A G E N D A. Standing Items Lead. Time. Dr Nina Pearson. 1. Welcome, Apologies and Chair s introduction. 3 mins. Dr Nina Pearson

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1 LUTON CLINICAL COMMISSIONING GROUP PUBLIC BOARD MEETING TO BE HELD ON TUESDAY 1st March :45 17:00 TRAINING ROOM, 1 ST FLOOR, MEDICI MEDICAL PRACTICE, 3 WINDSOR STREET, LUTON LU1 3UA A G E N D A Standing Items Lead Suggested Timing Time 1. Welcome, Apologies and Chair s introduction 2. Declarations of Interests in Relation to Agenda Items * 3. Declarations of Hospitality relating to Agenda Items ** 4. Minutes of the meeting held on 15 th December Matters arising from the meeting held on 15 th December Chairs Report Dr Nina Pearson Dr Nina Pearson Dr Nina Pearson Dr Nina Pearson Dr Nina Pearson Dr Nina Pearson 3 mins 2 mins 2 mins 3 mins 5 mins 14:45 15:00 5 mins 15:00 15:05 7. Chief Officer s Report Carol Hill 5 mins 15:05 15:10 8. Patient Story Anthea Robinson 20 mins 15:10 15:30 *Board Members are reminded that it is their responsibility to update their declarations of interests, notifying any change in circumstances on a new form to LCCG within a maximum of 28 days. New declarations will be requested from all Board members at least annually. ** All Declarations of Hospitality should be confirmed by . Strategic Items 9. NHS Planning (presentation pack) John Webster/Alan Davies 20 mins 15:30 15: Update on Stroke Nicky Poulain 10 mins 15:50 16:00 Break Performance Items 11. IQPR Nicky Poulain/D Foord 15 mins 16:10-16: M10 Finance Report Alan Davies 15 mins 16:25 16:40 Information Items Endorsement of Chair update (verbal) Carol Hill 5 mins 16:40 16: Minutes circulated 13a Patient Safety and Quality Committee (redacted) 25 th November b Clinical Commissioning Committee 21 st January c Audit and Risk Management Committee 2 nd February 2016 Nina Pearson 10 mins 16:45 16:55 13d Primary Care Joint Commissioning Committee 10 th November Any other business ALL 5 mins 16:55 17: Date and Time of Next Public Meeting: 3 rd May st Floor, Medici Medical Centre, 3 Windsor Street, Luton, LU1 3UA

2 Agenda Item 4 Draft Minutes Meeting : Luton CCG Public Board Meeting Date : 15 th December 2015 Time : 14:45 17:15 Venue : Medici Medical Practice, 1 st Floor Training Room 3 Windsor Street, Luton LU1 3UA Present: Dr Nina Pearson (NP) (Chair) Carol Hill (CH) Dr Monica Alabi (MA) Dr Chirag Bakhai (CB) Dr Anthea Robinson (AR) Jeannie Szumski (JS) Mahmood Aziz (MAz) David Kempson (DK) Lloyd Denny (LD) Gerry Taylor (GT) Dr Helen Turner (HT) Kathy French (KF) Alan Davies (AD) John Webster (JW) Nicky Poulain (NPo) David Foord (DF) Dr Anita Ray-Chowdhury (AR-C) Apologies: Dr Ruchira Karunadasa (RK) In Attendance: Angela Duce (ADu) Fiona Coton (FC) Chair Chief Officer Clinical Director Clinical Director Clinical Director Practice Nurse Member Lay Member, Finance & Procurement Lay Member, Finance, Audit and Governance Lay Member, Patient & Public Involvement Director of Public Health, LBC Secondary Care Member Independent Nurse Member Chief Financial Officer Director of Operations Director of Commissioning and Integration Director of Quality and Clinical Governance Clinical Director for System Change Clinical Director Assistant Director of Operations Programme Support Officer (Minutes) 1 P a g e

3 178/15 1. Welcome, Apologies and Chair s Introduction (NP) Actions Introductions were made and apologies received as detailed above. 179/15 2. Declarations of Interest in Respect of Agenda Items (NP) There were declarations of interest from NP, JSz and AR for Item 11 Alternative Provider Medical Services (APMS) presentation. At this point NP would step aside and handover the Chair to DK. 180/15 3. Declarations of Hospitality relating to Agenda Items (NP) There were no declarations of hospitality to report. 181/15 4. Minutes of the Public Board meeting held on 27 th October 2015 (NP) The minutes were reviewed and approved with the exception: 84/15 clinical governance should be amended to read clinicians engagement. ADu 182/15 5. Matters arising from the Public Board meeting held on 27 th October 2015 (NP) 85/15 Carers in GP booking systems AR-C working with RK through Practice visits. Taking ideas forward and piloting in own surgery. Work in progress to find systemised process across all Practices. Update at next Board meeting. 85/15 Contact link to Carers LD had sent information to Lisann Blower. LD would speak to AR outside the meeting. 87/15 Equality and Diversity Strategy data this had been reviewed and is being considered by HR. 90/15 Financial Plan for 2016/17 - Financial plan being developed. We should be notified of our allocation before Christmas. 90/15 Invoice challenges - Included in November report. 183/15 6. Chairs Report (NP) Update on Patient Safety and Quality Committee: There had been an external review of six maternity Serious Incidents. DF had received an action plan and was undertaking a gap analysis. DF would share the action plan with GT and feed into the Maternity Action group. NPo would work findings into the L&D contract. CCG Complaints DF advised that complaints handling was outsourced to Luton Borough Council, and work was underway to improve the quality of reports to the PSQC. The information had previously been presented in a different format, but the committee have requested changes in the way and the type of data presented. All complaints were seen, reviewed and responded to by DF and/or CH. The Board noted the report. 184/15 7. Chief Officer s Report (CH) CH advised the Board of a change to the format of the Chief Officer s Report. Anyone who would like more detail on a specific item should contact the Lead Executive listed in the paper. Planning for 2016/17 item on agenda. CEOs had been invited to meet with Simon Stevens to outline 16/17 planning guidance. Allocations for CCG s would be published before Christmas. Communications and Engagement Strategy and Plan DF advised that this was progressing with LBC and a final version of the Plan would come to a future Board meeting. Latent TB Infection Testing for further information speak to NPo or JS. 2 P a g e DF NPo

4 Specialised Commissioning CCG is taking over responsibility from NHSE for Morbid obesity; Specialist wheelchairs; and Neurology out-patients services. NPo advised that a specialist commissioning team would be supporting us. Beds and Luton Mental Health Crisis Care Concordat pledge had been made to improve crisis care. An example of progress was a proposal to introduce street triage where Mental Health nurses work side by side with Police, jointly responding to urgent situations. Intention to redevelop Luton and Dunstable Hospital site this item was not included in the Chief Officer s report, but a verbal update. An outline business case had been developed by the hospital. The CCG invited comments from Commissioners, Co-commissioners and the Council. JW and his team would be leading on a response. The intention is to develop the site to suit the changing demands of healthcare in Luton and surrounding area. The buildings would need to be fit for purpose for the next 40 years and sized appropriately and used efficiently. This would be a very complex and detailed piece of work. JW would keep the Board appraised. Seven day services There was a question from LD on what is going to be different, how do we prepare Luton and what can people expect? CH advised that not all services needed to operate 7 days, and 7 day services was not just for hospitals. We would be looking locally at which services needed to provided over 7 days. The work was being progressed through SRG and Better Together, looking at the best mix of services to meet the demand. People should receive, for example, the same cardiac treatment as during the week. Psychiatric liaison had been expanded to 7 days. In other parts of the country GP Practices were offering a 7 day service but this needed to be publicised better as the service was not being fully accessed locally. NP would take up through Practice Managers meetings. The Board noted the report. 185/15 8. Patient Story (JSz) JSz introduced Ray a patient from her practice. Ray is 66 years of age nad has recently had his leg amputated. He has just been fitted with a prosthetic limb. Ray is diabetic, with a long history of diabetes in his family. His maternal grandfather had died in a diabetic coma at a Plymouth prison after being arrested when wrongly thought of as being drunk. His experience of the NHS was a massively positive one. The local GP surgery has been really helpful, there had been one problem with repeat prescriptions but it was corrected in the end. Ray used to smoke 60 cigarettes per day but with the the support of JSz and the GP surgery he had his last cigarette on 28 th May Around the same time he stopped smoking Ray had an angioplasty. He had been unable to work prior to this as he could not walk from the car park to his place of work. Once his arteries were clear he returned to work. After giving up smoking, the diabetes got worse and now needed insulin. Prior to 2000 Ray hadn t been in contact with his GP surgery as he hadn t had cause too although he was diagnosed with diabetes some years previously. Mobility problems began 3 years ago. During a holiday with a friend his foot was injured and it was left bleeding. He was carried off the plane and learnt he had gangrene. Back in the UK after calling 111, he went to his GP for antibiotics. He was admitted to Bedford Hospital where he under went a series of operations. 3 P a g e

5 Ray was in Bedford Hospital for almost 12 weeks and then had extensive hospital home care and district nurse care. Everything was done to help save the leg which after 6 months got infected. He was also falling frequently. Ray also had postural hypertension and dehydration and was in hospital 3 or 4 times over the next 6 weeks with infections. Ray then contracted CDiff and was very ill and admitted to intensive care. He had a preop consultation for amputation, but the leg wasn t removed at this stage. Ray went home after 6 weeks and could only walk with a split cast. He then developed charcot foot and later had reconstructive surgery at the beginning of this year which was a failure. Recovery time from the operation was lengthened due to reaction with the antibiotics. The metal work within the leg had come apart and he had another operation at the L&D which resulted in the amputation of the leg on 29 th June. Ray was unable to manage at home due to stairs and was helped by Social Services to find a care home. The prognosis was such that his other leg would have to be amputated in the future. Ray was concerned about the patient transport services. He has experienced a service where the equipment does not always function and drivers are frustrated with low morale. He believes that the service that patients are getting has been appalling with little improvement. There are times when transport is not turning up in time for apppointments, so appointments have been cancelled. This has happened once, and twice Ray got to his appointment in the last 10 minutes of the booked appointment. On one occasion Ray had nine teeth out with sticthes and had to wait 2.5 hours for transport. He is using patient transport a lot at the moment, and had been 30 minutes late to an appointment after waiting for over 2 hours. It was agreed that the issue relating to patient transport would be picked up through performance monitoring. Asked what makes a service great for a patient? Ray replied that the initial face to face with the receptionist, they are there to be helpful and not obstructive. You know that they are actually making an effort to fulfil your need. Most interaction is with reception. The surgery has changed its way of working where patients don t have an allocated GP and see whoever is available. He has no problem with that, with one exception. On the diabetic monitoring side, JSz is keeping eye on me. Very positive about surgery, the nurses who have been treating my leg, how they interact with me and the service I get. Asked with his history could anything else have been done to help earlier diagnosis? Ray responded that he was originally diagnosed about 1985 and sent to the L&D. During his teenage years he went through weight changes, at this stage the diabetes was taking place. Also picked up at medical for life insurance. Back then diabetes didn t have the profile is has now, and he spent long time left to his own devices on a diet. Asked about the language of hospital care, how you were told, how involved in decisions. Amputation surgery could have been done earlier instead of attempting reconstructive surgery. Consultant said amputation should have been done 18 months previously. Big mistake. First district nurse Ray saw, said to ask consultant if there is any point saving the leg. At the time, he was angry with this nurse, but now thinks they were right. 4 P a g e

6 Seven day services applies mainly to inpatients. Whilst in L&D I needed a picc line fitted before I could be discharged. It was a Friday and no Nurse was available to do it. So I couldn t leave for three days. Ray was thanked for coming in and sharing his story. He had given the Board a great insight to his patient experience. 186/ /17 NHS Planning (JW) JW gave the Board an update on the planning round. Planning guidance would be issued just before Christmas, which would confirm the planning and tariff assumptions for next year. The key messages were: The efficiency factor applied expected to be 2%, 3.1% cost uplift, +1.1% net adjustments in favour of the Provider. Net increase could be reflected in the allocation for next year. NHSE Board will sign-off allocations on 17 th December. This will recognise the total spend across CCG population. The allocations will be firm for the first 3 years. We will be developing a system plan over the next few months. We will ensure that the plans we develop align with common set of assumptions. These will be a good base for the 5 Year Plan. Updates will be given at Board meetings in line with the planning timetable. QIPP 100% delivery at Month 8-4.5m. New schemes were currently being developed by the PMO for 16/17. We have no single scheme at the value of 5m, but have a sufficient number of schemes that provide value. Noted that the Governance arrangements would need refreshing in line with the Plan. NP advised that there would be a conversation outside of the Board meeting on how it should be represented visually. NP noted that we were delivering 100% this year unlike last year. QIPP was work in progress at this stage. 187/ Stroke Pathway Development (NPo) NPo updated the Board on the Stroke Pathway since the last meeting. Met with Provider, Virgin Care and Professor Tony Rudd (National Director for Stroke Care) on 4 th December to review Luton and Dunstable Hospital s stroke performance. We have agreement from L&D to produce a plan outlining improvements to address poor performance. Professor Rudd will attend a Stroke ward round at the L&D on 6 th January Two new Consultants have been recruited from Lister and Northwick Park. Issues around consultants doing ward rounds but not always recording information. Awaiting Milton Keynes and Beds CCGs to confirm their patient flows. As Commissioners we need to take responsibility for commissioning early supported discharge (ESD). We are working with Virgin Care to reach the criteria for ESD. Next steps are key in making sure patients are engaged around pathways. The Sentinel Stroke National Audit Programme (SSNAP) data is being reviewed by the Stroke Action Group. Noted on SSNAP data that all Providers are struggling on speech and language therapy. NPo advised that this would be picked up at local level. Noted there needed to be reference in the report with a link to where the evidence had come from. Agreed that a follow up report with recommendations would be presented to the Board in February. NPo 5 P a g e

7 188/ APMS (NPo) [Helen Turner left the Board meeting.] DK took over as Chair due to NP s conflict of interest. Please note that acronyms should not be used at Public Board meetings. NPo gave a presentation on Alternative Provider Medical Services (APMS). Luton currently has 4 APMS Practices where contracts are coming to an end Sundon Park, Moakes, Whipperley and the Town Centre, with the Town Centre GP Surgery s list size exceeding commissioned expectations. Patients from two of the Practices tend to overuse A&E and the Walk-In Centre which is unsustainable in financial terms. 4 APMS contracts are now coming to an end which offers opportunity to review and do things differently in line with Urgent Care strategy. There had been consultation and stakeholder engagement. NPo had met with Practices. There had been enabling work done at Sundon Park on premises. They have capacity to take on more patients and more premises. The Town Centre is looking to develop something significant in the centre of town. We need to align plans with emergency care system, look at urgent services and have started an Integrated Impact Assessment. NPo will share with the Board the list of stakeholders. Agreed that it was key that the Workforce plan needed to be better and that practices would have capacity to provide the service. CH we need to think about engagement. Work up different models of scenarios, what it might look like when patients move from one practice to another. This was already in the public domain but at the start of the process. The four Practices have been named. We now need to push NHS contracts on and the NHSE legal team have advised of the need to go out to procurement. The Board agreed that they supported the strategy. [Gerry Taylor left meeting.] 189/ M8 Finance Report (AD) AD updated the Board on the key points from the Month 8 Finance Report. Month 8 favourable with an underspend of 289k against budget, this reduces the YTD cumulative overspend to 189k. In Acute there is a 160k overspend. Medicines Management had an underspend of 164k. This underspend will be reviewed in January and we will report in more detail at the next Board meeting. Overall forecast is held at breakeven against plan, consistent with Month 7. Credit note from NHSPS of 240k is offset against movement in Acute, due to an invoice for Cardiac MRI scans of 190k. We have built into the position a risk of recharge for Cardiac MRI. Few signs of risk, but most significant is Better Care Fund where emergency activity reductions have not been achieved. 945k of the risk pool is shown against forecast as retained by LCCG. Discussions are taking place with Luton Borough Council to agree position. This should be resolved by the end of the week. We will be meeting with the Finance Director at L&D to get agreement on most items under challenge. These should be resolved by the end of this week. The key risk for this financial year was Better Care Fund, we have a process underway in this area. Main adverse in acute line is recharge of Cardiac MRI. We took the view this month 6 P a g e

8 to be prudent and have built it into our forecast position. JW advised that we have a Risk and Opportunities log that we keep and that is the process element. Key message is that it is a very tight financial position but we will build in as much head room as we can. We will look at every opportunity between now and the year end. We are still on plan. 190/ Minutes circulated (NP) The minutes for the Patient Safety and Quality Committee (28/10/15), Clinical Commissioning Committee (22/10/15) and Primary Care Joint Commissioning Committee (10/11/15) were noted. 191/ Any other business (All) NPo advised the Board that the diagnosis rate for dementia was improving and was currently at 67%. DF advised that the L&D would be holding a Listening Event on Tuesday 19 th January We had arranged a PRG meeting for that evening. The Chair advised that the recruitment process had started following the announcement of CH s retirement. There was no further business and the meeting closed at 17: Date and Time of Next Meeting (NP) 1 st March 2016, 14:45-17:15 1 st Floor, Medici Medical Centre, 3 Windsor Street, Luton LU1 3UA 7 P a g e

9 Agenda Item 6 PAPER FOR THE LUTON CLINICAL COMMMISSIONING GROUP PUBLIC BOARD MEETING TO BE HELD ON TUESDAY 1 ST MARCH 2016 TITLE PRESENTED BY (Plus contact details for pre Board enquiries) LEAD CLINICIAN/MANAGER WHAT IS THE OBJECTIVE OF THE PAPER? WHAT IS THE BOARD BEING ASKED TO DO? Chairs Report Dr Nina Pearson Dr Nina Pearson Chair John Webster Director of Operations/Deputy Chief Officer This report summarises key activity, risks and decisions arising from the Board s sub-committees and groups, improving the flow of information and assurance coming to the Board. Further information may be found in the minutes and highlight reports also circulated to the Board, or by contacting the Chair or Executive member directly. The Board is requested to note the Report. WHICH OTHER COMMITTEES HAVE REVIEWED THIS PAPER? HAS AN IIA BEEN CARRIED OUT? WHAT IS THE IMPACT? IF THE IMPACT IS NEGATIVE, HOW WILL IT BE MANAGED? WHICH CORPORATE OBJECTIVE(S) DOES THIS PAPER RELATE TO WHAT ARE THE KEY RISKS? (State risk ID and risk as stated on the Risk Register) All INTEGRATED IMPACT ASSESSMENT (IIA) N/A POSITIVE/NEGATIVE/NEUTRAL* LINK TO CORPORATE OBJECTIVES AND RISK All All 1

10 Reporting Highlights from LCCG Sub-Committees: Report to Public Board Meeting Date of Meeting Chair Executive Lead Patient Safety and Quality Committee 27 th January 2016 Kathy French David Foord LCCG are under trajectory for C-difficile both as a CCG and the main acute provider, The L&D Hospital. This means LCCG are the second best performing CCG within the area. Venous Thrombotic Event (VTE) - there is remedial action plan in place with the L&D to review hospital acquired thrombosis (HAT). To date only the plan has been received within the CCG Q1. Work continues to engage with the Trust to understand the number of HAT and any learning for Q2 and Q3. L&D Serious Incident Governance Report was received by the Committee. Assurance on progress with actions following the review would be received through the Quarterly Provider Quality meetings. The Care Quality Commission (CQC) inspected the L&D hospital the week commencing 19 th January. The CCG were not present at the immediate feedback session but it is understood that the inspection went well. The CCG would learn more at the Quality Surveillance group meeting on the 5 th February. The CCG are working with ELFT on their serious incident reporting process as there have been delays in receiving reports. This is being discussed at Executive level. Transforming Care- the first Milton Keynes, Bedfordshire and Luton Transforming Care Partnership Board took place on 20 th January. Then board is working to develop collaborative commissioning over a wider area. There are 11 people currently within Luton form the Transforming Care cohort. Ofsted are currently undertaking an inspection of Luton Borough Council. The process is expected to take four weeks and will include children s safeguarding and Looked After Children. 2

11 Chair Executive Lead Clinical Commissioning Committee 18 th of February Anita Ray-Chowdhury Nick Poulain Overactive Bladder- proposal by L and D for a Nurse Led service with regards to Percutaneous posterior tibial nerve stimulation for overactive bladder syndrome ("PTNS"). It was acknowledged that this was an effective suitable option for our patients and it was suboptimal sending patients out of area. However more reassurance was needed on establishing the service in L and D with the small numbers that would be treated and reassurance needed that this service would not be misused. IIA for the cancer strategy was approved- discussion regarding improving screening and how to improve the engagement of the GPs and patients along the uptake and attendance to screening and treatment was discussed as part of the strategy. Developing a Practice Nurse and Health Care Assistant Network This network was supported by the CCC. It would work closely with the CCG to align work streams. Mental Health Street Triage Business Case- The Committee received a proposed strategy for an integrated system of the police, paramedic and mental health services to work together. Option 4b A full team comprising a Mental Health Nurse, a Senior Paramedic & a Police Officer, based on 1 Shift per day. 3.00pm until 1.00am 10 Hours. Was agreed to go ahead. Alcohol Worker and the role of CCG & LBC Commissioners- A proposal from Public Health to continue supporting this A and E based service in L and D Hospital. It was recognised that there may be overlap in the service that was provided by the psychiatric liaison and this service. However further data was requested with regards to how effective this service had been, and what were the differences between this and the liaison service. Children s Palliative Care Strategy The strategy aims to develop timely, flexible and responsive, child and family centred, palliative care services, by strengthening universal services so that generalists can support children and families appropriately and build upon strengthening and further developing the current multidisciplinary model of specialist palliative care. It was agreed that support would be given to integrate this strategy into the work of primary care clinicians. In order to facilitate this important strategy. MOT QIPP 2016/17 Several areas were discussed and would be engaged with in primary care. Financial Target 2016/17. The financial target for Medicines Optimisation QIPP for 2016/17 is 1.0M. Investment scheme 155K: The scheme will mainly reward practices for achieving targets across a range of QIPPs but additionally practices will need to complete several audits. QIPP Schemes (n=9): The QIPP 2016/17 involves many therapeutic areas diabetes (carried forward from 2015/16 QIPP), respiratory, nutrition, central nervous system and inflammatory disease (Rheumatoid arthritis, IBD and dermatology). Other schemes include processes and mental health and wound care are in development). 3

12 Agenda Item 7 PAPER FOR THE LUTON CLINICAL COMMMISSIONING GROUP PUBLIC BOARD TO BE HELD ON TUESDAY 1 st MARCH 2016 TITLE PRESENTED BY (Plus contact details for pre Board enquiries) Chief Officer s Report Carol Hill Chief Officer Carol.Hill@lutonccg.nhs.uk LEAD CLINICIAN/MANAGER WHAT IS THE OBJECTIVE OF THE PAPER? To provide a briefing for the Board of significant activities since the last Board meeting, which do not feature in other items on the Board agenda. WHAT IS THE BOARD BEING ASKED TO DO? Receive the report to inform questions and discussion. WHICH OTHER COMMITTEES HAVE REVIEWED THIS PAPER? HAS AN IIA BEEN CARRIED OUT? WHAT IS THE IMPACT? IF THE IMPACT IS NEGATIVE, HOW WILL IT BE MANAGED? WHICH CORPORATE OBJECTIVE(S) DOES THIS PAPER RELATE TO WHAT ARE THE KEY RISKS? (State risk ID and risk as stated on the Risk Register) None INTEGRATED IMPACT ASSESSMENT (IIA) N/A POSITIVE/NEGATIVE/NEUTRAL* LINK TO CORPORATE OBJECTIVES AND RISK ALL Items could link to any of the key corporate risks 1

13 Chief Officer Report January/February Planning for 2016/17 and future years Delivering the Forward View: NHS Planning Guidance 2016/ /21 Published 22 nd December 2015 Within the Planning Guidance there is a requirement for the NHS to produce two separate but connected plans: A five year Sustainability and Transformation Plan (STP), place based and driving the Five Year Forward View A one year Operational Plan for 2016/17, organisation based but consistent with the emerging STP. Development of the one year Operational Plan is covered in detail in the NHS Planning item on today s agenda. STPs will cover the time period October 2016 to March 2021, and will be submitted in June 2016 for formal assessment by NHS England. The STPs will become the single application and approval process for being accepted onto transformational programmes with transformational funding for 2017/18 onwards. The STP requires system leadership and involves five key components: 1. Local leaders coming together as a team 2. Developing a shared vision with the local community, which also involves local government as appropriate 3. Programming a coherent set of activities to make it happen 4. Execution against the plan 5. Learning and adapting The STP will be the overarching umbrella plan, holding underneath it a number of different specific delivery plans, some of which by necessity be on different geographical footprints. Since publication of the Planning Guidance in December a number of meetings and conversations have taken place with the key partner organisations in Luton (Luton CCG, Luton Borough Council, L&D Foundation Trust, East London Foundation Trust, Cambridge Community Services). The driving principle is to plan and commission at the most appropriate population level to achieve the outcomes we need for Luton people. For some planning issues this will be on a larger population than just Luton e.g. hospital services, specialised services, and for some planning issues the focus will need to be much more local e.g. Primary Care, and even smaller populations than the town e.g. Cluster based commissioning. The first task required of the STP process was to confirm to NHS England the population community of the umbrella plan. Working with partners and neighbours the STP footprint covering Luton has been submitted as Luton, Bedfordshire and Milton Keynes. To support the development of STPs the Planning Guidance contained a number of questions to test the emerging plans against. These fall into the following headings to assess the size of the gaps: How will you close the health and wellbeing gap? This section should include your plans for a radical upgrade in prevention, patient activation, choice and control, and community engagement. How will you drive transformation to close the care and quality gap? This section should include plans for new care model development, improving against clinical priorities, and rollout of digital healthcare. How will you close the finance and efficiency gap? This section should describe how you will achieve financial balance across your local health system and improve the efficiency of NHS services. For the year 2016/17, as part of the process for the longer term plans, there are nine must dos for the NHS. Many of these relate to the Constitutional Standards with improvement trajectories required for : A&E four hour waiting time 2

14 Referral to Treatment incomplete pathways 62 day cancer waiting times Over 6 week diagnostic waiting times Category Red 1, Red 2, and A19 Ambulance response times. Agreement and delivery against improvement trajectories allows funding to be released to providers from the Sustainability and Transformation Fund in 16/17. In subsequent years funding is dependent on assessment of the STP. Developing Sustainability and Transformation Plans to 2021 Letter issued 16 th February A letter and further guidance has been issued to CCGs, NHS Trusts and Foundation Trusts, and Local Authorities. Key points are: A different type of planning process is required, releasing energy and ambition, and requires the NHS at both local and national level to work in partnership across organisational boundaries and sectors. Develop local leadership and collaboration, in the form of governance arrangements and processes needed to produce a STP and implement it. This includes the nomination of one CCG Chief Officer, provider CEO or Local Authority CEO to be responsible for overseeing and co-ordinating the process. Assess the scale of the challenge by assessing the size of the three gaps. Identify key priorities to tackle over the next five years. These should all be completed by Easter. National support will be provided to assist each local system. After Easter the focus should be on developing the detail of the plans to be submitted in the summer. These should include delivering against the nine must dos and closing the gaps in the three areas outlined. More national support will be available. Sustainability and Transformation funding: The Spending Review settlement enabled the NHS to invest 2.139bn in this fund in 16/17, with 1.8bn allocated to the sustainability element of the fund to bring the NHS provider trust sector back to financial balance. Quarterly release of the fund to providers is dependent on achieving deficit reduction, access standards and progress on transformation. Mirroring the conditions on providers to access the fund, the real terms element of growth in CCG allocations for 17/18 onwards will be contingent on the development and sign off of a robust STP during 16/17. Key Dates What Who When Support on gap analysis and STP development National Bodies week commencing 29 Feb Gap analysis/data with each footprint National Bodies throughout March and NHSE Regions Short return Footprint 11 April Outline STPs Footprints/Reg w/c 22 April Events Build STPs Apr/May/June Submit STP Reg Directors and 30 June 5YFV board Series of Regional conversations national National Body of Throughout July teams and footprints CEOs, National Directors and footprints Lead Executives: Carol Hill / John Webster Carol Hill Chief Officer 22 nd February

15 Agenda Item 10 PAPER FOR THE PUBLIC BOARD MEETING TO BE HELD ON TUESDAY 1 ST MARCH 2016 TITLE PRESENTED BY (Plus contact details for pre Board enquiries) LEAD CLINICIAN/MANAGER WHAT IS THE OBJECTIVE OF THE PAPER? Stroke work programme Nicky Poulain, Director of Commissioning & Integration Author: Amanda Flower, Assistant Director, Planned Care Amanda.flower@lutonccg.nhs.uk Dr Uzma Sarwar, GP Clinical Lead, Stroke Amanda Flower, Assistant Director, Planned Care The purpose of this paper is to provide an update to the Board regarding the programme of work to improve and develop stroke pathways. WHAT IS THE CCC BEING ASKED TO DO? 1. Note the contents of the report and agree the proposed work plan WHICH OTHER COMMITTEES HAVE REVIEWED THIS PAPER? HAS AN IIA BEEN CARRIED OUT? WHAT IS THE IMPACT? IF THE IMPACT IS NEGATIVE, HOW WILL IT BE MANAGED? WHICH CORPORATE OBJECTIVE(S) DOES THIS PAPER RELATE TO INTEGRATED IMPACT ASSESSMENT (IIA) Not complete, in progress LINK TO CORPORATE OBJECTIVES AND RISK Commissioning differently Driving financial sustainability WHAT ARE THE KEY RISKS? (State risk ID and risk as stated on Risk Register) 503 Lack of capacity and resources to effectively deliver key objectives 505 Failure to achieve safety, quality and outcome objectives for patients. 1

16 1. Background A report was provided to the LCCG Board in December 2015 which outlined the need to review Stroke pathways following the 2012 Midlands and East Strategic Health Authority review of stroke provision and development of the Stroke specification in September This paper summarises progress to date and sets out next steps and future key milestones. 2. Luton Stroke Action Group The Luton Stroke Action Group met for the first time in September 2015 and has met monthly since. The group includes representation from Luton CCG (Clinical Lead for Stroke, Assistant Director for Planned Care and Deputy Director Nursing & Quality), Bedfordshire CCG, Milton Keynes CCG, Luton & Dunstable University NHS Foundation Trust (LDH), the Strategic Clinical Network, The Stroke Association, and Virgin Healthcare. The priority for the Stroke Action Group to date has been addressing performance at the LDH. 3. LDH Performance The Sentinel Stroke National Audit Programme (SSNAP) is a programme of work which aims to improve the quality of stroke care through the audit of service provision against evidence based standards. Information is collected regarding the quality of care provided to patients who have had a stroke when they arrive at hospital up until 6 months after their stroke. The results are presented across 10 domains (see table below) covering 44 key indicators. In quarter /15 and quarter /16 the LDH were achieving level E which indicates significant improvement required, in quarter 2 of 2015/16 the position has improved to D. Through 2016/17 the priority is to move performance to a minimum of level B. 2

17 The Stroke Action Group has recommended the following indicators for the 2016/17 LDH contract: Ref Stroke LQR 6 Stroke LQR 7 Stroke LQR 8 Stroke LQR 9 Quality Requirement Overall SSNAP Team Centred KI The Trust Stroke Service should achieve an overall SSNAP Team centred KPI of level B for each quarter in 2016/17 Note: within domain 10 ESD is not currently commissioned service and if this continues to have an impact then this will be taken into consideration by commissioners Stroke Unit (SSNAP Domain 2): % of patients are directly admitted to a stroke unit within 4 hours of clock start Stroke Unit (SSNAP Domain 2): % of spend at least 90% of their time on a stroke unit % of patients with high risk TIA treated within 24 hours but not admitted Threshold/ Target/ Standard SSNAP B 90% 80% 60% Method of Measurement SSNAP Quarterly report through the Service Quality Performance Report. Monthly report from the Trust through the Service Quality Performance Report. SSNAP quarterly data to be reported through the Service Quality Performance Report. Monthly report from the Trust through the Service Quality Performance Report. SSNAP quarterly data to be reported through the Service Quality Performance Report. Monthly report from the Trust through the Service Quality Performance Report Consequence of Breach and Comments GC9 SNNAP Team Centre KI level below B: Q1 - RAP GC9 Q2-5,000 if D or E Q3-10,000 if C, D or E Q4-10,000 if C, D or E 1000 per patient breach for all breaches if overall achievement falls below 90% and breach analysis for all patients. GC per patient breach for all breaches if overall achievement falls below 80% and breach analysis report for all patients. GC9 Timing of application of consequence Quarterly Monthly Monthly Monthly 3

18 On 4 th December 2015 and 6 th January 2016 the National Clinical Director for Stroke, Prof. Tony Rudd, visited the LDH to review clinical care processes and how these can be developed to improve Trust performance and outcomes for patients. The feedback and recommendations from these visits has been captured in the Luton Stroke Action plan and this is reviewed and monitored through the monthly Stroke Action Group. Key actions include: recruitment of a dedicated stroke business manager and clinicians (2 consultants and clinical nurse specialist) review of Speech and Language Therapy (SALT) access (access to SALT impacts 4 of the SSNAP domains) development of front end processes (CT alerts and requests, and thrombolysis to be offered within footprint of CT suite) stroke registrar on-call rota to be brought on site training for emergency department staff 4. Future configuration The 2012 Stroke review concluded a preferred option of 3 Hyper Acute Stroke Units as follows: Lister Hospital (North Hertfordshire) Watford Hospital (West Hertfordshire) LDH (Luton) Bedfordshire CCG (BCCG) and Milton Keynes CCG (MKCCG) have indicated the need for sustained improved performance at the LDH to support future commissioning decisions regarding the future configuration of stroke care. Furthermore BCCG will consult on future options, aligned to the healthcare strategic review, during the summer of A meeting is planned for April 5 th to include all Lead Stroke Clinicians and Executive Directors with responsibility for Stroke from LCCG, BCCG, MKCCG, the LDH, Bedford Hospital and Milton Keynes Hospital. The meeting will be chaired by Prof. Rudd and will discuss future whole system configuration and pathways for stroke care. 5. Next steps For Luton CCG the crucial next steps are: 1. April/May Develop a business case for Early Supported Discharge and 6 month reviews (neither currently commissioned) to be presented to the Clinical Commissioning Committee in April 2016 and to a subsequent LCCG Board meeting. 2. May/June Lead the development of a whole system business case (LCCG, MKCCG, BCCG and relevant providers to co-author) regarding future stroke service configuration and pathway development (following the meeting of 5th April). 3. Currently - Map all current stroke services and existing patient flows. 4. Currently - Work with the Stroke Association and Healthwatch to develop patient focus groups. 6. Recommendations The Board are asked to: 1. Note the contents of this update and support the future work plan. 4

19 Agenda Item 11 PAPER FOR THE LUTON CLINICAL COMMISSIONING GROUP BOARD TO BE HELD ON 01 March 2016 FINAL v1 TITLE PRESENTED BY (Plus contact details for pre Board enquiries) LEAD CLINICIAN/MANAGER WHAT IS THE OBJECTIVE OF THE PAPER? WHAT IS THE BOARD BEING ASKED TO DO? WHICH OTHER COMMITTEES HAVE REVIEWED THIS PAPER? HAS AN IIA BEEN CARRIED OUT? WHAT IS THE IMPACT? IF THE IMPACT IS NEGATIVE, HOW WILL IT BE MANAGED? WHICH CORPORATE OBJECTIVE(S) DOES THIS PAPER RELATE TO WHAT ARE THE KEY RISKS? (State risk ID and risk as stated on the Risk Register) INTEGRATED QUALITY AND PERFORMANCE REPORT (IQPR) Nicky Poulain, Director of Commissioning & Integration David Foord, Director of Quality & Clinical Governance Report Prepared by Pauline Fitzpatrick, Business Intelligence & Performance Analyst Pre Board Enquiries to: Nicky Poulain, Director of Commissioning & Integration David Foord, Director of Quality & Clinical Governance This paper gives a review of the performance for Luton Clinical Commissioning Group (LCCG) and its key providers against national and local indicators together with actions being taken to improve performance with indicative timescales. The Board are asked to note the contents of the report and review the actions as set out, and recommend any further actions. INTEGRATED IMPACT ASSESSMENT (IIA) No N/A LINK TO CORPORATE OBJECTIVES AND RISK Commissioning Differently Driving Financial Sustainability 505 Failure to achieve safety, quality and outcome objectives for patients 509 Significant failure of a major provider who is then unable to deliver contract requirements 510 Failure to achieve objectives for safeguarding children & vulnerable adults 544 Failure to meet objectives regarding safeguarding and health of Looked After Children 549 System instability due to the transition to new mental health and community services providers 550 Lack of system ownership of the Five Year Strategy and Better Care Fund Plan

20 Background The Integrated Quality Performance Report (IQPR) has been structured to align with NHS England delivery dashboard based on the planning requirements set out in Everyone Counts: CCG Assurance Framework. The report contains the following contents: 1 Executive Summary NHS Constitution Quality & Safety Outcomes Framework Better Care Fund Finance Appendix...21 Please note that n/a in tables means not available, and n/ap means not applicable Page 2

21 Executive 1 Summary The IQPR dashboard provides the Governing Board with a regular monthly update on the performance of LCCG against national and local indicators as outlined in the NHS England Everyone Counts:CCG Assurance Framework. Performance summary across the indicators domain are given below for financial Month 9 (December 2015): NHS Constitution: In December 2015, the constitution standards were met with the following exceptions: 18 weeks RTT Incomplete pathways: One LCCG patient waited more than 52 weeks at the Royal Free Hospital. Cancer Wait Times: LCCG did not meet the 62 Day standard target. Ambulance Handover: The handover greater than 60 (+3) minutes indicator has been breached eight months out of nine, and the handover between 30 (+3) and 60 (+3) minutes indicator has been breached every month this year. Quality & Safety: The following Quality and Safety indicator targets were not met: Healthcare Associated Infections In December 2015, the reported LCCG C.Difficile infections breached the YTD ceiling. Serious Incidents and Never Events In January 2016 LDH reported a Never Event of wrong site surgery. A&E full initial assessment within 15 minutes for patients LDH has not yet met this indicator in However they have made considerable progress and are now at 91.3%. Health checks offered and delivered The April to December 2015 data has shown that the targets have not been met. MMR Coverage Both indicators breached the 95% target in Q2. Breastfeeding The Breastfeeding initiation rates reported for October to December 2015 by LDH has not met the 75% target. The Breastfeeding status recorded at 6-8 weeks indicator was not met in December 2015 by Cambridgeshire Community Services (CCS). Surgical Safety Checklist The LDH has reported 98.7% in December 2015 data against a target of 100%. East London Foundation Trust (ELFT) Mental Health There were three indicators not met in December 2015; these were People on Care Programme Approach (CPA) having Formal Review, Delayed transfer of care and % of Children Did Not Attend (DNA) first appointment. CCS The newborn TB indicator Newborn TB vac <90 days of birth-rolling year was breached in December 2015 due to lack of vaccine. However the position is expected to recover in year as vaccine shortages have been addressed. Better Care Fund: The Non-Elective Admissions targets for Q1 and Q2 have not been achieved. A sharp rise in admissions at the end of 2015 has now placed pressure on the end of year target for the Admissions of Older People to Residential/Nursing Homes indicator. Finance:. The Month 9 position shows an overspend in-month and year to date, although the forecast remains to achieve the planned deficit. Please note that n/a in tables means not available, and n/ap means not applicable Page 3

22 The main reasons for the year to date position are overspends on Acute contracts; increased investment in Mental Health and an improvement in the prescribing position. Please note that n/a in tables means not available, and n/ap means not applicable Page 4

23 2 NHS Constitution NHS Constitution - LCCG Indicator Year End Performance Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD Avg RTT 18 Weeks 18 weeks RTT admitted (adjusted) 93.2% 90% 92.6% 93.6% n/ap n/ap n/ap n/ap n/ap n/ap n/ap n/ap 18 weeks RTT non-admitted 96.4% 95% 97.4% 97.7% n/ap n/ap n/ap n/ap n/ap n/ap n/ap n/ap 18 weeks RTT incomplete 96.0% 92% 97.2% 97.1% 97.2% 97.3% 96.9% 96.4% 95.8% 96.1% 94.8% 96.5% 52 weeks RTT incomplete n/ap Diagnostic test Diagnostic waits 6 weeks 0.98% 1% 1.9% 0.6% 0.3% 0.8% 0.96% 2.8% 0.4% 0.5% 0.8% 1.01% Cancer Wait - 2 week All Cancer two week wait 95.1% 93% 95.4% 97.4% 94.9% 94.4% 94.3% 93.9% 96.3% 95.8% 94.7% 95.2% Cancer Breast Sympton 2 week wait 95.4% 93% 97.7% 90.9% 93.3% 87.5% 94.0% 96.8% 97.5% 97.5% 97.2% 94.7% Cancer Wait - 31 day 31 day first definitive treatment 98.9% 96% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 96.4% 98.4% 99.4% 31 day sub treatment - surgery 98.2% 94% 100.0% 100.0% 83.3% 100.0% 91.7% 100.0% 100.0% 100.0% 100.0% 97.2% 31 day sub treatment - drug 100.0% 98% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 31 day sub treatment - radiotherapy 96.3% 94% 100.0% 96.4% 100.0% 100.0% 94.4% 91.7% 100.0% 100.0% 100.0% 98.1% Cancer Wait - 62 day 62 day urgent GP referral 84.9% 85% 93.1% 85.3% 95.8% 83.8% 85.0% 94.4% 78.1% 74.2% 84.4% 86.0% 62 day screening 92.7% 90% n/ap 100.0% 100.0% 100.0% 66.7% 85.7% 100.0% 100.0% 100.0% 94.1% 62 day upgrade 81.9% 85% 80.0% 100.0% 85.7% 100.0% 66.7% 100.0% 100.0% 33.3% 100.0% 85.1% Mixed Sex Mixed sex accomodation breach Mental Health - Care Programme Approach (CPA) Early Intervention in Psychosis (EIP) services - Proportion of people on CPA who are followed up within 7 days of discharge 97.0% 95% 89.3% 97.1% n/a 93.2% Note: Quarterly data is shown in column of the third month of the quarter. Please note that n/a in tables means not available, and n/ap means not applicable Page 5

24 NHS Constitution LDH Indicator RTT 18 Weeks Year End Performance Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 18 weeks RTT admitted (adjusted) 94.0% 90% 93.1% 95.5% n/ap n/ap n/ap n/ap n/ap n/ap n/ap n/ap 18 weeks RTT non-admitted 96.7% 95% 97.6% 98.2% n/ap n/ap n/ap n/ap n/ap n/ap n/ap n/ap 18 weeks RTT incomplete 96.9% 92% 97.9% 97.8% 97.6% 97.7% 97.3% 97.0% 96.4% 96.5% 95.3% 97.1% 52 weeks RTT incomplete Diagnostic test Diagnostic waits 6 weeks 0.9% 1% 2.0% 0.5% 0.3% 1.01% 0.9% 2.9% 0.2% 0.4% 0.7% 0.98% Cancer Wait - 2 week All Cancer two week wait 95.5% 93% 94.6% 96.9% 94.8% 93.4% 94.6% 94.4% 96.3% 96.7% 96.0% 95.3% Cancer Breast sympton 2 week wait 95.6% 93% 98.7% 96.0% 89.5% 85.9% 90.3% 95.7% 97.6% 98.0% 98.4% 94.5% Cancer Wait - 31 day 31 day first definitive treatment 100.0% 96% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 31 day sub treatment - drug 100.0% 98% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 31 day sub treatment - surgery 99.2% 94% 100.0% 100.0% 89.5% 96.2% 100.0% 100.0% 100.0% 100.0% 100.0% 98.4% 31 day sub treatment - radiotherapy 100.0% 94% n/ap n/ap n/ap n/ap n/ap n/ap n/ap n/ap n/ap n/ap Cancer Wait - 62 day 62 day urgent GP referral 89.6% 85% 90.8% 91.2% 91.0% 87.9% 87.3% 94.6% 88.1% 87.5% 88.0% 89.6% 62 day screening 95.9% 90% 96.2% 100.0% 100.0% 97.8% 88.2% 90.7% 93.3% 95.3% 100.0% 95.7% 62 day upgrade 82.7% 85% 90.0% 77.8% 88.5% 80.0% 78.6% 64.3% 90.9% 75.0% 100.0% 82.8% A&E Waits A&E 4 hour wait 98.6% 95% 99.0% 99.0% 99.1% 99.2% 98.8% 98.3% 98.5% 98.6% 98.3% 98.8% A&E 12 hour trolley wait Category A Ambulance Calls Ambulance Category A (Red 1) Response < 8 Mins 84.4% 75% 93.0% 96.5% 91.4% 83.1% 90.2% 87.8% 89.2% 79.7% 84.2% 88.3% Ambulance Category A (Red 2) Response < 8 Mins 80.5% 75% 89.1% 85.0% 86.4% 82.9% 79.3% 75.2% 75.9% 77.9% 77.7% 81.0% Ambulance Category A Response < 19 Mins 94.1% 90% 99.0% 97.8% 97.3% 96.6% 96.7% 94.9% 95.9% 96.1% 95.4% 96.6% Ambulance Handover (Arrival to Handover) - amended Ambulance handover > 60 (+3) minutes - amended n/a Ambulance handover 30 (+3) to 60 (+3) minutes - amended n/a Mixed Sex Mixed sex accomodation breach n/ap Cancelled Operations Cancelled operations - new date within 28 days n/a 0 YTD Avg Note: Quarterly data is shown in column of the third month of the quarter. Please note that n/a in tables means not available, and n/ap means not applicable Page 6