action Assigned to Due Action Description Progress to Date Date Completed Claire Jackson Actions to mitigate this risk are currently under review PAGE 6

102 Governing Body Assurance Framework 2017/8 : NHS Blackburn with Darwen CCG MENU Corporate Objective Corporate Objective 5: To maintain and improve performance against NHS core standards and statutory requirements Risk There is a risk that providers deliver poor quality care and do not meet quality standards and outcomes CO5.1 Initial Current Target Risk Owner Dr Malcolm Ridgway Likelihood Possible Possible Unlikely Financial / VFM Severity Major Major Major Compliance / Regulatory Level Innovation / Quality / Outcomes Date Apr-17 Sep-17 Apr-18 Reputation Controls Joint Pennine Lancashire Quality Committee (PLQC) established and meets monthly Internal quality structures functioning well as confirmed through internal audit reports (high assurance on performance reporting) Monitoring assurance received through contractual route that provider cost improvement plans will not negatively impact on quality and safety of services Lancashire Quality Surveillance Group established and Provider Quality Accounts reviewed by PLQC Patient experience monitored using patient surveys Quality and performance lead attends monthly Community Contract Quality and Performance meetings Primary Care Quality Group established which will monitor primary care quality data/framework Routine GP practice visits underway Assurance Pennine Lancashire Quality Committee minutes Integrated Quality, Performance and Effectiveness Reports and exception reports CQC inspection visits reports (ELHT and LCFT both now rated "Good") Minutes from Contract and Performance meetings NHS England external assurance meetings (monthly) - quality issues discussed Mersey Internal Audit Agency Review s CSU Quality and Performance Team reviewed provider quality accounts External assurance received via Healthwatch reports which are now regularly received and reviewed via the CCG's Operational Delivery Group Gaps in Controls Availability of quality data relating to community services is improving but still needs development Awaiting quality and performance dashboard from NHS England to enable monitoring of general practice Gaps in Assurance ACTION PLAN Action Assigned to Due Action Description Progress to Date Date Completed Malcolm Ridgway review quarterly Monitor progress against Quality Strategy on-going Quality and performance lead from CCG now attends Contract Quality and Malcolm Ridgway review monthly Performance meetings on-going PAGE 9

103 Governing Body Assurance Framework 2017/18 : NHS Blackburn with Darwen CCG Corporate Objective Corporate Objective 6: To commission improved out of hospital care MENU Risk Clinical workforce capacity is challenged across the system CO6.1 Initial Current Target Risk Owner Dr Malcolm Ridgway Likelihood Likely Likely Possible Financial / VFM Severity Major Major Major Compliance / Regulatory Level Innovation / Quality / Outcomes Date Apr-17 Sep-17 Apr-18 Reputation Controls Workforce Development Group established to review opportunities for recruitment and retention (short/medium term) with Health Education North West. Wider system re-design is planned (new models of care/organisational form) to stimulate workforce recruitment and retention across the health economy. Wider system re-design is planned (new models of care/accountable care system) to stimulate workforce recruitment and retention across the system. CCG has full delegated authority to co-commission primary medical care which enhances the CCGs remit to influence local GP workforce development in conjunction with NHS England including supporting General Practice in workforce review, skill mix, and development. New roles in primary care will be encouraged to create a sustainable workforce across primary care as a whole including increasing Advanced Nurse Practitioners and Health Care Assistants to allow GPs to become Expert Generalists. Integrated localities will support this through reducing GP workload to allow them to take on more complex work. QOEST scheme will allow practices to plan ahead in terms of sustainable workforce. Physicians Associates have commenced their training Contractual levers used to ensure commissioned levels of activity delivered. LCFT and ELHT are recruiting nationally and internationally using innovative recruitment strategies Gaps in Controls On-going financial pressures on NHS resources 2017/18 Capacity and workforce pressures are exacerbating existing recruitment and retention problems Physicians Associates will require 2 year training programme Clinical Workforce capacity is a national issue (reported as 5.9% shortage) Cap on agency spend is exacerbating issues with safe staffing levels which is impacting on service delivery (reduction in local health services) Assurance Primary Care Strategy is approved and finalised. 5 year Sustainability and Transformation Plan covering a Lancashire and South Cumbria footprint sets out the ambitions for transformational change including workforce requirements. CCG has engaged with both Health Education North West and Pennine Lancashire organisations to review opportunities to encourage GP placements in BwD Pennine Lancashire Quality Committee monitors and receives assurance of "Safer Staffing" levels across providers GP Forward View Operational Plan was submitted to NHS England on 23rd December 2016, which incorporated planning for workforce, capacity and future models of care. Gaps in Assurance ACTION PLAN Action Assigned to Due Action Description Progress to Date Engaging with both Health Education NW and Pennine Lancashire Date Completed organisations to create opportunities to encourage GP placements Malcolm Ridgway Review quarterly Workforce development group established to review recruitment opportunities in BwD Malcolm Ridgway/Claire Jackson/Roger Parr Review quarterly Collaboration with Healthier Lancashire Programme to support the development of 5 year STP including workforce requirements System Leader Forum established and workforce identified as one of five key tests of the transformation programme Refresh of Primary Care Strategy to include design of larger organisational form Malcolm Ridgway Completed through MCP contracts GP Forward View Operational Plan submitted PAGE 7

104 GOVERNING BODY MEETING REPLACEMENT PROCESS FOR THE ACCOUNTABLE OFFICER (AO) ROLE FOR BLACKBURN WITH DARWEN (BwD) CLINICAL COMMISSIONING GROUP (CCG) Date of Meeting 6 TH SEPTEMBER 2017 Agenda Item 13 CCG Corporate Objectives Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality GOVERG BODGOVERNING BODY MEETING Clinical Lead: Senior Lead Manager Finance Manager N/A N/A Mr Roger Parr Equality Impact and Risk Assessment N/A Page 1 of 5

105 completed: Patient and Public Engagement completed: Financial Implications Risk Identified Report authorised by Senior Manager: Y N/A N/A N/A Mr Roger Parr Decision Recommendations The Governing Body is requested to support the two stages outlined in this paper. Page 2 of 5

106 1. Introduction CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BODY (GB) MEETING 6 TH SEPTEMBER 2017 REPLACEMENT PROCESS FOR THE ACCOUNTABLE OFFICER (AO) ROLE FOR BLACKBURN WITH DARWEN (BwD) CCG 1.1 The purpose of this report is to provide a briefing for GB Members on the proposed process to appoint a replacement for the CCG s AO. 2. Background 2.1 As colleagues are aware, Dr Chris Clayton has resigned from his position as AO of BwDCCG having received alternative employment; his last working day for BwDCCG has been mutually set as the 30 th of September Therefore, the GB and Membership of BwDCCG need to urgently consider the options available to replace the AO function. Given the timing, it will be difficult if due process is used to fill the vacancy prior to Dr Clayton leaving. 3. Constitutional Considerations The BwDCCG Constitution is very clear in this regard; it states that the Clinical Chief Officer (CCO) of the group is an elected General Practitioner (GP) member of the GB. The CCO is also the AO for this CCG. Furthermore, eligibility is by nomination and then appointment is by a panel interview and assessment centre. Grounds for removal are upon termination of the contract on a 6 month notice period. That said, on the 8 th of July 2014, the membership did agree that the the roles of the CCO who is also the AO and Clinical Director for Quality and Effectiveness are removed from the election process. Therefore, it would seem that any such potential applicant currently needs to be a practicing GP who is a member of the GB who is nominated (presumably by the GB) and who would need to go through an appointment process as described above. 4. Other Considerations BwDCCG has a strong history of engagement with its Membership and over the years of its existence has moved forward on developments; a strong factor in this engagement has been having an AO who has continued to practice as a GP in the BwD area. As members of the GB are aware, work has been rapidly proceeding across Pennine Lancashire (PL) to align the commissioning functions and consideration needs to be given to the opportunities available through this approach. Furthermore, nationally there is an Page 3 of 5

107 emerging picture of CCGs coming together and sharing senior executive posts such as AOs Members are also reminded of the move in PL to develop an Accountable Care System (ACS); alongside the potential for a Multispecialty Community Provider (MCP)/Primary and Acute Care System (PACS). There is, therefore, the need to consider the implications of any long term AO appointment with this regard. There is an additional consideration, somewhat unique to BwD, in that there is a long established close working relationship between the NHS and the Local Authority (LA) and there are examples across England where Joint AO posts have been created between these organisations. BwDCCG continues to have a strong integrated commissioning function with our LA partners. The AO Role To briefly describe the role, NHS England sets out the duties of an AO as follows and holds the AO responsible for ensuring that the CCG complies with (further detail can be found in the full Job Description which can be provided upon request): their obligations under section 14Q of the NHS Act 2006 (duty on CCGs to exercise their functions effectively, efficiently and economically); their obligations under section 14R of the NHS Act 2006 (duty as to improvement in quality of services); their financial duties under sections 223H 223J of the NHS Act 2006; their duties in relation to accounts and audit, the provision of financial information to the NHS England and the provision of information required by the Secretary of State under paragraphs of Schedule 1A of the NHS Act 2006; NHS England s guidance on the management of conflicts of interest and any forthcoming guidance on the conduct of business, and that employees comply with your organisation s code of conduct and act with probity; and Any other provisions of the NHS Act 2006 as specified in guidance published by the NHS England The AO is also responsible for ensuring that the CCGs exercise their functions in a way which provides good value for money. Proposal Given the timescales involved and the complexity of the constitutional requirements and the wider considerations of appointing a new AO in the context of the current health and care system changes, it is proposed to create a two stage process in appointing a successor AO for BwDCCG. Stage 1 That the CCG sets out to appoint an Interim AO until 31 st March 2018 and will seek to do this from the current GP GB members subject to a review of suitability requirements etc. The CCG would then go to the Membership to seek an Interim GP GB Member to maintain the clinical leadership. Page 4 of 5

108 If no such interim appointment is possible, then the CCG should then seek urgent change to the Constitution to allow an alternative approach to appointment in the interim period. Stage 2 That during the interim phase, the CCG embarks upon a conversation with the CCG Membership upon the options of AO leadership that are available to the Membership in the context of the changing health and care system and associated practicalities such as the contractual mechanisms of appointment that are available and the timescales. It is proposed to call a Senate Meeting in September to start the engagement with the Membership. Depending upon the preferred model, any required changes to the Constitution can be agreed and ratified by the Membership during that time to allow any such future appointment to take place. Other potential alternative options to a GP GB member undertaking the AO role include: Sharing an AO with another CCG; Sharing an AO with the LA; Appointing an independent non GP AO which could include a development opportunity from within the Executive Team In addition, discussions shall take place with NHS England through the Chair to gain their support and advice on the suggested proposals. Conclusion Given the rapid timescales involved and the associated complexities, I believe a two stage process will fulfil the current constitutional requirements and also allow further time to discuss the breadth of options that are available to the Membership for a longer term appointment in the context of the current and future health and care systems. Recommendation The Governing Body is requested to support the two stages outlined in this paper. Graham Burgess Chair 24 th August 2017 Page 5 of 5

109 GOVERNING BODY MEETING Emergency Planning Resilience and Response - NHS England Core Standards Submission Date of Meeting 6 th September 2017 Agenda Item 14 CCG Corporate Objectives Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services x To maintain financial balance and improve efficiency and productivity To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements x To commission improved out of hospital care CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality GOVERNING BODGOVERNING BODY MEETING x Governing Body Meeting Page 1 of 5

110 Clinical Lead: Senior Lead Manager Finance Manager Equality Impact and Risk Assessment completed: Patient and Public Engagement completed: Financial Implications Risk Identified Report authorised by Senior Manager: Y Dr Chris Clayton Mr Iain Fletcher, Head of Corporate Services Mr Roger Parr Yes, as part of EPRR Planning and Policy Development N/A None None Mr Iain Fletcher, Head of Corporate Services Decision Recommendations The Governing Body are requested to: Agree the submission of full compliance against the core standards requirements; Note the proposal to submit a health economy report to NHS England within their timescales, and to receive the report at the next Governing Body meeting. Governing Body Meeting Page 2 of 5

111 CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BODY MEETING 6 TH SEPTEMBER 2017 EMERGENCY PLANNING RESILIENCE AND RESPONSE NHS ENGLAND CORE STANDARDS SUBMISSION 1. Introduction: 1.1 In July 2017 NHS England issued the revised Emergency Planning Resilience and Response Core Standards documentation. This included a request to review the core standards applicable to the CCG and to prepare a statement of compliance, to be endorsed by the CCG Governing Body, and submitted to NHS England by September NHS England also requested that CCGs directly received the compliance statements, and improvement plans, of its providers which is a continuation of the requirements placed on CCGs in In addition to this a deep dive on elements of governance was included in the revised core standards documentation for this year. However this area does not form part of the overall compliance rating. 1.3 Both Blackburn with Darwen CCG and East Lancashire CCG continue to submit one Core Standards submission on behalf of both CCGs as per agreements reached in 2014/15. This followed previous agreement to develop joint policies and plans in regards to EPRR, documents which have been developed, reviewed and approved via the necessary channels. 2. EPRR Core Standards: 2.1 The Core Standards document details the requirements of the CCG in terms of Emergency Preparedness, which includes Business Continuity and Major Incident planning. This is obviously in line with the CCGs role as a category two responder as detailed under the Civil Contingencies Act. 2.2 There are 38 core standards against which the CCG had to review its current arrangements in terms of its level of compliance. In undertaking this review the Head of Corporate Business and the Compliance and Resilience Manager considered the core standard detail, the arrangements currently in place against the standard and the expectation of the CCG specifically in terms of the Civil Contingencies Act and the NHS England Emergency Planning Framework. Obviously key to this has been the policy and plans in place around Emergency Planning Resilience and Response. These being the: Emergency Planning Resilience and Response Policy; Major Incident Plan (including the detailed on-call manager resource pack); Business Continuity Plan, Operational Response plan, Pandemic Influenza Plan and the Severe Weather Plan. 2.3 Following a detailed review the CCG considers itself to be fully compliant with the 38 core standards and therefore are suggesting submitting a statement of full compliance (see appendix 1), which has been endorsed by the Accountable Emergency Officers of both CCGs, to NHS England. 2.4 In line with NHS England requirements the CCGs will receive the compliance statements and improvement plans from Lancashire Care NHS Foundation Trust and East Lancashire Hospitals NHS Trust. In 2016/17 the CCG also received the compliance statement from Mersey Care NHS Foundation Trust. NHS England have agreed that they will report only through their lead Governing Body Meeting Page 3 of 5

112 commissioner. However we will continue to work with Mersey Care to ensure their Whalley site remains compliant. 2.5 A Pennine Lancashire health economy summary will be submitted to NHS England by 29 th September 2017 and will be shared with the Governing Body at the next meeting. 2.6 In 2017/18 NHS England set an additional six supplementary standards relating to governance. See section 4 below which includes further details. 3. Improvement Plans 3.1 From a CCG perspective we are not required to submit an improvement plan as we are fully compliant with the core standards. However please see section 4 below which details further work which is required to strengthen aspects of the separate governance requirements. 3.2 In relation to any provider improvement plans these will be presented as part of the health economy summary presented at the next Governing Body meeting. 4. Governance 4.1 As detailed a deep dive on governance has been implemented as part of this year s review. The CCG has identified areas which require strengthening in relation to elements of governance. As previously detailed this does not form part of the CCG statement of compliance. 4.2 Actions have been developed against the governance elements to strengthen the process/arrangements. See appendix Health Economy Assurances 5.1 The CCGs Compliance and Resilience Manager will continue to ensure systems and processes are in place to maintain compliance with the core standards and the CCGs requirements under the Emergency Planning Framework. 5.2 In relation to provider assurances the Head of Corporate Business (BwD), the Director of Corporate Business (EL) and the Compliance and Resilience Manager will continue to meet with providers on a regular basis to monitor implementation of any improvement plans and to ensure ongoing compliance is maintained. 6. Conclusions 6.1 The Head of Corporate Business and the Compliance and Resilience Manager have reviewed the core standard requirements and have assessed the CCG as being fully compliant. (See appendix three for the full Core Standards document.) In addition we are working with providers to review their compliance levels and will present their statements and improvement plans for completeness to the next Governing Body meeting. 6.2 The CCG will submit a health economy compliance report to NHS England. 6.3 Detailed work is ongoing in relation to business continuity (appendix 4). Governing Body Meeting Page 4 of 5

113 7. Recommendations 7.1 The Governing Body are requested to: Agree the submission of full compliance against the core standards requirements, and Note the proposal to submit a health economy report to NHS England within their timescales, and to receive the report at the next Governing Body meeting. Iain Fletcher Head of Corporate Business Ryan Catlow Compliance and Resilience Manager August 2017 Governing Body Meeting Page 5 of 5

114 Emergency Preparedness, Resilience and Response (EPRR) Assurance STATEMENT OF COMPLIANCE NHS Blackburn with Darwen CCG has undertaken a self-assessment against the NHS England Core Standards for EPRR (v5.0). Following self-assessment, and in line with the definitions of compliance stated below, the organisation declares itself as demonstrating the following level of compliance against the standards: Full Compliance Level Full Substantial Partial Non-compliant Evaluation and Testing Conclusion Arrangements are in place the organisation is fully compliant with all core standards that the organisation is expected to achieve. The Board has agreed with this position statement. Arrangements are in place however the organisation is not fully compliant with one to five of the core standards that the organisation is expected to achieve. A work plan is in place that the Board has agreed Arrangements are in place however the organisation is not fully compliant with six to ten of the core standards that the organisation is expected to achieve. A work plan is in place that the Board has agreed. Arrangements in place do not appropriately address 11 or more core standards that the organisation is expected to achieve. A work plan has been agreed by the Board and will be monitored on a quarterly basis in order to demonstrate future compliance. The results of the self-assessment were as follows: Number of applicable standards Standards rated as Red Standards rated as Amber Standards rated as Green Acute providers: 60** Specialist providers: 51** Community providers: 50** Mental health providers:48** CCGs: 38 **Also includes HAZMAT/CBRN standards applicable to providers: Standards: Acutes 14 / Specialist, Community, Mental health 7 Ambulance Service are required to report statements for 3 compliance levels as stated on page 6 of the Gateway letter Where areas require further action, this is detailed in the attached EPRR Work Plan and will be reviewed in line with the organisation s governance arrangements. I confirm that the above level of compliance with the EPRR Core Standards has been or will be confirmed to the organisation s board / governing body. Signed by the organisation s Accountable Emergency Officer Date of board / governing body meeting Date signed Statement of Compliance Version 2 14/07/16

115 DD2 DD4 DD5 Core standard Self assessment RAG Action to be taken Lead Timescale The organisation has published the results of the 2016/17 NHS EPRR assurance process in their annual report. The organisation has an internal EPRR oversight/delivery group that oversees and drives the internal work of the EPRR function The organisation's Accountable Emergency Officer regularly attends the organisations internal EPRR oversight/delivery group Review of national guidance on Annual Reports does not clearly detail the requirements for reporting of compliance against the EPRR Core Standards within annual reports. Informal meetings held between key EPRR personnel to ensure delivery of core requirements. Further work to be undertaken to incorporate quarterly updates on EPRR compliance / work programme within the remit of an operational group. SRO, who has delegated responsibility for EPRR, attends the informal meetings. Same SRO to be a member of the operational group referenced above. 2017/18 Annual Report to include narrative in relation to CCG compliance with EPRR Core Standards Identify internal operational group to include responsibility around receiving updates/assurances on EPRR compliance/progress. SRO for EPRR to be a member of the internal operational group. Ryan Catlow / Iain Fletcher Ryan Catlow / Iain Fletcher Ryan Catlow / Iain Fletcher In line with 2017/18 Annual Report deadlines 30th November th November 2018

116 Core standard Clarifying information Governance Organisations have a director level accountable emergency officer who is responsible for EPRR (including business continuity management) 1 Organisations have an annual work programme to mitigate against identified risks and incorporate the lessons Lessons identified from your organisation and other partner organisations. identified relating to EPRR (including details of training and exercises and past incidents) and improve response. NHS organisations and providers of NHS funded care treat EPRR (including business continuity) as a systematic and continuous process and have procedures and processes in place for updating and maintaining plans to ensure that they reflect: - the undertaking of risk assessments and any changes in that risk assessment(s) 2 - lessons identified from exercises, emergencies and business continuity incidents - restructuring and changes in the organisations - changes in key personnel - changes in guidance and policy Organisations have an overarching framework or policy which sets out expectations of emergency preparedness, Arrangements are put in place for emergency preparedness, resilience and response which: resilience and response. Have a change control process and version control Take account of changing business objectives and processes Take account of any changes in the organisations functions and/ or organisational and structural and staff changes Take account of change in key suppliers and contractual arrangements Take account of any updates to risk assessment(s) 3 Have a review schedule Use consistent unambiguous terminology, Identify who is responsible for making sure the policies and arrangements are updated, distributed and regularly tested; Key staff must know where to find policies and plans on the intranet or shared drive. Have an expectation that a lessons identified report should be produced following exercises, emergencies and /or business continuity incidents and share for each exercise or incident and a corrective action plan put in place. Include references to other sources of information and supporting documentation The accountable emergency officer ensures that the Board and/or Governing Body receive as appropriate After every significant incident a report should go to the Board/ Governing Body (or appropriate delegated governing group). reports, no less frequently than annually, regarding EPRR, including reports on exercises undertaken by the Must include information about the organisation's position in relation to the NHS England EPRR core standards self assessment. organisation, significant incidents, and that adequate resources are made available to enable the organisation to 4 meet the requirements of these core standards. Acute healthcare providers Specialist providers Ambulance service providers Patient Transport Providers 111 Community services providers Mental healthcare providers NHS England local teams NHS England Regional & national CCGs CSUs (business continuity only) Primary care (GP, community pharmacy) Other NHS funded organisations Self assessment RAG Red = Not compliant with core standard and not in the EPRR work plan within the next 12 months. Evidence of assurance Amber = Not compliant but evidence of progress and in the Action to be taken Lead Timescale EPRR work plan for the next 12 months. Green = fully compliant with core standard. Ensuring accountable emergency officer's commitment to the plans and giving a member of the executive Mark Youlton AEO East Lancashire - delegated to Angela Brown N/A N/A N/A management board and/or governing body overall responsibility for the Emergency Preparedness Chris Clayton AEO - Blackburn with Darwen - delegated to Iain Y Y Y Y Y Y Y Y Y Y Y Resilience and Response, and Business Continuity Management agendas Fletcher Having a documented process for capturing and taking forward the lessons identified from exercises and emergencies, including who is responsible. Yearly review of all EPRR documents and update to on-call pack N/A N/A N/A Appointing an emergency preparedness, resilience and response (EPRR) professional(s) who can following feedback from incidents/calls through embedded on-call demonstrate an understanding of EPRR principles. system. This includes implementing the lessons learnt from the Appointing a business continuity management (BCM) professional(s) who can demonstrate an recent Cyber Attack. Experienced operational lead in post. In Y Y Y Y Y Y Y Y Y Y Y understanding of BCM principles. addition there is regular attendance at key forums and LHRP to Being able to provide evidence of a documented and agreed corporate policy or framework for building aid learning and to keep up to date. resilience across the organisation so that EPRR and Business continuity issues are mainstreamed in processes, strategies and action plans across the organisation. That there is an appropriate budget and staff resources in place to enable the organisation to meet the Pennine Lancashire CCGs have an overarching EPRR policy N/A N/A N/A requirements of these core standards. This budget and resource should be proportionate to the size and with specific plans for Major Incident Planning, Business scope of the organisation. Continuity, Pandemic Influenza and Severe Weather. Each clearly setting out roles and responsibilities as a category 2 responder. All policies and plans have been reviewed in 2016/17 and are subject to review in quarter /18.. Y Y Y Y Y Y Y Y Y Y Y Governing Bodies, and their subcommittees, receive assurances N/A N/A N/A against policy and plans in place. Any significant incidents/events would be escalated to the Governing Body. Y Y Y Y Y Y Y Y Y Y Y Following the recent Cyber Attack both Governing Bodies were briefed via their respective Accountable Officers. Policy and plans stored on CCG website and shared internally. Duty to assess risk Assess the risk, no less frequently than annually, of emergencies or business continuity incidents occurring Risk assessments should take into account community risk registers and at the very least include reasonable worst-case scenarios for: 5 which affect or may affect the ability of the organisation to deliver its functions. severe weather (including snow, heatwave, prolonged periods of cold weather and flooding); Y Y Y Y Y Y Y Y Y Y Y Y Y staff absence (including industrial action); There is a process to ensure that the risk assessment(s) is in line with the organisational, Local Health the working environment, buildings and equipment (including denial of access); Resilience Partnership, other relevant parties, community (Local Resilience Forum/ Borough Resilience Forum), fuel shortages; and national risk registers. surges and escalation of activity; IT and communications; utilities failure; 6 response a major incident / mass casualty event Y Y Y Y Y Y Y Y Y Y Y Y Y supply chain failure; and associated risks in the surrounding area (e.g. COMAH and iconic sites) Being able to provide documentary evidence of a regular process for monitoring, reviewing and updating and approving risk assessments Version control Consulting widely with relevant internal and external stakeholders during risk evaluation and analysis stages Assurances from suppliers which could include, statements of commitment to BC, accreditation, business continuity plans. Sharing appropriately once risk assessment(s) completed Risks to CCGs, as detailed within community risk registers, are N/A N/A N/A covered within current plans. Revisions and additions will be made as required. Internal risk assessment and management systems in place. N/A N/A N/A Also a member of the Lancashire Local Health Resilience Partnership. Also the CCG is a member of the EPRR Leads meeting across providers and commissioners within Lancashire. There is also work with local social care providers in relation to risk identification. There is a process to consider if there are any internal risks that could threaten the performance of the organisation s functions in an emergency as well as external risks eg. Flooding, COMAH sites etc. There is a process to ensure that the risk assessment(s) is informed by, and consulted and shared with your Other relevant parties could include COMAH site partners, PHE etc. See above. Through Local Health Resilience Partnership and N/A N/A N/A 7 Y Y Y Y Y Y Y Y Y Y Y Y Y organisation and relevant partners. EPRR Leads meeting. Duty to maintain plans emergency plans and business continuity plans Effective arrangements are in place to respond to the risks the organisation is exposed to, appropriate to the role, Incidents and emergencies (Incident Response Plan (IRP) (Major Incident Plan)) Relevant plans: Major Incident Plan in place, along with an operational response N/A N/A N/A size and scope of the organisation, and there is a process to ensure the likely extent to which particular types of demonstrate appropriate and sufficient equipment (inc. vehicles if relevant) to deliver the required plan which details how the CCG will manage a local incident as 8 emergencies will place demands on your resources and capacity. Y Y Y Y Y Y Y Y Y Y Y Y responses part of their tactical co-ordination role. As detailed above review identify locations which patients can be transferred to if there is an incident that requires an evacuation; and any necessary revision will take place in quarter /18. Have arrangements for (but not necessarily have a separate plan for) some or all of the following (organisation outline how, when required (for mental health services), Ministry of Justice approval will be gained for an dependent) (NB, this list is not exhaustive): corporate and service level Business Continuity (aligned to current nationally recognised BC standards) evacuation; Business continuity plan in place. Business Impact Analysis N/A N/A N/A take into account how vulnerable adults and children can be managed to avoid admissions, and include undertaken across both organisations. Revised Business 9 Y Y Y Y Y Y Y Y Y Y Y Y Y appropriate focus on providing healthcare to displaced populations in rest centres; Continuity plan being developed and implemented in quarter 3. include arrangements to co-ordinate and provide mental health support to patients and relatives, in 10 HAZMAT/ CBRN - see separate checklist on tab overleaf Y Y Y Y Y Y collaboration with Social Care if necessary, during and after an incident as required; N/A N/A N/A N/A Severe Weather (heatwave, flooding, snow and cold weather) Severe Weather plan and links to Business Continuity Plan. N/A N/A N/A 11 Y Y Y Y Y Y Y Y Y Y Y Y Y make sure the mental health needs of patients involved in a significant incident or emergency are met and that they are discharged home with suitable support 12 Pandemic Influenza (see pandemic influenza tab for deep dive questions) Y Y Y Y Y Y Y Y Y Y Y ensure that the needs of self-presenters from a hazardous materials or chemical, biological, nuclear or Pandemic Influenza Plan in place. N/A N/A N/A 13 Mass Countermeasures (eg mass prophylaxis, or mass vaccination) Y Y Y Y Y Y Y radiation incident are met. N/A N/A N/A N/A 14 Mass Casualties Y Y Y Y Y Y Y for each of the types of emergency listed evidence can be either within existing response plans or as N/A N/A N/A N/A 15 Fuel Disruption Y Y Y Y Y Y Y Y Y Y Y Y Y stand alone arrangements, as appropriate. Business Continuity Plan in place. N/A N/A N/A Surge and Escalation Management (inc. links to appropriate clinical networks e.g. Burns, Trauma and Critical Care) Business continuity plan in place and links to Pennine Lancashire N/A N/A N/A 16 Y Y Y Y Y Y Y Y Y Y Y Y Trigger and Escalation Plan. Infectious Disease Outbreak Major Incident Plan and Business Continuity Plan in place. N/A N/A N/A Leadership for this would be via PH/PHE with links to providers. 17 Y Y Y Y Y Y Y Y Y Y CCG would take a tactical coordination/supporting role - dependent on impact. Evacuation Major Incident Plan and Business Continuity Plan in place. N/A N/A N/A 18 Y Y Y Y Y Y Y Y Y Y Y 19 Lockdown Y Y Y Y Y Y Y N/A N/A N/A N/A 20 Utilities, IT and Telecommunications Failure Y Y Y Y Y Y Y Y Y Y Y Y Business Continuity Plan in place. N/A N/A N/A 21 Excess Deaths/ Mass Fatalities Y Y Y Y Y Y N/A N/A N/A N/A having a Hazardous Area Response Team (HART) (in line with the current national service specification, including a vehicles and equipment N/A N/A N/A N/A 22 Y replacement programme) - see HART core standard tab 23 firearms incidents in line with National Joint Operating Procedures; - see MTFA core standard tab Y N/A N/A N/A N/A Ensure that plans are prepared in line with current guidance and good practice which includes: Aim of the plan, including links with plans of other responders Being able to provide documentary evidence that plans are regularly monitored, reviewed and Plans based on national recommendations and guidance. Plans N/A N/A N/A Information about the specific hazard or contingency or site for which the plan has been prepared and realistic assumptions systematically updated, based on sound assumptions: reviewed internally by relevant committees and recommended for Trigger for activation of the plan, including alert and standby procedures Being able to provide evidence of an approval process for EPRR plans and documents Governing Body endorsement. Full suite of policies/plans are Activation procedures Asking peers to review and comment on your plans via consultation subject to review in quarter /18. Identification, roles and actions (including action cards) of incident response team Using identified good practice examples to develop emergency plans Identification, roles and actions (including action cards) of support staff including communications Adopting plans which are flexible, allowing for the unexpected and can be scaled up or down 24 Location of incident co-ordination centre (ICC) from which emergency or business continuity incident will be managed Y Y Y Y Y Y Y Y Y Y Y Y Y Version control and change process controls Generic roles of all parts of the organisation in relation to responding to emergencies or business continuity incidents List of contributors Complementary generic arrangements of other responders (including acknowledgement of multi-agency working) References and list of sources Stand-down procedures, including debriefing and the process of recovery and returning to (new) normal processes Explain how to support patients, staff and relatives before, during and after an incident (including Contact details of key personnel and relevant partner agencies counselling and mental health services). Plan maintenance procedures (Based on Cabinet Office publication Emergency Preparedness, Emergency Planning, Annexes 5B and 5C (2006)) Arrangements include a procedure for determining whether an emergency or business continuity incident has Enable an identified person to determine whether an emergency has occurred On call Standards and expectations are set out Major Incident Plan, Business Continuity Plan and Operational N/A N/A N/A occurred. And if an emergency or business continuity incident has occurred, whether this requires changing the - Specify the procedure that person should adopt in making the decision Include 24-hour arrangements for alerting managers and other key staff. Response plan - key link to on-call process and the detailed oncall pack. 25 deployment of resources or acquiring additional resources. - Specify who should be consulted before making the decision Y Y Y Y Y Y Y Y Y Y Y Y Y - Specify who should be informed once the decision has been made (including clinical staff) Arrangements include how to continue your organisation s prioritised activities (critical activities) in the event of Decide: Revised Business Continuity Plan is being signed off which N/A N/A N/A an emergency or business continuity incident insofar as is practical. - Which activities and functions are critical includes the identification of critical services and arrangements - What is an acceptable level of service in the event of different types of emergency for all your services for their continuation in the event of a business continuity 26 Y Y Y Y Y Y Y Y Y Y Y Y Y - Identifying in your risk assessments in what way emergencies and business continuity incidents threaten the performance of your incident. This follows the completion and review of Business organisation s functions, especially critical activities Impact Assessments across the CCGs as a result of the 2016/17 deep dive. Arrangements explain how VIP and/or high profile patients will be managed. This refers to both clinical (including HAZMAT incidents) management and media / communications management of VIPs and / or high profile N/A N/A N/A N/A 27 Y Y Y Y Y management Preparedness is undertaken with the full engagement and co-operation of interested parties and key stakeholders Specify who has been consulted on the relevant documents/ plans etc. Links with providers. Meetings to review and discuss plans and N/A N/A N/A (internal and external) who have a role in the plan and securing agreement to its content arrangements. Including links with clinicians as well as managers. Also member of the Lancashire wide EPRR Leads 28 Y Y Y Y Y Y Y Y Y Y Y Y Y meeting. In addition the CCG is a member of ELHT's Emergency Preparedness and Organisational Response Committee. Arrangements include a debrief process so as to identify learning and inform future arrangements Explain the de-briefing process (hot, local and multi-agency, cold) at the end of an incident. Business Continuity Plan in place and links to local NHS England N/A N/A N/A 29 Y Y Y Y Y Y Y Y Y Y Y Y Y arrangements.

117 Core standard Clarifying information Acute healthcare providers Specialist providers Ambulance service providers Patient Transport Providers 111 Community services providers Mental healthcare providers NHS England local teams NHS England Regional & national CCGs CSUs (business continuity only) Primary care (GP, community pharmacy) Other NHS funded organisations Evidence of assurance Self assessment RAG Red = Not compliant with core standard and not in the EPRR work plan within the next 12 months. Amber = Not compliant but evidence of progress and in the Action to be taken Lead Timescale EPRR work plan for the next 12 months. Green = fully compliant with core standard. Command and Control (C2) Arrangements demonstrate that there is a resilient single point of contact within the organisation, capable of Organisation to have a 24/7 on call rota in place with access to strategic and/or executive level personnel receiving notification at all times of an emergency or business continuity incident; and with an ability to respond or 30 escalate this notification to strategic and/or executive level, as necessary. Y Y Y Y Y Y Y Y Y Y Y Explain how the emergency on-call rota will be set up and managed over the short and longer term. SMOC is the single point of contact 24/7 supported by a detailed N/A N/A N/A on-call pack and the Director On-Call (2nd tier) who would take a tactical co-ordination role in a major incident. Those on-call must meet identified competencies and key knowledge and skills for staff. NHS England published competencies are based upon National Occupation Standards. 31 Y Y Y Y Y Y Y Y Y Y Documents identify where and how the emergency or business continuity incident will be managed from, ie the This should be proportionate to the size and scope of the organisation. 32 Incident Co-ordination Centre (ICC), how the ICC will operate (including information management) and the key Y Y Y Y Y Y Y Y Y Y Y Y roles required within it, including the role of the loggist. Arrangements ensure that decisions are recorded and meetings are minuted during an emergency or business continuity incident. 33 Y Y Y Y Y Y Y Y Y Y Y Y Y Arrangements detail the process for completing, authorising and submitting situation reports (SITREPs) and/or commonly recognised information pictures (CRIP) / common operating picture (COP) during the emergency or 34 Y Y Y Y Y Y Y Y Y Y Y Y business continuity incident response. 35 Arrangements to have access to 24-hour specialist adviser available for incidents involving firearms or chemical, Both acute and ambulance providers are expected to have in place arrangements for accessing specialist advice in the event of incidents biological, radiological, nuclear, explosive or hazardous materials, and support strategic/gold and tactical/silver chemical, biological, radiological, nuclear, explosive or hazardous materials Y Y command in managing these events. 36 Arrangements to have access to 24-hour radiation protection supervisor available in line with local and national Both acute and ambulance providers are expected to have arrangements in place for accessing specialist advice in the event of a radiation Y Y mutual aid arrangements; incident Duty to communicate with the public 37 Arrangements demonstrate warning and informing processes for emergencies and business continuity incidents. Arrangements include a process to inform and advise the public by providing relevant timely information about the nature of the unfolding event and about: - Any immediate actions to be taken by responders - Actions the public can take - How further information can be obtained - The end of an emergency and the return to normal arrangements Communications arrangements/ protocols: - have regard to managing the media (including both on and off site implications) Y Y Y Y Y Y Y Y Y Y - include the process of communication with internal staff - consider what should be published on intranet/internet sites - have regard for the warning and informing arrangements of other Category 1 and 2 responders and other organisations. Arrangements ensure the ability to communicate internally and externally during communication equipment 38 failures Y Y Y Y Y Y Y Y Y Y Y Y Information Sharing mandatory requirements Arrangements contain information sharing protocols to ensure appropriate communication with partners. These must take into account and include DH (2007) Data Protection and Sharing Guidance for Emergency Planners and Responders or any guidance which supersedes this, the FOI Act 2000, the Data Protection Act 1998 and the CCA 2004 duty to communicate with the public, or subsequent / additional legislation and/or guidance. 39 Y Y Y Y Y Y Y Y Y Y Y Y Training is delivered at the level for which the individual is expected to operate (ie operational/ bronze, On-call senior managers are of a senior leadership level (8b and N/A N/A N/A tactical/ silver and strategic/gold). for example strategic/gold level leadership is delivered via the 'Strategic above) and receive training on commencement of their on-call Leadership in a Crisis' course and other similar courses. responsibilities and receive a detailed on-call pack, in addition there is a 'buddy' system in place to support. In addition we have received training via NHS England and take part in system wide exercises. Arrangements detail operating procedures to help manage the ICC (for example, set-up, contact lists etc.), Major Incident Plan and Business Continuity Plan - key link to oncall process. The Operational Response Plan is also pivotal in N/A N/A N/A contact details for all key stakeholders and flexible IT and staff arrangements so that they can operate more than one control/co0ordination centre and manage any events required. this area. Through the CCGs robust on-call system on-call N/A N/A N/A managers/directors capture relevant information on calls received. In a major incident the Directors would have access to additional resource to log actions etc., which includes ability to utilise the loggists within ELHT. A number of members of staff from both organisations have also been trained as loggists recently. In hours via Accountable Emergency Officer or Operational Lead, N/A N/A N/A Out of Hours via on-call - under direction of NHS England. Also a single EPRR account is in place and can be used if required. N/A N/A N/A N/A N/A N/A N/A N/A Have emergency communications response arrangements in place CCG plans have clear communications elements. In addition the N/A N/A N/A Be able to demonstrate that you have considered which target audience you are aiming at or addressing in CCGs have the 24/7 support of the CSU Communications and publishing materials (including staff, public and other agencies) Engagement team for support. Also, following on from the recent Communicating with the public to encourage and empower the community to help themselves in an Cyber Attach, we had the opportunity to review the emergency in a way which compliments the response of responders communication arrangements with General Practice. Using lessons identified from previous information campaigns to inform the development of future campaigns Setting up protocols with the media for warning and informing Having an agreed media strategy which identifies and trains key staff in dealing with the media including nominating spokespeople and 'talking heads'. Having a systematic process for tracking information flows and logging information requests and being able to deal with multiple requests for information as part of normal business processes. Being able to demonstrate that publication of plans and assessments is part of a joined-up communications strategy and part of your organisation's warning and informing work. Have arrangements in place for resilient communications, as far as reasonably practicable, based on risk. Internally arrangements are in place - mobiles etc. Externally N/A N/A N/A process in place to communicate with Trust - mobile/separate phone line. Where possible channelling formal information requests through as small as possible a number of known Existing operational processes already exist. N/A N/A N/A routes. Sharing information via the Local Resilience Forum(s) / Borough Resilience Forum(s) and other groups. Collectively developing an information sharing protocol with the Local Resilience Forum(s) / Borough Resilience Forum(s). Social networking tools may be of use here. Co-operation Organisations actively participate in or are represented at the Local Resilience Forum (or Borough Resilience Attendance at or receipt of minutes from relevant Local Resilience Forum(s) / Borough Resilience Represented by NHS England Lancashire. N/A N/A N/A 40 Y Y Y Y Y Y Y Y Y Y Forum in London if appropriate) Forum(s) meetings, that meetings take place and memebership is quorat. Demonstrate active engagement and co-operation with other category 1 and 2 responders in accordance with the Treating the Local Resilience Forum(s) / Borough Resilience Forum(s) and the Local Health Resilience Linked to all relevant local responders i.e. receiving assurance of N/A N/A N/A CCA Partnership as strategic level groups plans and systems in place and working with key stakeholders. In 41 Y Y Y Y Y Y Y Y Y Y Y Y Taking lessons learned from all resilience activities addition the CCGs are a member of the Lancashire EPRR Leads Using the Local Resilience Forum(s) / Borough Resilience Forum(s) and the Local Health Resilience meetings. Arrangements include how mutual aid agreements will be requested, co-ordinated and maintained. NB: mutual aid agreements are wider than staff and should include equipment, services and supplies. Partnership to consider policy initiatives The CCGs have signed up to the Lancashire Mutual Aid N/A N/A N/A 42 Y Y Y Y Y Y Y Y Y Y Establish mutual aid agreements Agreement. Arrangements outline the procedure for responding to incidents which affect two or more Local Health Resilience Identifying useful lessons from your own practice and those learned from collaboration with other N/A N/A N/A N/A 43 Y Y Y Y Partnership (LHRP) areas or Local Resilience Forum (LRF) areas. responders and strategic thinking and using the Local Resilience Forum(s) / Borough Resilience Forum(s) 44 Arrangements outline the procedure for responding to incidents which affect two or more regions. Y Y Y and the Local Health Resilience Partnership to share them with colleagues N/A N/A N/A N/A Arrangements demonstrate how organisations support NHS England locally in discharging its EPRR functions Examples include completing of SITREPs, cascading of information, supporting mutual aid discussions, prioritising activities and/or services Having a list of contacts among both Cat. 1 and Cat 2. responders with in the Local Resilience Forum(s) / Detailed within policy and associated documents, specifically the N/A N/A N/A and duties etc. Borough Resilience Forum(s) area CCGs Operational Response Plan which outlines our tactical 45 Y Y Y Y Y Y Y coordination response. All of which are shared with NHS England with arrangements discussed at the LHRP and the EPRR Leads meetings. Plans define how links will be made between NHS England, the Department of Health and PHE. Including how N/A N/A N/A N/A 46 Y information relating to national emergencies will be co-ordinated and shared Arrangements are in place to ensure an Local Health Resilience Partnership (LHRP) (and/or Patch LHRP for the N/A N/A N/A N/A 47 London region) meets at least once every 6 months Y Y Arrangements are in place to ensure attendance at all Local Health Resilience Partnership meetings at a director Representation on Lancashire Local Health Resilience N/A N/A N/A 48 Y Y Y Y Y Y Y Y level Partnership at Director Level, or their representative. Training And Exercising Arrangements include a current training plan with a training needs analysis and ongoing training of staff required Staff are clear about their roles in a plan Taking lessons from all resilience activities and using the Local Resilience Forum(s) / Borough Resilience Training provided for on-call/senior managers with the provision N/A N/A N/A to deliver the response to emergencies and business continuity incidents A training needs analysis undertaken within the last 12 months Forum(s) and the Local Health Resilience Partnership and network meetings to share good practice of a bespoke on-call information pack - provided in group Training is linked to the National Occupational Standards and is relevant and proportionate to the organisation type. Being able to demonstrate that people responsible for carrying out function in the plan are aware of their sessions and, more recently, via 1:1 for new members. All oncall events are reported and analysed and supporting information Training is linked to Joint Emergency Response Interoperability Programme (JESIP) where appropriate roles Arrangements demonstrate the provision to train an appropriate number of staff and anyone else for whom training would be appropriate for the is enhanced to provide sufficient support to managers. Local 49 Y Y Y Y Y Y Y Y Y Y Y Y Y Through direct and bilateral collaboration, requesting that other Cat 1. and Cat 2 responders take part in purpose of ensuring that the plan(s) is effective your exercises training is planned based on a series of common themes. In Arrangements include providing training to an appropriate number of staff to ensure that warning and informing arrangements are effective Refer to the NHS England guidance and National Occupational Standards For Civil Contingencies when addition the debrief findings of the Cyber Attack have support identifying training needs. review of systems and processes. Developing and documenting a training and briefing programme for staff and key stakeholders Being able to demonstrate lessons identified in exercises and emergencies and business continuity Arrangements include an ongoing exercising programme that includes an exercising needs analysis and informs Exercises consider the need to validate plans and capabilities incidents have been taken forward Training provided for on-call/senior managers with the provision N/A N/A N/A future work. Arrangements must identify exercises which are relevant to local risks and meet the needs of the organisation type and of other interested Programme and schedule for future updates of training and exercising (with links to multi-agency of a bespoke on-call information pack that is updated regularly parties. exercising where appropriate) following lessons learnt and to provide sufficient support to Arrangements are in line with NHS England requirements which include a six-monthly communications test, annual table-top exercise and live Communications exercise every 6 months, table top exercise annually and live exercise at least every managers. CCGs have been involved in exercises with local 50 exercise at least once every three years. Y Y Y Y Y Y Y Y Y Y Y Y Y three years partners. In addition the CCG led the tactical coordination of the If possible, these exercises should involve relevant interested parties. recent Cyber Attack. Lessons identified must be acted on as part of continuous improvement. Arrangements include provision for carrying out exercises for the purpose of ensuring warning and informing arrangements are effective 51 Demonstrate organisation wide (including on call personnel) appropriate participation in multi-agency exercises Y Y Y Y Y Y Y Y Y CCG involved in exercises - both locally and regionally. Also taking tactical coordination of the recent Cyber Attack. N/A N/A N/A 52 Preparedness ensures all incident commanders (on call directors and managers) maintain a continuous personal development portfolio demonstrating training and/or incident /exercise participation. Y Y Y Y Y Y Y Y Y Y Training provided for on-call/senior managers is documented, as N/A N/A N/A is attendance on exercises and debriefing sessions which aid development. Engagement of Senior Managers and Directors On- Call in response to the Cyber Attack and the Manchester bombing.

118 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group Appendix 4 Business Continuity Policy and Plan (Incorporating Blackburn with Darwen and East Lancashire CCG) Ref: ELCCG_EP02 Version: 3 Supersedes: Version 2 Author (inc Job Title): Ryan Catlow Compliance and Resilience Manager Ratified by: (Name of responsible Committee) Date ratified: Pennine Lancashire Quality Committee TBC Review date: December 2018 Target audience: All staff including contractors, agency and temporary staff This policy can only be considered valid when viewed via the East Lancashire and Blackburn with Darwen CCGs websites. If this document is printed into hard copy or saved to another location, you must check that the version number on your copy matches that of the one online. Review and Amend Log

119 Version No Date Section Description of change 2 13/07/16 All Complete review and overhaul of plan to ensure more detailed action plans are in place should business continuity be required. 3 18/08/2017 All Complete review and addition of elements linked to Business Impact Analysis exercise. ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 2 of 29

120 Contents DOCUMENT STATUS... 4 FOREWORD... 4 SECTION 1: BUSINESS CONTINUITY POLICY AND FRAMEWORK INTRODUCTION DUTIES FOR BUSINESS CONTINUITY AND RECOVERY IMPLEMENTING THE BUSINESS CONTINUITY PLAN TRAINING AND EXERCISING SECTION 2 BUSINESS CONTINUITY PLAN FOR CCGS INTRODUCTION ACTIVATING THE PLAN MANAGING THE PLAN SPECIFIC ACTIONS EXTRAORDINARY EVENTS RECOVERY EQUALITY IMPACT ASSESSMENT IMPLEMENTATION AND DISSEMINATION MONITORING AND REVIEW ARRANGEMENTS CONSULTATION REFERENCES AND BIBLIOGRAPHY ASSOCIATED DOCUMENTS (Response plans are held centrally by the Compliance and Resilience Manager / individual teams) APPENDICIES APPENDIX A BUSINESS IMPACT ANALYSIS TEMPLATE APPENDIX B DIRECTOR ON CALL ACTION CARD ACTIVATING THE BUSINESS CONTINUITY PLAN APPENDIX C DIRECTOR ON CALL ACTION CARD TEAM BUSINESS CONTINUITY PLAN ACTIVATION ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 3 of 29

121 DOCUMENT STATUS This document details the response to national Emergency Planning, Resilience and Response (EPRR) requirements and covers both NHS Blackburn with Darwen Clinical Commissioning Group and NHS East Lancashire CCG. Unless clearly documented the term CCG or CCGs within this plan should be taken to refer to both Blackburn with Darwen and East Lancashire. Any specific detail relevant to only one of the CCGs will be clearly documented. FOREWORD This document contains both the business continuity policy and framework providing the strategic overview (Section 1) and the business continuity plan (section 2) which summarises the practical steps which will be taken in the event of significant disruption to business continuity. It should be read alongside the suite of Emergency Planning related policies and plans which include: EPRR Policy Operational Response Manual Major Incident Plan Pandemic Influenza Plan Severe Weather Plan Senior Manager On-Call pack. SECTION 1: BUSINESS CONTINUITY POLICY AND FRAMEWORK 1. INTRODUCTION Business continuity planning forms an important element of good business management and service provision. All business activity is subject to disruptions such as technology failure, flooding, utility disruption and terrorism. Business continuity management (BCM) provides the capability to adequately react to operational disruptions, while protecting welfare and safety. BCM involves managing the recovery or continuation of business activities in the event of a business disruption, and management of the overall programme through training, exercises and review to ensure the business continuity plan stays current and up to date. For the NHS, BCM is defined as the management process that enables an NHS organisation to: Identify those key services which, if interrupted for any reason, would have the greatest impact upon the community, the health economy and the organisation; Identify and reduce the risks and threats to the continuation of these key services; Develop plans which enable the organisation to recover and / or maintain core services in the shortest possible time. 1.1 The Benefits of an Effective BCM Programme An effective BCM programme within the CCGs will help the organisation to: Anticipate Prepare for Prevent Respond to Recover from ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 4 of 29

122 Disruptions, whatever their source and whatever part of the business they affect. 1.2 The Outcome of an Effective BCM Programme The outcomes of an effective BCM programme within the CCGs include: Key products and services are identified and protected, ensuring their continuity; The organisations understanding of itself and its relationships with other organisations, relevant regulators or government departments, local authorities and the emergency services is properly developed, documented and understood; Staff are trained to respond effectively to an incident or disruption through appropriate exercising; Staff receive adequate support and communications in the event of disruption; The organisation s supply chain is secured; The organisation s reputation is protected; The organisation remains compliant with its legal and regulatory obligations 1.3 Elements of BCM Lifecycle The industry standard, ISO22301 BCM, characterises BCM as a series of six lifecycle elements: BCM programme management; Understanding the organisation; Determining business continuity strategy; Developing and implementing BCM response; BCM exercising, maintaining and reviewing BCM arrangements; Embedding BCM in the organisations culture ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 5 of 29

123 2. DUTIES FOR BUSINESS CONTINUITY AND RECOVERY This document has been written to align to PAS2015 (framework for health services resilience) and the NHS England Business Continuity Framework. There are a number of key document that outline and detail the need for NHS organisations to establish a business continuity management system: Civil Contingencies Act 2004 NHS England Emergency Preparedness, Resilience and Response Framework 2015 NHS England Business Continuity Management Framework (service resilience) (2013) ISO Societal Security Business Continuity Management System 2.1 Civil Contingencies Act 2004 The Civil Contingencies Act 2004 outlines a single framework for civil protection in the UK. Part 1 of the act establishes a clear set of roles and responsibilities for those involved in emergency preparation and response at a local level. The Act divides local responders into two categories, imposing a different set of duties on each. Category 1 responders are those organisations at the core of the response to most emergencies and are subject to the full set of civil protection duties. Category 2 organisations are co-operating bodies. They are less likely to be involved in the heart of planning work, but will be heavily involved in incidents that affect their own sector. Category 2 responders have a lesser set of duties co-operating and sharing relevant information with other Category 1 and 2 responders. ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 6 of 29

124 All CCGs are listed as category 2 responders. 2.2 NHS England Emergency Preparedness, Resilience and Response Framework The purpose of this document is to provide a framework for all NHS funded organisations to meet the requirements of the Civil Contingencies Act (2004), the Health and Social Care Act (2012), the NHS standard contracts, the NHS England EPRR Core Standards (2015) and NHS England Business Continuity Framework (2013). The core standards provide the minimum standards which NHS organisations and sub-contractors must meet. 2.3 NHS England Business continuity Management Framework (system resilience) This highlights the need for business continuity management in NHS organisations. It lists the relevant standards and indicates the guidance organisations need to follow. It promotes joint working arrangements between NHS organisations when planning for and responding to disruptions. 2.4 International Standards for Business Continuity Planning There are a number of national and international standards relating to guidance for BCM that can be found in: ISO Societal Security Business Continuity Management System requirements ISO Societal Security Business Continuity Management System Guidance PAS 2015 Framework for Health Service Resilience This plan currently confirms to the BCM System ISO requirements. On 6 January 2014 NHS England produced a BCM Management Toolkit to help organisations meet these international and national standards. This Toolkit has been used to ensure all standards are met by the CCGs. 3. BUSINESS CONTINUITY POLICY AND PLANNING FRAMEWORK 3.1 Aim of Business Continuity Policy and Planning Framework The policy and planning framework aims to ensure that the principles of BCM are embedded throughout the organisation and provides assurance to staff, members, patients, stakeholders and the local population that key services during a disruption event can continue. 3.2 Objectives of the Business Continuity Policy and Planning Framework The objectives of the Business Continuity Policy and Planning Framework are: To ensure a comprehensive BCM system is established and maintained; To ensure key services, together with their supporting critical activities, processes and resources, will be identified by undertaking business impact analysis; To ensure risk mitigation strategies will be applied to reduce the impact of disruption on key services; To ensure plans will be developed to enable continuity of key services at a minimum acceptable standard following disruption; To outline how business continuity plans will be invoked and the relationship with the Pennine Lancashire CCGs Major Incident Plan; To ensure plans are subject to on-going exercising and revision; To ensure the CCG s Governing Bodies are assured that the BCM system remains up to date and relevant. ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 7 of 29

125 3.3 Scope The BCM system, which includes the Business Continuity Policy and Planning Framework and Business Continuity Plan, addresses those services which are provided by the Teams of the CCG: Corporate Finance Commissioning Quality (Including medicines management and safeguarding) 3.4 Roles and Responsibilities Ownership of BCM is required at every level within the CCG. Each Team must ensure that the business activities of each individual service under its jurisdiction are maintained if this service is identified as critical to the Team s function. Where a service is contracted out, or is dependent on external suppliers, the responsibility remains with the Team to ensure continuity. Team Leads need to seek assurance that suppliers and contractors also have robust business continuity arrangements in place. Key business continuity responsibilities are as follows: Chief Officer: has overall accountability for the successful implementation of business continuity. Accountable Emergency Officer: has overall responsibility for the successful implementation of business continuity. Chief Finance Officer: will be responsible for identifying resources for business continuity management systems where necessary and setting up unique cost codes and budget codes to track costs. Directors / Heads: responsible for drawing up Team business continuity plans and ensuring the successful implementation of contingency arrangements for critical services within their Teams. This may be delegated to a Lead for the Team. Managers and Teams: responsible for successful implementation of business continuity within their area of responsibility. Individual employees: each individual member of staff is responsible for ensuring they are familiar with the Business Continuity Plan and their role within it. 3.5 Business Impact Analysis The Business Impact Analysis is undertaken by each service identifying the priorities for their service. Business Impact Analyses from NHS Blackburn with Darwen and NHS East Lancashire CCGs were undertaken for the following areas of work:- Children s Community Corporate Business Finance Medicines Management Performance and Development Primary Care Quality Safeguarding Scheduled Care ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 8 of 29

126 The above functions were all assessed in terms of the functions they undertook which were priorities for the CCG against all threats. The full completed Business Impact Analysis assessments for the above are held as separate documents. The following functions are the prioritised functions for NHS Blackburn with Darwen and NHS East Lancashire CCGs following the BIA process. These are the functions that the CCG should reinstate first in the event of a Business Continuity disruption. Function Responsiveness to urgent care pressures within the hospital trust. Ensuring cash payments to providers and other contractors are made. NHS England Reporting Contract Reporting Inability to respond in time to requirements to NHS England. External relationship continuity, including GPs May be unable to issue contract on time. Providing service specification detail Feed NHS England with contract details e.g. contract tracker Commissioning Support for HR, Health and Safety and Information Governance Supporting Community Pharmacies to maintain the supply of medicines to vulnerable patients/rest centres in time of crisis Responding to FOI requests (incoming) and FOI responses (outgoing) within statutory time. Communications and Engagement - Urgent Care and Sensitive Matters Urgent medicines management queries from practices. As part of co-commissioning advice or support is sometimes required for practices across St Helens. Weekly Performance Reporting Ensuring statutory safeguarding responsibilities are met. Recovery Time Objective 0-4 hrs 0-4 hrs 0-4 hrs 0-4 hrs 0-4 hrs 0-4 hrs 0-4 hrs 0-4 hrs 0-4 Hrs 0-4 hrs 0-4 hrs 0-4 hrs 0-4 hrs 0-4 hrs 0.4 hrs 0-4 hrs 0-4 hrs For the purposes of business continuity, the CCG defines the following scale of Maximum Acceptable Downtimes: Scale Timeframe Rationale ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 9 of 29

127 A Immediate restart Typically used only for clinical and in-patient services where any interruption raises an immediate and unacceptablu le risk to people B One working day An unacceptablee risk will arise if this activity is not fully restored within 24 hours C Three working days The norm for service recovery - recovery within this timefram will not jeopardise patient safety or welfare D One working week The timeframe t for most non-clinical activity E Seven days plus Typically trainingg and similar activities that can bee suspended without significant impact in the short term t 4. IMPLEMENTING THE BUSINESS CONTINUITY PLAN 4.1 Triggers for Activation of Plan The CCG Business Continuity Plan is likely to be activated inn the following circumstances although the list is not exhaustive and the need to activate the plan will be decidedd by the Director on Call: Loss of access to CCG premises, Fusion House or Walshaw House (due to fire, flood or other incident effecting either the CCG premises or the surrounding roads) for longer than the MAD; Loss of amenities that support the CCG premises ncluding power, water or gas for longer than the determined MAD; Loss of IT access or servicess for longer than the determined MAD; Significant changes in the operating risk level necessitating a change in the operating environment. 4.2 Activating the Plan The Business Continuity Plan will be activated by the Director on Call when the Major Incident Plan has been activated orr is on standby and there is an incident that has the potential to cause business disruption and affect critical activities. Depending on the type of disruption, itt is possible that not all Teams will need to activate the Business Continuity Plan. INCIDENT Director on Call Activates Majorr Incident Plan ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Activates CCGS BCM Plans: All Teams Page 10 of 29

128 4.3 Managing Business Continuity During an Incident This is detailed in the Business Continuity Plan in Section 2 and is led by the Director on Call. 4.4 Standing Down When there is no further risk to business continuity from the incident, the Director on Call together with the Accountable Emergency Officer will declare the event over (stand down). 5. TRAINING AND EXERCISING 5.1 Training Directors On-Call and Senior Managers On-Call will be provided with business continuity training appropriate to their role. All other staff will require business continuity awareness training in relation to continuity plans for each service and this will be provided by the Compliance and Resilience Manager. 5.2 Exercising Teams will be expected to undertake business continuity exercises on a regular basis. These may take the form of a self-directed exercise by individual services using a scenario, table top exercises facilitated by the Compliance and Resilience Manager and multi-agency exercises. Exercises can take various forms, from a test of the communications plan, a desk- top walk through, to a live exercise. However in all cases, exercises should be realistic, carefully planned and agreed with all stakeholders, so that there is minimum risk of disruption to business processes. 5.3 Records A record of training and exercising undertaken within each Team will be kept by the Compliance and Resilience Manager so that the organisation has a central record of training undertaken. 5.4 Audit and Monitoring Criteria The Accountable Emergency Officer is responsible for ensuring policy and guidance on all business continuity arrangements is developed, including the production and maintenance of the CCG Business Continuity Policy and Plan which is approved by relevant internal groups. The Accountable Emergency Officer is responsible for ensuring the Policy and Plan is reviewed on an annual basis or earlier as a result of changes to legislation or changes to CCGS structure and / or procedures. Each Team will undertake a two yearly BIA and review the business continuity plan accordingly. Within the CCG, Accountable Emergency Officer will ensure that annual assurance reports are submitted to the Governing Body outlining the current status of CCG emergency preparedness. 5.5 Continuous Improvement ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 11 of 29

129 Business Continuity Plans will be updated in light of feedback from: Actual incidents and disruptions to business activities; Exercises and audits; Re-assessment off risks; Organisational, facility or system changes; External change ncluding change to partner organisations; Management reviews of the effectiveness of the business continuity process. 5.6 Distribution This Policy and plan is distributed to the relevant Heads of Service S and is available on the internet. SECTION 2 - BUSINESS CONTINUITY PLAN FOR CCGS 6. INTRODUCTION This plan should be followed should the need to activate the business continuity plan in the CCG be triggered. It may not be necessary to activate the whole plann and it will be possible to activate certain elements. 7. ACTIVATING THE PLAN The Business Continuity Plan will be activated by the Director on o Call when the Majorr Incident Plan has been activated or is on standby and there is an incident that has the potential to cause business disruption and affectt critical activities. Depending on the type of disruption, it is possible that not all Teams will need to activate their Business Continuity Plan. INCIDENT Director on Call Activates Major Incident Plan Activates East Lancashire CCG BCM Plans: All Teams 8. MANAGING THE PLAN 8.1 Roles and Responsibilities The Director on Call is responsible forr activating and coordinating the plan. However, it should be noted that there may also be a major incident which they will be leading on behalf of the organisation. In this scenario it is possible to delegate the leadership of f the business continuity plan to the senior managerr on call or other suitable delegate. If there is an incidentt that requires ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 12 of 29

130 evacuation of CCG premises and the Director on Call is not on site they should delegate the responsibility to an individual who is on site. 8.2 Action Required The action cards for the Director on Call and the Team Leads should be followed. Each Team has a comprehensive business impact analysis and internal arrangements in place which identify the critical functions and key recovery objectives in order to minimise disruption to essential services. 8.3 Incident Management Team If the incident looks like it may be prolonged it may be necessary to set up an Incident Management Team (IMT) to ensure the CCG critical activities are continued would convene a teleconference/set up an Incident Coordination Centre. Key individuals involved would be: Director on Call Team Lead Communications manager Co-opted members may also be included at the discretion of the Director On-Call. 8.4 Information Recording It is important that there is a clear record of decisions taken which should be recorded as a minimum this information will include: The nature of the decision; The reason for the decision; The date and time of the decision; Who has taken the decision; The extent of consultation and advice from external stakeholders; Who has been notified of the decisions made; Any review dates of the decision. 8.5 Finance and Resources If necessary a separate cost centre will be set up with a budget in agreement with the Chief Finance Officer. The Scheme of Delegation will apply. 8.6 Staff Safety Staff safety remains a high priority. If it is not safe for staff to be on CCG premises or traveling to and from CCG premises or on CCG business then staff should remain at home. This decision will be taken by the Director on Call or another Director. In the unlikely event that some staff are not able to travel home due to disruption then alternative arrangements should be sought. ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 13 of 29

131 Overnight accommodation may, in exceptional circumstances, may be required arrangements to be discussed and agreed with the relevant Director. 8.7 Outsourced Activity The CCG currently outsources a number of activities to M&LCSU. This includes critical activities such as, Human Resources, IT and elements of financial services and Communications. Teams with lead commissioner responsible for critical outsourced activities will capture this in their BIA and service continuity plans. Other critical outsourced activities include the management of Walshaw House to NHS Property Services for East Lancashire CCG and Fusion House to St Modwens for Blackburn with Darwen CCG. 8.8 Communications Involvement of the Communications team is key when activating business continuity plans. Communications support should come through the M&L CSU Communication Manager On-Call and they will be responsible for the consistency of internal and external messages. This will be supported by the CCG Communication Team. Staff messages are especially important and will be primarily agreed through the Director On- Call. When there are long periods of time when staff are working from home then consideration will be given to daily teleconferences to ensure staff are kept up to date with events and can liaise over business critical activities. External communications will be coordinated by the M&L CSU Communications Manager on Call who will liaise with colleagues in NHS England, acute trust providers and other communications colleagues as appropriate to ensure consistency of message. 9. SPECIFIC ACTIONS 9.1 Loss of Access to CCG Premises In the event of disruption to business operations at Walshaw House or Fusion House it is expected most staff would work from home or will be relocated to alternative accommodation. All staff are aware of evacuation points in the case of a fire alarm and this should be the first port of call for all staff so that the fire marshals can ensure staff are accounted for. In conjunction with CCG Directors and Team Leads, the Director on Call would seek to ensure that essential staff members from each Team were promptly relocated. Alternate accommodation would need to be sourced in conjunction with NHS Property Services and Local Health Partners. Other staff will be relocated once suitable accommodation can be identified and prepared. This may take some time and in the interim each Team will need to identify staff members who may be able to work from home and ensure that communication with staff is maintained. 9.2 Loss of Utilities to CCG Premises ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 14 of 29

132 The following disruption to utilities in CCG premises could affect CCG business: Water outage; Power failure gas for heating and hot water; Air conditioning failure Telephone failure In this situation, NHS Property Services would ensure utilities are restored as soon as possible. In necessary staff will be advised to work from home. 9.3 Technology Failure Technology support is provided to the CCG from M&L CSU. There is a service level agreement (SLA) which ensures that any system failure is quickly resolved: If a network switch goes down, M&S CSU will replace under SLA usually within 4-6 hours. If the print server goes down this would usually be for hours depending on the fault. If the print server fails then alternative arrangements are in place to ensure that desktops and laptops can be set up to print direct. This would be done by M&L CSU under the SLA. Servers are based off site providing back up and access to files and are covered under M&L CSU and would usually be up and running again within 48 hours with files backed up every night. Loss of power to CCG premises or difficulty in access would mean: Staff who work from laptops may have residual battery power for a short time; Staff with virtual private network (VPN) on their laptops would be able to access their drives and folders provided internet access is available and could documents to those that don t have VPN; If access to CCG premises is limited for an extended time, it is possible to set up VPN remotely via M&L CSU. 9.4 Reduced Staff Levels If staff levels were reduced below 75% the relevant Director would redeploy staff to support critical functions. If staffing levels reduced to below 30% further reorganisation of staff and discussions with other Teams would be undertaken to ensure adequate support for CCG critical activities. 10. EXTRAORDINARY EVENTS 10.1 Fuel Shortage If personal cars are not available those staff that can travel by foot, bicycle or public transport (if available) will be expected to do so. ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 15 of 29

133 All staff in the CCG are able to access their work s from home via if they have a home personal computer with internet access. Staff members with access (via VPN) to files stored on the network will work files to staff members with no access to the network. If there is a need for staff to work for prolonged periods of time at home then it is possible for M&L CSU to set up VPN remotely. This would be coordinated by the Incident Team Severe Weather In the event of severe weather which prevents staff from being able to travel to work, the arrangements for working remotely would be the same as for fuel shortages. Staff safety should be considered at all times Industrial Action In the event of industrial action where staff levels are affected, the Director on Call together with the Team Leads will reprioritise the critical activities and these functions will be the focus of the workforce Pandemic Flu In the event of pandemic flu where staff levels are affected, the Director on Call together with the Team Lead will reprioritise the critical activities and these functions will be the focus of the workforce. Planning and assumptions for pandemic flu are based on a worst case scenario of 50% of staff being absent from work. 11. RECOVERY 11.1 During the recovery period, the emphasis will be on getting services back to normal. It may be that it is easier for some services to return to normal and others will remain restricted depending on the incident. The following should be considered during the recovery phase: Reduced availability of staff; Loss of skill and experience; Uncertainty, fear and anxiety of staff; Public displacement and disorder in hospitals; Breakdown of community support mechanisms; Disruption to daily life (for example effect on transport systems, schools); Disruption to utilities and essential services; Disruption to internal / IT services / communication systems Build-up of infected waste; Contaminated areas; Disruption to supplies; Management of finances; Stopping and starting targets; Change in competitive position; Reputation damage Organisational fatigue; Economic downturn ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 16 of 29

134 11.2 Standing Down When there is no further risk to business continuity for the incident, the Director on Call together with the Accountable Emergency Officer will declare the event over (stand down) Debrief In order to identify lessons learned, a series of debriefs post incident are seen as good practice: Hot debrief: immediately after incident and incident responders (at each location); Organisational debrief: hours post incident; Multi-agency debrief: within one month of incident; Post incident debrief: within six weeks of incident. These will be supported by action plans and recommendations in order to update CCG plans and provide any further training required. 12. EQUALITY IMPACT ASSESSMENT Because there have now been a significant number of judicial review (process under which unlawful action is subject to review by the courts) cases concerning equality duties, it is possible to identify some general principles which the courts will apply when they are considering a case of this nature. However, the courts have the authority to develop or modify these principles as new cases come before them. From the cases to date, it is clear that the equality duties are taken very seriously by the Courts. They stress: the need to consider equality issues thoroughly in the context of the duties before any significant individual decisions are made or any policy is introduced or subject to significant change equality impact assessments may provide important evidence as to whether the public authority has complied with its duties. that a public authority should refer to Equality Act guidance and codes of practice explicitly and keep records of its decision making. If it departs from the code or guidance, there must be clear reasons to do so. if another organisation or person is carrying out a function under guidance by the public authority, the responsibility for ensuring that the general duties are met remains with the public authority the duties apply not just to decision-makers but also to those who implement them The Equality Analysis Checklist initial screening was used to determine the potential impact this policy might have with respect to the individual protected characteristics. The results from this initial screening indicate that this policy will not require a full Equality Analysis Assessment as there is no significant or disproportionate impact against any protected characteristic or at risk group. 13. IMPLEMENTATION AND DISSEMINATION ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 17 of 29

135 It will be arranged for all ratified policies to be added to the CCG Website and staff will be notified of all policy activity through the CCG s internal communication system. The CCG website will be the only point of access for up to date, version controlled CCG Policies. 14. MONITORING AND REVIEW ARRANGEMENTS This policy shall be reviewed annually or as and when incidents or national guidance deem it to no longer be fit for purpose. 15. CONSULTATION Systems of communication with external stakeholders are in place to minimise reputational risk to the organisation. These include a public website, public meetings of the Governing Body and the Annual General Meeting of the CCGS, together with patient engagement activities and consultation. Date Sent Name of Individual or Group Designation Were comments received, considered and incorporated If not incorporated record reason why Angela Brown Iain Fletcher Senior Management Team (EL) Pennine Lancashire Quality Committee Policy Group (BwD) Ops Group (BwD) Director of Corporate Business (EL CCG) Head of Corporate Business (BwD CCG) Yes/no Yes Yes 16. REFERENCES AND BIBLIOGRAPHY Oxford Clinical Commissioning Group The Civil Contingencies Act ; The Health and Social Care Act ; NHS Commissioning Board planning framework ( Everyone Counts: Planning for Patients 16 ); NHS standard contract 17 ; NHS England EPRR documents and supporting materials 18 NHS Commissioning Board Business Continuity Management Framework (service resilience) (2013) 19 ; NHS Commissioning Board Command and Control Framework for the NHS during significant incidents and emergencies (2013) 20 ; NHS Commissioning Board Model Incident Response Plan (national, regional and area team); NHS England Core Standards for Emergency Preparedness, Resilience and Response (EPRR) 21 ; ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 18 of 29

136 National Occupational Standards (NOS) for Civil Contingencies Skills for Justice 22 ; BSI PAS 2015 Framework for Health Services Resilience 23 ; ISO Societal Security - Business Continuity Management Systems Requirements 24. The role of accountable emergency officers 25 The Business Continuity Institute 26 Freedom of Information Act Competencies for NHS Commissioning Board co-chairs of Local health resilience partnership (LHRPs) 28 Competencies for Director of Public Health (DPH) co-chairs of LHRPs 29 Cabinet Office National Recovery Guidance ASSOCIATED DOCUMENTS (Response plans are held centrally by the Compliance and Resilience Manager / individual teams). 18. APPENDICIES Team Specific Plans Pandemic Influenza Plan Severe Weather Plan Major Incident Plan Emergency Planning and Resilience Policy Operational Response Manual Senior Manager On-Call pack Appendix A Business Impact Analysis Template Appendix B Director on Call Action Card Activating the BCP Appendix C Director on Call Action Card Team BCP Activation ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 19 of 29

137 APPENDIX A BUSINESS IMPACT ANALYSIS TEMPLATE Business Impact Analysis - Questionnaire Introduction: Business Impact Analysis (BIA) BIA is intended to collect the required information to support the development of business continuity plans at a service level. Although the information requirement may initially seem high, by conducting this analysis you will have completed the majority of your Business Continuity Plan (BCP). Instructions for BIA Completion Whilst the requested data is largely self-explanatory, the following instructions are designed to provide some guidance for completion: This BIA questionnaire is generic. Some areas may not be relevant to your function Section 01, once completed, aims to provide information on BIA administration and management and an overview of the team Section 02 should be completed for each function within that team (breakdown of a service is a part of the process of identifying recovery priorities) Completed BIAs should be returned the Business Continuity Lead Review of completed BIAs by the Team Business Continuity Lead ensures services which are critical are resumed or recovered first. Please contact your Business Continuity Lead or the Accountable Emergency Officer for further information. SECTION 01 Quality Team Service undertaking BIA Name of person conducting BIA Contact Details Team Lead Team Date of BIA Completion Service Business Continuity Plan (BCP) Location of Service BCP BCP Tested? If yes, when? ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 20 of 29

138 Service Overview Brief summary of service functions and objectives Where does the service sit within the organisational chart? (This is important to show the reporting structure for communication). SECTION 02 Individual Functions within a Service Note: This section must be completed for each function within the team. In business continuity terms, these functions are known as processes. Functions: Quality Name of Function Function Lead Brief summary of the functions objectives What do you do? (measurable in transactions, volumes of calls, mail, etc.) How do you do it? (measurable in deliverables, no of referrals, revenue, etc.) Total number of staff in function (inc. number of PT / FT staff) Key skills/key personnel - what skills are required to do each role? Are there any niche skills? Is there any one skill/ person that are critical to ensuring the function continues? Working Days & Hours - is it restricted to 9-5, Monday to Friday? Is shift work involved? Is it a 24 Hours function? Recruitment issues? Local employment issues? Local employment issues experienced? Skills register/audit available? If yes, where is this held? ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 21 of 29

139 Maximum Acceptable Downtime The scale below shows five target levels for recovery of service following a disruptive event. This scale is an important part of continuity planning as it indicates the order of priority in which services, or functions within a service, will be recovered. Maximum Acceptable Downtime (MAD) is the timeframe during which the recovery of systems, processes and activities must be achieved to prevent the risk of a significant impact arising if the downtime is exceeded i.e. what is the maximum down time which could be tolerated without incurring one or more of the consequences below? For the purposes of business continuity, the CCG defines a significant impact as any situation that could give rise to one or more of the following situations: An unacceptable risk to the safety and/or welfare of patients and staff A major breach of a legal or regulatory requirement A major breach of a contract, service level agreement or similar formal agreement The risk of financial impact, and/or A threat to the reputation of the Trust as a competent NHS organisation For the purposes of business continuity, the CCG defines the following scale of Maximum Acceptable Downtimes: Scale Timeframe Rationale A Immediate Restart Typically used only for clinical and in-patient services where any interruption raises an immediate and unacceptable risk to people B One Working Day An unacceptable risk will arise if this activity is not fully restored within 24 hours C Three Working Days The norm for service recovery - recovery within this timeframe will not jeopardise patient safety or welfare D One Working Week The timeframe for most non-clinical activity E Seven days plus Typically training and similar activities that can be suspended without significant impact in the short term MAD Using the scale above, measure the maximum tolerable period of disruption for this function the timeframe during which a recovery must become effective before an outage compromises the ability of the organisation to achieve its business objectives. ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 22 of 29

140 Standard Equipment & Key Assets (Plant) Excluding information and management technology, which systems and equipment do you use? (e.g. printing, kitchen equipment). Following an event it is possible that there will be limited resources available to your service/function what would need to be recovered first? Equipment and Key Assets First Next Later Last Office for administration and processing Reception and telephone answering Cash handling and management Nurse and medical support Canteen or meals / kitchen facilities Vehicles Premises Where does the function work? If various, please list Not applicable Not applicable Not applicable Not applicable What premises are adjacent to you (residential, business etc.)? Potential issues? (Is the building in a flood plain, next to neighbours who may create a disruption, e.g. petrol station or other e.g. railway line) Minimum space requirements (approx./ m2) Premises requirements First Next Later Last N/A Air Conditioning Caretaking Canteen or meals/kitchen facilities Heating Security ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 23 of 29

141 Dependencies Who do you do it with? Dependencies (who depends on you?) Interdependencies (What are the touch points with other internal department, other offices, external suppliers, customers, regulators, etc.) e.g. authority signatory. What do you rely on your dependency for? Are there any single source suppliers? Can alternatives be sourced quickly? Or spread the load? Dependencies Name of Supplier First Next Last Later Goods/Services Fuel Requirements Fuel Dependency - is your function dependent No upon fuel for vehicles and/or heating etc.? Yes If yes, provide detail How many staff members require vehicle use for work functions? How many staff can use public transport to get to and from work? How many staff live outside East Lancashire? Utilities Which supplies do you rely upon? Utility Name of Supplier First Next Last Later Gas Electricity Water Through NHS Property Services INFORMATION MANAGEMENT AND TECHNOLOGY (IM&T) ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 24 of 29

142 IM&T (which systems or applications are important to your service/function?). There will need to be an order for recovery and those that need to be recovered first would be those that are deemed critical to your work stream and should be listed below. System/Application First Next Later Last Number of Users Telecommunications & Remote Working How many Trust issued mobile phones are used within the function? How many staff member have work from home capability (e.g. VPN / Webmail)? Please list staff numbers and capabilities Other information Are there seasonal peaks of activity or special deadlines? (Are there penalties for not achieving the deadlines what would be the impact of not achieving deadlines?) If yes, include detail Are there any legal and regulatory requirements? Corporate targets, standards of service, management of waiting lists? Are there any easements that would assist workaround and alternative arrangements? No Yes Patient / Stakeholder relationships (what are their priorities? What are their expectations? Who is responsible for dealing with the customer?) Essential documentation: where and how is it held? Single Points of Failure (are there any single sources of suppliers? Are there any available contingencies) Near misses (have there been any near misses?) No Yes If yes, provide details ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 25 of 29

143 APPENDIX B DIRECTOR ON CALL ACTION CARD ACTIVATING THE BUSINESS CONTINUITY PLAN D : Activating the Business Continuit y Plan For Action by the CCG Director on Call Scope The Businesss Continuity Plan will be activated by the Director on Call when the major incident plan has been activated or is on standby, and there is ann incident that has the potential too cause business disruption and affect critical activities. Depending on the type of disruption, it is possible that not all directorates will need to activate their businesss continuity plan. Activating and escalating business continuity plans INCIDENT Director on Call Activates Majorr Incident Plan Activates A CCG BCM B Plans: All Number Actions: Time Completed Responsible e for activating the Business Continuity Plan for the CCGG and ensuring all Teams take the necessary actions 1 Set up a meeting / teleconference with Team Leads 2 Ensure Team Leads activate the communications cascadee and advise all staff of arrangements / where to report 3 Agree with Team Leads key activities needed and implement recovery plans 5 Notify key contacts. This will includee NHS England Midlands and Lancashire Commissioning Support Unit Local Providers 6 Ensure Team Leads establish immediate business needs,, escalatingg as appropriate ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 26 of 29

144 7 Maintain a log of all decisions / events / action taken using a Loggist if necessary 9 Ensure Team Leads have considered working arrangements for staff including moving key staff to another facility 10 Establish a communication plan both internally and externally with the support of M&L CSU Manager on call 11 Lead the organisation on the restoration of services to normal levels of delivery Information Relevant Plans EL CCG Business Continuity Policy and Framework and Business Continuity Plan Action Card E: Team Business Continuity Plan Activation Version Control Version No Date Reason ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 27 of 29

145 APPENDIX C DIRECTOR ON CALL ACTION CARD TEAM BUSINESS CONTINUITY PLAN ACTIVATION E : Team Lead Business Continuity Plan Activation For Action by Team Leads Business Continuity Lead Scope The Business Continuity Plan will be activated by the Director on Call when the Major Incident Plan has been activated or is on standby, and there is an incident that has the potential to cause business disruption and affect critical activities. Depending on the type of disruption, it is possible that not all Teams will need to activate their Business Continuity Plan. Activating and escalating business continuity plans Activates CCG BCM Plans: All INCIDENT Teams Director on Call Activates Major Incident Plan Activates East Lancs CCG BCM Plans: All teams Inform Team Lead Number Actions: Time Completed Responsible for activating the Business Continuity Plan and ensuring appropriate actions are taken and staff are aware 1 Alerted to the need to activate business continuity plan by Director on Call 2 Ensure that Team Lead knows that business continuity plans are activated 3 Alert staff through cascade system 4 Agree with key staff the activities needed and implement 5 Act as the Team link with the Director on Call 6 Attend any agreed briefings on behalf of the Team 7 Establish any immediate business needs along with your Team Lead ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 28 of 29

146 8 Maintain a log of all decisions / events / action taken 9 Ensure staff are clear of their working arrangements and keep these under review 10 Maintain communication channels with all staff using teleconference / / intranet 11 Ensure normal business is established as soon as feasible 12 Contribute to the incident debrief run by the Director on Call Information Relevant Plans Business Continuity Policy and Framework and Business Continuity Plan Action Card D: Activating Business Continuity Plan Version Control Version No Date Reason ELCCG_EP02 Business Continuity Policy and Plan Version 3, TBC Compliance and Resilience Manager, Corporate Business Page 29 of 29

147 GOVERNING BODY MEETING ANNUAL REPORT OF THE AUDIT COMMITTEE Date of Meeting 6 th September 2017 Agenda Item 15 CCG Corporate Objectives Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality GOGOVEG BODY MEETING Page 1 of 22

148 Y Clinical Lead: Senior Lead Manager Finance Manager Equality Impact and Risk Assessment completed: Patient and Public Engagement completed: Financial Implications Risk Identified Report authorised by Senior Manager: N/A Mr Roger Parr Linda Ring N/A N/A None None Mr Roger Parr Decision Recommendations The Governing Body is requested to note the content of the report. Page 2 of 22

149 CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BODY MEETING ANNUAL REPORT OF THE AUDIT COMMITTEE 6 TH SEPTEMBER Introduction The purpose of this report is to inform the Clinical Commissioning Group (CCG) Governing Body of the role and activities of the Audit Committee during the financial year 2016/ Role of the Audit Committee The Audit Committee has operated during the year in accordance with its agreed Terms of Reference. A summary of the audit committee s responsibilities are set out below and the full Terms of Reference are included as Appendix A. 3. Summary of Audit Committee Responsibilities The roles and responsibilities of the Audit Committee include the review of the establishment and maintenance of effective integrated governance, risk management and internal control systems across the whole of the CCG s activities, both clinical and non-clinical supporting the achievement of the CCG s objectives. It includes the review and monitoring of the internal and external audit functions, counter fraud and monitoring of the integrity of the financial statements of the CCG. The full role and responsibilities of the Audit Committee are shown in the Terms of Reference at Appendix A. 4. Membership of the Audit Committee Membership during the year has comprised of: Name Mr Paul Hinnigan (Chair) Dr J Randall Dr Geraint Jones Mrs Anne Asher (part) Dr Nigel Horsfield Invitations to attend the Audit Committee are normally provided to: CCG Chief Finance Officer Page 3 of 22

150 Internal Audit Representatives Counter Fraud Representatives External Audit Representatives CCG Chief Clinical Officer In addition, other officers from within the organisation have been invited to attend Audit Committees where it was felt that to do so would assist the Audit Committee to effectively fulfill its responsibilities. Administrative support has been provided by the Executive Assistant to the Chief Finance Officer. 5. Appointment of External Audit Grant Thornton were re-appointed as external auditors for Blackburn with Darwen CCG from 1 st April 2017 for a five year period. 6. Meetings during the year During the year 5 meetings were held on the following dates: 26 April May August November February 2017 The agenda for each of these meetings are shown in Appendix B and full minutes can be accessed on the CCG website. 7. Remuneration of the Audit Committee The fulfilment of Audit Committee responsibilities by Lay Members are expected as part of each individual Lay Member s contracts with the organisation. 8. Financial Statements On 26th April 2016, the Audit Committee reviewed the draft Annual Accounts and Annual Report including the Annual Governance Statement. The final version of the Annual Accounts was reviewed on 20th May 2016.The Audit Committee also reviewed the external audit report on the Annual Accounts. The Committee also approved the content of the 2016/17 Management Representation letter. 9. Internal Control and Risk Management Systems Page 4 of 22

151 At each meeting the Audit Committee has considered various reports from its Internal and External Auditors and the CCG Finance Officer. A full list of the reports received and other agenda items considered by the Audit Committee is contained in Appendix B. 10. External Audit Grant Thornton are the CCG s appointed external auditor. The Audit Committee has reviewed the work and findings of External Audit by: Discussing and agreeing the nature and scope of the 2016/17 Annual Plan; Considering the extent of its co-ordination with and reliance on internal audit; Receiving and considering reports derived from the Annual Plan: and Receiving and considering the annual audit letter before its submission to the Governing Body. The Audit Committee has also met in private with External Audit so as to allow the discussion of matters without the presence of executive officers. 11. Internal Audit and Anti Fraud The Audit Committee has reviewed and considered the work and findings of Internal Audit by: Discussing and agreeing the nature and scope of the Annual Plan; Receiving and considering regular progress reports from the Director of Internal Audit at Audit Committee meetings; Receiving and considering reports derived from the Annual Plan; Receiving the 2016/17 Head of Internal Audit s annual opinion on the system of internal control; Receiving the 2016/17 Internal Audit Report; Receiving the 2016/17 Anti Fraud Annual Report. The Audit Committee has also met in private with Internal Auditors so as to allow discussion of matters in the absence of executive officers. For both internal and external audit, the Audit Committee has ensured that management actions agreed in response to reported weaknesses, have either been implemented or that there has been adequate explanation for delays or non-implementation. 12. Relationships with other Committees The Audit Committee received minutes and reports from other Clinical Commissioning Group (CCG) Committees, eg Quality, Performance and Effectiveness Committee (QPEC), now the Pennine Lancashire Quality Committee and the CCG Primary Care Co-Commissioning Committee. The Audit Committee received reports on the financial planning of the Clinical Commissioning Group, reports on Page 5 of 22

152 the Quality Innovation, Productivity and Prevention (QIPP) programme, risk register and other corporate registers. 13. Looking Ahead Internal and External Audit work plans have been agreed and a proposed Audit Committee work plan for 2017/18 is shown in Appendix C which covers the main areas of work to be undertaken. 14. Recommendation The Governing Body is asked to note the content of this report. Mr Paul Hinnigan Audit Committee Chair 22 nd August 2017 Page 6 of 22

153 APPENDIX A AUDIT COMMITTEE TERMS OF REFERENCE 1.0 Purpose of the Committee The Audit Committee (the Committee) is established in accordance with Blackburn with Darwen s (BwD s) Clinical Commissioning Group s Constitution. These Terms of Reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the Constitution. The duties of the Committee will be driven by the priorities identified by the Clinical Commissioning Group, and the associated risks. 2.0 Roles and Responsibilities 2.1 Integrated Governance, Risk Management and Internal Control The Committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the Clinical Commissioning Group s activities (clinical and non-clinical) that support the achievement of the Clinical Commissioning Group s objectives. Its work will dovetail with that of the Pennine Lancashire Quality Committee which the Clinical Commissioning Group established to seek assurance that robust clinical quality is in place and drive improvements to services. In particular, the Audit Committee will review the adequacy and effectiveness of: All risk and control related disclosure statements (in particular the governance statement), together with any accompanying Head of Internal Audit Opinion, external audit opinion or any other appropriate independent assurances, prior to endorsement by the Clinical Commissioning Group. The underlying assurance processes that indicate the degree of achievement of Clinical Commissioning Group objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements. The policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification. The policies and procedures for all work related to counter fraud and security as required by NHS Protect. In carrying out this work the Committee will primarily utilise the work of internal audit, external audit and other assurance functions, but will not be limited to these sources. It will also seek reports and assurances from Officers as appropriate, concentrating on the over-arching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness. Page 7 of 22

154 This will be evidenced through the Committee s use of an effective Assurance Framework to guide its work and that of the audit and assurance functions that report to it. As part of its integrated approach, the Committee will have effective relationships with other key committees so that it understands processes and linkages. However, these other committees must not usurp the Committee s role 2.2 Internal audit The Committee shall ensure that there is an effective internal audit function that meets the Public Sector Internal Audit Standards (2013) and provides appropriate independent assurance to the Audit Committee, Clinical Chief Officer and Clinical Commissioning Group Governing Body. This will be achieved by: Consideration of the provision of the internal audit service, the cost of the audit and any questions of resignation and dismissal. Review and approval of the internal audit strategy, operational plan and more detailed programme of work, ensuring that this is consistent with the audit needs of the organisation, as identified in the assurance framework. Considering the major findings of internal audit work (and management s response) and ensuring co-ordination between the internal and external auditors to optimise audit resources. Ensuring that the internal audit function is adequately resourced and has appropriate standing within the Clinical Commissioning Group. An annual review of the effectiveness of internal audit. 2.3 External audit The Committee shall review and monitor the external auditor s independence and objectivity, the work and findings of the external auditors, and, consider the implications and management s responses to their work. This will be achieved by: Consideration of the appointment and performance of the external auditors, as far as the rules governing the appointment permit (and make recommendations to the Governing Body when appropriate). Discussion and agreement with the external auditors, before the audit commences, on the nature and scope of the audit as set out in the annual plan, and ensuring coordination, as appropriate, with other external auditors in the local health economy. Discussion with the external auditors of their evaluation of audit risks relating to both the financial statements and value for money conclusion, and associated impact on the audit fee. Review of all external audit reports, including the report to those charged with governance, agreement of the annual audit letter before submission to the Clinical Commissioning Group and any work undertaken outside the annual audit plan, together with the appropriateness of management responses. Page 8 of 22

155 Ensuring there is a clear policy for the engagement of external auditors to supply non audit services 2.4 Other assurance functions The Audit Committee shall review the assurance framework and the corporate risk register as well as findings of other significant assurance functions, both internal and external and consider the implications for the governance of the Clinical Commissioning Group. These will include, but will not be limited to, any reviews by Department of Health arm s length bodies or regulators/inspectors (for example, the Care Quality Commission and NHS Litigation Authority) and professional bodies with responsibility for the performance of staff or functions (for example, Royal Colleges and accreditation bodies). In addition, the Committee will review the work of other committees within the organisation, whose work can provide relevant assurance to the Committee s own areas of responsibility. In particular, this will include the work of the Quality, Performance and Effectiveness Committee and the Primary Care Commissioning Committee. 2.5 Counter fraud The Committee shall satisfy itself that the Clinical Commissioning Group has adequate arrangements in place for countering fraud and security that meet NHS Protect s standards and shall review the outcomes of counter fraud work. It shall also approve the counter fraud work programme. 2.6 Management The Committee shall request and review reports and positive assurances from Directors and Managers on the overall arrangements for governance, risk management and internal control. The Committee may also request specific reports from individual functions within the Clinical Commissioning Group as they may be appropriate to the overall arrangements. 2.7 Financial reporting The Audit Committee shall monitor the integrity of the financial statements of the Clinical Commissioning Group and any formal announcements relating to the Clinical Commissioning Group s financial performance. The Committee shall ensure that the systems for financial reporting to the Clinical Commissioning Group, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the Clinical Commissioning Group. Annual Reports and Accounts In accordance with the CCG s Constitution (Scheme of Reservation and Delegation) the Committee is authorised to approve the Group s annual report and annual accounts. The Audit Committee shall review the annual report and financial statements before submission to the Governing Body (for information), focusing particularly on: Page 9 of 22

156 The wording in the annual governance statement and other disclosures relevant to the Terms of Reference of the Committee; Changes in, and compliance with, accounting policies, practices and estimation techniques; Unadjusted mis-statements in the financial statements; Significant judgements in preparing of the financial statements; Significant adjustments resulting from the audit; Letter of representation Explanations for significant variances Qualitative aspects of financial reporting. 2.8 Review instances where Standing Orders / Standing Financial Instructions have been waived. 2.9 Review, at least annually, the Clinical Commissioning Group Governing Body s schedules of losses special payments and register of gifts and hospitality and declaration of Clinical Commissioning Group members interests Whistleblowing The Committee shall review the effectiveness of the arrangements in place for allowing staff to raise (in confidence) concerns about possible improprieties in financial, clinical or safety matters and ensure that any such concerns are investigated proportionately and independently. 3.0 Deliverables 3.1 Reports of assurance to the Clinical Commissioning Group Governing Body that the functions as identified in the Audit Committee Work plan have been performed. 3.2 Minutes recording the decisions reached and the reasons for such decisions shall be maintained and be submitted to the Clinical Commissioning Group Governing Body. 4.0 Constraints/Risks 4.1 Audit reporting and publishing of annual accounts are set within pre-determined dates. 5.0 Membership 5.1 The Committee shall be appointed by the Clinical Commissioning Group as set out in the Clinical Commissioning Group s Constitution and may include individuals who are not on the governing body. The Lay Member on the Governing Body with a lead role in governance will chair the Audit Committee. As a minimum membership shall be made up of:- Lay Member for Governance (Chair) Secondary Care Doctor One other Lay Member GP Page 10 of 22

157 Members must comply with the requirements of the CCG s Conflict of Interest Policy. In the event that all clinical members are excluded from decisions due to conflicts of interest clinical input may be sought from elsewhere if and when required. The Accountable Officer will be invited to attend meetings and discuss at least annually with the Audit Committee the process for assurance that supports the Annual Governance Statement. The Accountable Officer will be invited to attend when the committee considers the draft Annual Governance Statement, the Annual Report and Accounts. The Chief Finance Officer and other Executives from the Clinical Commissioning Group may be in attendance at the specific invitation of the Chair. 6.0 Governance and Reporting 6.1 The Audit Committee will report to the Clinical Commissioning Group Governing Body on how it discharges its responsibilities. The Committee will report to the governing body at least annually on its work in support of the annual governance statement, specifically commenting on: The fitness for purpose of the Assurance Framework The completeness and embeddedness of risk management within the organisation The integration of governance arrangements The appropriateness of evidence that show the organisation is fulfilling regulatory requirements relating to its existence as a functioning business This annual report should also describe how the Committee has fulfilled its terms of reference and give details of any significant issues that the Committee considered in relation to the financial statements and how they were addressed. 6. The Committee shall report after each meeting on all matters within its duties and responsibilities. The report should be completed in line with the agreed template and the full minutes will be submitted to the next meeting of the governing body. 6.3 Quorum Quorum shall be 2 members. 6.4 Frequency The Audit Committee shall meet at least four times per annum and at least once a year will meet with Internal Audit and External Audit with no other officers present. The Chief Finance Officer will arrange secretarial support for the committee. 7.0 Relationships/Interdependencies with other Bodies 7.1 The Audit Committee is informed by corporate business transacted by the Clinical Commissioning Group Governing Body and its Sub-Committees. 8.0 Location of information such as plans, or contact information 8.1 Information relating to the business of the Audit Committee is saved electronically on the Corporate Drive. 9.0 Related Policies 9.1 Being Open Policy Whistle Blowing Policy Fraud and Corruption Policy Page 11 of 22

158 Conflict of Interest Policy Standing Financial Instructions Standing Orders 10.0 Schedule of Meetings times per annum as a minimum. Page 12 of 22

159 CLINICAL COMMISSIONING GROUP (CCG) APPENDIX B AUDIT COMMITTEE Tuesday 26 th April 2016 at 3.30 p.m. in the Board Room, Fusion House, Evolution Park, Haslingden Road, Blackburn BB1 2FD A G E N D A Item No: Agenda Item Member Responsible 1. Chair s Welcome Mr Paul Hinnigan Report 2. Apologies for Absence and Confirmation of Quoracy Mr Paul Hinnigan 3. Declarations of Interest Mr Paul Hinnigan 4. Minutes of the Meeting held on 23 rd February 2016 Mr Paul Hinnigan Attached 5. Matters Arising Mr Paul Hinnigan 6. Risk Management Report Mrs Claire Moir Attached External Audit Progress Report Mr Chris Whittingham Internal Audit Progress Report Head of Audit Opinion and Annual Report 2015/16 Draft Audit Plan 2016/17 Mersey Internal Audit Agency Insight Update Mrs Lisa Warner Attached Attached Attached Attached Anti-Fraud Annual Plan 2016/17 Progress Report Mrs Sharon Brock Attached Attached Draft Annual Report and Financial Statements 2015/16 Annual Review of Accounting Policies Mr Roger Parr To Follow To Follow 11. Financial Plans 2016/17 Mr Roger Parr Attached 12. Losses and Special Payments Mr Roger Parr Attached 13. Waivers and Standing Orders Mr Roger Parr Attached 14. Corporate Registers Mr Roger Parr Attached 15. Quality, Innovation, Productivity and Prevention (QIPP) Mr Roger Parr Attached Page 13 of 22

160 16. Audit Committee Work Plan 2016 Mr Paul Hinnigan Attached Quality, Performance and Effectiveness Committee Minutes of the Meeting held on 27 th January 2016 Minutes of the Meeting held on 1 st March 2016 Draft Minutes of the Meeting held on 29th March 2016 Mr Paul Hinnigan/ Dr Nigel Horsfield Attached Attached Attached Primary Care Co-commissioning Committee Delegated Functions Self-Certification Quarter 4 Draft Minutes of the Meeting held on 15 th March 2016 Mr Paul Hinnigan Attached Attached 19. Any Other Business Mr Paul Hinnigan 20. Date and Time of Next Meeting Mr Paul Hinnigan Friday 20 th May at 10 a.m. in the Board Room, Fusion House. Page 14 of 22

161 CLINICAL COMMISSIONING GROUP (CCG) AUDIT COMMITTEE Friday 20 th May 2016 at 10 am in the Board Room, Fusion House Evolution Park, Haslingden Road, Blackburn, BB1 2FD A G E N D A Item No: Agenda Item Member Responsible Report 1. Chair s Welcome Mr Paul Hinnigan 2. Apologies for Absence and Confirmation of Quoracy Mr Paul Hinnigan 3. Declarations of Interest Mr Paul Hinnigan 4. Minutes of the Meeting held on 26 th April 2016 Mr Paul Hinnigan Attached 5. Matters Arising Mr Paul Hinnigan Anti-Fraud Annual Report 2015/16 Mrs Sharon Brock Attached External Audit 2015/16 Audit Findings Report Mr Chris Whittingham To Be Tabled 8. Letter of Representation Mr Roger Parr To Be Tabled 9. Any Other Business Mr Paul Hinnigan 10. Date and Time of Next Meeting Mr Paul Hinnigan August - to be confirmed Page 15 of 22

162 CLINICAL COMMISSIONING GROUP (CCG) AUDIT COMMITTEE Tuesday 30 th August 2016 at 10 a.m. in the Board Room, Fusion House, Evolution Park, Haslingden Road, Blackburn BB1 2FD A G E N D A Item No: Agenda Item Member Responsible Report 1. Chair s Welcome Mr Paul Hinnigan Verbal 2. Apologies for Absence and Confirmation of Quoracy Mr Paul Hinnigan Verbal 3. Declarations of Interest Mr Paul Hinnigan Verbal 4. Nomination of Deputy Chair Mr Paul Hinnigan Verbal 5. Minutes of the Meeting held on 20 th May 2016 Mr Paul Hinnigan Attached Matters Arising Action Matrix Mr Paul Hinnigan Verbal Attached 7. Risk Management Report Mrs Claire Moir Attached 8. Annual Governance Statement 2016/17 Mrs Claire Moir Attached External Audit Progress Report Annual Audit Letter 2015/16 Mr Chris Whittingham Attached Attached Internal Audit Progress Report Mersey Internal Audit Agency Insight Update Assurance Framework Reviews Annual Review of the Effectiveness of Internal Audit Mrs Karan Wheatcroft Mrs Karan Wheatcroft Mrs Karan Wheatcroft Mrs Karan Wheatcroft Mr Paul Hinnigan Attached Attached Attached Attached Anti-Fraud Progress Report Mersey Internal Audit Agency Insight Information Alerts NHS Protect Briefing National Fraud Initiative Briefing Reports of Fraud, Bribery and Corruption Mrs Sharon Brock Attached Attached Attached Attached Attached 12. Draft Annual Report of the Audit Committee Mr Paul Hinnigan Attached 13. Review of Effectiveness of Arrangements in Place for Staff to Raise Concerns Mrs Claire Moir Verbal Page 16 of 22

163 14. Losses and Special Payments Mr Roger Parr Attached 15. Waivers and Standing Orders Mr Roger Parr Attached 16. Corporate Registers Mr Roger Parr Attached 17. Quality, Innovation, Productivity and Prevention (QIPP) Mr Roger Parr Attached 18. Audit Committee Work Plan 2016/17 Mr Paul Hinnigan Attached Quality, Performance and Effectiveness Committee Minutes of the Meeting held on 26 th April 2016 Minutes of the Meeting held on 31 st May 2016 Minutes of the Meeting held on 28 th June 2016 Governance Arrangements Mr Paul Hinnigan/ Dr Nigel Horsfield Mr Roger Parr Attached Attached Attached Verbal Primary Care Co-commissioning Committee Self-Certification for Quarter 1 Minutes of the Meeting held on 31 st May 2016 Mr Paul Hinnigan To Follow Attached 21. Any Other Business Mr Paul Hinnigan Verbal 22. Date and Time of Next Meeting To be confirmed Mr Paul Hinnigan Verbal Page 17 of 22

164 CLINICAL COMMISSIONING GROUP (CCG) AUDIT COMMITTEE Tuesday 29 th November 2016 at 1 p.m. in the Board Room, Fusion House, Evolution Park, Haslingden Road, Blackburn BB1 2FD A G E N D A Item No: Agenda Item Member Responsible 1. Chair s Welcome Mr Paul Hinnigan Report 2. Apologies for Absence and Confirmation of Quoracy Mr Paul Hinnigan 3. Declarations of Interest Mr Paul Hinnigan 4. Minutes of the Meeting held on 30 th August 2016 Mr Paul Hinnigan Attached 5. Matters Arising Mr Paul Hinnigan 5.1 Action Matrix Attached 6. Risk Management Report Mrs Claire Moir Attached 7. Annual Governance Statement 2016/17 Update Mrs Claire Moir Attached External Audit Progress Report External Audit Services Contract Award Mr Chris Whittingham Mr Paul Hinnigan Attached Internal Audit Progress Report Annual Review of Effectiveness Mersey Internal Audit Agency Insight Report Mrs Lisa Warner Mr Paul Hinnigan Attached Attached Attached Anti-Fraud Progress Report Recent Cases NHS Protect Quality Assurance Process: Post Assessment Final Report Managing Conflicts of Interest Internal Audit Framework for Clinical Commissioning Groups Submission Process for Clinical Commissioning Groups Quarterly Assessment October 2016 Mrs Sharon Brock Mr Paul Hinnigan Mr Paul Hinnigan/ Mrs Claire Moir Attached Attached Attached Attached Attached Attached 12. Losses and Special Payments Mr Roger Parr Attached 13. Waivers and Standing Orders Mr Roger Parr Attached 14. Corporate Registers Mr Roger Parr Attached Page 18 of 22

165 15. Quality, Innovation, Productivity and Prevention (QIPP) Mr Roger Parr Attached 16. Audit Committee Work Plan 2016/17 Mr Paul Hinnigan Attached Quality, Performance and Effectiveness Committee and Pennine Lancashire Quality Committee Minutes of the Meeting held on 30 th August 2016 Minutes of the Meeting held on 28 th September 2016 Minutes of the Meeting held on 26 th October 2016 Mr Paul Hinnigan/ Dr Nigel Horsfield Attached Attached Attached Primary Care Co-commissioning Committee Minutes of the Meeting held on 20 th September 2016 Mr Paul Hinnigan Attached 19. Any Other Business Mr Paul Hinnigan 20. Date and Time of Next Meeting Mr Paul Hinnigan To be confirmed Page 19 of 22

166 CLINICAL COMMISSIONING GROUP (CCG) AUDIT COMMITTEE Tuesday 28 th February 2017 at 1 p.m. in the Board Room, Fusion House, Evolution Park, Haslingden Road, Blackburn BB1 2FD A G E N D A (REVISED) Item No: Agenda Item Member Responsible 1. Chair s Welcome Mr Paul Hinnigan Report 2. Apologies for Absence and Confirmation of Quoracy Mr Paul Hinnigan 3. Declarations of Interest Members and attendees are requested to identify any interests relating specifically to the agenda items being considered (see guide below) and inform the Chair and Audit Committee Secretary in advance of the meeting. Mr Paul Hinnigan 4. Minutes of the Meeting held on 29 th November 2016 Mr Paul Hinnigan Attached 5. Matters Arising Mr Paul Hinnigan 5.1 Action Matrix Attached 6. Risk Management Report Mrs Claire Moir Attached 7. Annual Governance Statement 2016/17 Update Mrs Claire Moir Attached External Audit Progress Report Audit Plan 2016/17 Mr Chris Whittingham Mrs Karen Murray Attached Attached Internal Audit Progress Report Final Report for the External Quality Assessment of the Mersey Internal Audit Agency Insight Update Assurance Framework Benchmarking Report Primary Care Quality Assignment Report 2016/17 Internal Audit Effectiveness Mrs Lisa Warner Dr Stephen Gunn Mr Paul Hinnigan Attached Attached Attached Attached Attached Attached Anti-Fraud Progress Report Recent Fraud Cases Sentinel Newsletter Insight Fraud Investigations TBC Attached Attached Attached 11. Losses and Special Payments Mr Roger Parr Attached Page 20 of 22

167 12. Waivers and Standing Orders Mr Roger Parr Attached 13. Corporate Registers Mr Roger Parr Attached 14. Quality, Innovation, Productivity and Prevention (QIPP) Mr Roger Parr Attached 15. Conflicts of Interest Indicator Quarterly Assessment Mr Paul Hinnigan Attached 16. Timetable for the Production of the Clinical Commissioning Group Annual Report Mr Paul Hinnigan Attached 17. Audit Committee Work Plan 2016/17 Mr Paul Hinnigan Attached Pennine Lancashire Quality Meeting Minutes of the Meeting held on 28 th September 2016 Minutes of the Meeting held on 26 th October 2016 Minutes of the Meeting held on 23 rd November 2016 Mr Paul Hinnigan/ Dr Geraint Jones Attached Attached Attached Primary Care Co-commissioning Committee Minutes of the Meeting held on 15 th November 2016 Mr Paul Hinnigan Attached 20. Any Other Business Mr Paul Hinnigan 21. Date and Time of Next Meeting Mr Paul Hinnigan Page 21 of 22

168 Audit Committee Work Plan 2017/18 APPENDIX C Item INTERNAL CONTROL Risk Assurance Framework & Risk Register April 2017 May 2017 Aug 2017 Nov 2017 Feb 2018 Annual Governance Statement Receive the Minutes of the Pennine Lancashire Quality Committee Receive the Minutes of the Primary Care Co-commissioning Committee Review Audit Committee Work Plan Review Draft Audit Committee Annual Report for Governing Body Review effectiveness of arrangements in place for staff to raise concerns Review of Terms of Reference Review of Effectiveness of Internal Audit EXTERNAL AUDIT Audit Plan Annual Audit Letter Progress Report INTERNAL AUDIT Audit Plan Progress Report Head of Internal Audit Opinion ANTI FRAUD Annual Plan Progress Report Internal Assessment Annual Report OTHER Losses and Special Payments Waivers and Standing Orders Gifts and Hospitality / Registers of Interests/Procurement Register Private meeting between Lay Members, Internal Audit and External Audit FINANCIAL REPORTING Draft/Final Annual Accounts and Financial Statements (D) (F) Annual Review of Accounting Policies (D) (F) Annual Governance Statement (D) (F) Draft Annual Report (D) (F) Page 22 of 22

169 GOVERNG BODY GOVERNING BODY MEETING COMMUNICATION AND ENGAGEMENT REPORT SEPTEMBER 2017 Date of Meeting 6 th September 2017 Agenda Item 16 CCG Corporate Objectives Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care x x x x x x CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention x Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay x Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality GOVERG BODGOVERNING BODY MEETING x x x Governing Body Meeting Page 1 of 6

170 Clinical Lead: Senior Lead Manager Finance Manager Equality Impact and Risk Assessment completed: Patient and Public Engagement completed: Financial Implications Risk Identified Report authorised by Senior Manager: Y Chris Clayton Lucie Higham Roger Parr EIA was completed on the Communication and Engagement Strategy July 2015 Yes on going Within Budget Engagement risk is reducing Mr Iain Fletcher Decision Recommendations The Governing Body is requested to: 1. Note the contents of the report. 2. Feedback any comments or suggestions in relation to communications and engagement activity and comment on future plans. 3. Receive a further report at its meeting in October Governing Body Meeting Page 2 of 6

171 CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BODY MEETING 6 SEPTEMBER, 2017 COMMUNICATION AND ENGAGEMENT REPORT SEPTEMBER Introduction This report provides a summary of activity on communications and engagement by Blackburn with Darwen CCG. 2 Background NHS Blackburn with Darwen CCG is supported in its communications and engagement activity by the Midlands and Lancashire Commissioning Support Unit. 3 Communication and Engagement Report September This report provides a summary of activity on communications and engagement by Blackburn with Darwen CCG between March and May It covers a wide range of activity, including: - Engagement including staff and stakeholder; - Proactive and reactive media relations; - Integrated communications - Design and marketing; - Website and digital media; - Campaigns: and - Future work 4 Overall assessment 4.1 The Communications Team supported the delivery of a staff survey in April 2017 which was well received. The results of this year s Ipsos Mori Annual CCG survey were also analysed and showed a significant improvement both in engagement satisfaction and take-up by stakeholders, compared with the previous year. The Communications Team also successfully delivered the implementation plan for the new Self Care Prescribing Policy. 4.2 The CCG has published its Annual Report for 2016/17 on the website and a summary is currently being designed and will be published in time for the Annual General Meeting (AGM) in September. 5 Media interest and management 5.1 The coverage for the CCG continues to be strong during the last quarter. 5.2 There have been a number of proactive and reactive stories featured in the local media, particularly relating to the Cyber Attack which affected the NHS nationally and the implementation of the CCG s new Self Care prescribing policy. However, purdah was also during this period so there was not as busy as usual due to the restrictions on publicity. Governing Body Meeting Page 3 of 6

172 5.3 Media Activity Media activity March 17 May 17 Media enquiries received 1 Proactive media releases issued 30 Facebook posts 143 Twitter posts Website The website is also constantly being improved and new sections have been added such as Health Apps. The number of new visitors is increasingly steadily. Table of Activity Page reviews Unique Page Reviews Avg Time on Page New Entrances 13,534 10,952 00:01:40 6,787 Key pages reviewed: 1. Meet the team; 2. Local services and GP Practices; 3. Contact us; 4. Get involved and current consultations; 5. Vacancies; 6. Policies and procedures; 7. Governing Body meetings; 8. Dementia knowledge quiz; 9. About us. 6 Integrated communications 6.1 The Team has continued to work closely with neighbouring East Lancashire CCG as we moved towards a joint team approach and other health economy partners including Blackburn with Darwen Council, Public Health, East Lancashire Hospital Trust and Lancashire Care Foundation Trust as part of a Pennine Lancashire Partners Communication Group. This mainly involved planning for a series of engagement events which were due to be held over the summer. 7 Design and marketing 7.1 The Midlands and Lancashire Commissioning Support Unit s Design team has produced a number of materials, including: Procedures of Limited Clinical Value (PLCV) guidelines; Self-Care Prescribing materials including posters and handouts for patients; Governing Body Meeting Page 4 of 6

173 Annual Report Front Cover; NHS guidelines for corporate templates including Team Brief and Stakeholder bulletin. 8 Digital media 8.1 The CCG has continued to improve its social media presence with more than 3,500 followers on Twitter and 1598 Facebook followers. It is now a crucial tool for the CCG to communicate and engage with residents and organisations. It was a major part of the delivery of the implementation plan for the new Self Care Prescribing Policy to raise awareness about the changes to prescriptions. 9 Campaigns and marketing 9.1 A number of campaigns have been supported this quarter including promotion of Summer health messages. The Communications Team are now planning for this year s Winter campaign which is usually the biggest of the year Engagement, Insight and Market Research More new members have now been recruited for the new Citizen Panel, a membership scheme for people interested in sharing their views and experiences to help to develop and improve services locally. The current membership stands at 144 and the Blackburn with Darwen Youth Forum have pledged to support with 100 members, taking the total to 244. A new recruitment plan has been put together to ensure that membership is as diverse as possible, together with the current breakdown of membership. The communications and engagement assistant has attended a number of health related events and venues and proactively encouraged members of the public to join the scheme. Breakdown of Membership: 65 % Female; 35% Male White British 76 %; White Irish 1%; White Polish 0.5%; BME 20%; Black Caribbean 1%; Age %; %; %; %; %; %; %; 81 over 1% Disability yes 23 %; no 76% The Communications Team has continued its efforts to engage with hard to reach groups. A series of meetings was organized with Myerscough College in Blackburn to look at how engagement with students could be improved. This resulted in a full day session with students led by Dr Pervez Muzaffar talking about summer health, drugs and alcohol. The Account Manager has attended a health day at a mosque in Blackburn one weekend to improve links with community groups and patients. During the last quarter, the communication team has also carried out a successful engagement exercise to support the redesign of Audiology Services. Three engagement events were organized for patients, carers, providers and wider stakeholders. The CCG has continued to engage with stakeholders including face to face, via the e-newsletter and at events. A monthly newsletter is sent out to everyone on the stakeholder database. Many stakeholders were also involved in the Ipsos Mori CCG 360 survey which was carried out in the Spring An internal audit on the CCG s stakeholder engagement is currently being carried out and the results are expected shortly. The Communications Team has also supported a number of HSJ Award entries for this year. Governing Body Meeting Page 5 of 6

174 The Communication Team has also supported the launch of the new STEP service for Vulnerable People which was awarded to CGL and is working closely with its Communications Team. The Account Manager continues to support the Equality and Inclusion Business Partner in addition to the CCG s monthly Team Brief and weekly joint CCG bulletin. As part of the CCG s Annual Assurance, the CCG s efforts to engage with hard to reach groups and its establishment of an Engagement Oversight Group were commended by NHS England. As part of stakeholder engagement, a meeting of the Blackburn with Darwen (BwD) Patient Participation Group Representatives (PPGRs) took place at Darwen Health Centre on 25 th April 2017, attended by the Chair and the Account Manager for Communication and Engagement. Amongst items for discussion at the meeting were NHS Patient Registration Standard Operating Principles and an open discussion was also held where representatives asked questions and raised concerns. Future work The priority for the coming quarter for the Communication Team is to deliver another successful AGM and stakeholder event, in addition to supporting the QIPP and Commissioning Intentions agenda Recommendation The Governing Body is requested to: 1 Note the contents of the report; 2 Feedback any comments or suggestions in relation to communications and engagement activity and comment on future plans; 3 Receive a further report at its meeting in October Iain Fletcher Head of Corporate Business August 11, 2017 Governing Body Meeting Page 6 of 6

175 GORNIN GOVERNING BODY MEETING REVIEW OF REGISTER OF INTERESTS Date of Meeting 6 TH SEPTEMBER 2017 Agenda Item 17 CCG Corporate Objectives Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care X X X X X CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality G BODGOVERNING BODY MEETING X X X X X X X X Page 1 of 3

176 Clinical Lead: Senior Lead Manager Finance Manager Equality Impact and Risk Assessment completed: Patient and Public Engagement completed: Financial Implications Risk Identified Report authorised by Senior Manager: N/A Mrs Claire Moir Mr Roger Parr This report is for information only This report is for information only This report is for information only This report is for information only Mr Iain Fletcher Y Decision Recommendations The Governing Body is requested to note the content of the report. Page 2 of 3

177 GOVERNING BODY MEETING 6 TH SEPTEMBER 2017 REVIEW OF REGISTER OF INTERESTS 1. Introduction The purpose of this briefing is to provide the Governing Body with an update on its Register of Interests. Following new guidance from NHS England and subsequent revision to the CCG s Conflicts of Interest Policy, the CCG s Registers of Interests have been reviewed to ensure compliance with the new guidance. 2. Governing Body Register Governing Body Members have recently been requested to review their Declaration of Interests to update the register. There has been one change to the register since the last review as follows: Dr Chris Clayton has amended his declaration to include that his wife is a Director at PricewaterhouseCoopers. The updated register (attached as Appendix 1) was presented to the CCG s Audit Committee on 22 nd August 2017 and has been published on the CCG s website in line with statutory requirements. 3. Recommendation The Governing Body is requested to note the content of the report. Mr Iain Fletcher Head of Corporate Business 24 th August 2017 Page 3 of 3

178 REGISTER OF INTERESTS NHS BLACKBURN WITH DARWEN (BwD) CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BODY - AUGUST 2017 Name and position within, or relationship with, the CCG Type of Interest Description of Interest (including for indirect interests, details of the relationship with the person who has the interest) Dr Adam Black (General Practitioner (GP) Executive Member) Financial Dates Interest Relates From and To Actions to be taken to mitigate risk (to be agreed with Line Manager or a Senior CCG Manager) GP Partner for Cornerstone Practice 2008 Present As per CCG Conflicts of Interest (CoI) Policy Director of Cornerstone Healthcare Community Integrated Care 2009 Present As per CCG CoI Policy (CIC) Out of Hours (OOHs) sessional GP for East Lancashire Medical 2008 Present As per CCG CoI Policy Services (ELMS) Non-Financial Professional Director of Cornerstone Healthcare Charity 2010 Present As per CCG CoI Policy Indirect Wife is Speech and Language Therapist for 'Speak Easy' Charity Mr Graham Burgess (Chair) Indirect Chair of Torus Social Housing Company, Warrington and St Helens Dr Chris Clayton (Clinical Chief Financial GP Partner for Darwen Healthcare (DHC). Dr M Ninan (GP Officer) Partner at DHC) is GP with Special Interests (GPwSI) in Cardiology. BwD Community Anticoagulation Service is run by DHC (Personal) Present As per CCG CoI Policy 2014 Present Indirect so no action 2004 Present As per CCG CoI Policy Mr Dominic Harrison (Director of Public Health, BwD Borough Council) Mr Paul Hinnigan (Lay Member - Governance) Dr Nigel Horsfield (Lay Member) Miss Claire Jackson (Director of Commissioning Operations) Indirect Wife is Chair of a Children's Centre Board in BwD 2007 Present As per CCG CoI Policy Indirect Wife is a Director at PricewaterhouseCoopers 2017 Present As per CCG CoI Policy Indirect Partner is a Lancashire County Councillor 2011 Present As per CCG CoI Policy Financial Director of Beardwood Business Services Limited 2012 Present No longer trading Director of Northlands Consultancy Services Limited 2016 Present Health Consultancy. Projects discussed with BwD CCG Chair in advance to ensure no conflict. Indirect Wife is Deputy Chief Finance Officer at East Lancashire CCG 2013 Present Interest Declared Non-Financial Professional and Personal Financial Friends and former colleagues work at East Lancashire Hospitals NHS Trust (ELHT), Beardwood Hospital and Gisburne Park Hospital Seconded from role jointly funded through the Local Authority and CCG As per CCG CoI Policy Indirect so no action Indirect Dr Geraint Jones (Lay Member - Non-Financial Professional Secondary Care Doctor (Retired)) and Personal Dr Penny Morris (GP Executive Member) Financial Friendships with colleagues at Blackburn with Darwen Borough Council and Trafford CCG Friends and former colleagues work at East Lancashire Hospitals NHS Trust (ELHT), Beardwood Hospital and Gisburne Park Hospital GP Partner DHC. Dr M Ninan (Partner at DHC) is GPwSI in Cardiology, BwD Community Anticoagulation Service is run by DHC. (Personal) Indirect so no action As per CCG CoI Policy TBC Present As per CCG CoI Policy

179 Mr Roger Parr (Deputy Chief Executive/Chief Finance Officer) Non-Financial Personal Indirect Non-Financial Professional Medical Advisor to the W M and BW Lloyd Trust (Charity) in 2016 Present As per CCG CoI Policy Darwen. Son is employed by G2 speech who provide speech recognition TBC Present As per CCG CoI Policy software and workflow management systems to NHS organisations Father is Chair of East Lancashire Hospice and Governor at 2014 Present As per CCG CoI Policy ELHT Public Sector Director of East Lancashire Building Partnership 2013 Present As per CCG CoI Policy Dr Zaki Patel (GP Executive Member) Dr John Randall (GP Executive Member) Dr Malcolm Ridgway (Clinical Director of Primary Care and Quality) Dr Preeti Shukla (GP Executive Member) Indirect Financial Financial Close relationship (Partner) with Director of Performance at 2015 Present As per CCG CoI Policy Blackpool CCG. GP at Umar Medical Centre (salaried) Present As per CCG CoI Policy Sessional work for ELHT 2017 Present As per CCG CoI Policy Sessional work for ELMS 2016 Present As per CCG CoI Policy Sessional work for Local Primary Care 2017 Present As per CCG CoI Policy GP at Oakenhurst Medical Practice 1992 Present As per CCG CoI Policy GP Partner, Dr Ali, within my practice receives financial TBC Present As per CCG CoI Policy remuneration for conducting Phase 3 trials for Merck; Sanofi; Novonordisk; AstraZenica. Oakenhurst Medical Practice currently hosts the Roe Lee TBC Present As per CCG CoI Policy Ultrasound Service I am a Medical Officer at the Priory Hospital, Preston TBC Present As per CCG CoI Policy I am a member of the Local Blackburn GP Federation TBC Present As per CCG CoI Policy I am a member of the OOHs Service, ELMS TBC Present As per CCG CoI Policy Indirect My wife is Executive Chief Nurse at Trafford CCG TBC Present As per CCG CoI Policy Financial Indirect Financial Wife, Diane Ridgway, is Chief Executive Officer, ELMS, Pennine Lancashire GP OOHs Provider Exclusion from any discussions regarding ELMS. Son in Law, James Bibby, works for ELMS Exclusion from any discussions regarding ELMS. Seconded to NHS England two days per week as a Primary Care Senior Responsible Officer Exclusion from decisions that might benefit the CCG. Daughter, Jennifer Ridgway, works as a Practice Nurse in 2014 Present Exclusion from any relevant discussion. Burnley Daughter, Rebecca Bibby, works for a Pharma Company 2012 Present Exclusion from any relevant discussion. supplying unlicensed drugs to hospitals. Salaried GP at Primrose Bank Medical Centre 2011 Present As per CCG CoI Policy Locum GP in Blackburn and East Lancashire area 2011 Present As per CCG CoI Policy Director AADI ADITI Limited (private company) 2012 Present As per CCG CoI Policy Local Medical Committee Member 2016 Present As per CCG CoI Policy British Medical Association sessional Sub-Committee Member 2016 Present As per CCG CoI Policy Mrs Janet Thomas (Associate Director of Quality and Commissioning) Non-Financial Professional Non-Financial Professional and Personal GP Survival England Representative 2016 Present As per CCG CoI Policy British International Doctors Association Executive Member Blackburn 2016 Present As per CCG CoI Policy Friends and former colleagues at Lancashire Care NHS As per CCG CoI Policy Foundation Trust and East Lancashire Hospitals NHS Trust

180 SUB-COMMITTEES AND GROUPS MINUTES GOVERNING BODY MEETING Date of Meeting 6 th September 2017 Agenda Item 18 CCG Corporate Objectives Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities To work collaboratively to create safe, high quality health care services To maintain financial balance and improve efficiency and productivity To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives To maintain and improve performance against core standards and statutory requirements To commission improved out of hospital care X X X X X CCG High Impact Changes Delivering high quality Primary Care at scale and improving access Self-Care and Early Intervention Enhanced and Integrated Primary Care and Better Care Fund Access to Re-ablement and Intermediate Care Improved hospital discharge and reduced length of stay Community based ambulatory care for specific conditions Access to high quality Urgent and Emergency Care Scheduled Care Quality X X X X X X X X Clinical Lead: Senior Lead Manager Finance Manager Equality Impact and Risk Assessment completed: Patient and Public Engagement completed: Financial Implications GOVERNING BODGOVERNING BODY MEETING N/A Mr Iain Fletcher N/A Report for information only Report for information only Report for information only

181 Risk Identified Report authorised by Senior Manager: Report for information only Mr Iain Fletcher Decision Recommendations The Governing Body is requested to receive and note the content of the report. Y Governing Body Meeting Page 2 of 3

182 GOVERNING BODY MEETING 6 TH SEPTEMBER 2017 SUB-COMMITTEES AND GROUPS MINUTES 1. Introduction This report presents the minutes of the Governing Body Sub-Committees and Groups for receipt and note by members. The minutes inform members of delegated and key decisions taken and provide information regarding items of particular interest or potential risk. 2. Sub-Committees and Groups 2.1 Primary Care Co-Commissioning Committee The ratified minutes of the meeting held on 31 st May 2017 are attached as Appendix Commissioning Business Group The ratified minutes of the meetings held on 10 th May 2017, 14 th June 2017 and 12 th July 2017 are attached as Appendices 2, 3 and Pennine Lancashire Quality Committee The ratified minutes of the meeting held on 24 th May 2017 are attached as Appendix Audit Committee The ratified minutes of the meeting held on 25 th May 2017 are attached as Appendix Recommendation The Governing Body is requested to receive and note the content of the report. Iain Fletcher Head of Corporate Business 24 th August 2017 Governing Body Meeting Page 3 of 3

183 CLINICAL COMMISSIONING GROUP (CCG) Minutes of the Primary Care Commissioning Committee (PCCC) held on Tuesday 31 st May 2017 Meeting Room 2 Blackburn Library PRESENT: Mr Graham Burgess Dr Malcolm Ridgway Mr Roger Parr Mr Paul Hinnigan Dr Nigel Horsfield Mrs Janet Thomas CCG Chair Clinical Director for Quality and Effectiveness Chief Finance Officer Lay Member - Governance Lay Member Executive Nurse & Associate Director of Quality & Commissioning IN ATTENDANCE: Mrs Catherine Lawless Mrs Sarah Danson Mrs Julie Kenyon Mr Stephen Toulmin CCG Development Officer (minutes) NHS England Senior Operating Officer Primary Care & Medicines Local Medical Council Min No: 1. Chair s Welcome The Chair welcomed everyone to the meeting and gave a short briefing with regards to the content of the agenda and general housekeeping. In addition the Chair welcomed Mr Toulmin to the meeting and formally invited him to stay for specific items in Part 2 of the Primary Care Co Commissioning meeting as his contributions would be of interest to the PCCC members. Dr Ridgway reminded participants that items in Part 2 of the meeting are confidential and are not to be shared outside the organisation. 2. Apologies for Absence and Confirmation of Quoracy Apologies for absence were received in respect of: Dr Stephen Gunn, Mr Peter Sellars, Dr Geraint Jones and Dr Preeti Shukla PCCC members were asked to note that there was an incorrect venue on the agenda previously circulated. The Chair apologised for this and informed PCCC members that Mr Hinnigan and Mrs Thomas would be arriving late. It was noted the meeting was still quorate. 3. Declarations of Interest The Chair asked members if they would like to declare any Conflicts of Interest (CoI) relating to items on the agenda. The Chair reminded those present that if, during the course of discussion a CoI became apparent, it should be declared at that point. Declarations declared by members of the Primary care Co Commissioning Committee are listed in the CCG s Register of Interests. The Register is available, either via the Secretary to the GB or the CCG website via the following link: Page 1 of 4

184 4. Questions from the Public No questions had been received from members of the public. 5. Minutes of the Meeting held on 28 th March 2017 The minutes of the previous meeting were reviewed and accepted as an accurate record, with the exception that Page 2 Item 7 Update on Prescribing QIPP, the conclusion should read that Mrs Kenyon is to provide an end of year report in July. RESOLVED That the Minutes of the Meeting held on 28 th March were approved as an accurate record. 6. Action Matrix / Matters Arising The action matrix was reviewed and updates were provided. 7. Primary Care Update Report Dr Ridgway asked PCCC members to note the contents of the Primary Care Update Report and drew the PCCC to key pieces of information. Estates & Technology Fund (ETTF) - The Primary Care Access Centre (PCAC) is not to be progressed by the CCG and is to be picked up by the Trust. North and West locality developments are progressing with the West the most developed. Dr Ridgway advised that regional funding is limited and CCG s are being asked to reassess their schemes identifying which is the most likely to go ahead. Dr Ridgway commented that he is hopeful one of the schemes will go ahead. Operational date GP Access Fund (GPAF) The scheme is delivering access to general practice across the borough seven days a week. During the weekend the Federation are also working with the Out of Hours Service, in making sure that appointments are utilised. The Federation are looking at developing a new service model which will improve triage and advice. The enhancements to this service will be operational by mid-june GP Opening Hours Dr Ridgway advised that following the recent Telegraph article with regards to Blackburn with Darwen GP Opening hours the CCG had asked Anne Cunningham, Public Health Analyst, Blackburn Council to provide analysis of the data. From the analysis of the data it was noted that the journalist had taken the information from NHS choices to which Dr Ridgway advised covers a mix of consultation hours, branch surgery opening hours and reception opening hours, which the journalist could have used in generating his report and was thus not a true picture of practice opening hours. The CCG shared their own data around practice opening times with Anne Cunningham and from this she deduced that the majority of the practices are open from p.m. and for those practices that are not open their branch surgeries are open during that time to see patients. This gave the average opening hours of 10.5 hours. It was noted that some practices are also providing extended hours. CONCLUSION: That the PCCC noted the Primary Care Update. The Chair recommended that Anne Cunningham be thanked for her work in providing analysis of the data supplied. 8. Conflict of Interest: Dr Ridgway raised an indirect conflict of interest on the Out of Hours Service due to his wife being the CEO at ELMS. Due to the nature of the discussion Dr Ridgway was allowed to stay and contribute to discussion. Improving the GP Workforce Dr Ridgway asked PCCC to note the contents of the report which focusses on the work to date the CCG has undertaken to develop safe, effective and sustainable Primary Care in the light of increasing demand and the challenged resources available. Dr Ridgway advised the PCCC that the CCG has taken into consideration the workforce crisis and have put measures in place to address this by investing in developing an alternative workforce which includes physician associates and clinical pharmacists. The CCG has also invested in GP training with 11 training practices, including 3 which have recently been developed and authorised. It was noted that the CCG are to continue to run their Protected Learning Time Events. These events have proved very successful in the past Page 2 of 4

185 which GP s and staff appreciate, this results in better education, a more motivated workforce and improved care for patients. Dr Ridgway further commented that the CCG are also looking at training Care Navigators who will be used to direct patients to the most appropriate services. The Out of Hours Service has been developing a new telephone triage service which will enable GP s to work from home in helping to expand the workforce. Mr Toulmin further advised that the Local Medical Committee, NHS England and CCG s are working together to try and identify practices that are perceived to be vulnerable Mrs Janet Thomas and Mr Paul Hinnigan joined the meeting. Dr Horsfield queried whether there were any areas that GPs felt that things could be done quicker and better by local clinicians and gave an example of GP s with special interests (GPwSI). Mr Toulmin advised that the workforce tool that is being utilised by practices may identify some areas. Mrs Thomas added to the discussion that NHS England have commissioned the development of the WRAPT Workforce Modelling Tool which is being used by community nurses and also the community mental health teams have done some work on workforce modelling to which both could be used to influence future decision making around new models of care. Mr Parr advised that the referral navigation triage process that the CCG is to put in place, will focus on three specialities, this may also start to inform on future decisions. Mr Hinnigan commented that he would like to have seen more specifics around how many GP s Blackburn with Darwen have, and when they planning to retire and also more information as to where the CCG are to get new GP s from included in the report. Dr Ridgway summarised by commenting that work is ongoing across Lancashire and South Cumbria to address the wider workforce issues and said he would bring back an update to the September meeting. ACTION: Dr Ridgway to provide an update with regards to GP workforce to the September meeting. Dr Ridgway said he would try and also invite Abdullahi Sheriff to the meeting to talk through the workforce tool with members. CONCLUSION: That the PCCC noted the contents of the report. 9. Revised Primary Care Co Commissioning Terms of Reference - Dr Ridgway asked PCCC to note the minor amendments to the Primary Care Co Commissioning Committee Terms of Reference to which it was noted that the Part 2 arrangements have been amended to request non-members to the meeting as appropriate. CONCLUSION: That the PCCC approved the amendments to the Primary Care Co Commissioning Committee. ACTION: The Primary Care Co Commissioning Terms of Reference to go to the Governing Body for final approval Mr Hinnigan recommended that a work plan for the year be developed for the PCCC, to keep PCCC members informed of what needs to presented, reviewed and looked at for the year. ACTION: Mr Sellars to develop a work plan and bring to the next meeting. 10. Any Other Business: Item 7 Primary Care Update Item Mr Hinnigan asked when will the business cases/pid s be available for the PCCC to look at? Dr Ridgway advised that they are been worked on and advised that he would bring back to the July meeting and advised that if any decisions are to be made before the July meeting it would be pending the Committee s approval. Further discussions took place around whether it would be beneficial to invite the West locality leads and the architect Mr Daniel Thorpe to the next meeting. ACTION: It was agreed that the Primary Care Group to look at the PID s. The Primary Page 3 of 4

186 Care Group are to be asked to also invite Mr Hinnigan and the Chair to the Primary Care Group for their comments. If necessary Dr Ridgway to invite the West scheme leads and Mr Daniel Thorpe, Architect for the West development to the PCCC meeting in July. GP Opening Hours Mr Hinnigan queried whether the PCCC should also have sight of information around patient none attendances. Mr Parr advised that as part of QOEST and the Prime Ministers Challenge fund he is aware of some software that has been secured from Primary Care that goes to NHS England to help pull this data through. ACTION: Dr Ridgway/Dr Parr to look at producing data. Date and Time of Next Meeting The next meeting will be held on Tuesday 18 th July p.m. in Meeting Room 2, Blackburn Central Library, Town Hall St, Blackburn, BB2 1AG. Apologies: Mr Gifford Kerr Page 4 of 4

187 Minutes of the Commissioning Business Group (CBG) Meeting Wednesday 10 th May p.m. Faraday Suite, Evolution Park, Haslingden Road, Blackburn BB1 2FD Present In Attendance Dr John Randall Mr Paul Hinnigan Dr Geraint Jones Dr Zaki Patel Mr Roger Parr Ms Claire Jackson Dr Adam Black Dr Chris Clayton Mr Ken Barnsley Dr Malcolm Ridgway Mrs Joanne Mattock Ms Samantha Jones Mrs Joy Arrandale Mr Barry Ashbolt Mrs Kelly Taylor Mrs Julie Kenyon Mrs Claire Moir Mrs Karen Cassidy General Practitioner Executive Member - Chair Lay Member - Governance Secondary Care Doctor (Retired) General Practitioner Executive Member Deputy Chief Executive/Chief Finance Officer Interim Director of Commissioning Operations General Practitioner Executive Member Clinical Chief Officer Head of Research Engagement and Intelligence, Blackburn with Darwen Borough Council (BwD BC) Clinical Director for Quality and Primary Care Minute Taker Scheduled Care Senior Commissioning Manager Commissioning Manager Mental Health & Learning Disability Principal Strategy Officer BwD BC Commissioning Lead - Maternity, Children & Families Senior Operating Officer Governance, Assurance and Delivery Manager Public Health Specialist (Live Well) Item Point Action 05/17/01 Apologies for Absence/Agenda Sequencing Apologies for absence had been received from Dr Penny Morris General Practitioner Executive Member, Dr Preeti Shukla, General Practitioner Executive Member, Mrs Janet Thomas, Executive Nurse/Associate Director for Quality and Commissioning, Mrs Karen Cassidy Public Health Specialist (Live Well), Mr Neil Holt, Head of Commissioning Performance. 05/17/02 Declarations of Interest & Confirmation of Quoracy The meeting was confirmed as quorate. The Chair reminded Members of their obligation to declare any interest they may have on any issues arising at Committee Meetings which might conflict with the business of Blackburn with Darwen CCG. No declarations of interest were made with regards to items on the agenda at this point. Commissioning Business Group Minutes 10 th May

188 The Chair reminded members that they should, if appropriate, make a declaration should a conflict emerge during the meeting and these would be recorded against the relevant agenda item. Info Mrs Samantha Jones entered the meeting. 05/17/03 Minutes of the Previous Meeting 5 th April 2017 The Minutes of the last meeting were reviewed and accepted as an accurate record RESOLVED: That the CBG approved the Minutes of the last meeting. 05/17/04 Matters Arising - Action Matrix Proposal for the Development of East Lancashire Medical Services (ELMS) Contract Miss Claire Jackson advised that discussions are ongoing as part of the ELMS Contract Review. The report will go to Joint Executive Team in June, the CBG in July and the Sustainability Committee in July ACTION: Mrs Joanne Mattock to add the report to the July Agenda Action Matrix Mr Paul Hinnigan requested that when an item is closed on the Action Matrix an explanation is given. ACTION: Mrs Joanne Mattock will ensure an explanation accompanies closed items on the Action Matrix. Joanne Mattock Joanne Mattock 05/17/05 Declaration of Any Other Business The sequence of items listed on the Agenda were not strictly followed. For Approval 05/17/06 Pennine Lancs Community Deep Vein Thrombosis (DVT) and Swollen Leg Service Proposal Dr Zaki Patel and Mrs Samantha Jones presented the paper to provide the CBG with an update on progress towards the Pennine Lancashire Community Deep Vein Thrombosis (DVT) service model. Mrs Jones provided an overview of progress to date and requested support for the proposal that a DVT only service is procured. Mrs Jones advised that the Community DVT Service pilot should be recognised as a financial success and is a great achievement for this service. 2 Commissioning Business Group Minutes 10 th May 2017

189 Questions and answers followed. It was agreed that the service specification and procurement timeline will be presented at the June CBG. It was further agreed that an Audit will be included in the Next Steps to address the pathway of patients presenting at hospital. ACTION: Mrs Jones to present the specification and timescales to the June meeting. ACTION: Mrs Mattock to add the report to the June Agenda RESOLVED: That the CBG: i. Noted the content of the report. ii. Agreed to receive the DVT service specification (excluding IV elements) for sign off at the June 2017 CBG. iii. Acknowledged the future timescales for service procurement across Pennine Lancashire. Samantha Jones Joanne Mattock 05/17/07 New Psychoactive Substances Framework Mr Barry Ashbolt presented the paper, which has already been to Blackburn with Darwen Borough Council Executive Board, and was brought to this meeting to seek the CBGs approval and support. An options paper will be developed regarding the long term delivery, post April It is anticipated this will be ready for discussion at the CCB in September 2017 and include commissioning, procurement and contracting models. The Chair thanked Mr Ashbolt for a concise and thorough overview of the policy. RESOLVED: That the CBG: i. Noted that New Psychoactive Substances present a significant public health risk requiring cross portfolio and senior level leadership support with commitment to addressing any ongoing and emerging threats, whilst continuing to improve access to prevention, drug education and support services across the life course. ii. Noted that the Council and the Clinical Commissioning Group has a responsibility in partnership to improve access to a range of drug and alcohol education and prevention offers, quality interventions, and to encourage self-care. iii. Noted and approve the recommendations and actions included in the New Psychoactive Substances Framework to ensure implementation of the actions relating to the four priority themed areas. iv. Agreed to ongoing commitment re: the membership of the Pan Lancashire Substance Misuse Preventable Harms Group to ensure practical implementation of the framework. 3 Commissioning Business Group Minutes 10 th May 2017

190 Mr Ashbolt left the meeting 05/17/08 Health and Wellbeing needs of Asylum Seekers, Refugees and Migrant Workers ACTION: It was agreed this Item would be deferred until the July meeting. 05/17/09 Intermediate Dermatology Service Procurement Dr Adam Black and Ms Samantha Jones presented the paper to provide the CBG with an overview of the model and service specification for the procurement of Intermediate level Dermatology Services in Blackburn with Darwen. Questions and answers followed.. ACTION: (i)dates of the Contract with East Lancs will be aligned with BwD. Miss Jones will review the risk and what is being done to mitigate this. (ii)ensure what goes out in the tender is financially viable and the expected level of activity is comparable with the benchmark (iii)an clarifying the impact and risk associated with the timescale on getting the Paper to Governing Body on 7 th June will be communicated to The Chair and Mr Roger Parr after the meeting. Joanne Mattock Samantha Jones Chair/Roger Parr Claire Jackson/ Roger Parr RESOLVED: That the CBG: i. Noted the content of the report and acknowledged the position and emerging issues. ii. Agreed the service specification. iii. iv. Approved the procurement timescales. Agreed to the request for a CBG Chairs Action to approve the final financial and activity modelling for this procurement. 05/17/10 Improving Access to Psychological Therapies (IAPT) Mrs Joy Arrandale provided an update on the paper originally presented to the CBG in March in relation to the commissioning of IAPT services in Lancashire. Mrs Arrandale highlighted key elements of the report and highlighted Next Steps. Mr Parr clarified with Mrs Arrandale that the relevant baseline funding would deliver the future prevalence targets, and that the IAPT LTC non recurrent funding was in additional to this. Questions and answers followed. ACTION: i. Mrs Arrandale to take to joint Pennine Exec Team to Team. Outputs from Lancs wide scoping work to go back to September CBG. ii. Mrs Joanne Mattock to add on the Agenda in September. Joy Arrandale Joanne Mattock 4 Commissioning Business Group Minutes 10 th May 2017

191 iii. ELCCG will delay until September before deciding the way forward. iv. Mrs Arrandale to report back to Exec Team To Team on advantages of working together on a PL approach. v. Paper stated all CCG s confirmed their support to allow LCFT to increase activity in the 3rd sector, within the current contract term - this is not the case for EL. Paper to be corrected. RESOLVED: The paper and Next Steps were supported. For Recommendation 05/17/11 Mrs Claire Moir presented the Terms Of Reference Review (ToR). It was agreed further amendments will be made to the ToR. ACTION: i. Section 5.1 Membership removed interim from job titles. ii. Executive Nurse/Associate Director of Quality and Commissioning as a non-voting member in attendance to be added. iii. Section 5.1 Members are now differentiated between Voting and Non-voting members, not previously indicated. iv. Section 6.4 Voting add a sentence to describe the voting arrangements of the committee. v. Version control Include the date and version number at the footer of the document. Claire Moir RESOLVED: Subject to the above amendments being made in line with discussion, the CBG approved the Terms of Reference. Mrs Moir left the meeting Standing Item 05/17/12 Rightcare/Quality, Innovation, Productivity, Prevention (QIPP)/Paediatric Update Mr Roger Parr gave an overview on QIPP activity. Mrs Kelly Taylor gave a presentation on Children Young People and Maternity. And covered the reduction of Paediatric Admissions, the successful flu vaccine pilot for children, Primary Care Access (8 Spoke appointments protected every day for children). Paediatric Spoke Presentations, Paediatric Respiratory Opportunity, and a Summary of Savings to Date and Going Forward plan. The Chair thanked Mrs Taylor. ACTION: Further analysis on how we compare to other CCGs admissions and are they significantly different.. Kelly Taylor 5 Commissioning Business Group Minutes 10 th May 2017

192 RESOLVED: The CBG noted the content of the presentation. 04/17/13 Any Other Business: Investment Schedule will be available in the Content Locker Agreed to bring back to the meeting a paper on Non-Alcoholic Fatty Liver Disease, following discussion at CMET. Chair Date and Time of Next Meeting Wednesday 14 th June at 1 pm Darwin Suite, Evolution Park, Blackburn. Info The Chair thanked everyone for their attendance and the meeting closed. 6 Commissioning Business Group Minutes 10 th May 2017

193 Minutes of the Commissioning Business Group (CBG) Meeting Wednesday 14 th June p.m. Room 10/11, Innovation House, Evolution Park, Haslingden Road, Blackburn BB1 2FD Present In Attendance Dr John Randall Mr Paul Hinnigan Dr Geraint Jones Dr Zaki Patel Mr Roger Parr Ms Claire Jackson Dr Adam Black Dr Chris Clayton Dr Malcolm Ridgway Dr Penny Morris Dr Preeti Shukla Mrs Janet Thomas Mrs Karen Cassidy Mrs Joanne Mattock Miss Samantha Jones Mrs Kelly Taylor Mr Neil Holt Mr Stuart Hayton Dr Dinesh Mathur General Practitioner Executive Member - Chair Lay Member - Governance Secondary Care Doctor (Retired) General Practitioner Executive Member Deputy Chief Executive/Chief Finance Officer Interim Director of Commissioning Operations General Practitioner Executive Member Clinical Chief Officer, Blackburn with Darwen Clinical Director for Quality and Primary Care General Practitioner Executive Member General Practitioner Executive Member Executive Nurse/Associate Director for Quality and Commissioning Public Health Specialist (Live Well) Minute Taker Scheduled Care Senior Commissioning Manager Commissioning Lead - Maternity, Children & Families Head of Commissioning Performance Urgent Care Transformation Manager General Practitioner Item Point Action 06/17/01 Apologies for Absence/Agenda Sequencing Apologies for absence had been received from Mrs Julie Kenyon, Senior Operating Officer. 06/17/02 Declarations of Interest & Confirmation of Quoracy The meeting was confirmed as quorate. The Chair reminded Members of their obligation to declare any interest they may have on any issues arising at Committee Meetings which might conflict with the business of Blackburn with Darwen Clinical Commissioning Group (CCG). The Chair reminded members that they should, if appropriate, make a declaration should a conflict emerge during the meeting and these would be recorded against the relevant agenda item. The General Practitioners (GPs) present declared a Conflict of Interest in Item Info 1 Commissioning Business Group Minutes 14 th June 2017

194 06/17/08 Acute Visiting Service (AVS) Specification which involved the commissioning of the AVS due to either GPs present being involved in on call work for the current provider, or benefiting from the service in general from a Practice perspective. It was agreed that due to the nature of the conflict, the GPs could remain in the meeting, but not participate in the discussion. The GPs present declared Conflict of Interest in Item 06/17/09 Proposal to Undertake a Review of Urgent Care Provision Across Pennine Lancashire the GPs could remain in the meeting, but not participate in the discussion as this is a process paper. 06/17/03 Minutes of the Previous Meeting 10 th May 2017 The Minutes of the last meeting were reviewed and noted that further clarification was required on item 05/17/10 Improving Access to Psychological Therapies (IAPT). ACTION: Mrs Joanne Mattock will review the Minutes taken at the last meeting and provide further clarification. RESOLVED: The CBG approved the Minutes of the last meeting subject to more clarification on Item 05/17/10 IAPT 06/17/04 Matters Arising - Action Matrix Joanne Mattock Community Service Specification It was agreed future Service Specifications will include the following paragraph: Due to the evolving nature of the health and care system, the provider will be expected to adapt the model of care and innovate in order to maximise value, offer flexibility to support the needs of the system and continuously improve outcomes and experience for patients and carers. ACTION: Service Specifications will now include this paragraph. RESOLVED: The CBG supported the paragraph to be included in all current and future Service Specifications 06/17/05 Declaration of Any Other Business Claire Jackson Following discussion at the Pennine Lancashire CCGs Board to Board meeting, Mr Paul Hinnigan requested a timescale for when the joint commissioning group will commence with East Lancashire (EL) CCG. In reply Miss Claire Jackson advised CBG Terms of Reference (TORs) have been shared and discussions are starting on how to proceed across the two CCGs. Dr Chris Clayton advised that there is a difference in expectations and a move towards having a joint meeting will start in September, perhaps with shadow meetings with some organisational development work until Christmas 2017 and proceed with decision making meetings from January Commissioning Business Group Minutes 14 th June 2017

195 For Approval 06/17/06 Dual Energy X-ray Absorptiometry (DEXA) Scanning Service Contract Award Recommendation Report Dr Adam Black presented the paper to approve the contract being awarded to the preferred provider, following the evaluation process. Discussion was held on the significant difference in cost. RESOLVED: That the CBG: i. Noted the content of the report. ii. Agreed to approve the preferred provider. Miss Samantha Jones joined the meeting 06/17/07 Blackburn with Darwen Community Deep Vein Thrombosis (DVT) Service Procurement Business Case. Dr Zaki Patel presented the paper to seek approval from the CBG on the following: i. Note the position of ELCCG and potential opportunity to join up commissioning opportunities; ii. To note the successful outcomes of the current pilot service; iii. To discuss options outlined and approve a preferred option with consideration of risk and benefits; iv. To review and approve the proposed new service specification and KPI s. Currently, ELCCG have delayed their decision on commissioning a Community DVT Service to a later date. Also ELCCG wish to see the impact of the BwD Service, before they make a decision. Therefore, it is proposed to award the contract to the current provider (Option 2) for two years and ELCCG to join at a later stage. Mr Roger Parr advised that we are proposing a single tender waiver, rather than procuring the contract on the open market, as there are a series of tests to ascertain whether this warrants an open market approach. The paper identifies the risks in terms of challenge. i. ACTION: Agreed to go ahead with Option 2 and bring this item back next month (July) to the CBG to look at risks - how they were evaluated and why we feel it is low risk. ii. ACTION: Mrs Samantha Jones will include mobility/mortality reduction and correct a typo on Exclusion Criteria. iii. ACTION: Dr Chris Clayton requested Commissioners pursue the need to find a OOH resolution Joanne Mattock Samantha Jones 3 Commissioning Business Group Minutes 14 th June 2017

196 iv. ACTION: There is some concern ELCCG don t have a community DVT Service as this could be a requirement of the Recovery Plan around A&E. Miss Claire Jackson will raise at the next A&E Delivery Board (AEDB). RESOLVED: The CBG noted the content of the report and supported Option 2. Samantha Jones Claire Jackson Mrs Karen Cassidy joined the meeting Miss Samantha Jones left the meeting 06/17/08 Acute Visiting Service Speculation (AVS) The Chair clarified the Conflict of Interests which were resolved earlier in the meeting. Miss Claire Jackson and Dr Penny Morris presented the paper to seek approval from the CBG on the following: i. Note the update on current position in relation to Acute Visiting Service. ii. Approve the updated service specification and support the commissioning of a redesigned Acute Visiting Service within a reduced financial envelope as approved by Governing Body. Discussion was held around the change of the specification and the alteration of the hours of operation, to reflect current activity patterns and current service resource. After a look at activity patterns, it is being proposed the first and last hours are changed to start at am, with 5.30 pm as the last referral. After 5.30 pm there will be a clinician to clinician discussion and, if there is capacity they would consider it. If there isn t capacity, then Primary Care will have to take back responsibility for the patient. It was noted that discussions are still ongoing with the provider. ACTION: The updated Service Specification was supported, subject to further negotiation on timings and concerns about cut off at the end of the day and will be brought before the CBG in August for further discussion RESOLVED: The CBG supported the updated Service Specification, subject to further negotiation with the provider 06/17/09 Proposal to Undertake a Review of Urgent Care Provision Across Pennine Lancashire The Chair welcomed Mr Stuart Hayton, Urgent Care Transformation Manager, and introductions were made. Mr Hayton presented the paper to seek approval and sign off: i. The proposed review process and timescales ii. The proposals for public engagement and formal consultation iii. The use of the Pennine Lancashire Evaluation Criteria for the assessment of options within the review. Chair s Action Claire Jackson/ Penny Morris 4 Commissioning Business Group Minutes 14 th June 2017

197 Mr Hayton advised this is the start of the process to review the urgent care position across Pennine Lancashire and to begin a conversation with a whole range of stakeholders. The start of the process is to look at what people think urgent care access should look like. The paper has a suggested timescale, area of scope, and methodology, in tandem with the timescale of the transformation programme across Pennine Lancashire. By September it is hoped the structure will be in place across Pennine Lancashire, allowing consultation during Autumn/Winter, with a view to implementation early next year. Mr Hayton concluded that the paper has been to Sustainability Committee in East Lancashire prior to the CBG today. Questions and Answers followed. ACTION: It was noted that the paper will be presented at the next Operational Meeting on Friday 16 th June and there will be a number of engagement events across the Summer, starting in July. RESOLVED: CBG supported the proposal, but agreed that the direction of travel needs to be Transformational. 06/17/10 Assessment and Support for Children and Young People Requiring Ventilation Joanne Mattock Dr Dinesh Mathur and Mrs Kelly Taylor presented the paper and asked the CBG to: i. Approve the development of a Pennine Lancashire framework of packages of care for children and young people with complex needs including those with ventilation needs. ii. Approve the development of a Pennine Lancashire assessment team for all children and young people with complex needs including those with ventilation needs. iii. Agree to serve notice to ELHT regarding the current Community Ventilation Service. iv. Approve the submission of a contract variation to LCFT to separate the Complex Needs Nurse role from the Special School Nursing Service as part of the streamlining of the assessment process. v. Recommend ratification through Governing Body due to the contract value. Mrs Taylor gave a background on why the service is being reviewed which is around the complexity of the service, the different elements involved within the teams, the funding of individual ventilation packages and the block contract currently in place with East Lancashire Hospitals NHS Trust (ELHT), to ensure there are no dual payments. 5 Commissioning Business Group Minutes 14 th June 2017

198 ELCCG had gone through a similar process where provision had moved to a new framework of accredited providers offering greater choice for families and reduced cost. Lancashire Care NHS Foundation Trust (LCFT) remain one of the main providers for ELCCG. The main provider for BwD is ELHT and the paper outlined the key options for future commissioning of this service:- Mrs Taylor drew attention to the two main options - Option 1 (The preferred option) Development of a Pennine Lancashire, Complex Packages of Care Framework including ventilation, Option 2 Separate Blackburn with Darwen and East Lancashire Frameworks or Option 3 BwD to work with ELHT to provide service on a cost per case basis. The Paper has already been to Operations Group, Executive Team and Pennine Lancashire Joint Executive Meeting. Questions and answers followed. Mr Roger Parr sought clarification on the fourth recommendation to approve LCFT separate roles and asked if this was straight forward. In response, Mrs Taylor advised that draft specifications are in place and discussions have been held in an open and transparent way. Kelly Taylor ACTION: Mrs Taylor agreed to build a procurement plan to widen the framework and to robustly engage with EL on block spend/staffing justification, and escalate if necessary. RESOLVED: The CBG supported the recommendation for Option 1 to move to commissioning a framework and noted that the paper will go to Governing body in July for formal ratification. Mrs Taylor left the meeting. Standing Item 05/17/12 Rightcare/Quality, Innovation, Productivity, Prevention (QIPP)/ Paediatric Update: The Chair thanked Mr Neil Holt for his presentation at the last meeting Governing Body. Mr Holt gave an update on the current QIPP position for and reported on paediatric admission comparisons across Lancashire and benchmarking. 6 Commissioning Business Group Minutes 14 th June 2017

199 ACTION: Miss Jackson agreed to raise the issues of Paediatric dental care/early prevention as a significant contributor to hospital admissions at the next Accident and Emergency Delivery Board (AEDB). RESOLVED: The CBG noted the content of the presentation Claire Jackson Dr Preeti Shukla left the meeting. Mr Paul Hinnigan left the meeting. 04/17/14 Any Other Business: AVS Dr Adam Black sought clarification on the timescale of AVS paper. Miss Jackson responded that a draft update will be presented to the meeting in August, which was agreed. Date and Time of Next Meeting Wednesday 12 th July at 1 pm Room 10/11, Innovation House, Evolution Park, Blackburn. Info The Chair thanked everyone for their attendance and the meeting closed at 3.40 pm. 7 Commissioning Business Group Minutes 14 th June 2017

200 Minutes of the Commissioning Business Group (CBG) Meeting Wednesday 12 th July p.m. Darwin Suite, Innovation House, Evolution Park, Haslingden Road, Blackburn BB1 2FD Present In Attendance Dr John Randall Mr Paul Hinnigan Dr Zaki Patel Ms Claire Jackson Dr Chris Clayton Dr Malcolm Ridgway Dr Preeti Shukla Mrs Janet Thomas Mrs Joanne Mattock Mr Neil Holt Mrs Julie Kenyon General Practitioner Executive Member (Chair) Lay Member - Governance GP Executive Member Interim Director of Commissioning Operations Clinical Chief Officer, Blackburn with Darwen Clinical Director for Quality and Primary Care GP Executive Member Executive Nurse/Associate Director for Quality and Commissioning Minute Taker Head of Commissioning Performance Senior Operating Officer Item 07/17/01 Apologies for Absence/Agenda Sequencing Apologies for absence had been received from Dr Geraint Jones, Secondary Care Doctor (Retired) Mr Roger Parr, Deputy Chief Executive/Chief Finance Officer Dr Adam Black General Practitioner Executive Member Dr Penny Morris, General Practitioner Executive Member Mrs Karen Cassidy, Public Health Specialist Action 07/17/02 Declarations of Interest & Confirmation of Quoracy The meeting was confirmed as quorate. The Chair reminded Members of their obligation to declare any interest they may have on any issues arising at Committee Meetings which might conflict with the business of Blackburn with Darwen Clinical Commissioning Group (CCG). Info Out of Hours - Following the chairs review of the paper and the potential Conflicts of Interest it was recognised that the CBG would be unable to reach a decision, the paper was withdrawn from the agenda. It was noted that there will be a discussion at the Clinical Management Executive Team (CMET) to provide clinical reflection and National Urgent Care requirements and local transformation proposals. 1 Commissioning Business Group Minutes 12 th July 2017

201 ACTION: The National requirements and proposed local response for OOH and clinical advice would be discussed at the CMET to ensure clinical input and steer. More information would be ascertained on the national direction of travel and how local plans could be more transformational on delivery. A revised paper would be brought to a future meeting of the CBG RESOLVED: CBG noted the content of the Chair s update. 07/17/03 Minutes of the Previous Meeting 14 th June 2017 The Minutes of the last meeting were reviewed and agreed as a true record. 07/17/04 Matters Arising - Action Matrix Mr Paul Hinnigan requested that an update be provided on progress to develop a joined up commissioning committee across Pennine Lancashire CCGs. Miss Claire Jackson updated the meeting on the specifics of Acute Visiting Service Specification (AVS). Following further negotiation with the providers, wording has now been proposed for approval by CBG members. AVS will operate between the hours of 9:00 and 6.30 pm, Monday to Friday excluding bank holidays. Referrals must meet service criteria and should be advised to the service as they arise during the day to ensure the best use resource of the AVS service, rather than in batches to avoid potential lack of capacity at the end of the day. The service will broadcast where it anticipates it will reach service capacity, or has reached, service capacity, to ensure that the host Practices can consider other service alternatives for their patients. The AVS service may by exception and at its own discretion, subject to the appropriateness of the referral and available service capacity, broker referrals after 5.30 pm. Miss Jackson advised that an overview of progress in relation to AVS would be provided to the next Senate meeting on Thursday 27 th July to seek further feedback from GP members. ACTION: CJ to provide an update at the Senate meeting relating to AVS. RESOLVED: CBG supported the proposed wording. Miss Jackson advised that Assessment and Support for Children and Young People requiring Ventilation proposals had been approved by Governing Body members on 5 th July An update in relation to associated efficiency savings will be provided to CBG members in September. 2 Commissioning Business Group Minutes 12 th July 2017

202 ACTION: CJ to provide an update on efficiency savings to CBG in September. RESOLVED: CBG noted the update. Miss Jackson advised that, at the recent Accident and Emergency Delivery Board (A&EDB), Paediatric admissions were discussed and the Utilisation Management Team were requested to review how the paediatric pathway currently impacts on admissions. RESOLVED: CBG noted the update. For Approval 07/17/06 Intensive Home Support Service (IHSS) Miss Jackson introduced the paper which outlined the background in relation to the development of the BwD CCG IHSS which was commissioned in The service was redesigned in 2016 in response to growing demand in urgent care and community services, particularly in patients over 65. The CBG members were requested to support the proposed new model of medical oversight for IHSS and receive a revised service specification at the September meeting for approval and assurance of readiness to deliver. A discussion was held on the benefits and risks of the proposal and Mrs Julie Kenyon gave a detailed review on the proposals. The service would offer IV therapy for cellulitis and rehydration provided by Non-Medical Prescribers with medical oversight provided by own GP. From 1 st October 2017, the service would provide 7 days a week 8.00 am 8.00 pm, with referrals accepted until 6.00 pm. It was noted that further modelling was required on activity, impact and cost of the service. A discussion was held on IV and the hydration pathway for the elderly and their aftercare. Members noted that the proposal could be presented to Clinical Senate and CMET to support further clinical engagement. ACTION: Revised Service specification to the September meeting. RESOLVED: That the CBG agreed to: i. Support the proposals for the new model of medical oversight for IHSS; ii. Agree that the revised service would be brought back to the CBG in September. 3 Commissioning Business Group Minutes 12 th July 2017

203 07/17/07 Blackburn with Darwen Community Deep Vein Thrombosis (DVT) Service Update. Members noted that, following approval of the DVT business case to extend the current contract for 2 years at the last meeting in June, further details outlining the risks and mitigating action was requested. Dr Zaki Patel outlined the recommendations addressing this and requested that members consider the risks and mitigation actions and agree to continue to support the decision to award the extension of the contract for 2 further years. A discussion was held regarding service value for money. It was agreed members concerns were addressed in the previous paper submitted to the June meeting regarding this issue. Work is ongoing to resolve OOHs pathway concerns and an update would be provided to CBG members in October ACTION: It was agreed that minor details would be discussed and agreed via the Executive Team. RESOLVED: That the CBG: i. Noted the content of the report; ii. Agreed to continue to support the decision to award the extension of the contract for two further years following the management of the minor details and risks outlined in the report, Standing Item 07/17/08 Quality, Innovation, Productivity, Prevention (QIPP)/Right Care Update: Mr Neil Holt gave an update on the current QIPP position for and reported on 2017/18 Waterfall Diagram. Mr Holt drew members attention to the full year impact/effect indicated. Members noted that the total QIPP savings identified to date were 9,577,721. Mr Neil Holt provided an update on requirements in relation Right Care delivery plan submissions and timescales including: Back Injections 30 th June 2017 Medicine Waste 31 st July 2017 Chronic Obstructive Pulmonary Disease 31 st August 2017 Mr Paul Hinnigan welcomed the level of detail being provided in relation to QIPP which gave greater assurance of delivery and risks to CBG members. 4 Commissioning Business Group Minutes 12 th July 2017

204 For Information 07/17/11 Any Other Business Future Meetings - The Chair opened a discussion about the future of the CBG meetings and the proposal for a Joint Committee across Pennine Lancashire CCGs. Dr Chris Clayton responded by outlining some of the challenges in forming a combined functional group which are currently being worked through by CCG Executive Teams. There was an expectation that the first meeting should take place in September in some form. It was agreed that further discussion in relation to progress would take place at August CBG. The Chair advised that he would be on annual leave for the next meeting and proposed that Dr Adam Black should deputise as Chair. It was agreed that attendance would be checked to ensure quoracy. ACTION: An would be circulated to check attendance and members were requested to respond as soon as possible. Progress of a Joint Committee to be raised at the next CBG in August. It was noted that a meeting would take place but the format would be reviewed depending on attendees. 07/17/12 Date and Time of Next Meeting The next meeting was scheduled for Wednesday 9th August at 1 pm in the Darwin Suite, Innovation Centre. The Chair thanked everyone for their attendance and the meeting closed. Info 5 Commissioning Business Group Minutes 12 th July 2017

205 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group PRESENT: Michelle Pilling Dr Asif Garda Dr Stephen Gunn Lucille Hinnigan Dr Nigel Horsfield Dr Geraint Jones Julie Kenyon Kathryn Lord Caroline Marshall Sharon Martin Claire Moir Dr Malcolm Ridgway Debbie Ross Dr Zeenat Sykes In Attendance: Deryn Ashby Simon Bradley Judith Johnston Elaine Johnstone Caroline Marshall Vanessa Morris David Rintoul Collette Walsh PENNINE LANCASHIRE QUALITY COMMITTEE Minutes of the meeting held on 24 May 2017 Lay Advisor: Quality and Patient Engagement, ELCCG - Chair GP Representative, Pendle, Pendle Locality, ELCCG GP Representative, BwDCCG Deputy Chief Finance Officer, ELCCG Lay Member, BwDCCG Lay Member, BwDCCG Senior Operating Officer, Primary Care Community & Medicines Commissioning, BwDCCG Head of Quality, Pennine Lancashire CCGs Locality Lead Quality and Performance, M&LCSU Director of Performance and Delivery, ELCCG Governance, Assurance and Delivery Manager, BwDCCG Director of Quality and Performance, BwDCCG Head of Safeguarding Children, ELCCG GP Representative, Rossendale Locality, ELCCG Executive Assistant, ELCCG minutes Quality and Performance Manager, M&LCSU Head of Clinical Commissioning, ELCCG Service Director, M&LCSU Locality Lead Quality and Performance, M&LCSU Infection Prevention & Control Lead Nurse, Pennine Lancashire CCGs Quality and Performance Manager, M&LCSU Head of Commissioning, Integrated Community Services, ELCCG Attended for Specific Items: Dr Nick Roberts Clinical Director, Medicines for Older People, ELHT Rachel Watkin Hyndburn Locality Manager, ELCCG Lewis Wilkinson Quality and Performance Support Officer, M&LCSU REF: Welcome & Chair s Update RATIFIED The Chair opened the Pennine Lancashire Quality Committee and welcomed all attendees. Members reflected on the tragic events in Manchester on Monday night with recognition of the lives lost and life-changing injuries that have been sustained. It was noted that emergency services responded quickly to the events as well as managing normal services. Manchester Hospitals managed the incident, with some casualties presenting at ELHT. Communications have been sent to practices about what to do should patients present with any shrapnel injuries and of the need to report them to counter terrorism. ACTION Page 1 of 19 Minutes Approved by the Chair: 07/06/2017

206 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group Apologies Apologies were received from: Ryan Catlow, Susan Clarke, Jackie Hanson, Kirsty Hollis, Dr Gifford Kerr, Dr Yasara Naheed, Dr Lisa Rogan, Dr Paul Taylor, and Janet Thomas Presentation: Stroke Service Dr N Roberts attended to present an update in relation to the Stroke service. He opened by advising that the staff working within the department strive to deliver good stroke care. He acknowledged that the department manager, Jo Deegan, had developed the slides but was unable to attend today. ELCCG and BwDCCG have some of the highest rates for stroke in the North West, as well as morbidity from stroke; the number of admissions are higher than the national average. He added that there are a high number of suspected stroke patients that present at the Trust as well. There are 44 Key Performance Indicators, and the data for this is now available twice a year, as opposed to four times a year previously. These indicators are divided into domains, and all are evidence-based. He advised that the performance has been a major focus and the Trust s unverified SSNAP data indicates that the Trust have improved since the last assessment. The current service delivery model was detailed. This included the care being led by the Stroke MDT. If the patient recovers quickly they are discharged to the community stroke team for each CCG. If they require further treatment or care, they are transferred to the recovery unit at Marsden Ward, Pendle Community Hospital. Dr Roberts explained the Thrombolysis provision. A patient needs to be seen and thrombolysed within 3 hours of the onset of symptoms; between 9 and 5 there is a consultant service, but out of hours this is undertaken as part of the Lancashire and Cumbria Stroke Network Telestroke service. The Chair queried this, and Dr Roberts explained that it is a telephone consultation with a consultant that will review the scans and notes and decide whether thrombolysis is necessary. RATIFIED Dr Roberts explained that increased access to the scans, both current and past, would be beneficial to the service. This is being discussed within ELHT, but the proposal is being supported by the Radiology Department. S Martin queried the reasons for the E grading in the pathway; she asked if it was the stay in A&E, the diagnostics or the access to the consultant. Dr Roberts advised that this is a difficult query, advising that comparisons have been made to London where 10m have been spent on the service to ensure patients are aware of the process and access the service quickly. He explained that the paramedics are supportive and transport a patient to A&E quickly. He advised that there are delays with patients attending A&E within the 3-hour window because they do not request assistance at the onset of symptoms, but attend later when the symptoms persist. He added that there are also delays within the pathway that can be improved. It was confirmed that thrombolysis is the best treatment and most likely to save lives. Page 2 of 19 Minutes Approved by the Chair: 07/06/2017

207 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group Dr M Ridgway queried which is the key intervention, of the 10 listed, that needs to be focused on. C Walsh questioned the delays, and whether it was an issue with understaffing, the stroke beds are filled with patients that might not have a stroke. Dr Roberts advised that this is included on the slides. Dr Roberts continued, explaining that there had been a issue with a lack of consistent data provided to the SSNAP database. This has been addressed, and two administrative assistants have been employed to update the data accurately and in a timely fashion. The Trust are also monitoring the data themselves, hence the development of the /unverified SSNAP data, to provide contemporaneous monitoring. It was noted that the Trust do not have sufficient staff to fulfil RCP guidelines, but there is a known national shortage of Stroke consultants. The Trust has recently employed two Stroke Nurse Practitioners to support the team. They are providing a positive impact to the team. S Martin noted that they may support changing the culture within A&E to ensure stroke patients are seen and thrombolysed quickly. In addition, RCA reports are completed for patients where the KPIs have not been met to identify any immediate improvements that can be made to the pathway, There is a slow transfer to the acute stroke unit from A&E. He advised that this was due to a number of reasons, including waits for CT scan, and physical transfer of the patient from the A&E department to the stroke unit. Dr Garda stated that some of the delays that arise as a result of cultural behaviour are a concern and need to be addressed. Dr Roberts concurred noting that this is improving within the Trust, but it has taken time to improve. Dr Roberts stated that patients that present with a suspected stroke are also being referred more quickly. Dr Sykes reported that GP practices often receive phonecalls from care homes where a patient has symptoms indicative of a stroke but have not referred them to A&E; there is some training that could be undertaken in care homes to improve this reaction time. C Walsh observed that improvements have been made, which is positive. She noted a need for an action plan against the SSNAP areas with clear actions that can be monitored against. RATIFIED Dr Roberts noted that the final part of the improvements is a request for increased therapy staffing levels, as this is below national guidelines. C Walsh noted that this is part of a discussion currently being held with ELHT to make improvements. Dr Roberts advised that early supported discharge is key to improving the overall service. C Walsh agreed, stating that a Task and Finish Group has been pulled together to review the discharge issues and will spend 12-weeks looking at this area. Dr Roberts advised that there are ongoing SSNAP Improvement Actions, including specialist assessments, occupational therapy, physiotherapy, speech and language and MDT working. He noted that during winter there was funding provided to support the stroke team and the performance improved, but this funding has stopped. S Martin observed that there are not sufficient resource to provide everything needed across the health economy, but there is close liaison with ELHT to agree how to allocate the resource to improve the performance within Stroke. J Johnston queried the sustainability of the improvements made. Dr Roberts stated that the early supported discharges cannot be improved further without further investment. Page 3 of 19 Minutes Approved by the Chair: 07/06/2017

208 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group The Chair queried the anticipated future demand. Dr Roberts advised that there is increased survival from heart attacks, which would mean an increase in demand for the stroke service. C Walsh acknowledged that the Trust are keen to improve the Stroke service. She noted that there are a number of delays on the pathway that could be addressed. Dr Roberts concluded the presentation by advising that the next steps for the team include a visit from the SSNAP national team on 18 July A business case has been developed and is under discussion. There is also a request to combine the stroke units on to 1 site at RBH to maximise efficiencies. Dr Horsfield queried how well the team make beds available to accommodate the anticipated 2 admissions per day. Dr Roberts advised that the stroke team are taking responsibility for this. Dr Horsfield observed that this flow needs to improve in order to effect improvements. Dr Garda queried whether there have been visits to the National Stroke Centre in Salford. Dr Roberts confirmed that visits had been undertaken. He noted that the Stroke Centre have a different approach to RBH. S Martin noted that this is a hyper-acute conversation that would need to be held outside of this meeting. Dr Roberts added that the ELHT service covers Lancashire and Cumbria, whereas the Salford Centre covers a city. C Marshall noted that the stroke performance was very high at one time, but has dropped over time. She asked about the timescales that are being worked to in order to improve services. Dr Roberts stated that this needed the CCG to decide about the additional funding and resources needed. Dr Roberts confirmed that an internal action plan has been developed and can be shared with C Walsh. ACTION: Dr Roberts to share the Stroke Action Plan with C Walsh for discussions prior to the SSNAP National Visit on 18 July 2017 The Chair noted that it was positive to hear that there had been some progress despite the overall disappointment that the performance was not improving. However, it was clear that there needs to be further work to improve the performance and quality concerns. ACTION: RATIFIED Stroke Update to be returned to committee in August 2017 to provide assurance against the concerns raised. Dr Roberts and R Watkin were thanked for attending the meeting Declarations of Interest There were no interests declared by members. It was confirmed that L Hinnigan was attending the meeting to represent K Hollis. The meeting was quorate. Page 4 of 19 Minutes Approved by the Chair: 07/06/2017

209 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group Minutes of the Meeting Held On 26 April 2017 Some amendments were offered for the meeting held on 26 April These were: Present: It was confirmed that V Morris and R Newby represent both EL and BwD CCGs : Advancing Quality Update Page 6, first paragraph: This is being mitigated through the ELHT Clinical and Effectiveness Meeting : Pennine Lancashire Risk Management Update Page 11, first paragraph. A meeting has been scheduled for 11 May 2017, With the above amendments, the minutes were formally ratified. The minutes for the meeting held on 26 April 2017 were approved as an accurate reflection of the meeting Action Matrix : Memory Assessment Service K Lord advised that an update paper will be available at the July committee : BwDCCG Equality and Inclusion Annual Report D Ashby to confirm with C Bentley that this was completed Matters Arising There were no matters arising. S Martin exited the meeting RATIFIED CONFIDENTIAL DISCUSSIONS Provider Updates The paper was tabled for reference. K Lord advised that the paper has been reduced and requested feedback on the new format. The content of this item is for committee members and attendees only, and is not for wider distribution. The confidential minutes of this part of the meeting will be circulated under separate cover. Members received and acknowledged this report. Page 5 of 19 Minutes Approved by the Chair: 07/06/2017

210 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group Pennine Lancashire Quality and Performance Report Month 12 S Bradley and M Connell attended to present the Pennine Lancashire Quality and Performance Report for Month 10. A&E There was underperformance against the 4-hour A&E target in March Ambulance Calls There has been underperformance against all 3 ambulance call targets for both BwDCCG and ELCCG in March RTT Incomplete There was underperformance against the RTT incomplete standard in March 2017 for BwDCCG. Year to date target is currently being met, but is close to the trajectory. There has been an improvement in all areas, with the exception of Urology. This is being monitored. Cancer 62-day Target (Standard) This was met for both CCGs in March 2017; however the target for 2016/17 was not met for either CCG. Clostridium Difficile There were 5 cases identified for ELCCG in March This target has been breached. 73% of the cases of C-Diff were identified as unavoidable. Of the remaining cases, some lessons learned included antibiotic prescribing to patients. MRSA There have been 7 cases of MRSA throughout 16/17; of these, 1 has been attributed to ELCCG against a target of 0. BwDCCG have had 0 cases through 2016/17. RATIFIED E-Coli In March 2017 there were 20 E-Coli cases identified within the population of East Lancashire, and 17 cases in Blackburn with Darwen. Quality Premium: 2016/17 It was explained to members that CCGs must achieve at least 1 constitutional target in order to qualify for any Quality Premium funds. In 2016/17 BwDCCG achieved 0 out of the 4 constitutional measures so does not qualify for any Quality Premium funds. ELCCG achieved 1 out of the 4 constitutional measures, 2 out of the 5 national measures, and 1 out of the 3 local measures. Dr M Ridgway raised a concern about the impact on the system of not achieving the Quality Premium targets, as significant funding removed from the system as a consequence. Dr H Jones observed that it would be beneficial to have a report at the next meeting detailing the money lost as a result of not achieving the Quality Premium, and a comparison of how other areas are achieving the targets. ACTION: L Hinnigan to liaise with K Hollis about a paper detailing the loss of the Quality Premium funds, and how other areas are achieving the Page 6 of 19 Minutes Approved by the Chair: 07/06/2017

211 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group targets Quality Premium: E-Coli V Morris informed members that detail has now been published from NHS England concerning the new Quality Premium (QP) planned for : Reducing Gram Negative Bloodstream Infections (GNBSIs) and inappropriate antibiotic prescribing in at risk groups. This Quality Premium measure consists of three parts: reducing gram negative blood stream infections (BSI) across the whole health economy reduction of inappropriate antibiotic prescribing for urinary tract infections (UTI) in primary care sustained reduction of inappropriate prescribing in primary care The targets across Pennine Lancashire for 2017/18 are: 257 cases for ELCCG; 141 cases for BwDCCG. The CCGs across Pennine Lancashire are by looking at the last cases of E coli in depth and are working to find the most effective method of collection for the primary care core data set. Dr G Jones queried the number of E-coli cases and how they were identified. V Morris explained that there were approximately 300 per year, and these would usually be identified when a patient presents at hospital. K Lord observed that this will be part of the Quality Premium for 2017/18, so there will be finance attached to achievement of the targets. Dr M Ridgway queried the different C-Diff rates between EL and BwD CCGs, also noting that the C-Diff rates vary across all CCGs. V Morris explained that the target is set depending on the amount of work previously undertaken. She added that Lancashire North CCG has a significant issue with C-Diff cases, but the reason for this is not clear. Public Health England hold some data, but have not shared this. ACTION: RATIFIED V Morris to request the C-Diff data from NHS England and ascertain the reasons for the variance The Chair was concerned that 5 GPs had not engaged in the PIR process; V Morris explained that the GPs had declined the invitation to participate, and were duly informed that the recommendation would subsequently be that the case was avoidable as they did not engage in the process. She added that a review will be undertaken over a 12- month period to identify if there are any patterns developing around PIR engagement from GPs. A newsletter will also be circulated to GPs providing some information about lessons learned from reviews. IAPT Prevalence The notional monthly LCFT commissioned prevalence target for Improving Access to Psychological Therapies (IAPT) was met for EL CCG and at Trust level in March 2017, however this was not met for BwD CCG in-month. The LCFT commissioned 15% prevalence target for the 2016/17 operational year was not met for 1 CCG area: Fylde and Wyre local commissioners had agreed for capacity to be prioritised on reducing internal waiting times ahead of completing welcome calls and entering new patients into treatment. Page 7 of 19 Minutes Approved by the Chair: 07/06/2017

212 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group IAPT Recovery The 50% Recovery target was met for both BwD and EL CCGs in March 2017, but was not met for 2 CCG areas in March 2017: Fylde and Wyre and Lancashire North. IAPT Waiting Times The standard for 75% of patients to enter treatment within 6 weeks was met for both BwD and EL CCGs in March 2017, The standard for 95% of patients to enter treatment within 18 weeks was also met for both BwD and EL CCG in-month. IAPT waiting time targets were met for all other CCG areas in March 2017, as well as for the 2016/17 operational year. Long internal waits remain an issue in some areas, particularly for high intensity interventions; this is largely attributed to a lack of qualified IAPT professionals nationally. Internal waits are monitored in detail at CCG level on a monthly basis at the Performance Improvement Subgroup and across Pennine Lancashire, at the end of March 2017, there was 1 patient waiting over 18 weeks for CBT in the Blackburn with Darwen area. Early Intervention Psychosis The target for 50% of patients experiencing a first episode of psychosis to commence a NICE-concordant package of care within 2 weeks was met for both BwD and EL CCG in March MAS Seen Within 6-weeks The target for 70% of patients to be seen by the Memory Assessment Service (MAS) within 6-weeks was not met for either BwD or EL CCG in March The 6-week target was met for 2 CCG areas in-month: Blackpool and Fylde and Wyre. The strong performance in Fylde and Wyre is as a result of additional resources being placed into that area by Fylde and Wyre CCG, and the Trust report that the atypically strong performance in the Blackpool locality is due to a more consistent referral rate than in other CCG areas, as well as the availability of a trainee Advanced Nurse Practitioner funded for the Fylde Coast. Local recovery action plans and trajectories are in-place for all CCG areas. The 6-week target is expected to be met for West Lancashire CCG and Morecambe Bay CCG (formerly Lancashire North CCG) from April 2017, and by September 2017 for: East Lancashire; Blackburn with Darwen; Chorley and South Ribble; and Greater Preston CCGs. Beyond September 2017, the Trust report that sustainable performance for the Blackburn with Darwen, East Lancashire, Greater Preston, and Chorley and South Ribble CCG areas is dependent on service redesign and Shared Care. Redesign work is progressing in both areas led by local commissioners. RATIFIED Attention Deficit Hyperactivity Disorder Concerns remain around waiting times for new adult patients referred into the Attention Deficit Hyperactivity Disorder (ADHD) service, with 62% of new adult patients seen within 18 weeks in the 2016/17 operational year. Commissioners have also raised concerns that the service model currently being delivered is not in-line with the model previously agreed by commissioners. This has been escalated to executive level and an options paper is expected to be received by Blackburn with Darwen CCG, as lead commissioner, in May Page 8 of 19 Minutes Approved by the Chair: 07/06/2017

213 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group Out of Area Treatments There was an average of 21 Out of Area Treatments in March 2017 against a target of 0 and a tolerance threshold of 15. There has been an increase in the number of out of area PICU placements in April and May The Trust report that this is a direct result of a high number of delayed discharges from PICU wards over recent months. Once these discharges are completed, the OATs position is expected to improve. A trajectory to further reduce the numbers of OATs throughout 2017/18 is in development and is based on the next phase of Intensive Community Services, such as the development of the expansion of the Acute Therapy Service, additional Crisis Support Units and the development of Crisis Houses. There is also a unit specifically for children that is due to open in Preston Accident and Emergency 4 and 12-Hour Breaches where Psychiatric Assessment was Requested Overall, Q4 saw an increase in the number of 4 and 12 Hour Accident and Emergency breaches where psychiatric assessment was requested. A joint LCFT and ELHT action plan is in production following the recommendations made by the independent review undertaken by the Royal Colleges of Emergency Medicine and Psychiatry in This is expected to be shared with the CCGs in June The next phase of Intensive Community Services is also expected to reduce the demand for A&E mental health assessments and inpatient mental health beds, as these are rolled out during 2017/ week There was 1 patient waiting over 52-weeks in March This patient us under the speciality of Maxillofacial Surgery, which is commissioning by Spec Comm; this has been included for reference. CQC Reports SB informed members that the recent LTH CQC inspection resulted in a Requires Improvement recommendation. A Risk Summit will be scheduled to review the issues. BMI Lancaster Hospital was identified as Requires Improvement, although CQC recently undertook an announced visit with positive feedback. BMI Beeardwood CQC report is due for publication. The Chair noted that on Page 46 it was reported that the Out of Hours GP had requested a single dose of steroid from Burnley Urgent Care Centre for a child, which was refused with a recommendation that the patient wait in A&E with an approximate wait of 5-hours. C Marshall assured members that this is being discussed with ELHT to understand what happened, and will be discussed at the next meeting with ELMS. Members acknowledged the report RATIFIED S Martin returned to the meeting; J Kenyon exited the meeting. Page 9 of 19 Minutes Approved by the Chair: 07/06/2017

214 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group Pennine Lancashire Serious Incident Review Group Recommendations L Wilkinson presented the paper to the committee. ELCCG On 06 April 2017, 7 reports were reviewed. Of these, 5 were approved for closure and 2 were rejected; 1 report was returned to the provider, and 1 report required an internal CCG action. On 20 April 2017, 8 reports were reviewed. Of these, 6 reports were approved for closure and 1 was rejected; this report required an internal CCG action before closure could be approved. BwDCCG On 27 April 2017, 7 reports were reviewed. All 7 were approved for closure. During this period, a total of 2 extension requests were submitted by ELHT; all requests were approved, and both were received before the RCA deadline. This is a decrease in the number of extension requests received from ELHT. C Marshall noted that an increase has been seen since this report, but this is due to capacity. There have been 4 extension requests submitted by LCFT in March 2017; all requests were approved. Of the 4 extension requests, 1 was received before the RCA deadline, and 3 requests were received after the deadline. The number of extension requests received from LCFT remains high in comparison to previous months. Timely submission of extension requests will be reinforced with LCFT via the monthly Quality and Performance Meeting. C Marshall advised that the next report will show that an extension request was declined. In April 2017 all Rapid Reviews were submitted by ELHT, but 2 were received outside the 72-hour timeframe. For LCFT, 2 reports were received outside the 72-hour timeframe. The requirement for timely submission of rapid reviews under the Serious Incident Framework has been reinforced with both ELHT and LCFT. RATIFIED The report also provided a summary of the position of StEIS incident reports up to 10 May ELCCG has 78 incidents open at present. Of these, 32 are awaiting additional information from the provider, 8 are awaiting the CCG decision on closure, and 4 are awaiting an internal CCG action. 7 reports are overdue, and 27 reports are approaching deadline. BwDCCG has 59 incidents open at present. Of these, 8 are awaiting additional information from the provider, 27 are awaiting the CCG decision on closure, and there are none awaiting an internal CCG action. 8 reports are overdue, and 16 reports are approaching deadline. The Committee formerly received the report for information. Page 10 of 19 Minutes Approved by the Chair: 07/06/2017

215 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group L Wilkinson exited the meeting /17 CQUIN Reconciliation Q4 for EL and BwD CCG Hosted Contracts 2016/2017 CQUIN Reconciliation has taken place for Q4 for ELCCG and BwDCCG hosted contracts. BMI Evidence has been submitted by BMI and discussed at the BMI Quality Review Meeting on 04 May Of the 3 indicators, 2 have been fully reconciled. The Clinical Collaborative Event, for the third indicator, has been deferred until June ELHT Evidence has been submitted by ELHT and discussed at the ELHT Quality Review Meeting on 03 May There is a data lag for the Sepsis indictor and Antibiotic Consumption indicator; these have not been reconciled. The remaining 8 indicators have been fully reconciled. LCFT Evidence has been submitted by LCFT; however, following review further information was requested and will be discussed at the Quality and Performance Meeting on 17 May Evidence has also been submitted against the Q3 unreconciled schemes, with full achievement of all milestones. Therefore the 6 outstanding Q3 milestones have been reconciled, and 3 out of the 6 Q4 milestones have been reconciled. MCFT Evidence has been submitted by MCFT and discussed at the MCFT Quality Review Meeting on 05 May National data is required for 1 of the indicators; therefore this has not been reconciled. The remaining indicator for Q4 has been achieved. IAPT Consortium The IAPT Consortium has submitted partial evidence against the Q4 indicators. Evidence is outstanding for 1 indicator, and there is a national data lag for the Improving Data Quality indicator. 6 out of the 8 Q4 indicators have been achieved. RATIFIED Age UK Evidence has been submitted by Age UK and discussed at the Age UK Contract Review Meeting on 02 May The Q4 milestone has been met. About Health Evidence has not been submitted by about Health. Reminders have been sent with a deadline given of 12 May Specsavers Audiology Evidence has been submitted and reconciled. Q4 milestones have been achieved. Members were asked to support the recommendations relating to release of the CQUIN monies for Quarter 3, where indicated, and Quarter 4. Members acknowledged the report and approved the recommendations for payment of CQUIN monies as outlined in the report Page 11 of 19 Minutes Approved by the Chair: 07/06/2017

216 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group BwDCCG Risk Management Update C Moir presented the Risk Management Update and Corporate Risk Register for BwDCCG; ELCCG postponed their update until the next meeting. Blackburn with Darwen CCG The full Corporate Risk Register was presented. For BwDCCG there are 11 operational risks and 7 strategic risks held on the register. These were broken down into separate headings, as follows: Risks relating to NHS Constitution Targets Performance against A&E 4-hour target Risk of service delivery in Emergency Medical Services (ambulance) Failure to achieve cancer targets if activity increases as anticipated 18-week Referral to Treatment Quality / Safety Risks Lack of sufficient and sustainable capacity in diagnostics for patients with suspected and confirmed cancer Failure to achieve the stroke quality requirements during 2016/17 Initial health assessments for Looked After Children not being completed within the 20 working day statutory timeframe Inability of patients aged 18 and under to access Tier 4 Mental Health in-patient beds when assessed as requiring that facility Failure to meet the reforms for children with educational needs and disability (SEND) as set out in the Children s Act (2014) RATIFIED One risk was recommended for closure: Increased safeguarding in quality and demands in the system are having a direct impact on established safeguarding adult capacity within the CCG. This has been recommended for closure as it has been held at target risk rating, and the allocation of the Safeguarding Adult workload is now shared across a joint team. D Ross advised that there is a remaining gap for the Safeguarding Adult Medical role. There were no new risks added, and no risks for closure during the reporting period. Members acknowledged the report and the updates to the Risk Register, and approved the recommendations ELCCG Freedom of Information Report This report detailed the amount, type and status of Freedom of Information (FoI) requests received for ELCCG from 01 January to 31 March Page 12 of 19 Minutes Approved by the Chair: 07/06/2017

217 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group A total of 57 requests have been received during this period. 51 have been responded to within the statutory timescale, and 6 cases are still active although within the 20-day time limit. No internal reviews or referrals to the Information Commissioners Office were requested against any FoI responses during this period. There were no exemptions, where the CCG could refuse to provide the requested information, during this period. The report detailed a breakdown of FoIs by applicant and theme. The highest number of requests were received from commercial applicants, and the most requests were queries pertaining to commissioning services. These requests were further categorised into type. Members noted the report ELCCG Q4 Complaints Report K Lord presented the report detailing the complaints, concerns and queries received by ELCCG within Quarter 4, January - March It was noted that the number of complaints has decreased from the last quarter, but there has been an overall increase since Q1. There has also been a year-on-year increase in the number of complaints, MP letters and PALS enquiries; this is not consistent with national trends, which have shown a reduction since 2015/16. There were also 2 compliments received during this quarter. In Q4 the highest number of complaints received related to Continuing Heath Care (CHC), with commissioned support services as the second highest. There were 2 new cases referred to the Parliamentary Health Service Ombudsman during Q4, which are currently under review for full investigation. In July 2016 a report was submitted to the Lancashire IPA Board which demonstrated that East Lancashire CCG had the highest number of CHC complaints of the 6 Lancashire CCGs in attendance. It also had the highest proportion of overall complaints being categorised as being about CHC services. RATIFIED During Q4, 11 MP letters were received from 5 different MPs. 4 queries were abut commissioned support services, 4 about CHC, 2 about Medicines Management, and 1 about a residential home. During this period, 100% of complaints were acknowledger within 3 days, and there were no breaches of the statutory 6-month timescale to respond to complaints. Work is taking place to produce more detailed information about handling times. The CSU Complaints Team are working to change the focus of complaints management to reflect a more individual action plans for complainants and broader service improvements. As part of this, services are asked to complete a lessons learnt log, where appropriate. CSU continue to produce a regular sitrep followed by a call between the Complaints Team and the CCG, which continues to work well. Communication is improved and prevents cases being delayed. A dedicated member of the complaints team, experienced in CHC processes, has been allocated to case managed CHC complaints for the CCG. The Complaints Manager is also co-ordinating Ombudsman cases to meet Page 13 of 19 Minutes Approved by the Chair: 07/06/2017

218 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group case deadlines. K Lord informed members that the Q1 report for 2017/18 will be a joint Pennine Lancashire report. The Chair queried whether the CHC complaints relate to PuPOC. K Lord confirmed that some of them do, particularly where other agencies were required to provide information and did not do so. Communication with families regarding the progress of claims was also an issue. She advised that one of the Ombudsman cases is related to CHC reviews. She advised that one case relates to a death in a care home, but that the Ombudsman had changed the scope of this review. E Johnstone observed that there is a pattern appearing where the CHC assessment was conducted and declined, but now the solicitor is putting in a complaint about the process rather than an appeal against the decision; this then needs to be handled as a complaint, rather than a dispute about the outcome. It is an unintended consequence of the solicitors actions, but is being mitigated by improved communication between the CHC Team and the Complaints Team. Members acknowledged the report Pennine Lancashire CCGs Safeguarding Quarterly Dashboard Report This report provides an update of the key safeguarding priorities within the last 3 months in respect of Blackburn with Darwen and East Lancashire CCG s. It highlights key progress on risk areas, any barriers encountered, and a summary of the workload. D Ross advised that more staff were needed within the team to support the portfolios, including an increase in medical capacity. There have been a number of issues regarding the designated functions in BwD as ELHT have given notice to terminate the positions. This impact will need to be factored in to future papers. The Chair asked if there were any areas of concern that have not been addressed. D Ross stated that the Designated Doctor function for both areas is still a concern as the capacity does not meet the intercollegiate framework advice. However, NHS England are sighted on the issues, but a plan needs to be developed to take this area forward. There is currently a review of the functions, mindful that there is still a gap in capacity. A further paper concerning capacity will be presented to a future committee which will detail how to provide the functionality to keep the population safe. Dr M Ridgway noted that the safeguarding agenda has expanded nationally, but there has been no increase in resources to manage this increase; therefore there needs to be a decision about how best to use existing resource sensibly. RATIFIED S Martin queried whether there is resource to put something in place locally if ELHT give notice on their contract. D Ross advised that this is still in negotiation but the likely outcome will be termination of the contract. This would, however, provide an opportunity to align the services on a Pennine footprint. There are issues with the backlog of Health Assessments for CLA; the CCG are not receiving updates from ELHT about the action plan. Children s Commissioners are working closely with the team and expecting a recovery dashboard in Q1 2017/18. Burnley and Blackburn are priority areas for the PREVENT scheme. As such, the safeguarding team are in close liaison with the anti-terrorism teams and taking any Page 14 of 19 Minutes Approved by the Chair: 07/06/2017

219 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group necessary precautions. NHS England also facilitated a conference regarding Extreme Right Wing issues, which is a high risk in the area as well. Neither CCG are compliant with the safeguarding mandatory training. D Ross noted that bespoke training will be targeted at level 1, and that face-to-face training will be available for those that need it, once the team is at full capacity. For the Child Sexual Exploitation provision, BwDCCG commission two health practitioners into a co-located team called Engage. There are a number of operational and strategic meetings for CSE, with a number of cases in EL and BwD. The Chair queried if the issues raised in the televised account of the Rochdale CSE cases could happen locally and why Burnley did not appear to have any prosecution for CSE. She asked DR whether the recent changes would help; D Ross advised that there have been a number of prosecutions over the last 12-months. In addition, the police are looking at different methods to help to secure the prosecution. S Martin asked if there was provision in place for people to raise historical issues should they feel able to raise them. D Ross advised that the police have a system for people to raise historical CSE cases. Dr Garda noted the difficulties of supporting mental health problems for patients who had a history of sexual exploitation; he asked what advice they should be offered, and whether they should be directed to the police. D Ross noted that this would depend on what they would like to happen. The Chair queried whether a bulletin could be shared with GP practices directing them to the services available for patients that present with historic CSE issues. ACTION: Safeguarding Team to arrange for a bulletin to go to GP practices detailing the contact details and advice for people that wish to disclose cases of historic sexual abuse. The Chair observed that it was a key area of work for Pennine Lancashire to support people with Adverse Childhood Experience as they can present with multiple health problems in later life. RATIFIED D Ross noted that there have been a number of requests for safeguarding involvement in procurement processes. She advised that a request has been circulated that requests are sent to the safeguarding inbox and not individuals team members to ensure it is actioned in a timely manner. The Chair asked whether the LSCB is identifying increased numbers of people involved in radicalisation, nationally and locally, particularly in the light of recent events. D Ross assured the members that there is a county-wide group looking at this area. She also noted that online sexual grooming and radicalisation online occur in a very similar manner, and is much more prevalent online. Members noted the report and approved the recommendations CQC Review of Health Services for Children Looked After and Safeguarding in Lancashire: Action Plan Update D Ross reminded members that the original CQC Lancashire-Wide Action Plan was presented to PLQC in Autumn An updated plan was submitted to CQC on 21 December 2016, with further progress being monitored by NHS England. Positive Page 15 of 19 Minutes Approved by the Chair: 07/06/2017

220 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group feedback was received from the CQC inspector, and there will be ongoing monitoring of this action plan via the NHS England Steering Group until September Since submission of the action plan in December 2016, several amber actions have moved to green. S Martin queried whether the safeguarding team were assured that all actions would be completed within the timescales. D Ross advised that this was not the case, explaining that there is significant interdependency with local authority, and there is a focus on reducing unwarranted variation. She also noted that there is reliance on LA colleagues, but there are plans in place to address the issues. D Ross advised that action 7.1 remains amber, due to the aforementioned issues with interdependencies with the Local Authority. They are the lead on this action, but there needs to be discussion about how to integrate on this area. Action 8.1 relates to CSE training; the team are assured that every organisation has something in place, but there was insufficient evidence available at the time of the inspection to verify this and close the action. This will be in place by September The Chair commended the team for the work and progress to date. She noted that this was acknowledged by the CQC in their feedback commending progress, leadership, the quality of the plan and collaborative working, as well as involvement with young people. S Martin observed that both LCC actions are linked to vulnerable children, and she asked whether the committee should escalate a request for assurance. D Ross advised that this had already been escalated at the Safeguarding Boards, and that there is a meeting in the next week to discuss progress. She agreed to speak to The Chair after this discussion to confirm if a Chairs Letter needs to be sent. ACTIONL: D Ross to liaise with M Pilling if a Chairs Letter needs to be sent to gain assurance on the LCC actions. Members acknowledged the update RATIFIED ELCCG Safeguarding Self-Assessment Accountability and Assurance, including Section 11 Requirements D Ross advised members that the Lancashire Safeguarding Children Board have requested that the Section 11 requirements are submitted on an annual basis. There has been agreement that these requirements will be incorporated into the annual CCG self-assessment accountability and assurance template. Members were asked to receive this report prior to submission to the Lancashire Safeguarding Children s Board. It was noted that the Blackburn with Darwen Safeguarding Children s Board require different assurance, so this will be presented in a different report. Work is ongoing to enable the team to provide joint assurance for 2018/19. D Ross asked members to request their staff to complete the relevant safeguarding training. S Martin requested that the non-compliant areas are broken down into directorates and the relevant lead contacted. ACTION: Safeguarding Team to send out a breakdown of mandatory training Page 16 of 19 Minutes Approved by the Chair: 07/06/2017

221 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group compliance per directorate Members acknowledged the report and approved it for submission to the Lancashire Safeguarding Children s Board Personal Health Budget Update J Johnston presented this report to update the committee on progress and current risks in relation to Personal Health Budgets (PHBs) for the Pennine Lancashire CCGs. The current local offer relating to PHBs for both CCGs is currently limited to those individuals eligible for CHC, joint packages of care, and children with complex needs who receive funding for individual packages of care. There are currently 10 PHBs in place for BwDCCG and 16 PHBs in place for ELCCG. The Committee will be kept apprised of progress towards the mandated PHB trajectory through the bi-monthly IPA update report. The administration of PHBs currently lies with the CSU as part of the Individual Patient Activity offer; managers from the 2 CCGs have tried to drive the development of processes and increase numbers on a Lancashire-wide footprint. This has been challenging, but a recent development is that the CCGs are now in a position to offer direct payments to individuals and their family in partnership with NHS Shared Business Services through the PHB Choices e-market. CCG managers will continue to pursue developments through the IPA Programme Board to look at providing a consistent offer across the STP footprint. East Lancashire is one of 5 pilot sites, supported by NHS England, in the national End of Life PHB programme. This pilot is currently based in the Ribblesdale locality; it was originally funded for 1 year, but has been extended to 2017/18. Learning from the first year of the pilot has been identified and feedback from patients and carers within the pilot has also been obtained. Priorities for 2017/18 around PHB and the PHB End of Life pilot have been identified and detailed within the report. Updates for these will be included in the bi-monthly IPA report to committee. The Chair thanked J Johnston, noting that these are some quite challenging targets. Members acknowledged the report RATIFIED /17 Quality Accounts This report was presented to inform the Committee of the process implemented for publication and sign off of the 2016/17 Quality Accounts for EL and BwDCCG hosted contracts. Organisations that provide healthcare commissioned by NHS England of Clinical Commissioning Groups are required to produce and publish an annual Quality Account, which must then be uploaded to the NHS Choices website by 30 June These are an important way for local NHS services to report on quality and show improvements in the services they deliver to local communities and stakeholders. Providers are required to share their Quality Accounts with the commissioner responsible for the largest number of patients that services have been provided to during the reporting period. The end of each Quality Account contains a statement from Page 17 of 19 Minutes Approved by the Chair: 07/06/2017

222 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group the provider s main commissioner reflecting on the content of the account and the quality of services provided. Draft Quality Accounts have been received for the main hosted providers for BwD and EL CCGs, and those where the CCG is an associate on the contract. These are: ELHT, LCFT, Calderstones / MCFT, BMI and Airedale NHS Foundation Trust (AFT). The draft accounts have been assessed, and the statements have been circulated to members for ELHT, LCFT and AFT. The remaining Quality Accounts are being assessed and statements are being prepared. M Ridgway asked if providers could be invited to give a summary presentation giving a high level overview to the committee. The Chair concurred and asked that the providers attend a future committee to present their Quality Accounts and performance. ACTION: D Ashby to arrange for providers to attend a future committee and present their Quality Accounts and performance Members acknowledged the report Quality Contract Meeting Minutes March 2017: BMI, ELHT, LCFT These were distributed prior to today s meeting for information. No comments were raised. Members acknowledged the minutes ELCCG Risk Management and Information Governance Minutes: April 2017 These were distributed prior to today s meeting for information. No comments were raised. Members acknowledged the minutes Cancer Tactical Meeting Minutes: April 2017 These were distributed prior to today s meeting for information. No comments were raised. Members acknowledged the minutes. RATIFIED Any Other Business Cyber-Attack Members received an update on the cyber-attack that occurred on 12 May It was noted that K Hollis, R Catlow and A Thornton worked with the locality and primary care teams to manage the situation and impact. They were commended for their hard work, and it was also recognised that primary care teams worked hard to keep their systems Page 18 of 19 Minutes Approved by the Chair: 07/06/2017

223 NHS Blackburn with Darwen Clinical Commissioning Group NHS East Lancashire Clinical Commissioning Group going with limited IT. All practices are now running with IT equipment, with the IT team visiting to finalise any software installations to help practices resume normal service. Members acknowledged the hard work of the IT team. It was also noted that the hospital had significant problems over that weekend with only 40% of equipment available, but they ensured that diagnostics were available as a priority. Members acknowledged the work and support offered in all areas to return the system to normal after the cyber-attack Items for the Risk Register There were no new items for inclusion on the Risk Register for either CCG Date & Time of Next Meeting The next meeting has been scheduled for Wednesday 28 June 2017 in Meeting Room 1, Walshaw House. The deadline for papers is 5pm on Monday 19 June The meeting closed at 15:45 RATIFIED Page 19 of 19 Minutes Approved by the Chair: 07/06/2017

224 CLINICAL COMMISSIONING GROUP (CCG) Minutes of the Audit Committee Meeting held on 25 th May 2017 at 2 p.m. in the Small Meeting Room, Fusion House Evolution Park, Haslingden Road, Blackburn, BB1 2FD PRESENT: Mr Paul Hinnigan Dr Nigel Horsfield Dr Geraint Jones IN ATTENDANCE: Mr Roger Parr Mr Chris Whittingham Mrs Pauline Milligan Lay Member Governance (Chair) Lay Member Lay Member Secondary Care Doctor (Retired) Chief Finance Officer Manager Assurance, Grant Thornton UK LLP Governing Body Secretary (minutes) Min No Item Action By Chair s Welcome The Chair welcomed everyone to the meeting of the Clinical Commissioning Group s (CCG s) Audit Committee (AC) Apologies for Absence and Confirmation of Quoracy Apologies were received in respect of: Dr John Randall, General Practitioner (GP) Executive Member; Mrs Claire Moir, Governance, Assurance and Delivery Manager; Mrs Sharon Brock, Local Anti-Fraud Specialist, Mersey Internal Audit Agency (MIAA); Mrs Lisa Warner, Senior Internal Audit Manager, MIAA; Mrs Karen Murray, Director Assurance, Grant Thornton UK LLP. The Chair explained that, as the purpose of the meeting was to agree the final annual accounts, some members of the CCG and members of MIAA were not required to attend the meeting. The meeting was confirmed as quorate Declarations of Interest The Chair invited members to declare any interests they may have in relation to items on the agenda. No declarations of interest were made. Declarations declared by CCG staff are listed in the CCG s Registers of Interests. The Registers are available, either via the Secretary to the Governing Body, or on the CCG website via the following link: The Chair reminded members that they should, if appropriate, make a declaration should a conflict emerge during the meeting.