NHS North East Hampshire & Farnham Clinical Commissioning Group Governing Body meeting held in Public

Transcription

1 NHS North East Hampshire & Farnham Clinical Commissioning Group Governing Body meeting held in Public Rushmoor Borough Council, Concorde Room,Farnborough,GU14 7JU. 08 February :00-08 February :00 Overall Page 1 of 109

2 Time 3.00pm Item no 1 Introduction Governing Body meeting held in Public Wednesday 8 February 2017 from 3pm to 5pm Rushmoor Borough Council Concorde Room Farnborough GU14 7JU Chairman s Welcome & Apologies Item Lead Attachments Andy Whitfield Verbal 3.05pm 2 Register of Interest To receive and note the register of interests of members ensuring that members do not participate in making decisions on an issue where a conflict of interest is established. To receive any verbal updates on the interests of members Andy Whitfield Paper 3.10pm 3 Governing Body Assurance Framework and Corporate Risk Register To note the paper Andy Whitfield Paper 3.25pm 4 Unapproved Minutes of the Governing Body meeting held in Public on Wednesday 23 November 2016 To approve the minutes of the Clinical Commissioning Group s Governing Body meeting Andy Whitfield Paper 5 Action Tracker from the Governing Body meeting held in Public on Wednesday 23 November 2016 To receive the Action Tracker and any verbal updates Andy Whitfield Paper Presentations 3.30pm 6 Quarter 3 Review of Strategic Objectives Ros Hartley Paper 3.45pm 7 Organisational Development Plan Ros Hartley Paper Papers for decision 3.55pm 8 Virgin Contract Ratification Roshan Patel Paper 9 Southern Health Contract Ratification Roshan Patel Paper Matters for Governing Body to discuss and note 4.15pm 10 Integrated Performance Report Quality Performance Quality, Innovation, Productivity and Prevention (QIPP) Finance To note the paper 4.30pm 11 Quality Report To note the paper Roshan Patel Alison Edgington Emma Holden Paper Paper Page 1 of 2 Page 1 of 2 Overall Page 2 of 109

3 Information to note and not for discussion 4.40pm 12 Sub-Committees of NHS North East Hampshire and Farnham Clinical Commissioning Group s Governing Body To receive summary updates from recent meetings of the Governing Body Committees: Clinical Executive Committee Finance and Performance Committee Quality Improvement Committee Audit and Risk Delegated Primary Care Commissioning Committee Patient and Public Engagement Committee 4.50pm 13 Questions received from the Public in advance of the meeting To respond to the questions received from the public. 14 The next Governing Body Meeting in Public Governing Body meeting in public is scheduled to take place on Wed 12 April 2017 Rushmoor Borough Council, Farnborough GU14 7JU between 3pm and 5pm 5.00pm 15 Close Steven Clarke Elaine Budd Emma Holden Peter Cruttenden Mark Hammond Kathy Atkinson All Andy Whitfield Paper Paper Paper Paper Paper Paper Verbal Verbal Page 2 of 2 Page 2 of 2 Overall Page 3 of 109

4 Corporate Register of Interests 2016 version 16 January 2017 Name Relevant and Material Interests Governing Body Finance and Performance Audit & Risk Clinical Executive Remuneration & Nominations Quality Improvement Patient & Public Engagement Delegated Primary Care Commissioning Whitfield, Andy (Dr) Clinical Lead & Chair Updated 01 February 2017 Key A= Attendance = Member GP Principal at Southwood PMS Practice Provider of private Occupational Health Services Shareholder in Salus Medical Services Ltd Chair MacIsaac, Maggie No interests to declare A A - - Chief Officer Lay Members Atkinson, Kathy Chief Executive of Safer Tourism Foundation Chair Lay Member with Patient and Public Involvement Portfolio Budd, Elaine Senior Portfolio Manager for Global Customers Vodafone PLC Cruttenden, Peter Councillor in the Parish of Steep, near Petersfield Chair Chair Lay Member with Company-Nominated Trustee of the Horizon Housing Group Pension Scheme Governance Portfolio the pension scheme of a Croydon-based social housing provider Hammond, Mark Palfrey, Ed (Dr) Secondary Care Consultant Governing Body Clinical Directors Bibawy, Peter (Dr) Directorship Georgetown Associates Ltd (family consultancy company) Trustee Council for AT Risk Academics (Charity) NED- General Pharmaceutical Council Penna (global people management business) member of the Public Sector Advisory Board Part time consultant to Frimley Health FT undertaking medical revalidation as an appraisal lead. Private practice advice given to Medical Directors of NHS acute trusts. GP partner in Southlea Group Practice, Aldershot, Hampshire Private practice that deals with medico-legal claims and Healthchecks Shareholder in Guildford Physiotherapy and Sports Clinic Wife is a psychiatrist working for Southern Heath Shareholder in Salus Medical Services Ltd Son is a community Ambassador for the CCG Chair - - Page 1 of 7 Overall Page 4 of 109

5 Name Relevant and Material Interests Governing Body Finance and Performance Audit & Risk Clinical Executive Remuneration & Nominations Quality Improvement Patient & Public Engagement Delegated Primary Care Commissioning Clarke, Steven (Dr) Dempster, Jane (Dr) Fairbairn, Olive (Dr) Wernick, Edward (Dr) CCG Directors Hartley, Ros Director of Strategy and Partnerships Holden, Emma Director of Quality and Nursing Partner at Branksomewood Healthcare Centre Working in partnership with Lloyds Pharmacy who have established an onsite pharmacy at Branksomewood Healthcare Centre Wife is GP Partner, River Wey Medical Practice, Farnham Health Centre. Wife is shareholder in Inside View company providing some diagnostic services such as ultrasound and echocardiograms. Lead GP for Fleetwood Lodge care home, Fleet Shareholder in Salus Medical Services Ltd Lives in Farnham and registered with Farnham practice GP Partner at Farnham Dene Medical Practice Shareholder in Salus Medical Services Ltd Shareholder in Farnham Integrated Care Services Ltd Occasional locum at Alexander House Surgery, Farnborough Employed at Jenner House Surgery, Farnborough as a regular locum Trustee of RHL (Rushmoor Healthy Living) a local charity involved in providing services that improve the health and well-being of the local population Trustee and Chairman of the Broadhurst Welcome Home Community Ltd a trust fund which provides grants for providers and individuals with mental health problems in Rushmoor and parts of Surrey Heath and Hart GP Principal in Downing Street Group Practice, Farnham Wife is a physiotherapist at Basingstoke Hospital Shareholder in Salus Medical Services Ltd Shareholder in Farnham Integrated Care Services Ltd - Chair No interests to declare No interests to declare A Page 2 of 7 Page 2 of 7 Overall Page 5 of 109

6 Name Relevant and Material Interests Governing Body Finance and Performance Audit & Risk Clinical Executive Remuneration & Nominations Quality Improvement Patient & Public Engagement Delegated Primary Care Commissioning Patel, Roshan A A Chief Finance Officer Riverside Meadows Management Company Limited Director Alison Edgington, Director AE executive Interims Ltd. Interim Director of Delivery Associate Directors and Managers Lawrence, Kirsten No interests to declare - - A Deputy Director of Delivery Pettman, Mary Husband is Director of Strategy Poole Hospital NHS Foundation Trust - A A Deputy Director of Finance Fiona Hoskins No interests to declare A - - Deputy Director of Quality & Nursing Trippner, Gillian No interests to declare Lisa Mercer Deputy CFO for Financial Management and Reporting Oliver White Deputy CFO for Planning and Performance Emma Williams Associate Director of Urgent & Integrated Care and System Resilience Clinical Leads Ahmed, Arfan (Dr) Targeted prevention & School Governor, Henry Tyndale School (County Council SLD), Ship Lane, Farnborough, Hampshire A A No interests to declare A - A No interests to declare GP at Monteagle Surgery, Yateley Work Stream Targeted prevention and earlier prevention Page 3 of 7 Page 3 of 7 Overall Page 6 of 109

7 Name Relevant and Material Interests Governing Body Finance and Performance Audit & Risk Clinical Executive Remuneration & Nominations Quality Improvement Patient & Public Engagement Delegated Primary Care Commissioning earlier intervention Ballard, Martin (Dr) Professional development and workforce planning Bennett, Karl (Dr) IT- both CCG and Vanguard Boylett, Sharon (Dr) Introducing new models of integrated health & social care/ End of Life Couderc, Ushadevi (Dr) Primary Care Elliott, Jane (Dr) Targeted prevention and earlier intervention/ Diabetes Hoff, Hanne (Dr) Urgent Care Clinical Lead Shareholder in Salus Medical Services Ltd GP Downing Street GP Tutor Health Education Kent, Surrey and Sussex (HEKSS) employee since 2012 Trustee on Post Graduate Education Centre Board Frimley Health NHS Foundation Trust GP Advisor to Clare Park Hospital One session per month advising on GP education and engagement Out of Hours Regular sessions worked for North Hampshire Urgent Care. Shareholder in Salus Medical Services Ltd GP at Oakley Health Group. The same locality is currently in negotiation with North East Hampshire and Farnham CCG to participate in an integrated care pilot which will involve development of IT systems to support this activity Wife is senior partner at Station Road surgery, part of Surrey Heath CCG and a GP member of the Surrey Heath CCG board with no specific portfolio. Shareholder in Salus Medical Services Ltd Nurse Practitioner at Alexander House Surgery, Farnborough Nurse Practitioner in North Hampshire Urgent Care out of hours service Wessex Patient Safety Collaborative Wessex Academic Health Science Network (WAHSN) Shareholder in Salus Medical Services Ltd GP Partner in Holly Tree Surgery, Farnham Husband is Consultant Ophthalmologist at Frimley Health NHS FT Shareholder in Salus Medical Services Ltd GP in Crondall New Surgery, Farnham Husband is a senior GP Partner in Crondall New Surgery and Medical Director of NHUC Locum GP in North Hampshire Urgent Care out of hours service Clinical Auditor of North Hampshire Urgent Care Honorary tutor in the department of Pharmacology, Toxicology and Page 4 of Page 4 of 7 Overall Page 7 of 109

8 Name Relevant and Material Interests Governing Body Finance and Performance Audit & Risk Clinical Executive Remuneration & Nominations Quality Improvement Patient & Public Engagement Delegated Primary Care Commissioning King, Nelly (Dr) Cancer Lead Micklethwaite, Glen (Dr) Medicines Optimisation Rishworth, Viv (Dr) Individual Funding Requests Robinson, Karen (Dr) Prevention and Self Care Rosling, Lesley (Dr) Mental Health and Learning Disabilities/ Dementia Russell, Kate (Dr) Community Paediatrics Med Management Melinda Veck, Med Management Pharmacist Clare Watson, Med Management Jennifer Fynn, Head of Medicines Management Therapeutics at the University of Cardiff North Hampshire Urgent Care Board Employed as Clinical Auditor Shareholder in Salus Medical Services Ltd GP Southlea Practice Shareholder in Salus Medical Services Ltd Senior GP Partner in Milestone Surgery, Farnborough Shareholder in Salus Medical Services Ltd GP Downing Street - Register of Interests Form to be completed Shareholder in Salus Medical Services Ltd GP Southlea Practice GP Partner Shareholder in Salus Medical Services Ltd GP Southlea Practice Register of Interests Parochial church council member St Mary Church Frensham no conflict Trustee Ridgeway School(Special needs school) Farnham no conflict Shareholder in Salus Medical Services Ltd GP Downing Street Practice Register of Interests Form to be completed Shareholder in Salus Medical Services Ltd No interests to declare No interests to declare Husband is Pharmacy manager at Fernhurst Pharmacy Ltd A A Inderpal Chheena Locum Pharmacist for Boots Sarah Ellis-Martin Married to a NEHF CCG employee who is currently also doing a temporary role at Guildford and Waverley CCG Page 5 of 7 Page 5 of 7 Overall Page 8 of 109

9 Name Relevant and Material Interests Governing Body Finance and Performance Audit & Risk Clinical Executive Remuneration & Nominations Quality Improvement Patient & Public Engagement Delegated Primary Care Commissioning Sarah Sneath No interests to declare Emily Dewey No interests to declare Other Organisations Sallie Bacon (Dr) Director of Public Health Hampshire County Council Boddy, Jean Surrey County Council Employed by Hampshire County Council. Husband is Professor of Public Health at Southampton University Medical School. A No interests to declare A Claire Hooke Area Director North & East Hampshire, Hants County Council Employed by Hampshire County Council A Pears, Robert Consultant in Public Health, Hampshire County Council Ed Walton Vamplew, Tim Research Policy and Performance, Surrey County Council Elspeth Griffiths Associate Director of HR Central, South No interests to declare A - - Employed by Hampshire County Council Associate member of the Asian Welfare and cultural Association, Eastleigh No interests to declare No interests to declare A and West CSU David Brown (Dr) GP at Farnham Dene Practice Chair of the Practice Council Shareholder with Salus Shareholder and Director of Farnham Integrated Care Services Ltd Page 6 of 7 Page 6 of 7 Overall Page 9 of 109

10 Name Relevant and Material Interests Governing Body Finance and Performance Audit & Risk Clinical Executive Remuneration & Nominations Quality Improvement Patient & Public Engagement Delegated Primary Care Commissioning Firmin, Christina Practice Manager at Giffard Drive Surgery Secretary of the Practice Council Samantha Hudson Employed Hampshire County Council as Head of Communities and Wellbeing Sue Hathaway Work capacity - RUS is the Umbrella operation supporting the voluntary sector in Rushmoor Kefford, Sharon (GP) Safeguarding Children Employed by West Hampshire CCG as named GP for Safeguarding Children assigned to NEHF CCG GP Giffard Drive Surgery Nigel Watson (Dr) Chief Executive Officer, Wessex Local Medical Committee (LMC) Keith Myhill, Head of None to declare Procurement- Commissioning Support Frank Rust, Rushmoor Councillor and Member of APG Member of Rushmoor Borough Council Member of Hampshire County Council Trustee of Rushmoor Citizens Advice Trustee of Rushmoor Voluntary Services Financial Director of Rushmoor Gymnastics Academy Board Member of Rushmoor Mediation Service Page 7 of 7 Page 7 of 7 Overall Page 10 of 109

11 Governing Body Title of Paper Corporate Risk Register Agenda Item 3 Date of meeting 8 February 2017 Lead Andy Whitfield Author Governance Team Purpose To Approve Strategic To Ratify Objective To Discuss Number 13 To Note X Risk Unique Risk ID The CCG would be subject to reputation and statutory failings without the identification and appropriate management of risks. N/A Executive Summary The management of risk supports the day-to-day working and achievement of the strategic objectives of the CCG. This document ensures that risks are identified and managed appropriately. Governing Body Assurance Framework: The Governing Body is asked to note the Governing Body Assurance Framework document. Corporate Risk Register: Following a risk update at its last meeting, the attached risk register details those risks on the Corporate Risk Register that are currently scored 15 and above (red) There are 15 risks on the corporate risk register that are rated 15 and above. Each of these is overseen by an individual risk manager and a governing body sub-committee. The following new risks have been added to the corporate risk register since the last meeting on 11 January 2017 Risk CR45 Multi-Agency Safeguarding Hub (MASH) has been added to the Safeguarding risk register. Risk CR46 Quality in Domiciliary Care has been added to the Safeguarding risk register. The following updates have been added since the meeting on 11 January 2017: Risk CR01 SECAmb Ambulance response times- This risk has been upgraded from a gross risk score of 10 (amber) to gross risk score of 15 (red). The Target Risk Score has been upgraded from 1 Rare to 2 Unlikely. A third control has been put in place- This winter the CCG funded Ambulance handover nurses at Frimley Park Hospital during peak times. Update to the progress column- Working closely with SECAmb and SCAS around handover delays which ultimately result in an impact on Ambulance response times. Risk CR02 95% A&E standard- In comparison with acute care peers across the system (Hampshire and Surrey), Frimley South has performed well (top two) despite having had a difficult January (performance at c.82%). Evaluation taking place around recent A&E performance through the Christmas and New Year period and can report back next month as to the findings Risk CR03 Referral to Treatment- Planned Care Programme Board Commenced CR04 Diagnostic 6 week wait. The likelihood for this risk has been changed to unlikely which is now in line with the target. It will be recommended at the next Clinical Executive and Finance and Performance meetings that this jointly owned risk is removed from the corporate risk register. The risk was updated with the following: 3/01/2017 diagnostic standard consistently met at Frimley for over a year. Royal Surrey performance improving. 30/01/17 Performance against this target is now consistently being met. Page 1 of 13 Overall Page 11 of 109

12 Risk CR05 12 hour breaches- 12 hour breaches are now reviewed as part of the SI Process. Risk CR06 62 day cancer target- CCG/FHFT cancer catch up on 28/11/16 to discuss actions taken to improve tumour pathways. RSCH remedial action plan update (04/01/17) states partial assurance for the cancer waits due to some improvement. However, RSCH remain below revised trajectory and performance is heavily dependent on timings of referrals from other hospitals and capacity of brachytherapy element of the prostate pathway. Work is underway to address these areas, but recovery remains some time away. The Planned Care Performance Board will have oversight for assurance of actions on this risk. Risk CR07 Managing long waiting cancer patients- Agreement on the process for the root cause analysis and feedback on themes to CQRM on a quarterly basis; shared breach policy is still to be agreed with the Trusts of St. Luke's Cancer Alliance (St Luke s Cancer Alliance is an historic entity, clinically driven and operates within a culture of collaboration between cancer provider organisations of Ashford and St Peter s Hospitals NHS Foundation Trust, Frimley Health NHS Foundation Trust, Royal Surrey County Hospital NHS Foundation Trust and Surrey and Sussex Healthcare Trust. The future of this Alliance is not clear due to the newly formed Surrey and Sussex Cancer Alliance. The likelihood for this risk has been changed to unlikely which is now in line with the target. It will be recommended at the next Quality Improvement committee meeting that this risk is removed from the corporate risk register. The Planned Care Performance Board will have oversight for assurance of actions on this risk. Risk CR09 Cancers diagnosed at stage 1 or Baseline data report submitted and agreed trajectory for improvement for the remainder of the financial year with expectation that these will continue via the Quality Schedule in 2017/18. The likelihood for this risk has been changed to unlikely which is now in line with the target. It will be recommended at the next Quality Improvement committee meeting that this risk is removed from the corporate risk register. The Planned Care Performance Board will have oversight for assurance of actions on this risk. CR11 Primary Care Vulnerability- Procurement halted as a result of low expressions of interest. Internal service and plan to be developed. CR12 Primary Care Recruitment- Vanguard workforce workstream is behind schedule and has been flagged as 'high risk'. Vanguard steering board is taking action to address this. CR19 Funding new initiatives post Vanguard- Vanguard projects producing evaluation of achievements in 2016/17 and plans for 2017/18 for review in February. Outputs of these reviews will help to inform and prioritise investments in 2018/19. No red rated risks have been closed since the last Governing Body meeting. The Governing Body is asked to note the red rated risks on the Corporate Risk Recommendations Register and the updates to the Governing Body Assurance Framework. Publication Public Website Staff Website (intranet) Please provide details on the impact of following aspects Equality and Quality Impact Assessment N/A Patient and Stakeholder Engagement N/A Financial Impact and Legal implications N/A Governance and Reporting- which other meeting has this paper been discussed Committee Name Date discussed Outcome Audit & Risk Committee 21 st December 2016 Update noted Page 2 of 13 Overall Page 12 of 109

13 Governing Body Assurance Framework Theme Objective CCG Objectives for 2016/17 Improved services, outcomes and care quality for our population 1. Ensure local people receive high quality services that are safe, improve outcomes for people, and are delivered with kindness and compassion. Where care does not meet required standards, take action to improve the quality of these services. 2. Deliver the actions within our improvement programmes to improve the quality, outcomes and performance of services. Our improvement programmes include: (1) prevention and self-care, (2) primary care, (3) integrated community care, (4) urgent and emergency care, (5) planned care, (6) specialist care 3. Ensure that all constitutional standards are achieved for the North-East Hampshire & Farnham population. System reform 4. Through the delivery of the Vanguard Programme and through the development and delivery of the Frimley and Hampshire & Isle of Wight Sustainability and Transformation Plans (STPs), accelerate the pace and scale of delivery of new models of care and transformation. 5. Develop, agree and put in place revised contracting, payment and governance arrangements with partners to support delivery of the system strategy, and the creation of a place-based system of care. Engagement and Partnerships 6. Strengthen and embed robust processes to engage and co-design with the local community, ensuring that their views and experiences directly influence CCG priorities, plans and delivery 7. Further improve and embed the arrangements through which member practices operate within and contribute to the work of the CCG, in order to accelerate planned service improvements 8. Further develop and strengthen the partnerships we need to improve health and health services for our population 9. Effectively discharge our responsibilities as lead commissioners for children s services and for mental health and learning disability services, ensuring that these services meet the needs of the populations they serve. Financial sustainability 10. Continue to refine and implement our five year financial plan which ensures the sustainability of services for our population and ensures that CCG has the resources and resilience it needs to deliver its strategy 11. Deliver our annual financial plan, achieving value for money and meeting our financial obligations. CCG people and organisation 12. Refresh and implement our organisational development plan, developing our people, culture and clinical leadership to enable innovation and excellence, managing within our running costs 13. Ensure that the necessary internal systems, processes, constitutional and governance arrangements are in place to enable the CCG to deliver its duties and responsibilities Page 3 of 13 Overall Page 13 of 109

14 High Risk Summary: Chart Ref Risk Current Score Score Trend Consequence Likelihood Current Previous month 3 months ago 6 months ago General direction 1 = Negligible 1 = Never Score of Travel 5 = Catastrophic 5 = Almost Certain 1 Constitutional Targets Financial Targets 3 Provider/Partner failure impacting on Service Delivery 4 Engagement with Member Practices Delegated Commissioning 9 9 N/A N/A Vanguard programme N/A N/A 7 System Resilience and Business Continuity CCG Sustainability Conflicts of Interest Management of collaborative arrangements for Mental Health & Learning Disability Services N/A Page 4 of 13 Overall Page 14 of 109

15 Chart Ref Risk Name & Description CCG Strategic Objectives 16/17 Risk Owner & Clinical Lead/Risk Manager Assurance Committee Current Risk Rating Consequence x likelihood Actions Key Controls Assurance Source 1 Risk: Performance against Constitutional Targets a) Ambulance Response Times b) Increased number of delayed transfers at Frimley Park Hospital (nursing home placements, home care packages and Patient & Family choice) c) Increase in Continuing Health Care Expenditure (CHC) d) A&E 4 hour wait 1 & 3 15 (3x5) a1) A new recovery plan and trajectory is being negotiated with North West Surrey CCG a2) SECAmb are implementing their Immediate Handover Procedure a3) NEHF CCG working with Frimley Park A&E to reduce handover times. b1) NEHF CCG have developed an action plan which will be used in planning discussion with the Frimley System Resilience Group b2) The CCG have developed a trajectory to reduce the rate of delayed transfers of care from 3.5% to 3.9%. Finance and Performance Committee established to review monthly Integrated Performance Report which includes performance against Constitutional Targets. a1) Contract monitoring meetings with providers a2) Monthly face-to-face meetings with SECAmb a3) CQC inspection undertaken and active monitoring by Monitor and NHS England. b1) regular monitoring of the Discharge to Assess beds NHS England quarterly Assurance Meetings Integrated Performance Report and key issues raised at each Governing Body meeting Internal and External Audit reports NHS England requirement Interim Director of Delivery Alison Edgington Governing Body c2) Two fixed term posts started June 2016 in post CHC financial risk reduced now that we have introduced two additional staff / but are there quality / patient experience risks c3) Monthly Performance & Governance meetings introduced by West Hampshire CCG for escalation and this group will lead of drafting a CHC service specification. c4) a performance scorecard has been developed and can be accessed to run reporting by the CCG. c1) Local CHC working group overseeing performance and evaluation of planned projects. c2) CHC Governance & Performance group and plans. d2) Contract Quality review meetings with Frimley d1) Vanguard and System Resilience Group developing a range of projects designed to target key areas of challenge including Out of Hours and local authorities to reduce delays and increasing GP support to Frimley to help improve discharge. d2) The Quality team are working with Frimley Health to determine reasons for 12 breaches of patients waiting longer than 12 hours in A&E 2 Risk: Failure to meet financial obligations and requirement. 10 &11 Chief Finance Officer Roshan Patel Finance & Performance 12 (4x3) Vanguard programmes designed to deliver savings CCG actively imbed Right Care CCG actively manage GP referrals Deliver QIPP (savings) schemes Mitigation of new financial risk being determined estimated 1.2m cost of national funded nursing care back backdated to April 16 Contract Review Meetings Robust scrutiny of chargeable activity Finance & Performance Committee Integrated Performance Report Internal audits carried out on financial business NHS England Page 5 of 13 Overall Page 15 of 109

16 Chart Ref Risk Name & Description CCG Strategic Objectives 16/17 Risk Owner & Clinical Lead/Risk Manager Assurance Committee Current Risk Rating Consequence x likelihood Actions Key Controls Assurance Source 3 Risk: Significant impact on North East Hampshire & Farnham CCG due to Providers and or Partner failure (in particular; Financial, Quality or Performance) In April the Care Quality Commission issued Southern Health NHS Foundation Trust with a warning notice to improve governance arrangements in particular around investigations and learning from incidents and deaths. NHS Improvement subsequently put an additional condition on the Trusts License to provide NHS Services. 1 & 2 Directors Roshan Patel Emma Holden Alison Edgington Governing Body 12 (3x4) Further development of the Quality Strategy Practice Support Visits being rolledout across all practices Guildford & Waverley CCG are being held to account on RSCH remedial action plan Board to Board meetings with providers. Signed Contract with all providers Monthly contract review meetings and use of contractual incentives and levers System-wide established networks e.g System Resilience Group Contract Quality Schedules in place for all providers Clinical Quality Review, Serious Incident and Learning Panel Meetings in place Regular CQRM meetings Quality report to Governing Body. Quality exception dashboard to Quality Improvement Committee NHS England Quarterly Assurance meetings. Internal Audit Reports for services provided by partner organisations (e.g Safeguarding, Continuing Health Care etc.) CCG Internal Audit Reports NHS Improvement has issued Royal Surrey County Hospital (RSCH) with an improvement notice Page 6 of 13 Overall Page 16 of 109

17 Chart Ref Risk Name & Description CCG Strategic Objectives 16/17 Risk Owner & Clinical Lead/Risk Manager Assurance Committee Current Risk Rating Consequenc e x likelihood Actions Key Controls Assurance Source 4 Risk: There is insufficient engagement with Member Practices which may impact on relationships, and CCG programme development & delivery. 7 Interim Director of Delivery Alison Edgington Governing Body 6 (2x3) Work continues on the separation of the Communications and Engagement Strategies to include internal communications and engagement Regular meetings held between the Chair and Secretary of the Practice Council & Chief Officer and Chair. Further development of the CCG Intranet to provide as an additional resource and means of communication with Member Practices. Regular locality meetings established & taking place CCG website operational Engagement and working together is a key enabler of the Vanguard programme which the CCG is a key member Regular education days established with a dedicated section on relevant CCG business CCG processes have been developed to gain Member Practice engagement with decision-making. 5 Strategic Risk: Delegated Primary Care Commissioning. a) Insufficient allocations to CCG to support historic commitments. b) there is no early warning system in place to identify vulnerable practices in advance. c) failure to build a sustainable model of integrated primary care at scale d) two local practices have received requires improvement outcomes following Care Quality Commission inspections. 2 Interim Director of Delivery Alison Edgington Governing Body 9 (3x3) The Primary Care Strategy will include primary care sustainability. Determine the criteria and intelligence monitoring to support an early warning system. The Delegated Primary Care Commissioning Committee are overseeing these risks and determining ways of working with practices for the future. Delegation and Collaboration Agreements in place between CCG and NHS England. Model terms of reference for delivery of statutory functions and duties. Practice resilience programme being put in place which will include a supported health check to assess future needs and resilience. Only one remaining practice is rated as requires improvement Delegated Primary Care Commissioning Committee now established NHS England Page 7 of 13 Overall Page 17 of 109

18 Chart Ref Risk Name & Description CCG Strategic Objectives 16/17 Risk Owner & Clinical Lead/Risk Manager Assurance Committee Current Risk Rating Consequenc e x likelihood Actions Key Controls Assurance Source 6 Risk: Vanguard fails to deliver in the following areas: Savings Transformation Sustainability 11 Interim Director of Delivery Alison Edgington Chief Finance Officer Roshan Patel Director of Strategy & Partnerships Ros Hartley Governing Body 9 (3x3) Regular reporting to Governing Body in order to determine any issues or areas of concern started in April Vanguard Steering Group in place to oversee programme delivery. Governing Body and its Sub- Committees overseeing any national requirements as they arise Reporting to National Vanguard team on progress NHS England Quarterly Assurance meetings Work stream leads providing Work stream reports for Vanguard Steering Group 7 Risk: The resilience of the systems and processes in respect of: Business Continuity Emergency /Operational Planning 13 Interim Director of Delivery Alison Edgington Chief Finance Officer Roshan Patel Governing Body 3 (3x1) Process for testing Business Continuity Plan to be determined. Emergency Preparedness Resilience and Response Plan Daily system resilience process On call system On call planning across the geographical patch Emergency Preparedness Resilience and Response Plan Assurance via checklist and NHS England assessment of CCG and Lead commissioner organisations with action plan regularly monitored Positive assurance from NHSE Wessex on winter preparedness Business Continuity Plan approved by the Governing Body on 28 September 2016 reviewed annually. Internal Audit Report NHS England requirement Page 8 of 13 Overall Page 18 of 109

19 Chart Ref Risk Name & Description CCG Strategic Objectives 16/17 Risk Owner & Clinical Lead/Risk Manager Assurance Committee Current Risk Rating Consequenc e x likelihood Actions Key Controls Assurance Source 8 Risk: The CCG is not sustainable due to lack of required resources in place to deliver strategic change including: workforce to deliver new models of care; training and development for future workforce; organisational development programmes that challenge the status quo, communicate the change needed, shape the culture and values needed and empower staff; 9 Risk: reputational damage due to a failure to manage conflicts of interest effectively Director of Strategy & Partnerships Ros Hartley Chief Finance Officer Roshan Patel Remuneration & Nominations Governing Body 12 (4x3) 6 (3x2) Learning Agreement for staff - the statutory and mandatory document from the HR CSU Team is reviewed by RemCom. The value and purpose of a separate Learning Agreement will be undertaken to determine if it is still required. Operational Leadership Group reviewing mandatory training requirements for each team Organisational OD Plan in final draft stages to be approved by GB Review and revision of the management of declaration of Interests and conflicts of interest documentation to reflect requirements of new NHS England guidance. Interests determined for Vanguard Steering Board Conflicts of Interest Guardian appointed by the Governing Body Service Level Agreement with the Commissioning Support Unit for delivery of CCG mandatory training monitored Learning Agreement for Clinical Leads Recruitment into teams Leadership Programme Induction programme in place Annual Declaration of Interests Procedure Standing Orders detail process of management of conflicts of interests Committee Terms of Reference Standards of Business Conduct and Conflicts of Interests Policy Further information awaited from NHSE regarding mandatory on-line training requirements and results of the additional consultation which concluded on 31 October CCG Mission Statement and Objectives used in staff objectivesetting and appraisals. Monthly Workforce data which is reviewed at Remunerations and Nominations Committee. Review of the Register of interests at each Governing Body and subcommittee meeting. Internal Audit report with reasonable assurance. NHS England approved Standards of Business Conduct and Conflicts of Interests policy Conflicts of Interests declared at each Governing Body and subcommittee meeting NHS England Final Guidance issued 28 June 2016 Page 9 of 13 Overall Page 19 of 109

20 Chart Ref Risk Name & Description CCG Strategic Objectives 16/17 Risk Owner & Clinical Lead/Risk Manager Assurance Committee Current Risk Rating Consequence x likelihood Actions Key Controls Assurance Source 10. Risk: failure to manage collaborative commissioning arrangements for: Mental Health 9 Director of Strategy & Partnerships Ros Hartley Governing Body 8 4x2 Memorandum of Understanding (MoU) due to be completed and signed by (1) the Surrey Heath CCG and the North Hampshire and Farnham CCG Mental Health collaborative commissioning group and (2) the Surrey Mental Health Collaborative Commissioning Groups to formalise arrangements. Legal advice on the MoU being obtained prior to final approval. Formal consultation with North East Hampshire and Farnham affected staff where posts had been identified under TUPE as transferring to the Heartlands and East Surrey CCG Collaborative Commissioning Group had been completed and staff transferred. SLA for each collaborative to be in place with relevant CCGs Regular collaborative meetings to take place Monthly reports to CCGs on agreed work programme, contract activity, performance and finance Transition process to be concluded - embed new arrangements before start of new financial year in April Integrated Performance Report and key issues raised at each Governing Body meeting Internal and External Audit reports Relevant decision papers to be submitted to relevant CCG clinical executives and governing bodies by collaborative leads Regular attendance and reporting to Surrey Collaborative forums by collaborative executives and managers The Surrey Mental Health Commissioning Collaborative Transition Programme: - Two Collaborative Commissioning Groups have been established: (1) Surrey Heath CCG and North East Hampshire and Farnham CCG who would act as lead commissioners and (2) North West Surrey CCG, East Surrey CCG, Surrey Downs CCG and Guildford and Waverley CCG who would act as lead commissioner for this Heartlands and East Surrey Group. The Mental Health contract signed. Page 10 of 13 Overall Page 20 of 109

21 North East Hampshire and Farnham CCG Corporate Risk Register Executive Accountable Officer: Maggie MacIssac Review Committee: Governing Body Review Period: Monthly Last Updated: Strate gic Objecti ve ID Risk Type Risk Name Risk Description / Impact Controls in Place Additional risk reduction plan Lead Mgr Lead Exec Cmttee Date Risk GROSS RISK SCORE NET RISK SCORE TARGET RISK SCORE Identified inherent Current CR 01 Constitutional target SECAMb Ambulance response times Poor response times lead to poor clinical outcomes for patients. (Reference to CQC concerns regarding leadership and inadequate dispatch systems). 5 Catastrophic 3 Possible 15 1) New leadership team in 5 place (Geraint Davies Interim Catastrophic CEO). 2) CQC has investigated and full report published on 28 September - SECAMB overall rated inadequate 3) This winter the CCG funded Ambulance handover nurses at Frimley Park Hospital. during peak times 2 Unlikely 10 1) Remedial action plan to be signed off by lead commissioner Julia Ross (NHS North West Surrey) 5 Catastrophic 2 Unlikely 10 Jayne Tunstall Alison Edgington Review date Progress F&P 15-Jun Mar-17 16/11/16 - SECAMB has recently adopted Nature of Call (NoC) and Dispatch on Disposition (DoD) best practice It has already adopted national clinical call categorisation systems including hear and treat and see and treat and the rates of both have improved over the last 18 months. Ambulance Service produced recover plans - actioned Regular conversations, presentations and actions agree with System partners and CCG at A&E Delivery Board and other forums such as 'One Version of the Truth' Commissioned 2 Ambulance Handover nurses at A&E through winter 2016/17. Working closely with SECAmb and SCAS around handover delays which unltimatley result in an impact on Ambulance response times CR02 Constitutional target 95% A&E standard Delays in assessment and treatment in A&E can lead to patient decompensation. 5 Catastrophic 4 Likely 20 1) Fully constituted SRG 5 brings multi-agencies Catastrophic together to plan and respond to escalation within the urgent and emergency care system. 2) System escalation process. 3) Conference Calls. 4) Escalated Senior Manager calls when System is experiencing flow pressures 3 Possible 15 1) SRG has commissioned 5 5 workstreams including Catastrophic measures to improve admission avoidance, DToC and flow through the hospital system. 2) The Out of Hospital Vanguard workstream is overseeing 3 projects to support admission avoidance and acute patient flow. 3) Actions/Services developed as part of System Resileince plans and Winter Plan to avoid admissions and expedite discharges 2 Unlikely 10 Jayne Tunstall Alison Edgington SRG 25-May Mar In comparison with acute care peers across the system (Hampshire and Surrey), Frimley South has performed well (top two)despite having had a difficult January (performance at c.82%) Evaluation taking place around recent A&E performance through the Christmas and New Year period and can report back next month as to the findings. Evaluation taking plae around recent A&E performance through the Christmas and New Year period and can report back next month as to the findings CR03 Constitutional target RTT 18 week Increase in numbers of patients 5 Catastrophic 3 Possible 15 1) Constitutional target 85% standard waiting longer than 18 weeks for being met treatment could lead to unnecessary 2) Monitored at speciality delays in treatment level through the contract 5 3 Possible 15 1) GP referrals, investigation Catastrophic and management plan via localities as part of provider development. 5 Catastrophic 2 Unlikely 10 Kirsten Lawrence Alison Edgington F&P CE 25-May Mar-17 3/01/2017 RTT standard being met. Frimley performance good and Royal Surrey performance improving Planned Care Programme Board Commenced CR04 CR05 Constitutional target Diagnostics 6 week wait 99% standard Clinical/quality 12 hour breaches Patients waiting longer than 6 weeks for diagnostic assessment could delay diagnosis (Main issue with RSCH) Delays in assessment and treatment in A&E can lead to patient decompensation. 5 Catastrophic 3 Possible 15 1) Host commissioners 5 Guildford and Waverley CCG Catastrophic have agreed a remedial action plan with RSCH. 2) Target being met at FHFT 5 Catastrophic 4 Likely 20 1) Non-compliance with 5 recognised escalation Catastrophic process has been raised with the Trust. 3 Possible 15 1) Delivery of the remedial plan 2) Assurance from Guildford and Waverley that the remedial plan is having an impact. 3) NEH&F involvement in assurance telecoms and meetings. 3 Possible 15 1) Root cause analysis to be received by CQRM ( ) 2) New escalation procedures to be implemented 3) EH meeting with Nicola Ranger DoN. 5 Catastrophic 5 Catastrophic 2 Unlikely 2 Unlikely 10 Kirsten Lawrence 10 Fiona Hoskins Alison Edgington Emma Holden F&P CE 15-Jun Mar-17 3/01/2017 diagnostic standard consistently met at Frimley for over a year. Royal Surrey performance improving. 30/01/17 Performance against this target is now consistently being met. Hence this risk is recommended for down-grading. The likelihood is now reduced to 'unlikely' which brings the risk in line with target. QIC 01-May Jun Jan 17 Update request sent:30/01/ hour breaches are now reviewed as part of the SI Process. Page 11 of 13 Overall Page 21 of 109

22 CR06 Constitutional target 62 day cancer target urgent referral screening; & consultant upgrade Certain tumour site pathways consistently not meeting the constitutional target could impact on the overall achievement and outcomes for patients (RSCH issue) 5 Catastrophic 3 Possible 15 1) Constitutional Target met for our population 2) Monitor at Speciality Level 3) Escalation process in place if Target missed 5 Catastrophic 3 Possible 15 1) Guildford and Waverley 5 CCG host commissioner is Catastrophic working with the provider to understand the issues within specific tumour sites and put in place remedial actions to improve the pathways. 2) Assurance from Guildford and Waverley that the remedial plan is having an impact. 2 Unlikely 10 Kirsten Lawrence Alison Edgington QIC 01-Jun Mar CCG/FHFT cancer catch up on 28/11/16 to discuss actions taken to improve tumour pathways RSCH remedial action plan update (04/01/17) states partial assurance for the cancer waits due to some improvement. However, RSCH remain below revised trajectory and performance is heavily dependent on timings of referrals from other hospitals and capacity of brachytherapy element of the prostate pathway. Work is underway to address these areas, but recovery remains some time away Currently meeting target overall, but some pathways are not. Planned Care Programme Board will now have oversight for assurance of this metric CR07 Clinical/quality Managing long waiting cancer patients Challenges with ensuring implementation of the Managing Long Waiting Cancer Patients 104 days backstop policy and the shared breaches policy 5 Catastrophic 3 Possible 15 1) Local cancer CQUIN has 5 been developed Catastrophic 2) Working with St Luke s Cancer Alliance, provider and South East Clinical Cancer Network to agree the shared breaches policy 2 Unlikely 10 1) CQUIN to be agreed with 5 the provider (See 07 and 09). Catastrophic 2) Root cause reduction process on place and results discussed at FHFT CQRM quarterly 2 Unlikely 10 Kirsten Lawrence Alison Edgington QIC 01-Jun Mar Agreement on the process for the root cause analysis and feedback on themes to CQRM on a quarterly basis; shared breach policy is still to be agreed with the Trusts of St. Luke's Cancer Alliance (St Luke s Cancer Alliance is an historic entity, clinically driven and operates within a culture of collaboration between cancer provider organisations of Ashford and St Peter s Hospitals NHS Foundation Trust, Frimley Health NHS Foundation Trust, Royal Surrey County Hospital NHS Foundation Trust and Surrey and Sussex Healthcare Trust. The future of this Alliance is not clear due to the newly formed Surrey and Sussex Cancer Alliance) Following review, recommend this risk is removed as the policy has been implemented and will be monitored via the CQRM and Planned Care Programme Board. CR10 Clinical/quality Continuing Healthcare Hampshire Long standing failure of current Hampshire-wide service to comply with national framework standards including the reviews process and Funded Nursing Care. 4 Major 4 Likely 16 1) West Hampshire CCG WHCCG) are providing the service on behalf of the Hampshire 5. 2) External consultancy has compiled a remedial action plan. 3 Major 2 Unlikely 6 1) Business case under development. 2) Awaiting access to WHCCG newly implemented performance management system (QA+) which will enable access to activity and performance reports. 30th June Major 2 Unlikely 8 Charlotte Keeble Alison Edgington F&P 1st June Mar-17 16/11/16 - Arrangements now in place for CHC Reviews to be undertaken by CHC Direct to commence beginning Dec 16 and be completed by end Jan 17. Close review to ensure this now takes place is being applied Clinical Executive being asked to approve investment in Funded Nursing Care to ensure CCG compliance with national standards Performance against the 28 day national standard for 'checklist to decision support tool' = 39 days in September 2016 reduced to 33 days currently. CR11 Clinical/quality Primary care vulnerability When primary care vulnerability arises in an unexpected manner, quality of services being provided to patients is put at risk 4 Major 4 Likely 16 Commissioning team provide proactive support to GP practices at time of crisis and analyse risk to patients This is an ad-hoc rather than a systematic approach. 4 Major 4 Likely 16 1) Implementation of practice Health Check tool in 2016/2017 will provide more structure to gathering early warning signs 2) Viability action plan to be delievered. 4 Major 2 Unlikely 8 Lauren Penningto n Emma Holden DPCC 03-Jun Mar Local resilience programme approved by DPCCC which will include self assessment and locality sustainability plan Procurement halted as a result of low expressions of interest. Internal service and plan to be developed. CR12 Clinical/quality Primary care recruitment The increasing challenges in recruiting GPs is resulting in short term vulnerability for practices and is impacting on the long term sustainability of the current primary care model 4 Major 4 Likely 16 There are very limited existing controls in place to support practices in addressing this risk 4 Major 4 Likely 16 1) Submission and approval of primary care workforce stabilisation package by Vanguard Steering Group 2) Primary Care Workforce Group to develop the recruitment improvement plan. 4 Major 2 Unlikely 8 Lauren Penningto n Alison Edgington DPCC 03-Jun Mar Local resilience programme approved at DPCCC Vanguard workforce workstream is behind schedule and has been flagged as 'high risk'. Vanguard steering board is taking action to address this. Page 12 of 13 Overall Page 22 of 109

23 CR19 Vanguard programme Funding new initiatives post Vanguard New integrated ways of delivering services cease when Vanguard funding comes to an end. 4 Major 4 Likely 16 1 Negligble 1 Rare 1 1 Negligible 1 Rare 1 Roshan Patel F&P 14-Jul Feb Vanguard funding for approved by NHSE Vanguard projects producing evaluation of achievements in 2016/17 and plans for 2017/18 for review in February. Outputs of these reviews will help to inform and prioritise investments in 2018/19 CR27 Reputational Implementati on of the primary care strategy and general practice forward view GP practices need significant support to sustain and transform in line with the priorities in the CCG primary care strategy and general practice forward view. Without these changes GP practices will not be sustainable in the future 5 Catastrophic 4 Likely 20 Strategy action plan in place; likely investment required identified 5 3 Possible 15 Consolidation of priorities Catastrophic identified in local and national documents will create a clear local action plan 4 Major 3 Possible 12 Kirsten Lawrence Alison Edgington DPCC 12/10/ /03/2017 A presentation to the F&P committee on 26/10/16 with identify the likely investment required to support primary care A presentation to the DPCCC on the 19/10/16 will identify the draft primary care commissioning intentions for 17/ Invetsment has been identifed for a GP resilience programme which is currenlty being procured. This wil support practices to assess vulnerablity and provide support for development and training/education. 1 CR38 Safeguarding Deprivation of Liberties Assessments Across Hampshire and Surrey the number of Deprivation Of Liberty (DOLs) assessment requests exceeds the capacity that the local councils have to complete the assessments. Creating a risk that people may be being deprived of their liberties, whilst under the care of a Healthcare organisation. 4 Major 4 Likely Currently the local councils are only assessing DOLs assessment requests that fall into the critical category. 3 Moderate 3 Likely 9 Hampshire County Council, montoring DOLs assessments against national standards. Area is an outlier with regards to volume of referrals but not timeliness of assessments. 1 Rare 1 Negligibl e 1 Philip Shaw Emma Holden Safeguar ding Mar-16 Nov Benchmarking data accuracy with local providers commenced March 2016, 2. Discussed at April Wessex SG Adult Board Quality Assurance Group - plans to include DOLs as part of annual audit plan 2016/ Planned discussion at Aug SG committee regarding downgrading risk due to no reported incidents. 1 CR40 Safeguarding Designated Doctor for Looked after Children Hampshire. No Designated Doctor for Looked After Children Hampshire. The resignation of the Designated Dr places the CCG as non-compliant with statutory guidance from 31st December Implications: Delays in delivery of care and assessments for looked after children in Hampshire. 4 Major 4 Likely 16 1) Monitoring at the CCGs Safeguarding Clinical Committee. 2) Monitoring at Hampshire 5 Committee gaps in controls. 3) Actively seeking appropriate candidates. 4) Designated nurse for looked after children in post. 5) Support from the childrens safeguarding team - designated doctor and named GPs where possible. 3 possible 4 Major 12 1) on-going active recruitment 2) Writing to all named GPs to seek an interested candidate 3) Written to neighbouring counties to seek suitable candidates. 4) Proposal agreed to recruit a psychiatrist into the role. Proposal being worked up. 1 Rare 1 neglligibl e 1 Naomi Black Disgnated Nurse Looked after Children Emma Holden Safeguar ding Feb-16 Oct ) Proposal paper written and out for comment / consultation. There are indviduals intersted in this position. CR44 Vanguard programme Lack of workforce plan There is no workforce strategy in place for the transformational change work 4 Major 4 Likely 16 Working with the New Care Model team at NHS England and Health Education England Wessex to kick start the planning process - The first session with the Out of Hospital Group on 1/12/16 has taken place. The PMO has met with the Workforce Lead and a plan to create a workforce plan and strategy is in place.the links to the STP are also being followed through to remove duplication. 4 Major 3 Possible 12 1 Negligible 1 Rare 1 Beryl Hodgson Roshan Patel SRG 18-Nov Feb Proposal for specialist resource approved by the Steering group on 15/12/2016. Rescource to be procured when funding approved by the Chief Finance Officer. 01/02/17 Invitations to quote have been sent to 5 possible suppliers. Responses are due by 6th February. Selection process will take place and contractor will be appointed to commence in March. Page 13 of 13 Overall Page 23 of 109

24 Minutes of the NHS North East Hampshire and Farnham Clinical Commissioning Group Governing Body Part II meeting held in public on Wednesday 23 November 2017 between 2pm and 5pm at The Holiday Inn, Farnborough. Present: In attendance: Apologies for Absence: Kathy Atkinson, Lay Member with Patient and Public Involvement Portfolio Dr Sallie Bacon, Director of Public Health for Hampshire County Council Dr Peter Bibawy, Medical Director and Clinical Director for Urgent Care, GP, Southlea Practice Elaine Budd, Lay Member Dr Steven Clarke, Clinical Director for Primary Care and Planned Care, GP, Branksomewood Healthcare Centre Peter Cruttenden, Chair of Audit & Risk Committee and Lay Member with Governance Portfolio and Vice Chair Dr Jane Dempster, Clinical Director for Community Care, Integration & Safeguarding, GP, Farnham Dene Medical Centre Alison Edgington, Interim Director of Delivery Mark Hammond, Lay Member Emma Holden, Director of Quality and Nursing Claire Hook, Area Director for North East Hampshire Adults Services, Hampshire County Council Maggie MacIsaac, Chief Officer Dr Ed Palfrey, Secondary Care Consultant Roshan Patel, Chief Finance Officer Dr Edward Wernick, Clinical Director for Acute Transformation and Performance Mary-Jane Steijger, Governance Manager (minutes) Nicky Sergeant, Area Director North East Hampshire, Southern Health NHS Foundation Trust Joe Croombs, Clinical Lead for Quality in Care Homes and Quality Programme Manager Care Home Managers Sarah Parkin, Sarah Carroll, Dafinka Aleksandrova, Ross Griffiths and Sunita Lol-Solanki Ros Hartley, Director of Strategy and Partnerships Dr Olive Fairbairn, Clinical Director for Mental Health, Maternity & Children, GP, Alexander House Practice Dr Andy Whitfield, Clinical Lead, and Chair, GP, Southwood Practice Jean Boddy, Area Director North and East Hampshire, Surrey County Council 1 Welcome and Introductions Peter Cruttenden welcomed everyone to the meeting. 2 Register and Declarations of Interests The following changes to the Register of Interests were noted: Kathy Atkinson stated that she had taken on a new role as Chief Executive of the Safer Tourism Foundation. Sallie Bacon stated that her entry was not included in the current version of the Register. Page 1 of 7 Overall Page 24 of 109

25 Dr Jane Dempster stated that she was also a shareholder of Farnham Integrated Care Services. The Governing Body noted the paper. No other conflicts of interest were declared. 3 Governing Body Assurance Framework The Governing Body reviewed the Governing Body Assurance Framework and considered the recommendation that CR07 lack of robust systems and processes in respect of Business Continuity and Emergency / Operational Planning should be deescalated or closed following the approval of the Business Continuity Plan at its meeting on 28 September Following discussion, it was agreed that risk CR07 should be updated rather than closed. The risk would be updated as follows: The resilience of the systems and processes in respect of: (1) Business Continuity and (2) Emergency /Operational Planning. The Process for testing Business Continuity Plan to be determined The Governing Body noted the paper. 4 Corporate Risk Register The Governing Body reviewed the red rated risks (those with a score of 15 and above) on the Corporate Risk Register - there were 13 red rated risks on the risk register each of which was overseen by an individual risk owner and a Governing Body Sub- Committee. The Governing Body noted that one new red rated risk had been added since the last meeting CR27 Implementation of the Primary Care Strategy and General Practice Forward View had been added by the Delegated Primary Care Commissioning Committee. The Governing Body noted the paper. 5 Care Home Programme Update Peter Cruttenden welcomed Joe Croombs, Clinical Lead for Quality in Care Homes and Quality Programme Manager for the presentation. Joe Croombs introduced Care Home Managers Sarah Parkin; Sarah Carroll; Dafinka Aleksandrova; Ross Griffiths and Sunita Lol-Solanki who would be supporting the presentation. Joe Croombs highlighted the following points: The CCG had 21 Nursing and Residential homes in total within its North East Hampshire catchment and 11 within the Farnham area with a combined total of 1378 beds. Under the new Care Quality Commission Inspection regime ratings for Care Homes within the CCG s catchment was as follows: 13 homes had been rated as requiring improvement ; 8 homes had been rated as good ; 9 had been inspected under the previous regime; and 2 newly built homes were yet to be inspected. The key aims of the Care Home Project was to proactively support the Care Homes to make quality improvements through the introduction of support visits; developing early Page 2 of 7 Overall Page 25 of 109

26 warning triggers when issues arose and providing comparative benchmarking data; aligning the work of the Quality Steering Group across Surrey and Hampshire. The Governing Body noted the future development of an interactive map showing all Care Homes within the CCG s catchment and for a document sharing site. Dr Ed Palfrey stated that the Quality Improvement Committee received updates on progress with this Care Home Project. Sallie Bacon commended the project for its innovative approach to joint working and asked to discuss this further with Joe Croombs outside the meeting. Peter Cruttenden thanked all the attendees for an informative presentation. The Governing Body noted the presentation. 6 Winter Presentation Alison Edgington introduced the presentation which updated the Governing Body on the key elements contained within the System Wide Resilience Plan for 206/17. The Governing noted progress and actions with the five national interventions set out by NHS England: (1) Streaming at the Front Door (2) NHS 111 (3) Ambulances (4) Improved Flow and (5) Discharge. Dr Peter Bibawy summarised the key elements of the Home for Christmas work stream which would take place during a five week period between 1 December 2016 and 9 January 2017 the focus of the work would be to maximise the ability of every patient to be Home for Christmas. The Governing Body noted the actions to support this work. The Governing Body noted that the Systems Resilience Group had been re-titled the A&E Delivery Board. The Governing Body noted the presentation. 7 Community Services Transfer Peter Cruttenden welcomed Nicky Sergeant to the meeting for the discussion of this item. Alison Edgington introduced the paper and summarised the main points around the intention of Southern Health Foundation Trust and Frimley Health Foundation Trust to work with all partners to integrate acute and community care services for the benefit of the local population in North East Hampshire and Farnham. This transfer of adult community services would be on an interim basis for duration of twelve months; to be reviewed at six months and evaluated at the end of that period. This twelve month pilot arrangement would allow the Primary and Acute Care System Vanguard to continue to develop its New Models of Care and consider procurement options. The Governing Body received assurances from Nicky Sergeant on the work that Southern Health and Frimley Health had focused on to achieve the safe and effective transfer of clinical services and staff which commissioners had deemed to be a commissioning priority and which had required diligent planning and delivery. Southern Health and Frimley Health had both accepted that there was more to be done on a partnership basis with other providers and GP colleagues, and welcomed the Vanguard proposition which had offered providers a unique opportunity to rethink and transform Page 3 of 7 Overall Page 26 of 109

27 clinical care pathways in favour of developing more care out of hospital. The Governing Body noted the key benefits of this proposal (as outlined in the paper) and the establishment of Interagency Forum to support acute/community/primary care integration. The Governing Body was informed that there were four remaining issues that required resolution prior to the commencement of the pilot arrangement regarding (1) finance (2) the lease of Fleet Hospital (3) data sharing and (4) agreement on the process for negotiation of the 2017/18 community contract; however, none of these issues were expected to pose a significant risk. Elaine Budd asked for confirmation that both Southern Health and Frimley Health had undertaken a full due diligence process. Roshan Patel confirmed that both organisations had undertaken due diligence on this service transfer. NHS Property Services would take over responsibility for running Fleet Hospital from Southern Health; there were no changes to Farnham Hospital and Aldershot Centre for Health since both were already managed by NHS Property Services. Dr Ed Palfrey asked Nicky Sergeant if Southern Health was confident that this service transfer was supported by the right clinical leadership. Nicky Sergeant responded that the service transfer was supported by experienced clinical leaders and it would be good opportunity for the two organisations to share best practices. Following discussion the Governing Body approved the transfer of adult community services from Southern Health to Frimley Health expected to commence from 1 January Unapproved Minutes from the meeting in public on 28 September 2016 The minutes of the meeting held on 28 September 2016 were approved without amendment as a correct record. The Governing Body approved the paper. 9 Action Tracker There was one outstanding action from the meeting on 28 September 2016: Clinical Commissioning Group 360 Stakeholder Survey Results had been deferred from the meeting on 23 November It was agreed that this action should be updated as follows: Feedback on the key themes of the stakeholder survey which had been incorporated into the action plan along with updates on 16/17 stakeholder survey to be presented at a future meeting - date to be confirmed. The Governing Body noted the paper. 10 Hampshire and Isle of Wight & Frimley Sustainability and Transformation Plans Emma Holden presented the paper on behalf of Ros Hartley who had offered her apologies for the meeting. The Governing Body was updated on progress with the development of the Page 4 of 7 Overall Page 27 of 109

28 Sustainability and Transformation Plans (STPs) for the North East Hampshire and Farnham CCG. Nationally 44 Sustainability and Transformation Plan footprints were being developed to deliver the NHS Five Year Forward View vision of better health, better patient care and improved NHS efficiency, setting out how this would be achieved locally. The North East Hampshire and Farnham CCG had opted to become part of two Sustainability and Transformation Plan footprints because of its overlapping boundaries across Hampshire and Surrey, namely within: (1) Hampshire and Isle of Wight and (2) Frimley. The Sustainability and Transformation Plans would require the CCG to work on a wider geographical footprint for strategic planning and operational delivery in relevant services such as urgent and emergency care (particularly major trauma). The Governing Body noted the five priorities and investments in services which had been identified for the Frimley Sustainability and Transformation Plan and the six priorities identified for Hampshire and Isle of Wight together with a summary of the investments in future services. Local ambitions were that patients lead healthier lives by promoting wellbeing in addition to treating illness and supporting people to take responsibility for their own health; citizens should have the access to high quality consistent care (on a 24 hour 7 day a week basis) as close as home as possible. It was noted that draft Sustainability and Transformation Plans for Frimley and Hampshire and Isle of Wight were due to be submitted to NHS England for approval prior to publication. The Governing Body acknowledged that one of the ongoing challenges remained the need to summarise Sustainability and Transformation Plan priorities into terms which were readily accessible to patients and it was anticipated that the planned engagement work with patients and carers would help to address this issue. The Governing Body noted progress with the Sustainability and Transformation Plans. 11 Integrated Performance Report Roshan Patel introduced the Integrated Performance Report with Performance data for August and Finance data for September 2016 and highlighted the following issues: The CCG had failed the referral to treatment standard for both July and August Frimley Health NHS Foundation Trust had failed the Referral to Treatment standard for August Frimley Health had set up additional lists in September and so the Referral to Treatment standard had been met. The Trust was seeking reimbursement for the costs at a marginal rate. Continuing Health Care costs continued to pose a key financial risk for the CCG and a number of work programmes were in place to understand and mitigate the issues. Total overspend at Month 6 was 740k. The CCG reported a surplus of 1,975k at the end of September 2016 which was in line with the financial plan. Ambulance response times continued to fail to meet the required NHS Constitutional requirements. The number of GP referrals into Frimley Health was showing an increase and work was being undertaken to validate referral data to further understand the position and Page 5 of 7 Overall Page 28 of 109

29 agree actions. The Clinical Executive Committee continued to scrutinise the increases in GP referrals to further understand the underlying causes and to help develop an action plan. The Local A&E Delivery Board (comprised of executive members from provider and commissioner organisations) was working to improve urgent care constitutional targets. The Urgent Care Board was meeting on fortnightly basis and now included senior managers from Frimley Park and representatives from partner organisations on A&E recovery. The Governing Body noted the Quality, Operational Delivery, Finance and Workforce sections of the report. 12 Quality Report Emma Holden informed the Governing Body of the key highlights regarding quality for the period October 2016 which had been highlighted through the Quality Improvement Committee and the Clinical Quality Review Meetings for all providers of care: Safeguarding The Quality Leads for Hampshire and Surrey CCG networks continued to work together collaboratively to ensure safeguarding arrangements for children and adults. Transforming Care arrangement regarding adults with a learning disability who were placed out of area continued to be monitored. The Safeguarding Committee met on 12 October 2016; the committee provides monthly reports to the Quality Improvement Committee. Infection and Prevention Two cases of Methicillin-Resistant Staphylococcus Aureus (MRSA) bacteraemia had been assigned to the CCG following investigation NHS England agreed that one of these cases should be re-assigned to a third party. Frimley Park Hospital had reported two cases of Clostridium Difficile (C-Diff) cases in September The investigative panel had concluded that there had been a lapse in care due to the incorrect antibiotics being given against Trust Policy. The CCG had agreed with this decision. Serious Incidents In October 2016 five serious incidents had been reported which involved North East Hampshire and Farnham CCG patients. Complaints The Clinical Commissioning Group had a total of 5 open complaints. The Friends and Family Test The Governing Body noted the results of the published Friends and Family Test data for its 23 member practices from August Practices that had submitted fewer than 5 responses were recorded as not applicable due to the limited sample size. Work was ongoing with all member practices to increase Friends and Family Test responses. Page 6 of 7 Overall Page 29 of 109

30 Acute Services The CCG continued to work closely with Guildford and Waverley CCG on progress against the remedial action plan for Royal Surrey County Hospital. Over-performance at Frimley Health remained an ongoing issue and A&E 4 wait times and referral to treatment were being closely monitored by the Quality Team. South East Coast Ambulance Foundation Trust Service NHS Improvement had confirmed that South East Coast Ambulance Foundation Trust had been placed under Quality Special Measures. NHS Improvement and NHS England were agreeing a remedial action plan with the provider a Single Oversight Group had been established to maintain oversight and scrutiny on progress with achievement of the remedial action plans. The Governing Body noted the report. 13 Papers to note not for discussion Governing Body Sub-Committee Reports The Governing Body noted the reports from the Governing Body Sub- Committees. 14 Questions received from the Public in advance of the meeting There had been one question submitted by Sue Hathaway, Development Officer at Rushmoor Voluntary Services on behalf of a resident which related to a local GP making a charge of 30 to sign a photograph for a passport the person in question was disabled and is on benefits. What is the CCG s policy in relation to GP making these charges. The view of the CCG was as follows: Counter signing passport photographs is at individual GP discretion should they wish to offer this service to patients and is not included in the national agreement for the provision of services from General Practice. By doing so, the GP and patient enter into a private arrangement which neither NHS England nor the CCG has any involvement in. However the CCG recognises that some patients may experience difficulties using this service. The Passport Office Advice line lists all professional bodies who can provide this service. For more information call The meeting closed at 5pm Page 7 of 7 Overall Page 30 of 109

31 Action Tracker from: Governing Body meeting held in Public on 23 November 2016 v 1 Feb 2017 Minute Reference 23 November 2016 Agenda Topic Summary of Action Required Responsibility for Action Due Date and Status 11 Integrated Performance Report As part of a regular reporting cycle the Governing Body Clinical Directors would provide high level feedback from the two monthly GP Training Sessions or TARGET Days to further improve the two way flow of information between the Governing Body and Member Practices. Governing Body Clinical Directors Added to the public agenda. Page 1 of 1 Overall Page 31 of 109

32 GOVERNING BODY Title of Paper 2016/17 Objectives Agenda Item 6 Date of meeting 8 th February 2017 Exec Lead Ros Hartley, Director of Strategy and Partnerships Clinical Sponsor Andy Whitfield, Clinical Chair Author Ros Hartley, Director of Strategy and Partnerships Purpose To Approve To Ratify To Discuss Strategic Objective Number To Note X All Risk See challenges below Unique Risk ID Executive Summary The following paper provides an update on our Q3 achievements against our strategic objectives. In summary our key achievements for 16/17 are: The CCG is integral to both Hampshire Isle of Wight and Frimley Sustainability & Transformation Plans and are leading on specific workstreams in each footprint The North East Hampshire and Farnham Accountable Care System Shadow Board is in operation reviewing system performance, delivery of the Vanguard programme, resource and service planning for 2017/18. The Board also successfully led contracting for 2017/18 Financial plans for 2017/18 and 2018/19 submitted on 23 rd December 2016 which achieves all Business Rules, although the level of risk within the plan is far higher than previous years Many key constitutional targets achieved Additional investment in Mental Health Services to deliver Parity of Esteem. Focused work on children and young people with mental health, with additional investments in the enhanced Eating Disorder service The CCG has been successful as part of the Hampshire bid for funding from NHS England to support the development of a specialist perinatal service in the CCG area. This service is being provided by Southern Health and is due to be operational by April 2017 On track to deliver the CCG s planned surplus, including the successful migration of Delegated Primary Care Commissioning Invested in both organisational and system development, with our clinical and non- clinical staff, member practices, partners and local people to achieve sustainable effective services Version 20 Sept 2016 Page 1 of 16 Overall Page 32 of 109

33 The challenges and areas of focus for the remainder of the year include: Achievement of constitutional and financial targets Ensuring sustainable workforce to deliver objectives Continued focus on outcomes delivered by New Care Models Collaborative working to ensure sustainability, and delivery of effective services Our continued delivery of Vanguard programmes of work aligning them to the new Sustainability and Transformation Plans Recommendations The Governing Body is asked to note our progress to date. Publication Public Website x Staff Website (intranet) x Please provide details on the impact of following aspects Equality and Quality Impact Assessment Patient and Stakeholder Engagement Financial Impact and Legal implications Governance and Reporting- which other meeting has this paper been discussed Committee Name Date discussed Outcome Version 20 Sept 2016 Page 2 of 16 Overall Page 33 of 109

34 CCG Objectives for 2016/17 Q3 Progress Priority Actions 2016/17 a) Implement a system wide quality improvement programme with clear and measureable outcomes. Q3 PROGRESS The Quality Team have identified 15 key work streams as part of its system-wide quality improvement programme, all progressing to plan. A: Improved Services, Outcomes and Care Quality for our Population b) Build upon existing approaches and frameworks to measure, improve and publish information on quality in local health and social care. c) Continue to embed robust systems and processes that safeguard vulnerable people in the local population. d) Agree and deliver a system wide programme of action to address clinical variation in order to improve the quality and cost effectiveness of service delivery. e) Enhance prevention and self-care by implementing the Recovery College; expanding Making Connections; improving how we respond to the needs of carers; and falls prevention. The Hampshire 17/18 Quality Contract schedules were all completed on time in partnership with the Hampshire 5 CCGs. Quality dashboard continues to be developed. The first draft of the new dashboard was piloted in November and December A project lead has been identified for review of the current management process for NICE guidance publications. Implementation of CCG Safeguarding topic of the month commenced in November First topic was Forced Marriage. Mitigating actions for Looked After Children s Designated Doctor agreed; Position remains vacant during Q3. All CCGs have signed up to the Initial Health Assessment service for looked after children becoming a locally commissioned service. Work around the management of expected rise in the number of Unaccompanied Asylum seekers has begun. Ongoing delivery of the Practice Support programme. Contract for the Making Connections (social prescribing) is in place. Recovery College programme is in place (38 courses with attendances), Coproduction with carers underway. The falls project, Walk and Live Confidently (WALC), is now established. Page 1 of 14 Page 3 of 16 Overall Page 34 of 109

35 A: Improved Services, Outcomes and Care Quality for our Population (cont/d ) Priority Actions 2016/17 f) Agree and begin implementation of the primary care strategy to increase the sustainability of, and extend access to general practice to 8am-8pm, in all localities by March g) Further develop existing Integrated Care Teams (ICTs), fully implementing the ICT model in all localities by March h) Ensure we have a single service for people with more complex needs who require specialist support to avoid a crisis, to come home from hospital or to decide what is next for them following treatment, which joins up existing services, and identifies a clear plan for Continuing Health Care. i) Bring together out-of-hours primary care and 111 services into a single offering integrated with other urgent care services. j) Implement the plan to deliver the NHS Seven Day Services Clinical Standards for the local population. k) Improve planned care services, implementing the Orthopaedics Extended Scope Pathway (ESP) Pathway; increasing the proportion of non-surgical interventions for people with chronic pain, and transferring ophthalmology services into the community where it is appropriate to do so. l) Proactively manage operational performance to ensure constitutional standards are delivered throughout the year, including leadership of the Frimley System Resilience Group. Q3 PROGRESS Primary Care Strategy agreed and approved (September 2016) and Primary Care Programme Board established from December General Practice Forward View submission submitted to NHS England December A project plan to commission extended access is currently under development. A mobilisation plan and clinical model is due to be agreed in Q4 for implementation between April and September A Primary Care Programme Board has been set up to replace the Primary Care Priorities Group. It will also monitor the success of the Vanguard funded locality plans. Of the 5 localities, 3 have plans in place approved by the Vanguard Steering Group. Integrated Care Teams in place. Outcomes for each locality being monitored. A Delayed Transfer of Care Group continues Continuing Health Care backlog initiative commenced in December The project group has designed a clinical advice and treatment service in collaboration with Surrey Heath CCG and a procurement board is meeting fortnightly to manage a competitive tender process. Action to systematically review local services against the Seven Day Clinical Standards is yet to commence, however ensuring appropriate 7 day services is a primary feature of system resilience planning for winter and beyond. All actions against this objective have been completed. Significant improvement in performance against the 95% A&E standard since September. Plans are in place for winter and there is a high level of partner confidence in those plans. A successful recruitment campaign has resulted in the appointment of an Associate Director for Integrated and Urgent Care and System Resilience, who started January Page 2 of 14 Page 4 of 16 Overall Page 35 of 109

36 Priority Actions 2016/17 a) Put in place a clinical leadership programme through which clinicians across the whole system come together to provide leadership and direction to the delivery and transformation of health and care services for the North East Hampshire and Farnham population. b) Lead the development and introduction of an accountable care system by April 2017 in which a single leadership team comprising providers and commissioners takes responsibility for the outcomes, operational and financial performance of local health and social care services. c) Develop and agree a procurement strategy that supports the system to deliver the new care models. Q3 PROGRESS The Clinical Leadership Programme will be a local programme for Clinical, Locality and ICT Leads. The programme will reflect the 2020 Leadership Programme to spread learning and development across the CCG. It will consist of 6 evening meeting modules and will give a more formalised and structured learning set to all Leads. The first cohort will commence on 19 th January The Accountable Care Shadow Board is reviewing system performance, delivery of the Vanguard programme, resource and service planning for 2017/18. The Board also successfully led contracting for 2017/18 during Q3. The CCG has a procurement strategy in place. B: System Reform d) Improve the way we commission services: develop a system wide quality framework that improves outcomes for local people, and a new Quality Assurance Framework for new care models introducing longer term outcome based contractual arrangements with providers, and creating a single population budget with Hampshire County Council and Surrey County Council for our population The CCG is actively involved in progressing the Quality agenda within both HIOW and Frimley Sustainability & Transformation Plans (STP). Wessex Regional Non-Executive STP conference planned to include Quality section Leading on Wessex Discharge and Flow work stream from quality perspective. STP Quality impact tool developed in partnership with STP quality leads. The Accountable Care Steering Board has approved a new way of agreeing contracts. e) Develop and agree a plan to extend our collaboration with other CCGs where this offers greater benefits for patients and better value for money. f) Agree Sustainability and Transformation Plans for the Hampshire & Isle of Wight and the Frimley systems by June 2016 and begin implementation. g) Deliver the priority IT deliverables: all GP practices on single system, increase the use and scope of the Hampshire Health Record, expand the use of e-referrals and e-prescribing. The CCG operates in several collaboratives across different systems. These have been maintained or strengthened over Q3. Closer collaboration with Hampshire CCGs is being explored. The CCG is integral to both STPs and has led on specific workstreams in each footprint. The plans have been approved by NHS England Digital projects continue to be rolled out. Page 3 of 14 Page 5 of 16 Overall Page 36 of 109

37 Priority Actions 2016/17 Q3 PROGRESS B: System Reform (cont/d) h) Deliver the priority estate deliverables: ensuring that Integrated Care Teams have the appropriate premises to fully operate, maximising the use of Aldershot Centre for Health and Farnham community hospital, and assessing the estate impact of the community bed consultation. Building work has been delayed at Farnham due to issues between the contractor and builder. Building work is set to commence in January and service commencement to be in March a) Deliver meaningful citizen engagement in the new care model programme: completing a consultation on the primary care strategy (by Oct 16) & on community bed provision (by Mar 17). The Primary care programme is now moving to developing the locality models. A public questionnaire was designed with over 500 responses and is being used to identify key issues we need to explore locally. C: Engagement & Partnerships a) Embed new ways of working which place collaboration with patients and the community at the heart of how we work: investing in collaborative leadership, developing a sustainable Community Ambassadors Programme, fully introducing the Patient Involvement Assessment Framework and ensuring we have sufficient skills and capacity to support co-production. Governing Body received a paper in November 2016 to reconsider the options for consultations on the programme and a formal letter has been sent out to all those who have engaged with us to date. The community ambassador programme continues. The CCG has launched the Innovation Conference a conference developed by an idea from one of our community ambassadors, with an aim to bring local people and voluntary sector colleagues to come together to identify how they could improve health and wellbeing in our local community. Our Empowering Engagement leadership programme continues. The CCG are developing a case study on our Community Ambassador programme with the National team for wider sharing. A significant piece of work has also been the development of a prevention My Health Matters section on our website, led by a clinical lead in the CCG. Page 4 of 14 Page 6 of 16 Overall Page 37 of 109

38 Priority Actions 2016/17 Q3 PROGRESS C: Engagement & Partnerships (cont/d ) b) Deliver a thriving programme of member practice engagement. c) Through the children and maternity services collaborative agree and begin implementation of a new model of children s integrated care teams across Hampshire agree a sustainable community paediatric service across the CCG d) Agree a revised model for commissioning mental health and learning disability services for our local population, by Sept 16. e) Ensure parity of esteem for Mental Health and Learning Disabilities is further developed including support to primary care and integrated care teams. Strong member practice engagement continues. The Children s Vanguard programme (Doing it Differently) continues to be developed. The new Community Paediatric service has been tendered and the new service will commence 1st April Mental Health/Learning Disabilities collaborative separated in December 2016 with new Governance arrangements now in place. Good progress has been made on the Mental Health Constitutional targets with all targets achieved. Dementia target has been met and exceeded for Q3. a) Deliver the CCG financial plan. CCG on track to deliver financial plan. D: Financial Sustainability b) Proactively manage contracts with providers and ensure that the CCG has the ability to deliver its activity and financial plan, resulting in hospital utilisation levels (admissions, A&E activity and bed days) being maintained at or below 2015/16 outturn levels. c) Deliver the agreed Quality, Innovation, Productivity and Prevention (QIPP) schemes for 2016/17. d) Develop and agree, by September 2016, a balanced financial plan for 2017/18. Contracts being proactively managed however activity is above 2015/16 levels. This is being addresses through a number of working groups such as the RTT Task and Finish Group, A&E Delivery Board. Also working within the Frimley STP to focus on the delivery of the 2017/18 QIPP plans. QIPP schemes showing 98% achievement YTD (Month 09), although this is nonrecurrently supported by the Cap & Collar contract arrangement with Frimley Health. Financial plans for 2017/18 and 2018/19 submitted on 23 rd December 2016 which achieves all Business Rules, although the level of risk within the plan is far higher than previous years Page 5 of 14 Page 7 of 16 Overall Page 38 of 109

39 Priority Actions 2016/17 Q3 PROGRESS a) Deliver the CCG Organisational Development programme Leadership cohorts for bands 7 and up and bands 3 6 continue. The organisational development plan has been developed and will go to the Remuneration and Numeration Committee for ratification and sign-off in February The Health and Wellbeing programme is in place and further discussions around future activities will take place at the Staff Partnership Forum in January. E: CCG People and Organisation b) Ensure clinical leadership roles are agreed and that these roles are deployed for maximum benefit in the system. c) Deliver our multi-professional workforce development programme. Staff voted on the options for the CCG s values in December. This will now be further discussed at the Staff Partnership Forum in January. Plans have been developed and will be implemented from January 2017 to adjust the support and programme of meetings for Clinical Leads to reflect the changing nature of the work. The evening meetings will be changed to a Clinical Leadership Programme with a wider membership and a structured programme to reflect the 2020 Programme and ensure appropriate professional development of the Clinical Leads. The day meetings will be changed into a Clinical Delivery Group that is focused on delivery against agreed objectives and targets. Linking with Wessex Practice Nursing Forum and reviewing tools/projects with regards to local implementation. Wessex Community Education Provider Network now established and linking with the CCG. d) Ensure effective internal and external communications. Primary care to be involved in pilot of Nursing Associate role. Regular internal staff briefings continue. We held a successful annual away day in October 2016 with over 60 staff attending with very positive feedback. Page 6 of 14 Page 8 of 16 Overall Page 39 of 109

40 Priority Actions 2016/17 Q3 PROGRESS E: CCG People and Organisation e) Improve our risk management processes and ensure they are driving CCG priorities and activity. f) Ensure key indicators and reporting processes are in place that enables monitoring of performance across all objectives. g) Improve the management of conflicts of interest. The CCG risk management process is in place and drives priorities of the CCGs and its committees. Performance Team monitor all key indicators. A comprehensive integrated performance report is submitted to the Finance and Performance Team every month. The revised conflicts of interest policy approved by Governing Body in September has now been circulated. Page 7 of 14 Page 9 of 16 Overall Page 40 of 109

41 Priority Actions in relation to Children s & Maternity, and Mental Health & Learning Disability Collaborative Commissioning As described in objective 9 above, the CCG is also responsible for commissioning children s and maternity services on behalf of Hampshire CCGs and mental health and learning disabilities services on behalf of Surrey CCGs. The table below summarises the priority actions in relation to these two Collaborative Commissioning Functions. Priority Actions 2016/17 Q3 PROGRESS Children s and Maternity Collaborative a) Respond to the recommendations of the National Maternity Review Better Births, ensuring all antenatal and postnatal maternity pathways deliver timely access to services, support choice and personalised packages of care; and ensuring appropriate healthy infant feeding practices are applied consistently across the county. b) Design locally based models of integrated paediatric care across the community and acute providers. c) Working in partnership, commission responsive and flexible mental health, learning disability and autism services that are supported by early intervention services and deliver the priorities of the Future in Mind plans. d) Continue to implement the requirements of the Children & Families Act ensuring families have access to a single Education, Health & Care Plans; timely and relevant information promoted through the Local Offer; development of personal budgets and ensure the process is supported by designated medical officers within the Acute Trusts. e) Continue to implement Transitions protocols and implementation of the Preparing for Adulthood strategy. The Better Births Pioneer continues to implement its vision. A Children s Vanguard programme (Doing it Differently) with Hampshire County Council continues to be developed. Additional funding of 708k was incorporated into the CAMHs contract to enhance the Eating Disorder service delivering the National specification. The service was successful in bidding for additional funding to support looked after children through personal health budgets. A Transition protocol has been developed. f) Develop a strategy, in partnership with Public Health, to reduce obesity levels in children. Partnership working with Public Health continues to develop an obesity strategy. Page 8 of 14 Page 10 of 16 Overall Page 41 of 109

42 Priority Actions 2016/17 a) Discharge our responsibilities as lead commissioner for the Surrey and North East Hampshire Integrated Commissioning Strategy for Emotional Wellbeing and Adult Mental Health. Q3 PROGRESS Two separate collaboratives have now been established, Heartlands and East Surrey and Blackwater Mental Health Alliance (North East Hampshire and Farnham CCG and Surrey Heath CCG). Mental Health and Learning Disabilities Collaborative b) Deliver the Mental Health Crisis Care concordat plan with the roll out across the collaborative of Crisis Cafes, development of urgent integrated/single point of access and completion of the adult mental health bed review. c) Complete the review of Surrey and Borders Partnership NHS Foundation Trust Learning Disability inpatient and community services and initiate the service redesign that aims to prevent inappropriate admissions by providing intensive support in a crisis. d) Work with our local authority and NHS England partners and providers to develop appropriate robust co-commissioning arrangements around the delegated, Section 117, and specialist areas of mental health and learning disability. e) Develop and implement plans that will deliver against the new access requirements for mental health. f) Source the data to enable commissioners to report against the new framework for people with learning disabilities. g) Develop and procure a perinatal service. The Single Point of Access for Mental Health Crisis was due to go- live 2 nd April 2017 but this has been delayed to June The Aldershot Safe Haven had a visit from Prime Minister Theresa May which led to some very positive publicity. The review has been completed and new service specification is being implemented. A partnership Section 117 policy between the Surrey CCGs, Surrey County Council and Surrey & Boarders Partnership has been drafted, agreed and signed off by all CCGs. Audit complete. The overall position showed fully confident. Completed in Q1. The CCG has been successful as part of the Hampshire bid for funding from NHS England to support the development of a specialist perinatal service in the CCG area. This service is being provided by Southern Health and is due to be operational by April Page 9 of 14 Page 11 of 16 Overall Page 42 of 109

43 CCG Objectives for 2016/17 Objectives Priority Actions 2016/17 Leads A: Improved Services, Outcomes and Care Quality for our Population 1. Ensure local people receive high quality services that are safe, improve outcomes for people, and are delivered with kindness and compassion. Where care does not meet required standards, take action to improve the quality of these services 2. Deliver the actions within our improvement programmes to improve the quality, outcomes and performance of services. Our improvement programmes include: (1) prevention and selfcare, (2) primary care, (3) integrated community care, (4) urgent and emergency care, (5) planned care, (6) specialist care 3. Ensure that all constitutional standards are achieved for the North-East Hampshire & Farnham population. a) Implement a system wide quality improvement programme with clear and measureable outcomes b) Build upon existing approaches and frameworks to measure, improve and publish information on quality in local health and social care c) Continue to embed robust systems and processes that safeguard vulnerable people in the local population d) Agree and deliver a system wide programme of action to address clinical variation in order to improve the quality and cost effectiveness of service delivery e) Enhance prevention and self-care by implementing the Recovery College; expanding Making Connections; improving how we respond to the needs of carers; and falls prevention f) Agree and begin implementation of the primary care strategy to increase the sustainability of, and extend access to general practice to 8am-8pm, in all localities by March 2017 g) Further develop existing Integrated Care Teams (ICTs), fully implementing the ICT model in all localities by March 2017 h) Ensure we have a single service for people with more complex needs who require specialist support to avoid a crisis, to come home from hospital or to decide what is next for them following treatment, which joins up existing services, and identifies a clear plan for Continuing Health Care i) Bring together out-of-hours primary care and 111 services into a single offering integrated with other urgent care services. j) Implement the plan to deliver the NHS Seven Day Services Clinical Standards for the local population k) Improve planned care services, implementing the Orthopaedics Extended Scope Physiotherapy (ESP) Pathway; increasing the proportion of non-surgical interventions for people with chronic pain, and transferring ophthalmology services into the community where it is appropriate to do so l) Proactively manage operational performance to ensure constitutional standards are delivered throughout the year, including leadership of the Frimley System Resilience Group Page 10 of 14 Emma Holden & Ed Wernick Emma Holden & Ed Wernick Emma Holden & Jane Dempster Andy Whitfield Alison Edgington & Olive Fairbairn Alison Edgington & Steven Clarke Alison Edgington & Jane Dempster Alison Edgington & Jane Dempster Alison Edgington & Peter Bibawy Alison Edgington & Peter Bibawy Alison Edgington & Steven Clarke Alison Edgington & Peter Bibawy Page 12 of 16 Overall Page 43 of 109

44 Objectives Priority Actions 2016/17 Leads 4. Through the delivery of the New Care Models Programme and through the development and delivery of the Frimley and Hampshire & Isle of Wight Sustainability and Transformation Plans (STPs), accelerate the pace and scale of delivery of new models of care a) Put in place a clinical leadership programme through which clinicians across the whole system come together to provide leadership and direction to the delivery and transformation of health and care services for the North East Hampshire and Farnham population b) Lead the development and introduction of an accountable care system by April 2017 in which a single leadership team comprising providers and commissioners takes responsibility for the outcomes, operational and financial performance of local health and social care services Andy Whitfield, Peter Bibawy & Emma Holden Maggie MacIsaac & Andy Whitfield B: System Reform 5. Develop, agree and put in place revised contracting, payment and governance arrangements with providers to support delivery of the system strategy, and the creation of a place-based system of care. c) Develop and agree a procurement strategy that supports the system to deliver the new care models d) Improve the way we commission services: develop a system wide quality framework that improves outcomes for local people, and a new Quality Assurance Framework for new care models introducing longer term outcome based contractual arrangements with providers, and creating a single population budget with Hampshire County Council and Surrey County Council for our population e) Develop and agree a plan to extend our collaboration with other CCGs where this offers greater benefits for patients and better value for money Roshan Patel Emma Holden & Ed Wernick Roshan Patel & Alison Edgington Maggie MacIsaac f) Agree Sustainability and Transformation Plans for the Hampshire & Isle of Wight and the Frimley systems by June 2016 and begin implementation Ros Hartley & Andy Whitfield g) Deliver the priority IT deliverables: all GP practices on single system, increase the use and scope of the Hampshire Health Record, expand the use of e-referrals and e-prescribing Roshan Patel h) Deliver the priority estate deliverables: ensuring that Integrated Care Teams have the appropriate premises to fully operate, maximising the use of Aldershot Centre for Health and Farnham community hospital, and assessing the estate impact of the community bed consultation Roshan Patel Page 11 of 14 Page 13 of 16 Overall Page 44 of 109

45 C: Engagement & Partnerships D: Financial Sustainability Objectives Priority Actions 2016/17 Leads 6. Strengthen and embed robust processes to engage and codesign with the local community, ensuring that their views and experiences directly influence CCG priorities, plans and delivery 7. Further improve and embed the arrangements through which member practices operate within and contribute to the work of the CCG, in order to accelerate planned service improvements 8. Further develop and strengthen the partnerships we need to improve health and health services for our population 9. Effectively discharge our responsibilities leading the commissioning collaborative for children s and maternity services and for mental health and learning disability services a) Deliver meaningful citizen engagement in the new care model programme: completing a consultation on the primary care strategy (by Oct 16) & on community bed provision (by Mar 17) b) Embed new ways of working which place collaboration with patients and the community at the heart of how we work: investing in collaborative leadership, developing a sustainable Community Ambassadors Programme, fully introducing the Patient Involvement Assessment Framework and ensuring we have sufficient skills and capacity to support co-production c) Deliver a thriving programme of member practice engagement d) Through the children and maternity services collaborative - agree and begin implementation of a new model of children s integrated care teams across Hampshire - agree a sustainable community paediatric service across the CCG e) Agree a revised model for commissioning mental health and learning disability services for our local population, by Sept 16 f) Ensure parity of esteem for Mental Health and Learning Disabilities is further developed including support to primary care and integrated care teams Objectives Priority Actions 2016/17 Leads 10. Continue to refine and implement our five-year financial plan which ensures the sustainability of services for our population and ensures that CCG has the resources and resilience it needs to deliver its strategy 11. Deliver our annual financial plan, achieving value for money and meeting our financial obligations a) Deliver the CCG financial plan b) Proactively manage contracts with providers and ensure that the CCG has the ability to deliver activity and financial plan, resulting in hospital utilisation levels (admissions, A&E activity and bed days) being maintained at or below 2015/16 outturn levels c) Deliver the agreed Quality, Innovation, Productivity and Prevention (QIPP) schemes for 2016/17 d) Develop and agree, by September 2016, a balanced financial plan for 2017/18 Page 12 of 14 Ros Hartley Ros Hartley Lauren Pennington Ros Hartley & Olive Fairbairn Ros Hartley & Olive Fairbairn Ros Hartley Ros Hartley & Olive Fairbairn Roshan Patel Roshan Patel Roshan Patel & Alison Edgington Roshan Patel Page 14 of 16 Overall Page 45 of 109

46 Objectives Priority Actions 2016/2017 Leads E: CCG People and Organisation 12. Refresh and implement our organisational development plan, developing our people, culture and clinical leadership to enable innovation and excellence, managing within our running costs 13. Ensure that the necessary internal systems, processes, constitutional and governance arrangements are in place to enable the CCG to deliver its duties and responsibilities a) Deliver the CCG Organisational Development programme b) Ensure clinical leadership roles are agreed and that these roles are deployed for maximum benefit in the system c) Deliver our multi-professional workforce development programme d) Ensure effective internal and external communications e) Improve our risk management processes and ensure they are driving CCG priorities and activity f) Ensure key indicators and reporting processes are in place that enable monitoring of performance across all objectives g) Improve the management of conflicts of interest Maggie MacIsaac Andy Whitfield & Peter Bibawy Emma Holden Ros Hartley Roshan Patel Roshan Patel Roshan Patel Page 13 of 14 Page 15 of 16 Overall Page 46 of 109

47 Priority Actions in relation to Children s & Maternity, and Mental Health & Learning Disability Collaborative Commissioning As described in objective 9 above, the CCG is also responsible for commissioning children s and maternity services on behalf of Hampshire CCGs and mental health and learning disabilities services on behalf of Surrey CCGs. The table below summarises the priority actions in relation to these two Collaborative Commissioning Functions. Children s and Maternity Collaborative Working in partnership provide the best possible start in life through high performing maternity and children s healthcare from pre-birth to adulthood Priority Actions 2016/17 a) Respond to the recommendations of the National Maternity Review Better Births, ensuring all antenatal and postnatal maternity pathways deliver timely access to services, support choice and personalised packages of care; and ensuring appropriate healthy infant feeding practices are applied consistently across the county b) Design locally based models of integrated paediatric care across the community and acute providers c) Working in partnership, commission responsive and flexible mental health, learning disability and autism services that are supported by early intervention services and deliver the priorities of the Future in Mind plans d) Continue to implement the requirements of the Children & Families Act ensuring families have access to a single Education, Health & Care Plans; timely and relevant information promoted through the Local Offer; development of personal budgets and ensure the process is supported by designated medical officers within the Acute Trusts e) Continue to implement Transitions protocols and implementation of the Preparing for Adulthood strategy f) Develop a strategy, in partnership with Public Health, to reduce obesity levels in children Mental Health and Learning Disability Collaborative Working in partnership to achieve parity of esteem for mental health and improve the health and wellbeing of adults with mental health or learning disabilities across the Surrey and North East Hampshire populations through high quality services that are equally accessible to all. Priority Actions 1 April 31 July 2016 a) Discharge our responsibilities as lead commissioner for the Surrey and North East Hampshire Integrated Commissioning Strategy for Emotional Wellbeing and Adult Mental Health b) Deliver the Mental Health Crisis Care concordat plan with the roll out across the collaborative of Crisis Cafes, development of urgent integrated/single point of access and completion of the adult mental health bed review c) Complete the review of Surrey and Borders Partnership NHS Foundation Trust Learning Disability inpatient and community services and initiate the service redesign that aims to prevent inappropriate admissions by providing intensive support in a crisis d) Work with our local authority and NHS England partners and providers to develop appropriate robust co-commissioning arrangements around the delegated, Section 117, and specialist areas of mental health and learning disability e) Develop and implement plans that will deliver against the new access requirements for mental health f) Source the data to enable commissioners to report against the new framework for people with learning disabilities g) Develop and procure a perinatal service Page 14 of 14 Page 16 of 16 Overall Page 47 of 109

48 GOVERNING BODY MEETING Title of Paper Final Draft Organisational Development Strategy and Action Plan Agenda Item 7 Date of meeting 8 February 2017 Exec Lead Ros Hartley Director of Strategy and Partnerships Clinical Sponsor Author Sharon Ward Interim Associate Director of Communications Angela Baxter - Business Manager Purpose To Approve x Strategic To Ratify Objective Number 12 To Discuss To Note Risk Risk: The CCG is not sustainable due to lack of required resources in place to deliver strategic change including: workforce to deliver new models of care; training and development for future workforce; organisational development programmes that challenge the status quo, communicate the change needed, shape the culture and values needed and empower staff Unique Risk ID Executive Summary This Organisational Development Strategy sets out our principles, vision and aims to develop an organisation which is fit for purpose and inclusive in its approach. This strategy is supported by an action plan detailing specific initiatives and projects. The CCG recognises the dynamic nature of organisational development and therefore see this as a living document which will be updated to reflect the changing needs of the organisation and external environment. Recommendations The Governing Body is asked to review and agree the final draft of the Organisational Development Strategy and Action Plan Publication Public Website Staff Website (intranet) Please provide details on the impact of following aspects Equality and Quality Impact Assessment Successful organisational development is a component of a high performing organisation capable of delivering on the quality agenda. No specific issues. Individual policies relating to the overall strategy are assessed for equality impact. Patient and Stakeholder Staff have been engaged in the development of the strategy. Version 20 Sept 2016 Page 1 of 21 Overall Page 48 of 109

49 Engagement Financial Impact and Legal implications Workforce capacity is a key component of delivering financial recovery. Governance and Reporting- which other meeting has this paper been discussed Committee Name Date discussed Outcome Senior Management Team 6/12/16 Members suggested this should be circulated to Clinical Directors for their review / comments and also discussed at the Staff Partnership Forum. Staff Partnership Forum 18/01/17 Ahead of the Staff Partnership Forum, members were asked to share the strategy and action plan with their respective teams. Feedback was then brought to the forum and a discussion took place positive feedback was noted. This feedback has subsequently been included within the attached document. This Committee meeting had not taken Remuneration and Nominations 01/02/17 place at the time of completing this Committee cover sheet. Version 20 Sept 2016 Page 2 of 21 Overall Page 49 of 109

50 Final draft v3 Organisational Development Strategy (Including Action Plan for ) Page 3 of 21 Overall Page 50 of 109

51 2 Contents 1. Foreword Context Local position About us Strategic vision and requirements Our objectives Organisational development to date Development Priorities 2016/ Evaluating the Organisational Development programme... 9 Appendix A - A summary of the progress against the development priorities Appendix B Action Plan for Page 4 of 21 Overall Page 51 of 109

52 3 1. Foreword NHS North East Hampshire and Farnham Clinical Commissioning Group (CCG) continually supports new and innovative ways of working with staff and partners in its constant drive for improvement and excellence. We support and encourage a forward thinking and innovative culture to deliver our vision of healthy people, living healthy lives in healthy communities. We absolutely know the only way to ensure this is to empower our staff and partners to have the right mind-set and skills to deliver this vision. We cannot do this without them. We are a bold, innovative and high-performing CCG leading the way nationally on a significant number of high profile initiatives. Our organisational development strategy is designed to ensure that our staff are part of an effective and empowered team, who understand how they are essential to the delivery of better, sustainable health care for our local population. The strategy and plan set out how we will do this. We recognise the challenges we face as an organisation and a system, but we believe we have the workforce in place to achieve our goals. This strategy sets out how we will empower, equip and engage our staff to succeed over the next five years. We provide a stimulating atmosphere that allows staff to deliver personal and organisational objectives and achieve career goals. We support professional development, enabling staff to make a meaningful contribution to the team and, by extension, the health of people living in North East Hampshire and Farnham. The CCG has an excellent track record of working with staff and recognises the value of listening to, and working with staff. We work in partnership with staff. We continually learn about peoples experiences and seek their views and input. This helps us work together, ultimately acting as a good employer, with strong, supported teams who share organisational goals and learning, to shape the delivery of high quality care for all. We pride ourselves on offering good working conditions, job security, lifelong learning, fair pay and benefits, staff involvement and a balance between work and personal life. As the CCG has evolved and developed so has our organisational development work and plan. The time is now right to revisit and refresh this in light of local and national changes and developments. We have invested significant time and resources to ensure our organisation and staff are fit for purpose and able to deliver. We are now working with partners and local people to shift this to the wider system. We have a strong collaborative culture with our health and social care partners, and using this as a basis, will ensure that the system as a whole is fit for purpose to deliver against the challenges and opportunities we now face. Maggie MacIsaac Chief Officer Dr Andy Whitfield Clinical Chair Page 5 of 21 Overall Page 52 of 109

53 4 2. Context Organisational development is a systematic approach to improving organisational effectiveness one that aligns an organisation s resources, financial and human, behind its priorities. This Organisational Development Strategy is a live document that will be regularly reviewed and refreshed to ensure that it meets the needs of staff, the organisation and ultimately the population we serve. The articulation and communication of this strategy throughout the organisation is important to its successful implementation. From the inception of the CCG in April 2013, we have recognised the importance of organisational development. Initially our focus was on developing the vision and values for the organisation and ensuring systems and processes were in place and working effectively to ensure that we could meet our statutory responsibilities. This process included ensuring a focus on quality, governance, and staff and public engagement, which continue to be the golden thread running through all the structures of the CCG starting at the top with the Governing Body. During 2015/16 we focussed much more on sustainability and investment in leadership development to ensure that our leaders and staff had the skills and capability to deliver in an increasingly challenged financial environment. Moving into 2016/17 the CCG recognises the need to focus on effective system leadership and collaboration with our partners and local people in order to support the delivery of both the CCG and wider system priorities as outlined in our Operational Plan and broader system wide objectives identified through our Happy, Healthy at Home programme and the Sustainability Transformation Plan. The NHS Five Year Forward View sets out the strategic direction for the NHS. Moving forward, we need to build a work force with the capabilities to work in partnership with other stakeholders to develop and implement Sustainability and Transformation Plans. These plans form the next stage of delivering the innovative level of change required to ensure the NHS is sustainable, effective and providing the highest quality of care in the future. North East Hampshire and Farnham CCG is a member of two footprints Hampshire and the Isle of Wight and Frimley Health and Care Sustainability Transformation Plans. In addition, the providers and commissioners in NHS North East Hampshire and Farnham CCG have committed, through the Happy, Healthy, at Home programme to design and put in place new arrangements through which organisations work together to deliver a new accountable care system. In light of the increased focus on systems transformation, through co-design and partnership collaboration, it is important to refresh our organisational development strategy and plan to ensure it supports both the delivery of the CCG s objectives and the successful implementation of the wider system aims. In addition, we need to ensure staff have the capacity and capability to continue to deliver today whilst working on the transformation of services and that they have the resilience to lead through the change and uncertainty that this brings. Page 6 of 21 Overall Page 53 of 109

54 5 This revised strategy and action plan builds on the existing strategy and culture of continuous selfexamination and learning but goes further to set out how the organisation, its people and teams will deliver the changes required for the local population we serve. 3. Local position 3.1 About us NHS North East Hampshire and Farnham Clinical Commissioning Group is a membership organisation comprised of 23 Member Practices and is responsible for commissioning a range of health services on behalf of the local population. The CCG covers a relatively small and predominantly urban geography across the two main districts in North East Hampshire (Rushmoor and Hart) and the Farnham locality in Surrey. Covering a population of c220, 000 and investing c 290m annually in local health services, we are committed to enabling patients and primary care clinicians to have a greater say in how health services are delivered locally. We work collaboratively with Surrey Heath and Bracknell & Ascot CCGs and collectively as commissioners we manage the complex Frimley system, which works across a number of NHS and local authority boundaries, with Frimley Health NHS Foundation Trust as the common acute provider. We also work collaboratively with partners across Hampshire and the wider Hampshire and Isle of Wight Sustainability and Transformation Plan. We operate within a Foundation Trust Provider landscape, with providers having good reputations for the quality of services and performance measures on the whole being achieved and we are a high performing CCG against a range of local and national outcome measures including the NHS Constitution. The CCG operates within a multi-stakeholder environment, where delivering successful outcomes is often reliant upon changes in other environments. This can be felt within aspects of organisational development and it is therefore important to clarify the scope in relation to this document. This document refers to the following stakeholders when proposing organisational development interventions: CCG Governing body CCG Executive Patient representatives (including carers and the general public) CCG officers and staff CCG Member Practices Page 7 of 21 Overall Page 54 of 109

55 6 3.2 Strategic vision and requirements To ensure that we can retain the knowledge and skills we already have, whilst continuing to attract high calibre effective people with succession potential, the CCG must continue to develop and maintain a strategy aimed at all levels of the organisation, for all roles. We want to continue to build the organisational values and behaviours required of a high performing, learning organisation, with a successful and effective ability to grow its talent. The leaders within the CCG are committed to embedding this strategy with an aim to bring about the behavioural change needed to nurture a culture which recognises and rewards outstanding performance at all levels. Following an extensive staff engagement process the CCG refreshed its vision and mission in 2015 to more accurately reflect the CCG s aims, to encourage collective buy in and ownership within the organisation and to highlight our focus on collaboration across the system. As a result the following vision and mission were adopted: Mission: statement: To ensure the right care, at the right time, in the right place for local people Vision: The best possible health and wellbeing for the people of North East Hampshire and Farnham Values and Behaviours for our staff North East Hampshire and Farnham Clinical Commissioning Group We recognise that to be a successful CCG we have to continue to ensure that all objectives and priorities are aligned and have a clear and single set of values that define how things are done and how we behave. One of our priorities for the year ahead is to revise our values, aligning them to the new challenges ahead for our workforce, by working with them to establish what they should look like now and what are the behaviours supporting them. From this we can identify how we can measure both the effectiveness and impact. Page 8 of 21 Overall Page 55 of 109

56 7 3.3 Our objectives NHS North East Hampshire and Farnham Clinical Commissioning Group (CCG) is a high performing organisation, focussed on working collaboratively with system partners and our communities to meet the needs of our population. This strategy outlines the steps we need to take to create an environment that allows staff to understand, embody and deliver the organisation s objectives and support the development and implementation of the wider planning required in the NHS for the future. Organisational development involves both more easily measured deliverables issues such as strategy, policies, structures and systems, and those less tangible such as developing appropriate skills, behaviours, attitudes, culture and a style of leadership that enable organisations to deliver optimum performance. Established on 1st April 2013, we have been on a three-year journey as a statutory body. Moving forward we want to develop our organisational development even further through evolving the culture and style of our organisation. Our organisational development objectives for this strategy are: Our vision and strategy Our relationship with partners and stakeholders Our structures and support arrangements Strengthening the organisation s commitment to its values, behaviours and relationships within and across the CCG. We will continue to optimise clinical and managerial partnerships, redefine working relationships with primary care and refresh our organisational vision. The work with clinical leads is an excellent example of the CCG investing resources in supporting and developing clinicians, current and future, to deliver against a challenging backdrop. Provide consistent and timely communication, delivering a programme of engagement with our stakeholders, patients, carers and general public. The CCG recognises that it must focus on improving its ability to respond to the needs of staff, members and stakeholders and develop its partnership working further to support the on-going development of our Happy, Healthy at Home programme and STPs. As a relatively small organisation, the CCG benefits from being agile and responsive to change. It also recognises that this same strength can be a challenge in relation to business continuity and resilience. We will continue to review our structures in line with our key objectives to ensure it is consistent and fit for purpose Page 9 of 21 Overall Page 56 of 109

57 8 Developing our workforce, clinical and non-clinical Valuing our workforce Leadership development and succession planning At every level of the organisation through knowledge, skill, insight and ideas will build organisational strength. Resilience and personal effectiveness was highlighted as an area for further development. We will continue to invest in staff and to help develop them in their career. The engagement from clinicians has improved and projects such as the TARGET GP engagement events and the prevention programme are showing tangible results. The CCG recognises that the welfare and wellbeing of its staff is critical to the continued success of the organisation. Ensuring staff feel supported and cared for is key to the CCG being a place where people want to work. An annual calendar of wellbeing activities has been developed to ensure staff are properly supported. To continue to invest in developing a strong, consistent and inspiring senior leadership team and developing leaders across the wider organisation with talent management and succession planning. 4. Organisational development to date The CCG has a credible track record of investing in development and continues to make progress on its development journey. A significant amount of progress has been made against the priorities identified in the organisational development plan particularly in relation to the development of leaders and staff across the CCG, through a bespoke in-house eight-month Leadership Development Programme and a supporting team member programme, the Enabling Success Programme. A Clinical Leadership Programme was launched in January 2016 and Clinical Leads have developed considerably during this period and are continuing to deliver on a variety of projects and schemes. These include the development of learning disability care, improved health education and advice using social media. The CCG Governing Body is key to modelling excellent behaviour in this aspect. From the outset we established a system of robust governance and shared ownership where each Governing Body member, both Lay and Clinical, has specific areas of responsibility. This creates a culture of shared ownership and good corporate governance and responsibility and we have made progress to implement this through the organisation. For example, clinical leads each have responsibility for specific areas of delivery and are aligned to a named manager who works with them to help them deliver against their specific objectives. During the past 18 months the organisation has worked hard to communicate with, listen to and engage with staff and key stakeholders. Following feedback from the recent NHS Staff Survey, the CCG has created regular opportunities for protected time where staff can come together to share and discuss drivers, ways of working, ideas and challenges in order to create shared ownership and encourage leadership at all levels. Page 10 of 21 Overall Page 57 of 109

58 9 In addition, the CCG has strengthened opportunities to bring together staff to encourage face-to-face communication and knowledge transfer across the organisation. Appendix A summarises some of the key organisational development activities and interventions over the last 18 months. 5. Development Priorities 2016/21 As a system leader for the local health economy, the CCG is aware of its key role in developing a highly skilled and trained workforce delivering high quality care, now and in the future. It is doing this by ensuring links to a range of health education organisations such as NHS Health Education Wessex, Kent Surrey Sussex Education and Thames Valley and Wessex Leadership Academy. The local workforce needs to be ready to be able to deliver new care models, some of which will require change to clinical behaviours. The ability of healthcare providers to combine delivery of services and financial sustainability with a dynamic, flexible workforce is critical in delivering high quality care. The CCG working with partners will look at existing and new roles and the skills and behaviours needed to deliver on this agenda. The CCG knows that the landscape of the NHS is changing, demand is continuing to rise with greater numbers of frail and elderly patients, the birth rate is increasing, there is longer life expectancy and the health of the population increasingly determined by lifestyle choices, all of which need to be considered when developing the workforce. The CCG's aim is to build a workforce that contributes to improving health outcomes for everybody in the local community and is able to meet the challenging demands of the future. Based on the progress the CCG has made to date, combined with the reflections, feedback and learning from a range of sources, including the NHS Staff Survey, six development themes have emerged and the CCG will focus on these over the next two years as it operationalises this strategy. Appendix B outlines these actions with timescales for achievement. 6. Evaluating the Organisational Development Strategy It is always a challenge to measure the impact and success of all aspects of an organisational development strategy. Some areas we can measure, for example, we know we have run a number of programmes for staff and patients to become involved and have a say in how we do things. What is more difficult to measure is if this has an overall impact on staff engagement and satisfaction. Our organisation would not exist without the energy and commitment of every member of staff in our CCG and our local stakeholders. Team members give their ideas, support and dedication to the organisation and it is important that as an organisation we value them and their contribution in return. Not only do we want to implement the actions identified in this strategy, but we also want to continue to create an organisational culture where people look forward to coming to work. To achieve this, we want to create an organisational culture that: Provides inspiring leadership that is open and transparent. Page 11 of 21 Overall Page 58 of 109

59 10 Engenders a feeling of belonging. Empowers staff to take control of their work. Enables personal and professional development. We will continue to work with the Staff Partnership Forum and continue to model excellence from the Governing Body as they are critical in fostering the right organisational culture. We will also explore how we can learn from other evaluations, such as the work of the Vanguard and the 2020 leadership programme, to identify if there are any transferable measurable indicators we can use. Page 12 of 21 Overall Page 59 of 109

60 11 Appendix A - A summary of the progress against the development priorities Development Priority Values, behaviours and relationships Communications and engagement Progress to date Refreshed organisational vision and mission implemented with increased visibility within the organisation. (March 2016) Staff consultation ongoing throughout the year to define the values (to be implemented January 2017) Development of new organisational values and behaviours in line with the new demands for workforce and in line with staff survey results (these results were discussed by members of the staff partnership forum, April, June and September 2016) Establishment of an active Staff Partnership Forum and implementation of a staff suggestion box (April 2016) Annual General Meeting with attendance of over 150+ and presentations from service users of their experiences of locally delivered health services (September 2016) Successful recruitment of 80+ Community Ambassadors volunteers appointed to support us to engage with a broad section of our local community, with formal induction and role matching process undertaken (September 2016) Development of Happy, Healthy at Home newsletter to support messaging to staff about our key programmes and what they are achieving (June 2016) Stakeholder events across a number of key priority areas including engagement on our Primary Care Strategy and Community Bed Review (September 2016) Learning sessions open to all staff including fraud awareness, equality impact assessments, how to engage hard to reach groups (these are held throughout the year to meet the needs of staff) Regular new staff induction programmes including new section on how to engage (April, June and September 2016) Annual all staff away days (July 2015 and Oct 2016) Regular team away days (various away days throughout the year, in particular with the Quality, Finance and Children and Maternity teams) Monthly staff team briefings (April through to April) Patient Participation Group workshop for Practice Managers and Patient Representatives (September 2016) Community Bed and Primary Care Strategy engagement (May- September 2016) Completed five locality engagement plans for future engagement Page 13 of 21 Overall Page 60 of 109

61 development, based on how to access seldom heard and key demographics for each of our localities (May-September 2016) Analysed results from the 360 Stakeholder Survey and presented high level actions to Governing Body (September 2016) with action plan presented (December 2016). 12 Organisational and individual resilience Leading change through difficult times Leadership development and planning Individual coaching and mentoring arrangements for clinical and non-clinical staff ( covered through individual performance reviews) Board to Board development events with partner organisations such as Southern Health NHS Foundation Trust and Frimley Health NHS Foundation Trust (March, April, November and December 2016) Health and Wellbeing Programme comprising of activities for staff including yoga, mindfulness and physical activity sessions (this is a live document regularly updated throughout the year and topics are discussed at the Staff Partnership Forum held six weekly) Access to Employee Assistance Programme (a helpline available to staff). Member of the Mindful Employer Charter, demonstrating a positive and enabling attitude to all staff in respect of mental health (access to this facility is provided when staff need assistance around mental health issues). Opportunities for staff development such as secondments, shadowing, acting up, access to NHS Leadership Academy programmes (covered through individual performance reviews). Skills and competency development (covered through individual performance reviews). HR systems and processes in place: 1:1s, team meetings, appraisals, personal development reviews held on a yearly basis with six monthly reviews Establishing a Staff Partnership Forum consisting of nominated representatives from each team within the CCG, chaired by a Governing Body Lay Member (meetings held on a six-weekly basis throughout the year) Staff away day covering mindfulness, resilience and workplace wellbeing (October 2016) Clinical Leadership Development Programmes led by a clinical chair (running since January 2016). The four main components of the programme have been delivery, innovation, collaboration and professional development Non Clinical Leadership Development Programmes (Bands 7-8c) 18 participants (from September 2015, due to be completed March 2017). Non Clinical Enabling Success Programme (Bands 3-6) - 13 Page 14 of 21 Overall Page 61 of 109

62 participants comprising of half day sessions running over a six month period (ending April 2017) Vanguard Leadership Programmes and education and development workshops (from April 2015, ongoing through ) Monthly TARGET sessions for CCG Member Practices, Practice Managers and Practice Nurses Practice Managers development sessions (ongoing) Prescribing Forums held every two months Governing Body development days and workshop sessions (December 2015, October 2016 and December 2016) Regular facilitated Executive team away time (March 2015, April, November, December 2016) 13 Governance, structures and processes Implementation of Clinical Leads objectives and performance management process through the Clinical Leadership Development Programme (running since January 2016), linking with organisational objectives. Implemented structured appraisal and PDP process and performance management processes (yearly and six monthly reviews) Regular directorate team meetings Updated Conflicts of Interest Policy approved by Governing Body in September 2016 and published on CCG website. Staff updated on the policy changes at Team Brief in December Conflict of interest is a standing item on every Governing Body meeting and all sub-committee meetings. Governing Body regularly reviews the Governing Body Assurance Framework which details key threats to the achievement of the CCG s strategic objectives (monthly) The Corporate Risk Register is regularly updated with Governing Body reviewing red rated risks at their meetings (monthly), with Audit & Risk Committee having overarching responsibility for reviewing all risks. Each Governing Body Sub-Committee has its own Risk Register which is reviewed and updated at each of its meetings. Equality and Quality Impact Assessment developed and launched with training session (lunch and learn) available for staff (April 2016) Page 15 of 21 Overall Page 62 of 109

63 14 Appendix B Action Plan for Theme Priorities: Lead: Progress to date: Milestone date: Our vision and strategy Align vision and mission to all strategic documents and incorporate into key organisational templates Communications Team March 2017 Develop a strategy to embed, evaluate and communicate the staff values and supporting behaviours. Communications Team March 2017 The CCG is participating in the national NHS Staff Survey with results available February The results will be analysed, summarised and presented to the Remuneration and Nominations Committee, Senior Management Team and the Staff Partnership Forum. Business Manager / Communications Team March 2017 Following feedback from the national NHS Staff Survey results, an action plan will be developed to address any issues highlighted from the survey and implement any immediate actions required. Business Manager / Communications Team May 2017 A key action from the national survey results will be to develop a bespoke staff survey (developed by the Staff Partnership Forum) to gain an insight into specific points raised. Business Manager / Communication June 2017 Page 16 of 21 Overall Page 63 of 109

64 15 Theme Priorities: Lead: Progress to date: Milestone date: Our vision and strategy (cont/d) The Staff Partnership Forum will continue to develop a series of initiatives to engage with staff and to act as a two-way communication between staff and the senior management team. Business Manager July 2017 Share key learning from the Empowering Engagement Programme across all staff teams and implement a showcase event to share the talent and learning The CCG is participating in the national 360 Stakeholder Survey with results available March The results will be analysed, summarised and presented to the Governing Body, Patient and Public Engagement Committee and the Senior Management Team. An action plan will be developed to address any issues highlighted from the survey and implement any immediate actions required. Communications Team Communications Team June 2017 September 2017 Theme Priorities: Lead: Progress to date: Milestone date: Our relationship with partners and stakeholders Implement and roll out the new programme of staff awareness sessions for engaging with seldom heard groups Continue the roll out of the Empowering Engagement Programme in connection with Healthwatch and Wessex Voices Partnership Manager Partnership Manager April 2017 June 2017 Develop the CCG and external website further to support our engagement programme and develop more interactive ways of engaging with our local stakeholders, in particular patients, carers and the general public Communications Team February 2017 Page 17 of 21 Overall Page 64 of 109

65 16 Our relationship with partners and stakeholders (cont/d..) Develop a new community forum to start a new and innovative dialogue with a broader range of stakeholders Continuously ensure that our working practices are supporting a culture for genuine engagement from patients, communities and the local frontline workforce in the CCG, Happy Healthy at home and STP programmes. Communications Team Communications Team September 2017 April 2018 Take consideration of key findings from the 360 survey and implement the action plan Communications Team January 2017 Implement local Innovation Event led by local stakeholders, including patients and the general public. Communications Team March 2017 Theme Priorities: Lead: Progress to date: Milestone date: Our structures and support arrangements Ensure regular monitoring and adherence to Conflicts of Interests management in line with CCG Assurance Framework. Reviewed at every Governing Body meeting and Governing Body subcommittee meeting according to the conflicts of internal policy approved 28/ Ensure conflict resolution training is provided to staff who have contact with members of the public Review our induction programme in line with the changing priorities and responsibilities of the Sustainability Transformation Plans Governance Team Director of Strategy and Partnerships Director of Strategy and Partnerships May 2017 June 2017 July 2017 Offer coaching programmes individually as part of the personal development planning process All Line Managers May 2017 Continue to hold monthly 1:1 meetings for staff with line managers, Personal Development Reviews and Personal Development Plans emerging from this All Line Managers Yearly with six monthly reviews Page 18 of 21 Overall Page 65 of 109

66 17 review. Our structures and support arrangements (cont/d..) A Learning and Development offer based on a needs assessment collated from all Personal Development Plans. Continue to roll out the programme of staff awareness sessions including fraud awareness, equality impact assessment etc Business Manager Business Manager January 2017 onwards January 2017 onwards Ensure our lay members are supported in their roles and that their roles are managed appropriately and in line with the CCG Assurance process. Clinical Chair October 2017 Further development and implementation of Equality and Quality Impact Assessment, along with Patient Engagement Impact Assessment, to ensure integrated systems with all our reporting processes Director of Quality and Nursing On-going initial phase complete by March 2017 Theme Priorities: Lead: Progress to date: Milestone date: Developing our workforce, clinical and non-clinical Further develop our Community Ambassador volunteer pool, supporting them to help us engage with our local communities. Complete the review of our local Patient Participation Groups, working with stakeholders, Practice Managers and GPs to improve how we work collaboratively. Communications Team Director of Strategy and Partnerships March 2018 June 2017 Following the above implement a new model of engagement for primary care. To be approved by the Patient and Public Engagement Committee. Director of Strategy and Partnerships June 2017 Continue to review and roll out the Clinical lead TARGET sessions and supporting e-news communication (supporting learning and education) Commissioning Team December 2017 Page 19 of 21 Overall Page 66 of 109

67 18 Developing our workforce, clinical and non-clinical (cont/d..) Launch a refreshed staff intranet and continue to develop our communications to provide on-going information and educational support to staff, specifically on key local issues, campaigns such as winter preparedness and opportunities were staff can provide input. Communications Team May 2017 Theme Priorities: Lead: Progress to date: Milestone date: Valuing our workforce Continue to develop the Staff Partnership Forum and staff suggestion box. Business Manager January 2017 onwards Following the NHS national staff survey, an action plan will be developed and discussed during regular team briefing sessions, the Staff Partnership Forum and senior management team meetings, to build on the feedback and understand what support is needed. Business Manager / Communications Team February 2017 onwards Develop a culture of inclusion and support including away days and other all staff events Business Manager January 2017 onwards Continue developing the Health and Wellbeing Programme based on staff survey results and staff feedback received via the Staff Partnership Forum. Business Manager January 2017 onwards Ensure that we share good news stories about the positive work our staff are doing every day and the impact they have on patients lives through places such as our Annual Report, Annual General Meeting, award opportunities, Happy, Healthy at Home newsletter, website etc. Communications Team January 2017 onwards Theme Priorities: Lead: Progress to date: Milestone date: Leadership Rollout the 2020 Programme for managers and Medical Director January Page of 21 Overall Page 67 of 109

68 19 development and succession planning clinicians. Continue to develop clinical leadership talent management and clinical leadership skills development programmes. Medical Director onwards January 2017 onwards Organisational objectives will be prioritised and assessed against existing clinical leads objectives and work and where there are competing priorities, clinical leads will align with the most urgent priorities. Medical Director Ongoing To link the clinical leads work to the wider Organisational Development strategy to ensure an appropriate fit and to also explore the opportunities of the Sustainability and Transformation Plans and how the leadership role the CCG is adopting can be reflected in the work of the Clinical Leads Programme. Medical Director June 2017 Continue to develop our staff resilience and succession planning, ensuring we have access to the right people, relationship and resources to deliver the STP. Director of Strategy and Partnerships April 2018 Continue to roll out and develop the high quality needs based Governing Body Development Programme. Clinical Chair / Governance Team Ongoing Continue to develop, review and implement the Executive Development programme. Chief Officer / Executive Team Ongoing Complete the 16/17 Leadership programme for Bands 6-8b and Enabling success programme Bands 3-6. Business Manager March 2017 Member of the Employers for Carers Charter. Partnership Manager To sign up 2017 Page 21 of 21 Overall Page 68 of 109

69 Governing Body Title of Paper Adult Community Services provided by Virgin Care ltd Agenda Item 8 Date of meeting 08/02/2017 Exec Lead Roshan Patel, CFO Clinical Sponsor Author Oliver White, Deputy CFO Purpose To Approve To Ratify To Discuss To Note X Strategic Objective Number A. Improved services, Outcomes and Care quality for our population Risk Unique Risk ID Disaggregation of the existing Virgin Community Services contract across Surrey (Adult) and the decisions that other commissioners are making as part of their procurements that may impact on the services delivered to our population. CR20 Executive Summary The Governing Body is asked to ratify the decision to contract with Virgin Care Ltd for adult community services for Farnham patients and community therapies for North East Hampshire and Farnham patients. Background As at the end of March 2017, the community services contract for children and adult services in Surrey provided by Virgin Care ltd will end. Children services are being procured under separate arrangement, led by Guildford & Waverley CCG. On the 11 th November 2015 the Governing Body agreed to look at alternative solutions to continue to the provision of adult community service with Virgin to allow the new model of care to be developed. The Governing Body agreed that any alternative short term contracting arrangement would only cover services currently in scope of existing Virgin arrangements. Following this decision North East Hampshire & Farnham CCG has been working with Surrey Heath CCG to agree a new contract with Virgin Care ltd for the provision of services. At the end of December 2016 the parties agreed in principal to enter a new contract agreement with Virgin to contract for the next financial year with the option to extend by two further periods of 6 months. Services/ contract The contract will be let under the 2017/18 NHS standard contract and as such commissioners have been working with Virgin Care ltd to ensure that the quality and reporting schedules are robust. The service delivered by Virgin Care ltd will be for the same services and outcomes as before. The contract agreed will be for 260k above the 2016/17 envelope (4.8%). The contract agreed for 2017/18 totals 11.3m, with North East Hampshire & Farnham s share of the contract worth 5.6m. Other Parties relevant to this contract; NHS Surrey Heath CCG, South East Hampshire CCG, and North Hampshire CCG. Recommendations The Governing Body are asked to ratify the new contract with Virgin Care Ltd starting 1 st April Version 20 Sept 2016 Page 1 of 2 Overall Page 69 of 109

70 Publication Public Website Staff Website (intranet) Please provide details on the impact of following aspects Equality and Quality No impact has been identified. Impact Assessment Patient and Stakeholder No impact on patients identified and on services to be provided. Engagement Financial Impact Legal and procurement advice has been taken to ensure the CCG can enter and Legal into a new contract with Virgin Care ltd. implications Governance and Reporting- which other meeting has this paper been discussed Committee Name Date discussed Outcome GB 11 Nov 2015 Decision to not continue with the wider collaborative agreement for adult services; and to work with Virgin Care ltd to maintain existing arrangements. GB 13 Jan 2016 Ratify decision for Children s services procurement to be separate from adult services. Finance and Performance - Updates throughout 2016 on negotiations and procurement. Version 20 Sept 2016 Page 2 of 2 Overall Page 70 of 109

71 Governing Body Title of Paper Novation of Southern Health Contract to Frimley Health Agenda Item 9 Date of meeting 08/02/2017 Exec Lead Roshan Patel, CFO Clinical Sponsor Author Oliver White, Deputy CFO Purpose To Approve To Ratify To Discuss To Note X Strategic Objective Number A. Improved services, Outcomes and Care quality for our population Risk Unique Risk ID Executive Summary The Governing Body is asked to ratify the decision to novate the North East Hampshire Community Services contract provided by Southern Health NHS Foundation Trust to Frimley Health NHS Foundation Trust effective from the 1 st January 2017 On the 27 September 2016 both Southern Health and Frimley Health NHS Foundation Trusts expressed their in interests in transferring North East Hampshire Community Services. A transition plan for the safe and effective transfer of service was subsequently produced and reviewed by the Governing Body on the 23 rd November Services will transfer under an interim arrangement with a duration of approximately 12 months, to be formally reviewed at 6 months and evaluated at the end of the period. In the meantime the system will continue to develop its New Model of Care procurement options. The Contract novates with no changes to the provision of service and no change in the contract value or payment mechanisms. The total contract value novating to Frimley Health NHS Foundation Trust is 5.9m. 24k will remain with Southern Health for the ongoing provision of Special School Nursing and Children s in Care. Recommendations The Governing Body is asked to ratify the decision to novate the North East Hampshire Community Services contract provided by Southern Health NHS Foundation Trust to Frimley Health NHS Foundation Trust effective from the 1 st January 2017 Publication Public Website Staff Website (intranet) Please provide details on the impact of following aspects Equality and Quality Under development Impact Assessment Patient and Stakeholder No impact on patients identified and on services to be provided. Engagement Financial Impact Legal and procurement advice has been taken to ensure the CCG can and Legal novate the contract. The novated contract will remain within the existing implications financial envelope. Version 20 Sept 2016 Page 1 of 2 Overall Page 71 of 109

72 Governance and Reporting- which other meeting has this paper been discussed Committee Name Date discussed Outcome GB 28 September 2016 Verbal update GB 23 November 2016 Review of proposed service transfer action plan Version 20 Sept 2016 Page 2 of 2 Overall Page 72 of 109

73 EXECUTIVE SUMMARY Governing Body Page 1 Title of Paper Integrated Performance Report December Agenda Item 10 Date of meeting 8th February 2017 Exec Lead Roshan Patel, CFO Clinical Sponsor N/A Author Ollie White, Assistant CFO Purpose To Approve Strategic To Ratify Objective To Discuss Number To Note X Risk Unique Risk ID N/A N/A Executive Summary To report to the Finance & Performance Committee on performance for the Clinical Commissioning group for the period from April 2016 to December Covering performance against the NHS Constitution targets, the Financial performance of the CCG, and delivery against the 2016/17 Improvement programmes. The Finance & Performance Committee is asked to note the performance for the period as set out in the report. Recommendations N/A Publication Public Website Staff Website (intranet) Please provide details on the impact of following aspects Equality and Quality Impact Assessment Patient and Stakeholder Engagement Financial Impact and Legal implications N/A N/A N/A Governance and Reporting- which other meeting has this paper been discussed Committee Name Date discussed Outcome Page 1 of 15 Overall Page 73 of 109

74 EXECUTIVE SUMMARY Page 2 INTEGRATED PERFORMANCE REPORT 2016/17 Monitoring Report Covering the following period: Performance - November 2016 Finance - December 2016 Page 2 of 15 Overall Page 74 of 109

75 Executive Summary Page 3 1 Executive Summary 1.1 This report covers financial data to December 2016, and performance data to November Key achievements Reduction in referral rates have continued in Q3 with referrals lower than last year. Referrals in the Farnham and Yateley localities continue to reduce at a greater rate than the remaining three localities Operating Plan and Financial plan, along with all key provider contracts agreed ahead of 23 rd December deadline RTT incomplete waiting list target met in October (92.1%) and November (93.1%) Key challenges facing the Organisation Continuing Healthcare continues to be a significant risk to the organisation. Total overspend of 1.3m at Month 9 Movement to a marginal risk share agreement from the historical cap and collar contract agreement with Frimley Health poses a key challenge to the CCG for 2017/18. The improvements outlined by the Vanguard programme form the key mitigation for this risk Performance issues at Royal Surrey County Hospital continue to impact on the CCGs overall Diagnostic treatment and RTT waiting time targets Delayed transfers of care at Frimley Park Hospital site Sustained delivery of the A&E 4 hour target at Frimley Health remains a key system challenge 1.2 This report contains the latest information available. Financial information is subject to audit. Page 3 of 15 Overall Page 75 of 109

76 PERFORMANCE AT A GLANCE Page 4 Indicator Unit YTD Target Sep-16 Oct-16 Nov-16 QTD YTD Travel Q U A L I T Y P E R F O R M A N C E Friends and Family Test Score Friends and Family Test (Response Rate) % 15.0% 24.6% 25.6% 25.6% 25.6% 24.4% Mixed Sex Accomodation Breaches No MRSA bacteraemia (CCG) No Clostridium Difficile (CCG) No MRSA bacteraemia (FPH) No Clostridium Difficile (FPH) No weeks referral to treatment times - admitted % 69.7% 67.8% 69.1% 69.1% 69.1% 18 weeks referral to treatment times - non-admitted % 80.5% 83.4% 82.3% 82.3% 82.3% 18 weeks referral to treatment times - incompletes % 92.0% 91.9% 92.1% 93.1% 93.1% 93.1% Number of incomplete patients w aiting more than 52 w eeks No Cancer: 2 week breast symptoms % 93.0% 98.1% 92.9% 96.7% 94.6% 95.0% Cancer: 2 week urgent GP referral % 93.0% 95.6% 95.7% 96.2% 95.9% 94.9% Cancer: 31 days diagnosis to treatment % 96.0% 100.0% 98.7% 100.0% 99.2% 98.3% Cancer: 31 days subsequent treatment - Chemo/Drug % 98.0% 97.4% 96.6% 100.0% 98.1% 98.4% Cancer: 31 days subsequent treatment - radiotherapy % 94.0% 100.0% 95.8% 96.4% 96.1% 96.9% Cancer: 31 days subsequent treatment - surgery % 94.0% 92.9% 100.0% 100.0% 100.0% 97.7% Cancer: 62 days screening referral % 90.0% 100.0% 100.0% 100.0% 100.0% 87.8% Cancer: 62 days urgent referral to treatment % 85.0% 81.6% 82.1% 78.1% 80.7% 84.6% Cancer: 62 days consultant decision to upgrade % 86.0% 100.0% 100.0% 75.0% 90.0% 94.9% Diagnostics 6 week w aits % 1.0% 1.7% 0.8% 1.1% 1.1% 1.1% GP Referrals No. 26,756 3,318 3,328 3,304 6,632 27,291 Total Elective Admissions (Spells) (Specific Acute) No. 17,916 2,433 2,353 2,520 4,873 18,748 Total Outpatient Attendances No. 171,148 20,315 19,718 20,739 40, ,796 Key: NHS Constitution Quality Premium Last 3 Months Indicator Unit YTD Target Sep-16 Oct-16 Nov-16 QTD YTD Travel A&E 4 hour w ait (FHFT) % 95.00% 95.85% 94.85% 91.28% 93.09% 92.80% Total A&E Attendances Excluding Planned Follow Ups P No. 40,487 5,205 5,318 5,138 10,456 41,840 E Total Non-Elective Admissions (Spells) (Specific Acute) No. 13,901 1,686 1,704 1,723 3,427 13,566 R Category A 19 minute transportation time (SECAmb) F % 95.00% 89.96% 90.00% 90.94% 90.47% 90.03% O Category A Red 1 Ambulance response times (SECAmb) % 75.00% 62.61% 64.71% 65.64% 65.19% 64.48% R Category A Red 2 Ambulance response times (SECAmb) M % 75.00% 52.80% 54.12% 56.44% 55.27% 54.18% A Delayed transfers of care w ith NHS responsibility (FHFT South) N Days 3, ,318 4,618 Estimated Diagnosis rate for people w ith dementia C % 66.7% 65.7% 67.0% 67.4% 67.4% 67.4% E Improving access to psychologial therapy - roll out % 15.0% 17.8% 17.8% 18.2% 18.0% 16.7% W O R K F O R C E Last 3 Months Improving access to psychologial therapy - recovery rate % 50.0% 50.0% 51.3% 51.4% 51.4% 52.4% Permanent Staff in Post FTE Staff Turnover % 11.0% 16.7% 17.5% 17.5% 17.5% 17.5% Sickness Rate % 3.5% 2.4% 3.8% 4.0% 3.9% 3.1% Information Governance Training % 82.5% 86.0% 0.0% 0.0% 0.0% Indicator Unit YTD Target Oct-16 Nov-16 Dec-16 QTD YTD Travel Q I P P F I N A N C E Last 3 Months GP Locality Urgent Care Savings,000 1, Acute Services: Reducing Variation, Prescribing, (126) (22) 0 (148) 693 Continuing Health Care, Other Savings,000 1, ,299 3,206 TOTAL QIPP,000 5, ,340 4,382 Programme Expenditure, ,805 23,431 23,317 24,162 70, ,805 Running Costs,000 3, ,174 3,506 Surplus / (Deficit),000 2, ,962 Better Payment Code % 95.0% 99.7% 94.1% 95.0% 95.9% 96.9% Capital Expenditure, Page 4 of 15 Overall Page 76 of 109

77 F O R M A Performance Page 5 2 Performance exception reports 2.1 RTT Performance Indicator Unit YTD Target Sep-16 Oct-16 Nov-16 QTD YTD Travel P E R F O R M A N C E 18 weeks referral to treatment times - admitted % 69.7% 67.8% 69.1% 69.1% 70.8% 18 weeks referral to treatment times - non-admitted % 80.5% 83.4% 82.3% 82.3% 83.2% 18 weeks referral to treatment times - incompletes % 92.0% 91.9% 92.1% 93.1% 93.1% 92.3% Programme board responsible for delivery: Planned Care Recovery trajectory status: Recovered, project closed A weekly Task & Finish group was established to focus on the challenges experienced at the Frimley Park Site. Performance has recovered in October and for November has improved further to 93.1%. The Task and Finish group has now been closed with outstanding actions subsumed by the newly established Planned Care Programme Board. 2.2 Diagnostic 6 Week Waits Last 3 Months Last 3 Months Indicator Unit YTD Target Sep-16 Oct-16 Nov-16 QTD YTD Travel Diagnostics 6 week waits % 1.0% 1.7% 0.8% 1.1% 1.1% 1.1% 2.3 Cancer Performance Last 3 Months Indicator Unit YTD Target Sep-16 Oct-16 Nov-16 QTD YTD Travel P L A N N E D & S P E C I A L I S T C A R E Cancer: 2 w eek breast symptoms % 93.0% 98.1% 92.9% 96.7% 94.6% 95.0% Cancer: 2 w eek urgent GP referral % 93.0% 95.6% 95.7% 96.2% 95.9% 94.9% Cancer: 31 days diagnosis to treatment % 96.0% 100.0% 98.7% 100.0% 99.2% 98.3% Cancer: 31 days subsequent treatment - Chemo/Drug % 98.0% 97.4% 96.6% 100.0% 98.1% 98.4% Cancer: 31 days subsequent treatment - radiotherapy % 94.0% 100.0% 95.8% 96.4% 96.1% 96.9% Cancer: 31 days subsequent treatment - surgery % 94.0% 92.9% 100.0% 100.0% 100.0% 97.7% Cancer: 62 days screening referral % 90.0% 100.0% 100.0% 100.0% 100.0% 87.8% Cancer: 62 days urgent referral to treatment % 85.0% 81.6% 82.1% 78.1% 80.7% 84.6% Cancer: 62 days consultant decision to upgrade % 86.0% 100.0% 100.0% 75.0% 90.0% 94.9% Programme board responsible for delivery: Planned Care Frimley Health NHS Foundation Trust overall has met the cancer constitutional targets. For North East Hampshire and Farnham Clinical Commissioning Group patients, the 62 day urgent referral to first treatment target has been missed for 3 consecutive months. Discussions are taking place with the Cancer Manager to understand the reasons and for assurance that Q3 will be met. Plans will be agreed through the Planned care delivery board and recovery trajectories agreed as necessary. Programme board responsible for delivery: Planned Care Performance has deteriorated in November with the CCG marginally missing the target at 1.1% although the numbers are small with 30 patients waiting over 6 weeks (Constitutional target missed by 2 patients). Performance at Royal Surrey County Hospital continues to cause this position, accounting for a third of all breaches (with just 5% of total diagnostic activity). An action plan is being monitored by Guildford & Waverley CCG as the lead commissioner. The plan is currently partially assured but no further details have been shared to date. Page 5 of 15 Overall Page 77 of 109

78 T & I N T E G R A T E D T & I N T E G R A T E D Performance Page A&E 4 Hour Waits Last 3 Months Indicator Unit YTD Target Sep-16 Oct-16 Nov-16 QTD YTD Travel 2.5 Delayed Transfers of Care Last 3 Months Indicator Unit YTD Target Sep-16 Oct-16 Nov-16 QTD YTD Travel A&E 4 hour w ait (FHFT) % 95.00% 95.85% 94.85% 91.28% 93.09% 92.80% Delayed transfers of care - Days (FHFT South) Days 4,790 1,027 1,015 1,039 2,054 7,417 A&E 4 hour w ait (FHFT South) % 95.00% 95.35% 95.64% 91.06% 93.37% 92.27% Delayed transfers of care - Patients (FHFT South) Patients A&E 4 hour w ait (FHFT North) % 95.00% 96.33% 94.12% 91.50% 92.83% 93.29% Delayed transfers of care w ith NHS responsibility (FHFT South) Days 3, ,318 4,618 Programme board responsible for delivery: Urgent & Integrated Care Recovery Trajectory: Behind plan The CCG is continuing to monitor A&E waiting times at Frimley Health which is made up of performance at the A&E department at Frimley Park Hospital (FHFT South) and performance at the Wexham Park A&E Department (FHFT North). Performance is managed through the respective A&E delivery boards. Whilst performance was expected to be challenging in November performance dropped below the agreed trajectory. Unvalidated data shows that the Trust has missed the target in December and January is also unlikely to be missed. Despite missing the target the Frimley Health is performing better than other Trusts within the region. To support recovery against the target key areas of focus include; Ambulance Handover delays, high frequency users, Mental Health patients, community delays, and bridging the bed gap at the Trust. Programme board responsible for delivery: Urgent & Integrated Care Delayed transfers of care continue to be a key challenge for the system, with sourcing of packages of care, increased complexity of packages of care requirements, availability of nursing/care homes, and family choice the key drivers of the increase. Improvement plans are being tracked by the A&E Delivery Board, with additional beds provided by Bracknell Forest ASC, additional beds commissioned within Farnham Community Hospital, alongside senior involvement in daily bed delay meetings, and a system focus on improving system flow. The Vanguard programme is providing investment to expand the Enhanced Recovery at Home service to further support discharge from Frimley Health. Page 6 of 15 Overall Page 78 of 109

79 FINANCE Page 7 3 Finance Indicator Unit YTD Target Sep-16 Oct-16 Nov-16 QTD YTD Travel F I N A N C E Last 3 Months Programme Expenditure, ,756 23,558 20,814 23,431 44, ,140 Running Costs,000 3, ,139 Surplus / (Deficit),000 2, , ,911 4,920 Better Payment Code % 95.0% 98.5% 99.7% 94.1% 96.3% 97.0% Capital Expenditure, Finance Summary The CCG is reporting a surplus of 3.0m as at the end of December 2016, this is in line with plan. The forecast year end position is expected to be 3.95m surplus, again this is in line with the 2016/17 plan submitted to NHS England. 3.2 Risks CHC continues in this financial year to be a significant risk to the organisation, the over spend as at month 9, for the totality of the service, is 1.3m. The current expected forecast outturn equates to an over spend of 1.7m at the end of the financial year. The 1.0m QIPP allocated against CHC has not been achieved during this year when you look at the totality of the expenditure, although some elements of the schemes have been successful, the demand and acuity of need has mitigated against any saving. The nationally mandated increase in Funded Nursing Care have been reflected in the CCG position this month, the over spend as at month 9 is 0.6m. 3.3 Mitigations The current pressures within CHC and FNC are currently being mitigated against with the release of the reserve contingency and various underspends within other areas. It should be noted that all current known risks have been mitigated against but any additional unknown pressure would prove extremely difficult to absorb within the plan. 3.4 Vanguard The North East Hampshire and Farnham Vanguard programme incurred costs totalling 2.5m to the end of December The CCG has received the first three quarters allocation totalling 3.9m. Workstream Category 16/17 Planned Budget Month 9 position Actual Expenditure A. Yateley Locality 415, ,792 B. Farnham Locality 459, ,330 C. Aldershot Locality 277,268 - D. Fleet Locality 277,268 - E. Farnborough Locality 281,427 41,000 F. Engagement 298, ,894 G.Prevention 332, ,296 H. IT 772,229 34,480 I. Acute 101,480 19,440 J. Enhanced Recovery at Home 291, ,367 K. Evaluation 200, ,000 L. Organisational Development 87,339 24,029 M. PMO 565, ,557 N. Estate 41,590 44,933 O. Ask and Offer 611, ,294 P. MDT Co-ordinators 111,403 94,275 Total 5,126,000 2,449, Vanguard funding 4,926,000 3,863,000 Evaluation Funding 200,000 50,000 ETTF Funding 5,126,000 3,913,000 Grand total 0 (1,463,314) We are currently working with the Vanguard team to confirm forecast outturn for this financial year and what requirement will be expected for next financial year should the schemes continue. Page 7 of 15 Overall Page 79 of 109

80 FINANCE Page I & E Position The table below shows the total CCG expenditure against plan by category as defined by the NHS England reporting structure. Annual Budget YTD Budget YTD Actual Variance ACUTE 148,538, ,403, ,413,731 9,946 COMMUNITY HEALTH SERVICES 21,382,780 16,042,990 14,931,414 (1,111,576) CONTINUING CARE 18,836,945 14,167,688 16,081,703 1,914,015 MENTAL HEALTH 19,444,111 14,583,000 14,520,266 (62,734) OTHER 14,981,117 8,627,685 7,922,914 (704,771) PRIMARY CARE 62,958,462 46,979,615 46,934,735 (44,880) PROGRAMME COSTS 286,142, ,804, ,804,763 0 CORPORATE 4,681,000 3,506,082 3,506,082 (0) RUNNING COSTS 4,681,000 3,506,082 3,506,082 (0) SURPLUS 3,950,000 2,962,494 0 (2,962,494) Grand Total 294,773, ,273, ,310,844 (2,962,494) 3.6 QIPP QIPP Performance continues to be a challenge for the organisation with the 2016/17 position supported by non-recurrent savings derived through the Cap & Collar Agreement with Frimley Health. Savings delivered through agreements with NHS Property services are further supporting this position. Page 8 of 15 Overall Page 80 of 109

81 Transformation for tomorrow Page 9 4 Progress towards the 2017/18 Delivery Programme The Operational Plan set out a series of projects across 7 delivery programmes. Through 2017/18 this section will be used to provide updates on progress against these plans. In the build up to April 2017, updates will be provided on the status of these plans as they prepare for delivery. All projects will be entered and monitored by the CCGs Project Management tool with this process due for completion by the end of January The statuses of the projects with corresponding savings are listed below: Programme Project Name Saving Target Development Status Comments Prevention & Self Care Recovery College / Making Connections / Carers 0.2m In development Making connections and Recovery College established in 2016/17. Scoping work underway to develop 2017/18 programme. Planned Care Prescribing 1.5m On Track Work programme developed by Prescribing team Right Care: Unwarranted Variation 1.8m In development Work underway within the Frimley STP work programme. Scoping of savings and delivery plans still to be developed. Primary Care/Integrated Care Locality Plans 3.0m In development Plans for Farnham & Yateley well defined, remaining 3 localities still in development. Growth in emergency admissions remains a challenge for the new financial year. Integrated Care Continuing Health Care 1.0m Scoping Work programme not yet established Acute Care Enhanced Recovery at Home 0.3m In development Frimley Health recruiting to new team alongside transfer of community staff from Southern Health Other Schemes 1.1m In development Savings across Property Services and Corporate costs being finalised. Page 9 of 15 Overall Page 81 of 109

82 APPENDICES Page 10 5 Appendices NHS Constitution Indicator Unit YTD Target Sep-16 Oct-16 Nov-16 QTD YTD Travel N H S C O N S T I T U T I O N M E T R I C S A&E 4 hour w ait (FHFT) % 95.00% 95.85% 94.85% 91.28% 93.09% 92.80% Category A 19 minute transportation time (SECAmb) % 95.00% 89.96% 90.00% 90.94% 90.47% 90.03% Category A Red 1 Ambulance response times (SECAmb) % 75.00% 62.61% 64.71% 65.64% 65.19% 64.48% Category A Red 2 Ambulance response times (SECAmb) % 75.00% 52.80% 54.12% 56.44% 55.27% 54.18% Trolley w aits in A&E not longer than 12 hours (FHFT) No weeks referral to treatment times - admitted % 69.7% 67.8% 69.1% 69.1% 70.8% 18 weeks referral to treatment times - non-admitted % 80.5% 83.4% 82.3% 82.3% 83.2% 18 w eeks referral to treatment times - incompletes % 92.0% 91.9% 92.1% 93.1% 93.1% 92.3% Diagnostics 6 w eek w aits % 1.0% 1.7% 0.8% 1.1% 1.1% 1.1% Number of incomplete patients w aiting more than 52 w eeks No Cancer: 2 w eek breast symptoms % 93.0% 98.1% 92.9% 96.7% 94.6% 95.0% Cancer: 2 w eek urgent GP referral % 93.0% 95.6% 95.7% 96.2% 95.9% 94.9% Cancer: 31 days diagnosis to treatment % 96.0% 100.0% 98.7% 100.0% 99.2% 98.3% Cancer: 31 days subsequent treatment - Chemo/Drug % 98.0% 97.4% 96.6% 100.0% 98.1% 98.4% Cancer: 31 days subsequent treatment - radiotherapy % 94.0% 100.0% 95.8% 96.4% 96.1% 96.9% Cancer: 31 days subsequent treatment - surgery % 94.0% 92.9% 100.0% 100.0% 100.0% 97.7% Cancer: 62 days urgent referral to treatment % 85.0% 81.6% 82.1% 78.1% 80.7% 84.6% Cancer: 62 days consultant decision to upgrade % 86.0% 100.0% 100.0% 75.0% 90.0% 94.9% Proportion of people under adult mental illness specialties on CPA w ho w ere follow ed up w ithin 7 days of discharge from Last 3 Months % 95.0% 88.9% 79.5% Mixed Sex Accomodation Breaches No Page 10 of 15 Overall Page 82 of 109

83 APPENDICES Page 11 Mental Health Targets Indicator Unit YTD Target Sep-16 Oct-16 Nov-16 QTD YTD Travel M E N T A L H E A L T H Estimated Diagnosis rate for people w ith dementia % 66.7% 65.7% 67.0% 67.4% 67.4% 67.4% Improving access to psychologial therapy - roll out % 15.0% 17.8% 17.8% 18.2% 18.0% 16.7% Improving access to psychologial therapy - recovery rate % 50.0% 50.0% 51.3% 51.4% 51.4% 52.4% The proportion of people that w ait 6 w eeks or less from referral to entering a course of IAPT treatment against the The proportion of people that w ait 18 w eeks or less from referral to entering a course of IAPT treatment against the People experiencing a first episode of psychosis treated w ithin tw o w eeks of referral Number of patients in inpatient beds for mental and/or behavioural healthcare w ho have either learning disabilities and/or autistic spectrum disorder (inc. Asperger's syndrome) Number of admissions to inpatient beds for mental and/or behavioural healthcare w ho have either learning disabilities and/or autistic spectrum disorder (inc. Asperger's syndrome) Transforming Care Learning Disabilities: Number of patients discharged to community settings Transforming Care Learning Disabilities: Patients w ithout a care coordinator Transforming Care Learning Disabilities: Patients not on the register Transforming Care Learning Disabilities: Patients w ithout a review in the last 26 w eeks Last 3 Months % 75.0% 95.6% 95.1% 95.8% 95.5% 92.3% % 95.0% 100.0% 100.0% 100.0% 100.0% 99.7% % 50.0% 83.3% 100.0% 83.3% 92.3% 71.8% No No No No No No Page 11 of 15 Overall Page 83 of 109

84 APPENDICES Page 12 Frimley Health performance Indicator Unit YTD Target Sep-16 Oct-16 Nov-16 QTD YTD Travel F R I M L E Y H E A L T H S O U T H Last 3 Months A&E 4 hour w ait % 95.00% 95.85% 94.85% 91.28% 93.09% 92.80% Total A&E Attendances Excluding Planned Follow Ups No. 34,243 4,421 4,531 4,385 8,916 35,272 Total Non-Elective Admissions (Spells) (Specific Acute) No. 12,230 1,497 1,527 1,482 3,009 11,944 Total Ordinary Elective Admissions (Spells) (Specific Acute) No ,547 Total Day Case Admissions (Spells) (Specific Acute) No. 1,790 1,719 1,837 3,556 13,373 Total Elective Admissions (Spells) (Specific Acute) No. 2,090 2,030 2,156 4,186 15,920 Consultant Led First OP Attendances (Specific Acute) No. 64,484 8,134 7,887 7,898 15,785 63,009 Consultant Led FU OP Attendances (Specific Acute) No. 76,795 9,420 9,038 9,879 18,917 73,500 Total Outpatient Attendances No. 141,279 17,554 16,925 17,777 34, ,509 GP Referrals No. 22,617 2,937 2,978 2,943 5,921 24,261 Other Referrals No. 9,795 1,209 1,261 1,215 2,476 9,654 Frimley Park Hospital SLA,000 79,474 10,042 10,042 10,042 20,083 80,558 Royal Surrey County Hospital Performance Indicator Unit YTD Target Sep-16 Oct-16 Nov-16 QTD YTD Travel R S C H Last 3 Months A&E 4 hour w ait % 95.00% 92.78% 92.93% 91.28% 92.22% 91.62% Total A&E Attendances Excluding Planned Follow Ups No. 40,487 5,205 5,318 5,138 10,456 41,840 Total Non-Elective Admissions (Spells) (Specific Acute) No. 13,901 1,686 1,704 1,723 3,427 13,566 Total Ordinary Elective Admissions (Spells) (Specific Acute) No. 3, ,288 Total Day Case Admissions (Spells) (Specific Acute) No. 14,728 2,040 1,970 2,122 4,092 15,460 Total Elective Admissions (Spells) (Specific Acute) No. 17,916 2,433 2,353 2,520 4,873 18,748 Consultant Led First OP Attendances (Specific Acute) No. 72,949 8,843 8,598 8,653 17,251 68,993 Consultant Led FU OP Attendances (Specific Acute) No. 98,199 11,472 11,120 12,086 23,206 90,803 Total Outpatient Attendances No. 171,148 20,315 19,718 20,739 40, ,796 GP Referrals No. 26,756 3,318 3,328 3,304 6,632 27,291 Other Referrals No. 12,976 1,638 1,677 1,706 3,383 13,152 Royal Surrey County Hospital SLA,000 5, ,287 5,388 Page 12 of 15 Overall Page 84 of 109

85 APPENDICES Page /17 QIPP Detail Indicator Unit Annual Target YTD Target Oct-16 Nov-16 Dec-16 QTD YTD Travel Q I P P Vanguard: Farnham Locality savings, Vanguard: Yateley Locality savings, Vanguard: Remaining Locality savings,000 2,107 1, GP Locality Urgent Care Savings,000 2,942 1, Right Care Reducing variation: Activity planning assumptions, Frimley Community Ophthalmology, Acute Services: Reducing Variation, Prescribing,000 1, (126) (22) 0 (148) 693 Review of Continuing Health Care processes, Continuing Health Care Market Management, Continuing Health Care,000 1, Allocative efficiencies,000 1, Estates Strategy, CCG Corporate Costs, Remedial Action: Frimley Cap, ,618 Other Savings,000 2,173 1, ,299 3,206 TOTAL QIPP,000 7,500 5, ,340 4,382 CCG Activity Performance Last 3 Months Indicator Unit YTD Target Sep-16 Oct-16 Nov-16 QTD YTD Travel A C T I V I T Y Last 3 Months Total A&E Attendances Excluding Planned Follow Ups No. 40,487 5,205 5,318 5,138 10,456 41,840 Total Non-Elective Admissions (Spells) (Specific Acute) No. 13,901 1,686 1,704 1,723 3,427 13,566 Total Day Case Admissions (Spells) (Specific Acute) No. 14,728 2,040 1,970 2,122 4,092 15,460 Total Ordinary Elective Admissions (Spells) (Specific Acute) No. 3, ,288 Total Elective Admissions (Spells) (Specific Acute) No. 17,916 2,433 2,353 2,520 4,873 18,748 Consultant Led First OP Attendances (Specific Acute) No. 72,949 8,843 8,598 8,653 17,251 68,993 Consultant Led FU OP Attendances (Specific Acute) No. 98,199 11,472 11,120 12,086 23,206 90,803 Total Outpatient Attendances No. 171,148 20,315 19,718 20,739 40, ,796 GP Referrals No. 26,756 3,318 3,328 3,304 6,632 27,291 Other Referrals No. 12,976 1,638 1,677 1,706 3,383 13,152 Page 13 of 15 Overall Page 85 of 109