GOVERNING BODY ASSURANCE COMMITTEE

Transcription

1 GOVERNING BODY ASSURANCE COMMITTEE Monday 19 th December pm 4:00pm Robert Robinson Room, Scarsdale, Chesterfield A G E N D A 1. To receive apologies for absence: Dr Anne-Marie Spooner 2. Declaration of Interests: Governing Body Assurance Committee Members to declare interest in items on the Agenda To receive and note any changes to the Register of Governing Body Members interests 3. Minutes of the Governing Body Assurance Committee held on 21 November 2016 To note 4. Matters arising from the Governing Body Assurance Committee of 21 November 2016 For Assurance Action Log To note 5. Integrated Finance, Performance and Quality Improvement Report Enclosure Verbal Paper A Paper B Paper B Paper C Paper D Presenter Ian Gibbard Ian Gibbard Ian Gibbard Ian Gibbard Darran Green/Jayne Stringfellow 6. STP Update Verbal Beverley Smith 7. 21C Update Verbal Beverley Smith

2 For Approval 8. Diabetes Transformation Fund Bid Paper E Ben Milton 9. HR Policies Travelling Expenses Policy Relocation Policy Paper F Suzanne Pickering 10. Security Policy Statement Paper G Suzanne Pickering Reports from Sub Committees for discussion/action relating to key matters 11. Minutes of the 21 Century Plan Delivery Group meeting of 14 November Minutes of the Primary Care Development Group meeting of 18 October Minutes of DHU 111 Contract Management Board of 26 October 2016 Paper H Paper I Paper J Darran Green Jayne Stringfellow Jayne Stringfellow 14. Any Other Business All 15. Date and Time of Next Meeting: Monday 23 rd January 2017, in the Robert Robinson Room, Scarsdale, Chesterfield, Derbyshire at 1:30pm

3 ND CCG Governing Body Assurance Committee 19 December 2016 Paper A NORTH DERBYSHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY ASSURANCE COMMITTEE MEETING 19 December 2016 Report Title: Declaration of Interest Register Item No: 2 Purpose: To publish the Register of Interest to the Governing Body Assurance Committee 1. Background and context A Declaration of Interest Register is required under the Code of Accountability and the interests declared will be reported to the North Derbyshire CCG Governing Body and will be available for public inspection. 2. Key matters for consideration To provide a Declarations of Interest Register for North Derbyshire Clinical Commissioning Group (NDCCG). 3 Financial Impact None. 4. Analysis of risk Requirement to embed into the CCG to ensure sound corporate governance structures and transparent decision-making processes within NDCCG. 5. Equality Impact Please describe how this report and/or the services described within it aid the CCG in achieving the objectives of the Equality Delivery system, namely: Better health outcomes for all: None directly Improved patient access and experience: None directly Empowered, engaged and well-supported staff: None directly Inclusive leadership at all levels: None directly 6. Recommendations To review the Declaration of Interest for the Governing Body to ensure that it is correct and consistent Author: Suzanne Pickering, Head of Governance Sponsor: Darran Green, Interim Chief Finance Officer Date: 2 December 2016 The NDCCG values Patient-Focus, Integrity, Courage and Responsiveness inform our decision making and behaviours

4 North Derbyshire Clinical Commissioning Group Register of Interests Governing Body and Sub Committees December 2016 Governing Body Member Interests Steve Allinson Spouse is an employee of Pennine Acute Hospitals NHS Trust Former Chief Officer, Tameside & Glossop CCG Appointed Commissioner, Board of Governors, DCHS Ben Milton Sessional (locum) GP in North Derbyshire CCG Practices Former Partner at Darley Dale Medical Centre Director of Darley Dale Private Health Care (including Indigo Training) - to cease March 2017 Part share of ownership of Winster & Youlgreave Surgeries until April 2017 Darley Dale Surgery is a member of the Primary Care Research Network and is funded to carry out research projects accordingly Ian Gibbard No relevant interests No spouse with relevant interests Roger Miller Assistant Director Derbyshire Adult Care No spouse with relevant interests Darran Green No relevant interests No spouse with relevant interests Jayne Stringfellow Governor Chesterfield Royal Hospital Foundation Trust Spouse is Trustee of Carers Trust East Midlands Iain Little Consultant in Public Health Derbyshire County Council Spouse Employed at Nottingham Hospitals NHS Trust Bruce Braithwaite Director of Operations, Alliance Surgical Register of Interests Governing Body, CRG and Sub Committee December 2016

5 PLC Director BD Braithwaite Ltd Director Veincare Ltd Clinical Lead and Deputy Clinical Chair of Circle NHS Treatment Centre, Nottingham. No spouse with relevant interests Debbie Austin School Governor Taxal and Fernilee Primary School, Whaley Bridge Spouse is Employee of DCHS, Interim Associate Director of Transformation Locum GP Gary Apsley No relevant interests No spouse with relevant interests Beverley Smith No relevant interests No spouse with relevant interests Anne-Marie Spooner GP Partner at Hasland Medical Centre Hasland Medical Centre is a member of the North Derbyshire GP Federation. No spouse with relevant interests Isabella Stone No relevant interests No spouse with relevant interests Praveen Alla GP Partner at Welbeck Road Health Centre Welbeck Road Health Centre is a member of the North Derbyshire GP Federation Marc Bicknell Chief Executive Designate and Director Railway Enginemen s Assurance Society Governing Body Assurance Committee Interests Steve Allinson Spouse is an employee of Pennine Acute Hospitals NHS Trust Former Chief Officer, Tameside & Glossop CCG Appointed Commissioner, Board of Governors, DCHS Ben Milton Sessional (locum) GP in North Derbyshire CCG Practices Former Partner at Darley Dale Medical Centre Director of Darley Dale Private Health Care (including Indigo Training) - to Register of Interests Governing Body, CRG and Sub Committee December 2016

6 cease March 2017 Part share of ownership of Winster & Youlgreave Surgeries until April 2017 Darley Dale Surgery is a member of the Primary Care Research Network and is funded to carry out research projects accordingly Ian Gibbard No relevant interests No spouse with relevant interests Darran Green No relevant interests No spouse with relevant interests Jayne Stringfellow Governor Chesterfield Royal Hospital Foundation Trust Spouse is trustee of Carers Trust East Midlands Gary Apsley No relevant interests No spouse with relevant interests Suzanne Pickering No relevant interests No spouse with relevant interests Isabella Stone No relevant interests No spouse with relevant interests Debbie Austin School Governor Taxal and Fernilee Primary School, Whaley Bridge Spouse is Employee of DCHS, Interim Associate Director of Transformation Locum GP Anne-Marie Spooner GP Partner at Hasland Medical Centre Hasland Medical Centre is a member of the North Derbyshire GP Federation. No spouse with relevant interests Marc Bicknell Chief Executive Designate and Director Railway Enginemen s Assurance Society Audit Committee Interests Steve Allinson Spouse is an employee of Pennine Acute Hospitals NHS Trust Former Chief Officer, Tameside & Glossop CCG Appointed Commissioner, Board of Governors, DCHS Ian Gibbard No relevant interests No spouse with relevant interests Darran Green No relevant interests No spouse with relevant interests Gary Apsley No relevant interests Register of Interests Governing Body, CRG and Sub Committee December 2016

7 No spouse with relevant interests Marc Bicknell Suzanne Pickering No relevant interests No spouse with relevant interests Martin Colclough No relevant interests Spouse is employed as a Deputy Director of Public Health England Carl Twibey Partner is employed by Derbyshire Community Health Services NHS Trust Roger Miller Assistant Director Derbyshire Adult Care No spouse with relevant interests Primary Care Co-Commissioning Committee Interests Steve Allinson Spouse is an employee of Pennine Acute Hospitals NHS Trust Former Chief Officer, Tameside & Glossop CCG Appointed Commissioner, Board of Governors, DCHS Ian Gibbard No relevant interests No spouse with relevant interests Gary Apsley No relevant interests No spouse with relevant interests Isabella Stone No relevant interests No spouse with relevant interests Marc Bicknell Jayne Stringfellow Governor Chesterfield Royal Hospital +Foundation Trust Spouse is Trustee of Carers Trust East Midlands Darran Green No relevant interests No spouse with relevant interests Beverley Smith No relevant interests No spouse with relevant interests Ben Milton Sessional (locum) GP in North Derbyshire CCG Practices Former Partner at Darley Dale Medical Centre Director of Darley Dale Private Health Care (including Indigo Training) - to cease March 2017 Part share of ownership of Winster & Youlgreave Surgeries until April 2017 Register of Interests Governing Body, CRG and Sub Committee December 2016

8 Darley Dale Surgery is a member of the Primary Care Research Network and is funded to carry out research projects accordingly Debbie Austin School Governor Taxal and Fernilee Primary School, Whaley Bridge Spouse is Employee of DCHS, Interim Associate Director of Transformation Locum GP Carolin Shearer Board member of Healthwatch Derbyshire Member of NDCCG Lay Rep Group Lisa Soultana Alexin Healthcare Ltd Non-Executive Director No spouse with relevant interests Jonathan Rycroft No relevant Interests No spouse with relevant interests Marie Scouse No relevant interests Elaine Michel Director in County Council with responsibility to advise all Derbyshire CCG s on Public Health Roger Miller Assistant Director Derbyshire Adult Care No spouse with relevant interests Sean King Deputy Secretary Derby and Derbyshire LMCs. Locum GP - Working at 2 of the High Peak Practices intermittently. Deputy GP for the Out of Hours Service DHU. GP Specialist Adviser for CQC (inspections out of County only). Occasional GP adviser for North Derbyshire GP Federation Board. Shortly to take up contract with HSCIC providing Clinical Assurance for their articles on NHS Choices. Share holder/director of Elmpharm Ltd. Operating company of Burlington Road community Pharmacy in Buxton. Ex-partner (left 1/4/15) Elmwood Medical Centre, 7 Burlington Road, Buxton. Spouse works as Nurse Consultant to EMIS software supplier based in Leeds. Hannah Belcher No relevant Interests No spouse with relevant interests Kerrie Woods No relevant Interests No spouse with relevant interests Register of Interests Governing Body, CRG and Sub Committee December 2016

9 David Knight No relevant Interests No spouse with relevant interests Tracey Phillip Primary Care Support Officer No relevant Interests No spouse with relevant interests John Stephen Grenville Company Secretary Derby & Derbyshire LMC Services Ltd Medical Member of HM Tribunals Service Clinical Complaints Advisor to the MDU Prescribing Sub Committee Interests Richard Clarey No relevant interests Sharon Dinham Nurse representative on ND CCG Clinical Reference Group Jean Richards No relevant interests Helen Gregory No relevant interests Jane Mellor No relevant interests Kate Needham Director/Secretary (10% Shareholder) of Hollowmoor Consultancy Ltd Maxine Orwin No relevant interests Dr Tim Parkin Owner/Partner in Blackwell Pharmacy, Gloves Lane, Blackwell Derbyshire Partner Limes Medical Centre, Blackwell, Blackwell Medical Centre, Village Surgery (Pinxton & South Normanton) Member of Hardwick CCG Prescribing Lead, Learning Disabilities Lead and Research Lead Kelly Monck No relevant interests Dr Elizabeth Riches Partner of GP Practice at Chatsworth Road Medical Centre GP Partner ND CCG Chatsworth Road Medical Centre is part of North Derbyshire GP Federation Martin Shepherd No relevant interests Guillermo Sierra Area Manager for Lloyds Pharmacy and a CCA rep for Derbyshire LPC Dr Lorraine Wooster Partner to be at Stubley MC Stubley Medical Centre is part of North Derbyshire GP Federation Dr Carolyn Emslie Practice member of ND CCG Partner at Springs HC Clowne Register of Interests Governing Body, CRG and Sub Committee December 2016

10 Springs HC is part of North Derbyshire GP Federation Dr Diane Fitzsimons Director of Darley Private Healthcare Partner at Darley Dale Medical Centre Darley Dale Medical Practice is a member of the North Derbyshire GP Federation Denise Shaw No relevant interests Senior Leadership Team Interests Sarah Everest No relevant interests No spouse with relevant interests Kate Needham Director/Secretary (10% Shareholder) of Hollowmoor Consultancy Ltd No spouse with relevant interests Adam Sutherst No relevant interests No spouse with relevant interests Marie Scouse No relevant interests No spouse with relevant interests Martin Colclough No relevant interests Spouse is employed as a Deputy Director of Public Health England Aaron Gillott Treasurer and Committee member of Derbyshire Alcohol Advice Service No spouse with relevant interests Laura Joy No relevant interests No spouse with relevant interests Simon Harris Non-remuneration Director at The South Wolds Academy Governor at Willow Brook Primary School Paramedic for St Johns Ambulance Service Paramedic for EMAS No spouse with relevant interests Non remuneratory Director for East Midlands Educational Trust. Katherine Majid Spouse is Acting CEO of DHCFT Register of Interests Governing Body, CRG and Sub Committee December 2016

11 ND CCG Governing Body Assurance Committee 21 st November 2016 Paper B NORTH DERBYSHIRE CCG GOVERNING BODY ASSURANCE COMMITTEE MEETING Robert Robinson Room, Scarsdale Monday 21st November 2016 PUBLIC SESSION MINUTES Present Ian Gibbard Chair Lay Representative (Audit) Gary Apsley Lay Representative (Patient Experience) Darran Green Interim Chief Finance Officer Dr Ben Milton Clinical Leader/Chair Suzanne Pickering Head of Governance Dr Anne-Marie Spooner GP, Chesterfield Beverley Smith Chief Transformation Officer Isabella Stone Lay Representative (Patient Experience) Jayne Stringfellow Chief Nurse and Quality Officer In attendance Minute Taker Pauline Innes PA to Chief Officer Chair / Clinical Lead Juanita Murray Designated Nurse for Children in Care Apologies Steve Allinson Chief Officer Dr Debbie Austin GP, High Peak Marc Bicknell Lay Representative (Audit) Opening of Business/Standing Items GBAC Apologies for Absence Apologies for absence were received from Dr Austin and Mr Bicknell in advance of the meeting and given at the meeting for Mr Allinson. GBAC Declaration of Interests No declarations of interest were made with regard to today s agenda. No changes to the Declaration of Interest Schedule were requested. The Register of Declarations was agreed up to date. GBAC Minutes of the North Derbyshire CCG Governing Body Assurance Committee of 24 October 2016 The minutes of the meeting held on 24 October 2016 were agreed North Derbyshire CCG Public Governing Body Assurance Committee Meeting Minutes

12 ND CCG Governing Body Assurance Committee 21 st November 2016 Paper B as an accurate record subject to slight amendment of point: GBAC Finance Report: Re-word second sentence to read The CCG was currently well placed to reach its control totals. The Chair signed the minutes. GBAC Matters Arising from the Minutes of the Governing Body Assurance Committee of 24 October 2016 There were no actions arising from the minutes of 24 th October Action Log The action log was received and noted and a number of actions were closed: Action 148 GBAC584.16: Mr Allinson requested further information on practice packs so that areas of could be identified. The Committee were in agreement to close this action. Action 150 GBAC585.16: HR Policies following discussion the Committee was in agreement for this action to remain OPEN, Mrs Pickering to action. Mrs Pickering Action 152 GBAC598.16: 1.5c of the report concerning year to date variance at Sheffield Teaching Hospitals was accurate; it did not align with the information in table 4.1. Mr Smith to action The Committee was in agreement to close this action. Action 153 GBAC598.16: Mr Smith to obtain an update from NHS Hardwick CCG for GBAC meeting in November. The Committee was in agreement to close this action. Action 154 GBAC602.16: Personal Health Budgets for people with long term conditions Mrs Smith agreed to review the IFR appeals policy and amend the proposed paper for clarity. The Committee was in agreement to close this action. Action 155 GBAC605.16: Working Together Public Consultation Engagement Plan Laura Joy to pass the Committee s comments back to the plan s writer. The Committee was in agreement to close this action. GBAC EPRR Core Standards Assessment Process and Compliance Statement: Mrs Pickering provided a point of accuracy for the EPRR core standards previously presented to the Committee in October It was reported that Derbyshire Health Care (DHcFT) were partially compliant with their EPRR standards, however, since the meeting in October 2016 it has been identified that NHS England provided the incorrect information and DHcFT North Derbyshire CCG Public Governing Body Assurance Committee Meeting Minutes

13 ND CCG Governing Body Assurance Committee 21 st November 2016 Paper B are non-compliant. A letter has been received from NHS England / Hardwick CCG which, Mrs Pickering offered to circulate to the Committee for information. Mrs Pickering provided clarity to the Committee informing that Hardwick CCG are working with commissioners and NHS England. NHS England have identified a senior member of the EPRR team to work with DHcFT, a peer review will also be undertaken through Derbyshire Community Health Care Trust who are fully compliant to enable improvements by the beginning of Mrs Pickering The Committee RECEIVED and NOTED the point of accuracy. GBAC Integrated Quality Finance & Performance Improvement The Committee received the Integrated Quality, Finance and Performance Improvement report. Finance Report Mr Green presented the finance report which covered the period of October 2016, the Committees attention was drawn to page 11 listing the CCGs financial positon. Salient areas of the finance report were highlighted to the Committee. With regard to acute variances the CCG have noted that providers have been pulling in a lot of additional activity with regards to 18 week targets. This has been seen particularly at CRHFT where there has been a vast increase in activity delivered in November. However, the CCG are aware that CRHFT will not be able to continue to deliver activity at that level. It was noted that referral data appears to have peaked but has flattened out in some instances and in one or two cases is now reducing. CRHFT position and the year to date forecast variance it was noted that these are not necessarily linear. There are still a number of penalties to be applied to CRHFT, which have been agreed with CRHFT. With regards to Continuing Health Care in the past the CCG have had a considerable range in terms of what the forecast outturn can be on CHC. A lot of work has taken place between the CCG finance team and the Local Authority, this work identifies what proportion of funding sits with Health and the Local Authority. The current activity continues to rise, however, the Broadcare system that Arden & GEM are using is providing improved management information. It was noted that the CCG have used all in year contingencies and despite the CCG lobbying around the 1% non-recurrent money that was put aside at the start of the year, however, NHS England are North Derbyshire CCG Public Governing Body Assurance Committee Meeting Minutes

14 ND CCG Governing Body Assurance Committee 21 st November 2016 Paper B not disclosing how this money will be used. The Committee noted that the CCG have been clear with NHS England that the financial position for North Derbyshire CCG remains in the balance. The Committee noted that the CCG expects to meet its financial duties for 2016/17. Dr Milton referred to activity at CRHFT ahead of winter pressures and waiting lists. Dr Milton enquired if waiting lists are being monitored and are the CCG seeing a dip in waiting lists that would go with increasing activity at CRHFT. Mr Green informed that discussions have taken place with CRHFT with regards to this concern. The Committee RECEIVED and NOTED the Finance Report. Performance Report Mr Green provided an update from the performance report highlighting salient areas for attention. A&E Waiting Times CRHFT: this is the 11 th consecutive month for under performance at the Trust. CRHFT intend back on plan by March 2017, however, the CCG have little confidence that this will be achieved. Ms Stone referred to minor injury units and shared her concern with regards to low number of patients presenting to the Whitworth minor injury unit. Mr Green stated this area of work is statistically mapped in to the performance report. Mrs Stringfellow referred to CRHFT attendances in terms of large numbers of patients presenting and suggested that the CCG need to be clearer within the report. Mr Green agreed to pick this concern up with Deborah Louch and Simon Harris. Stockport FT: Performance remains to be a concern; work is currently in place with a national team who have agreed a number of actions. East Midlands Ambulance Service: EMAS achieved the locally agreed regional performance and trajectories were met in October for Red 1 however, failed to achieve the Red 2 and A19 trajectory. There is no Remedial Action Plan (RAP) in place, however, there is a joint investigation to look at delivery of targets which has been submitted. Cancer 62 Day waits: although NHS Derbyshire CCG achieved the 85% national target in August. The main concern remains to be around patients being transferred from one provider to another. A new IPT policy was introduced in October 2016 which draws a line for the originating provider at 38 days. Mixed Sex Accommodation: all cases relate to either High Dependency Unity (HDU) or the Intensive Therapy unit (ITU) where the rules do not initially apply. The main focus Mr Green North Derbyshire CCG Public Governing Body Assurance Committee Meeting Minutes

15 ND CCG Governing Body Assurance Committee 21 st November 2016 Paper B appears to be around moving patients out of these settings which should be completed within 8 hours of admission. Quality Report Mrs Stringfellow provided an overview of performance from the Quality Report highlighting salient areas for attention. Mrs Stringfellow was pleased to report to the Committee that DHU evening and overnight district nursing service and Ashgate Manor (where the north district nursing team are based) has received a good rating from the CQC for the overall service. This particularly relates to palliative care patients. Two Member practices were rated as outstanding and two were rated as good. It was noted that an overall report will be presented through Primary Care Commissioning and will be shared with practices by the end of Dr Milton suggested that it may worth undertaking an up to date search of data in terms of outstanding practices which may be worth pursuing in terms of benchmarking. The Committee RECEIVED and NOTED the quality report in particularly the CQC performance as set out in Paper D. Policies for approval GBAC Managing Conflict of Interest Policy Mrs Pickering presented this agenda item and provided an update for the Committee, highlighting key points of interest. New Guidance was published by NHS England in June The policy has been reviewed to include all the changes to ensure that the CCG are compliant. Mrs Pickering highlighted major changes to the policy: All CCGs are required to have a minimum of 3 lay representatives and the CCG have 4; Introduction of Conflicts of interest guardian; Strengthen the process for breaches which has been included in section 10 of the policy; The policy has been strengthened around decision making and also around gifts and hospitality. The CCG are required to publish registers in terms of gifts and hospitality, procurement, register of interest and breaches. All of the above have been incorporated in the new guidance. The four Derbyshire CCGs have ensured that this is consistent, North Derbyshire CCG Public Governing Body Assurance Committee Meeting Minutes

16 ND CCG Governing Body Assurance Committee 21 st November 2016 Paper B moving forwards, previously for the last quarter the CCG had to complete a self-certification for NHS England on managing conflicts of interest. In terms of training it was noted that all CCG employees are required to complete conflict of interest training, however, nothing has been received from NHS England as yet, therefore this will need to be met by January 2018 as opposed to The Committee RECEIVED and APPROVED the Managing Conflict of Interest Policy. GBAC HR Policies: Mrs Pickering provided an update to the Committee on a number of HR Policies: Recruitment and selection policy This policy has been revised with a small administration change in section 4.45 with regard to internal candidates and how that procedure is managed. Raising Concerns at Work (Whistleblowing) Policy New guidance has been received from NHS England. The CCG have now included reference to have a Freedom to Speak guardian for the CCG which Ms Stone has kindly offered to lead and the Conflict of Interest guardian Mr Gibbard as Audit Chair. The CCG have expanded the scope to include whistleblowing to all employees and sub-contractors of providers a log has also been included for the recording of all matters. The Committee RECEIVED and APPROVED the changes to the Recruitment and Selection Policy and Raising Concerns at Work and the Whistleblowing policy as set out in paper F. GBAC Information Governance Policies For Information Mrs Pickering provided an update on 5 Information Governance Policies. All policies have been recommended by the information governance committee on behalf of the 4 CCGs. All policies have been localised for North Derbyshire CCG and are mostly administration changes to bring the policies in line. These Policies will also form part of the information governance toolkit for 2016/17. The Committee RECEIVED and APROVED the 5 Information Policies as set out in paper G. North Derbyshire CCG Public Governing Body Assurance Committee Meeting Minutes

17 ND CCG Governing Body Assurance Committee 21 st November 2016 Paper B GBAC STP Operational Plan and Financial Plan Mr Green provided a brief update on the STP Operational and Financial Plan. The Committee noted that the STP is in now in the Public domain. All Commissioners and Providers are equally signed up to the broad principles of the STP. The Committee NOTED that the STP Operational Plan and Financial Plan has been published and that there is more work to be done which will be presented back the Committee in due course. GBAC Safeguarding Children Annual Report 2015/16 Mrs Murray, Designated Nurse for Children in Care, Derbyshire was present for this agenda item, welcome and introductions took place. Mrs Stringfellow reported to the Committee that children services were separated out this year prior to this the designated role was undertaken solely by Mrs Webster. It was noted that this was in response to an inspection from CQC about the CCGs resourcing against looked after children. Annual Report on Safeguarding Children 2015/16 Mrs Murray presented the Committee with an update from the Safeguarding Children Annual Report 2015/16 on behalf of Mrs Kathy Webster, salient areas were highlighted for the Committee s attention: Children subject to a child protection plan, it was noted that Chesterfield and High Peak trends remain the same. The highest number of children on a child protection plan is Chesterfield and it is felt that the reason for this is due to the urban nature of the area. The largest category of children on a child protection plan in Derbyshire is for emotional abuse which is directly linked to domestic violence. CSE one of the highest areas is High Peak and Dales for children at risk and high risk of CSE. Domestic abuse trends remain consistent with the previous year. Children in Need numbers are gradually increasing which is outlined on page 11 of the report. North Derbyshire CCG have had no Serious Case (SCR) reviews for 2015/16. The CCG did have one serious incident learning review which to date has not been published yet, however, the learning from the lessons from the review are already being implemented. North Derbyshire CCG Public Governing Body Assurance Committee Meeting Minutes

18 ND CCG Governing Body Assurance Committee 21 st November 2016 Paper B In terms of the child death overview panel CDOP it was noted that this information is not complete. The data affects completed cases only, there has been 75 child deaths and 28 of these have got completed investigations. This is due to the CDOP chairs lack of capacity, however, the work is being pulled together and there is a plan for improvement in 2016/ 17. Markers of good practice were part of the work for 2015/16. All providers were either compliant or partially compliant, with plans for improvement in The priorities for the previous years are ongoing it was noted that the new priorities are outlined on page 17 / 18 of the report these priorities focus around the Wood Report which looks at the working of the LSCB which is an equally partnership between Health / Police and children s social care. Readiness for CQC inspections, domestic abuse and work around emotional wellbeing of children and the early help process in terms of Starting Point and how the CCG teases out the early help support and resource through Starting Point. The Committee noted that all costs for Safeguarding Children are neutral with the exception of starting point which continues to be a funding challenge. The Chair enquired about the GP view on Safeguarding for Children. Dr Spooner reported that from Hasland Medical Practice point of view GPs have good working relationship with Health. GP s are invited to attend meetings and safeguarding training is provided. The Chair enquired where there are variations across the patch, in terms of CSE cases queried if any analysis was available. Mrs Murray explained that the analysis is not in the report however, Social Care do look at trends and analysis as to why this happening. It was noted that there could be a number of reasons for this one being links to cities like Manchester, also in terms of assessments for CSE and how robust the assessment process is from different practioners. It was noted that the CSE toolkit is being remodelled. Mrs Stringfellow reported this work is analysed and then reported through the children safeguarding board. From these meetings it has been recognised that children are drawn in to larger cities i.e. Sheffield and Manchester where there are particular problems. Mrs Stringfellow pointed out that the CCG had committed to the funding of Starting Point and that this is also being discussed and considered by other CCGs for approval. Ms Stone enquired about the breakdown data for children from an ethnic background. Mrs Murray explained this area of work is North Derbyshire CCG Public Governing Body Assurance Committee Meeting Minutes

19 ND CCG Governing Body Assurance Committee 21 st November 2016 Paper B undertaken by Social Care. This is a concern that has been recognised as a need for children in care, Mrs Murray agreed to feed this concern back to Mrs Webster in term of Health reporting. The Committee NOTED and RECEIVED the position in 2015/16 for Safeguarding Children. GBAC Looked after Children Annual Report 2015/16 Mrs Murray highlighted salient areas of interest from the Looked after Children Annual Report 2015/16: The annual report for children in care has been written by Agnus Lakner, Designated Doctor at Chesterfield Royal Foundation Trust and is being presented to the Committee on the Providers behalf. It was noted that the report outlines the working of the teams, the multi-agency working and meeting the responsibilities of promoting the health and well-being (2015) of looked after children which is a statutory guidance. Chesterfield Royal Hospital Foundation Trust are commissioned to provide the children in care health service for Derbyshire. At the moment they sub contract to Derbyshire Health Care who undertake the initial health assessments for children living in Southern Derbyshire. Children under 5 are seen by Health Visitors from Derbyshire Community Health Care Services. In terms of children in care it was noted at present there are 585 children in care and although numbers have decreased in this financial year, however, it is felt that the trend is increasing this inevitably will have some impact for the CCG in the next financial year. Mrs Murray highlighted salient areas of the report for the Committees attention: Chesterfield Royal Hospital had a CQC inspection in April 2015 where children in care health services was rated as good, with positive comments around collaborative working and their assessment process. A pathway for an electronic process of children s information from social care to health and back again has been implemented, prior to this it was paper led process. This was to improve the timelessness and secure the patient identifiable information. It was noted that this has been successful and continues to improve. Voices of a child very strong positive comments were received from the feedback questionnaires that children and carers are asked to complete following their health assessment. Improvements have been seen with the quality in terms of North Derbyshire CCG Public Governing Body Assurance Committee Meeting Minutes

20 ND CCG Governing Body Assurance Committee 21 st November 2016 Paper B the health assessment. Mandatory training has taken place with DCHS, health visitor teams for 2015 and improvement has been seen, also master class training has taken place with the children in care nursing team to improve quality. Areas for continued improvement remain to be around the timeliness for the initial health assessment. This is when a child comes in to care from the day they are admitted assessments need to be completed within 20 working days which is led by a paediatrician. The sub contracts sit with Derbyshire Health Care (DHcFT) and CRHFT hold the contract. CRHFT have given notice to that sub contract due to poor performance, therefore from April 2017 the initial health assessments will be completed by CRHFT for the whole of Derbyshire Children. Dental checks have reduced analysis has taken place, this is due to recording issues in social care and the lack of understanding about dental registration and actually having dental checks. Concerns supporting young people with their emotional health and wellbeing difficulties especially being able to access CAMHS in a timely manner. Ongoing discussions are taking place in terms of bidding for funding through the children s commissioners for the next financial year to look at children in care as a priority group. With regard to any financial impact for the CCG it is felt that this will increase in terms of the population of children in care this is mainly around unaccompanied asylum seeking children and will be recognised in the next financial year. Derbyshire are required to take 108 children and at the moment Derbyshire have 23 children, however, Derbyshire are being very proactive from a Local Authority perspective in taking asylum seeking children. It was noted this inevitably will have a financial impact on the CCG. Dr Milton enquired if there is additional central funding available. Mrs Murray reported that additional funding is only available for social care, conversations have taken place with the Home Office raising this as a concern. Mrs Smith suggested that the CCG should escalate and explore channels, it was noted that the Local Authority do accept that the needs of children will be impacted upon for health. The Committee felt that it would be worth raising through the Health & Wellbeing Board. Mrs Smith agreed to take this concern back at an Executive level for further consideration. The Committee NOTED the risks identified in the report and endorse the priorities for 2016/17 in supporting the outcomes for children. GBAC Safeguarding Adults Annual Report 2015/16 North Derbyshire CCG Public Governing Body Assurance Committee Meeting Minutes

21 ND CCG Governing Body Assurance Committee 21 st November 2016 Paper B Mrs Stringfellow presented the Safeguarding Adult Report for 2015/16 which has been provided by Bill Nicoll, Adult Safeguarding Chair. A variety of areas have been identified from multiagency risks assessment to vulnerable adults at harm and also the dignity in care awards. Salient areas of interest were brought the Committee s attention: Mandatory adult safeguarding training figures are disappointing for North Derbyshire CCG. Mrs Stringfellow informed the Committee that clarity will be sought to determine if training figures could be improved upon. The Safeguarding Adult agenda is not quite as well developed as the children s agenda in terms of all components fitting together, this has been one of the key focuses for In terms of legalities the adult safeguarding board needs to be on the same legal footing as the children s board. The CCG are consistently being asked for a contribution to the Adult Safeguarding Board. The CCG contribute on behalf of all health partners 146,000 to the children s board and it is felt that CCGs will be unable to provide this amount of funding to the Adult Safeguarding Board. Discussions have been taking place in terms of the total investment in safeguarding and how this might be shared more equitably. The Committee noted that there are three key statutory agents for both boards, that is Health, Police, and the Local Authority and it appears that the contributions made to these boards are not equal. The CCG have been asked for extra funding from the Adult Safeguarding Board Chair; however the CCG have explained to the local authority that the CCG are happy to participate in a review of the funding, however cost pressures the CCG do not have this amount of money to invest. Conversations have taken place with Darran Green, Interim Chief Finance Officer with regards to this funding request. Mrs Stringfellow/ Mrs Pickering The Chair referred to the Audit Committee meeting held in December 2015 when Internal Audit reported that the Safeguarding Board appeared to not have a strategy or an up to date terms of reference (TOR). Mrs Stringfellow reported the Board does now have a strategy has been strengthened and the TOR have been tightened. Chief Nurse Officers prioritise attending Safeguarding Board meetings to support Bill Nicol with this work. The Committee NOTED the position for Adult Safeguarding and thanked Mrs Stringfellow for the informative report and fully support the view on the contribution to be made by others. North Derbyshire CCG Public Governing Body Assurance Committee Meeting Minutes

22 ND CCG Governing Body Assurance Committee 21 st November 2016 Paper B Update from Sub Committees GBAC Minutes of the 21 st Century Plan Delivery Group Meeting of 10 October 2016 The Committee NOTED the minutes of the 21 st Century Plan Delivery Group held on 10 October GBAC Minutes of the CRHFT QAG Meeting of 18 July 2016 The Committee NOTED the minutes of the CRHFT QAG meeting of 18 July GBAC Minutes of DHU CMB Meeting of 7 September 2016 and Minutes of DHU QAG 26 July 2016 The Committee NOTED the minutes of the DHU CMB meeting held on 7 September 2016 and the DHU QAG meeting held on 26 July GBAC Minutes of the Prescribing Sub-Group Meeting of 5 October 2016 The Committee NOTED the minutes of the Prescribing Sub Group Meeting held on 5 October GBAC Minutes of Joint Area Prescribing Committee of 11 October 2016 The Committee NOTED the minutes of the Joint Area Prescribing Committee Meeting held on 11 October GBAC Minutes of DCHS QAG of 26 July 2016 The Committee NOTED the minutes of the DCHS QAG meeting held on 26 July GBAC Any Other Business No other business was transacted. GBAC Date and Time of Next Meeting: Monday 19 th December :30pm in the Robert Robinson Room, Scarsdale, Chesterfield, S41 7PF. Signed by:. (Chairman) Dated: North Derbyshire CCG Public Governing Body Assurance Committee Meeting Minutes

23 ACTION LOG Paper C - Action Log Public - current Governing Body Assurance Committee Closed issues are hidden Action Log Item Action Responsibility Target Date Completed Status 150 GBAC HR Policies Mrs Pickering to provide HR Policies that are consistent across all CCGs 156 GBAC EPRR Core Standards Assessment Process and Compliance Statement: Mrs Pickering to circulate letter from Arden & GEM to the Committee for information 157 GBAC Performance Report A & E waiting times: re: Large number of patients presenting at A&E CRHFT - Mr Green to discuss with Debbie Louch & Simon Harris if figures could be clearer in the report. 158 GBAC Adult Safeguarding Report: Mrs Stringfellow and Mrs Pickering to clarify training figures for CCG Staff to ascertain if figures could be improved. SP Oct-16 On-going SP 19-Dec-16 DG 19-Dec-16 JS/PI 19-Dec-16

24 NORTH DERBYSHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY ASSURANCE COMMITTEE MEETING 19th December 2016 Report Title: Integrated Finance, Performance and Quality Improvement Report Item No: 5 1. Background and context The purpose of this Integrated Quality, Finance and Performance Improvement Report is to provide Governing Body Assurance Committee members with strategic assurance and overview of the CCG s performance across a range of metrics. It is designed to facilitate the CCG assurance process and enable triangulation of quality, finance and operational performance across the CCG. 2. Key matters for consideration This report covers the period of October 2016 unless more current information is available at the time of writing the report and includes the following items: Executive Summary Finance Report 2016/17 CCG Assurance Framework Dashboard Exception Reports Local performance Indicators Programme Assurance Board Report Quality Report Quality Premium 3 Financial Impact There is no direct financial impact on the CCG with regards this report, however it should be noted that should the CCG not achieve a number of the key performance indicators contained within the CCG Assurance Framework there will be a reduction in the Quality Premium available to the CCG in 2016/17. 1

25 4. Analysis of risk If the CCG fails to deliver against national and local standards it will have failed to deliver quality and outcomes for patients, which constitutes clinical risk. In addition, as described in section 3, if the CCG fails to achieve a number of the key performance indicators contained within the CCG Assurance Framework there will be a risk that the CCG will not attract the Quality Premium payment available to the CCG in 2016/17. This paper mitigates against these risks by ensuring that Governing Body Assurance Committee retain oversight of the CCG s performance against key national and local standards and are able to take remedial action as required and hold the organisation to account. 5. Equality Impact Please describe how this report and/or the services described within it aid the CCG in achieving the objectives of the Equality Delivery system, namely: Better health outcomes for all and improved patient access and experience: This report provides Governing Body Assurance Committee with an effective performance management mechanism that will ensure the CCG delivers national and local standards by commissioning safe, quality care for patients that improves outcomes, secures access and ensure an excellent patient experience. Empowered, engaged and well-supported staff/inclusive leadership at all levels: This report ensures that through effective performance management the CCG s staff will be empowered, engaged and supported to deliver. It will also ensure that the CCG commissions services from providers that demonstrate the values and behaviors encouraged within the CCG. 6. Recommendations Governing Body Assurance Committee is asked to: Note the October 16 CCG Financial Position, (page 8). Note the CCG s position against the CCG Assurance Framework Dashboard and identify any areas of concern that require information or analysis that the Governing Body feels necessary in the next report, (page 23). Note the amber QIPP position, (page 28). Note the Quality Premium Report, (page 74). 2

26 Author: Carl Twibey, Head of Financial Management Laura Joy, Deputy Chief Nurse Martin Colclough, Assistant Chief Finance Officer Adam Sutherst, Assistant Chief Finance Officer for Planning and Performance David Beardow, Assistant Governance Officer Sarah Darracott-Hawkins, Programme Support Officer Sponsor: Darran Green, Interim Chief Finance Officer Jayne Stringfellow, Chief Nurse and Quality Officer Date: 9 th December

27 Integrated Finance, Performance and Quality Improvement Report Governing Body Assurance Committee Date of Meeting: Monday 19th December

28 Integrated Finance, Performance and Quality Improvement Report Contents Table Executive Summary Finance Report /17 CCG Assurance Framework Dashboard Exception Reports Local Performance Indicators Programme Assurance Board Quality Report Quality Premium

29 Executive Summary Purpose The purpose of this summary report is to provide Governing Body Assurance Committee members with strategic assurance and overview of the Clinical Commissioning Group s performance across a range of metrics. The items highlighted within this summary covers the period of October 2016 unless more current information is available at the time of writing the report. Key Highlights NHS North Derbyshire CCG met the national standard for referral to treatment incomplete pathways within 18 weeks during October 16, (page 24). NHS North Derbyshire CCG met the national cancer standards for the proportion of people being seen within two weeks of an urgent referral, the proportion of people being treated within two weeks of referral during October 16, (page 25). NHS North Derbyshire CCG met the national target of 1% for diagnostic test waiting times proportion over 6 weeks during October 16, (page 24). NHS North Derbyshire CCG continued to meet the 66.7% national standard for dementia diagnosis rate during October 16. The CCG has also reached the sett Quality Premium standard in October 16, (page 26). NHS North Derbyshire CCG continued to meet the national IAPT standards for the proportion of people entering treatment, the proportion moving towards recovery, and waiting times during October 16, (page 26). NHS North Derbyshire CCG continued to meet the national standards for waiting times for early intervention in psychosis during October 16, (page 26). NHS North Derbyshire CCG are reporting no MRSA cases during October 16, and are below their C-Diff trajectory YTD, (page 26). CRHFT is performing exceptionally well against its ceiling of 31 cases of C Diff per year, with only two cases to date identified. (page 26) NHS North Derbyshire CCG has had no patients in mixed sex accommodation at CRHFT during October 16, (page 26) 6

30 Key Risk Areas NHS North Derbyshire CCG did not meet the 95% national standard for A&E waiting times during October 16, (91.5%). This is the twelfth consecutive month of underperformance for the CCG. Chesterfield Royal Hospital, Sheffield Teaching Hospitals, and Stockport Hospital also did not meet the national standard during October 16, (91.8%, 85.6%, and 77.6% respectively), (page 30). NHS North Derbyshire CCG has not met the national cancer standards for 62 days waits, first treatment administered within 62 days of urgent GP referral and screening referral during October 16, (page 37). NHS North Derbyshire CCG has not met the national cancer standards for the cancer 31 day waits subsequent radiotherapy within 31 days of decision to treat for October 16, (page 39). NHS North Derbyshire CCG has not met the number of 52 week + referral to treatment pathways/incomplete pathways during October 16, (page 29) East Midlands Ambulance Service continued to underperform against the national ambulance response time standards during October 16. Red 1 (62.1% against 75% standard), Red 2 (61.3% against 75% standard), A19 (84.8% against 95% standard), (Page 33) Outcome of Assurance Meetings The annual meeting to review North Derbyshire CCG s 2015/16 performance took place on the 19 th April The CCG received confirmation that the CCG has been given a rating of Good. The 2016/17 Quarter One meeting took place on 11 th August 16 and went positively. The 2016/17 Quarter Two meeting took place on 17 th October 16. Recommendations Note the October 16 CCG Financial Position, (page 8). Note the CCG s position against the CCG Assurance Framework Dashboard and identify any areas of concern that require information or analysis that the Governing Body feels necessary in the next report, (page 23). Note the amber QIPP position, (page 28). Note the Programme Assurance Board report, (page 46) Note the Quality Premium Report, (page 74). 7

31 Finance Report Financial position for the period

32 1 Finance Report ( ) The purpose of this report is to inform the CCG Governing Body Assurance Committee of the financial performance and position of the CCG. 2 Summary Finance Headlines Table 2.1 below shows the financial performance highlights for the year to date as well as the forecast year end position. Table 2.1 North Derbyshire CCG Finance Performance as at 30 November 2016 Performance Measure/Duty Target YTD Actual YTD Achievement % RAG Rating Target for Year Forecast Achievement Forecast Achievement % RAG Rating Report Section Control Total ( '000) 2,717 2, G 4,076 4, G 4.3 Running Costs ( '000) 4,167 4, G 6,329 6, G 4.2 & 12 QIPP ( '000) 7,340 5, A 12,958 9, A 11 Expenditure Run Rate ( '000) 291, , G 437, , G 4.3 Cash Drawdown ( '000) 297, , A 446, , G 7 Closing Cash Balance (% of drawdown) G G 7 BPPC NHS Value (%) G G 9 BPPC NHS Volume (%) G G 9 BPPC Non NHS Value (%) G G 9 BPPC Non NHS Volume (%) G G 9 9

33 3 CCG Financial Position The CCG receives regular updated confirmation of its Programme (commissioning of healthcare) resources and Admin resource which currently stand at 435,675,000 and 6,329,000 respectively. Tables 3.1 shows the allocation summaries split between Programme and Admin and the total resources available to the CCG. Table 3.1 Resource Limit 000 Programme Resource Limit 1 st November ,165 Charge Exempt Overseas Visitors (490) Total Programme Resource Limit 30th November ,675 Admin Resource Limit 1 st November ,329 No change in month - Total Admin Resource Limit 30 th November ,329 Total CCG Resource Limit November ,004 The above resource limit position includes the non-recurrent allocation of the underspend of 6,029, Summary Financial Position The CCG financial position has been analysed in accordance with the requirements of the ISFE (Integrated Single Financial Environment). This is a national financial system used by all CCGs and NHS England. It allows NHS England and the DoH to extract data directly from CCG ledgers as they are all on the same platform. Table 4.1 highlights the CCG Programme financial position at a summary level. 10

34 Table 4.1 Summary Financial Position North Derbyshire CCG (Programme Resources) Annual Budget YTD Budget YTD Actual YTD Variance Year End Forecast Variance Year End Var as % of Ann Bud Report Section '000 '000 '000 '000 '000 % Acute Services Chesterfield Royal Hospital FT 125,052 83,386 83,908 (522) (735) Stockport FT 22,224 14,816 14,986 (170) (221) Sheffield Teaching Hospitals FT 19,861 13,241 14,198 (957) (1,000) EMAS 8,274 5,516 5, East Cheshire NHS Trust 5,361 3,574 3,666 (92) (106) Royal Derby Hospital FT 2,749 1,833 1, Central Manchester University Hospitals 1,826 1,217 1,237 (20) (33) 1.81 Sheffield Children's Hospital FT 1, ,050 (115) (157) University Hospital of South Manchester 2,001 1,334 1, Derbyshire Community Health Service NHS FT 6,513 4,342 4, Other Acute Providers - NHS 5,974 3,978 4,306 (328) (664) Other Acute Providers - Non NHS 9,046 6,017 6,989 (972) (1,230) Non Urgent Patient Transport 2,448 1,576 1, , , ,756 (2,991) (3,883) 1.83 Mental Health Services Derbyshire Healthcare FT 23,064 15,376 15,392 (16) Derbyshire Community Health Service NHS FT 14,270 9,513 9, Other Mental Health Providers 7,007 4,650 4,780 (130) ,341 29,539 29,639 (100) Community Services Derbyshire Community Health Service NHS FT 32,898 21,932 21, Other Community Providers 2,404 1,602 1,719 (117) (175) 7.28 Hospices 2,739 1,826 1,855 (29) (45) 1.64 Voluntary Sector Individual Funding Requests Oxygen Contract (34) (50) 9.73 Better Care Fund 11,436 7,624 7, ,958 34,073 34,076 (3) (129) 0.25 Primary Care Local Enhanced Services 3,668 2,612 2, Basket of Services 3,790 2,526 2, Practice Prescribing 45,014 30,038 30,516 (478) (524) Central Prescribing (21) Out of Hours 4,574 3,044 3,068 (24) (36) 0.79 Primary Care Other (130) Co-Commissioning 37,360 24,857 24, ,828 64,025 63, Continuing Health Care Continuing Health Care 17,759 11,980 13,449 (1,469) (1,218) Funded Nursing Care 2,956 1,971 2,639 (668) (1,002) Continuing Health Care Children 1,505 1,003 1,033 (30) (45) 2.99 Arden & GEM CHC SLA 1, ,358 15,712 17,876 (2,164) (2,265) 9.70 Operational Costs (Non-Running Costs) Transformation & Commissioning Nursing & Quality (28) (26) 0.00 Property Services 0 0 (73) Arden & GEM Integrated Care Programmes Management Team (42) (264) ,525 1, (121) 7.93 In-Year Contingencies and Reserves In-Year Contingency & Allocations (3,642) 0 (2,511) 2,511 3, % Non Recurrent Reserve 4, In-Year Risk Contingency 2,210 2, ,210 2, Control Total 4,076 2, ,717 4, ,933 4,927 (2,511) 7,438 9, Total Programme Resources 435, , ,500 2,557 3,

35 Table 4.2 highlights the CCG Admin financial position at a summary level. Table 4.2 Summary Financial Position North Derbyshire CCG (Admin Resources) Annual Budget YTD Budget YTD Actual YTD Variance Table 4.3 highlights the CCG Overall financial position at a summary level. Year End Forecast Variance '000 '000 '000 '000 '000 Operational Costs (Running Costs) Board And Management Team 1, (56) Transformation & Commissioning 1,893 1,262 1, Finance 1, IM&T Nursing & Quality Arden & GEM 1, (1) 0 NHS Property Services (10) Total Admin Resources 6,329 4,167 4, Table 4.3 Summary Financial Position North Derbyshire CCG (Total Resources) Annual Budget YTD Budget YTD Actual YTD Variance Year End Forecast Variance '000 '000 '000 '000 '000 Total Programme Resources 435, , ,500 2,557 3,896 Total Admin Resources 6,329 4,167 4, Total CCG Resources 442, , ,507 2,767 4,076 5 Key Issues The CCG has a statutory obligation to not exceed its resource limit. The CCG has a planned underspend for of 4,076,000. The month 8 underspend is reported at 2,717,000 and remains in line with the CCG s plan at this stage of the year. The information contained in table 4.1 is based on 7 month s healthcare activity information for most providers and a 3 year rolling average of the prescribing information using the most recent data for September Chesterfield Royal The overall year to date position at Chesterfield Royal Hospital NHSFT has moved due to an overperformance in elective inpatient activity which is not anticipated to recover this financial year. Partially offsetting the elective overperformance is an underspend on high cost drugs where a delay has been seen on the uptake of NICE drugs added to formulary in September. These drugs are now starting to be prescribed therefore the underspend will not continue at the same rate. The year-end forecast has been revised to show an overspend of 735,000. This is mainly 12

36 due to a penalty the CCG previously expected to enact as the Trust looked to be on course to fail an ASI (available slot initiative) target. However, the Trust now appears to be able to meet the target as they have introduced additional capacity to their system. Table 5.1 below shows Chesterfield Royal s performance at a point of delivery level for the first 7 months of the year and it shows the position before the CCG has made adjustments for penalties. Table Chesterfield Royal Activity and Costs To Date by Point of Delivery POD Activity Plan Cost Plan '000 Activity Actual Cost Actual '000 Activity to Date Variance Cost to Date Variance '000 Activity Variance % Cost Variance % A&E 30,619 3,567 29,184 3,444 1, % 3.44% Elective 11,725 11,819 12,209 12,455 (484) (636) (4.13%) (5.38%) Non Elective 15,668 25,248 16,108 25,864 (440) (616) (2.81%) (2.44%) Outpatients First 21,605 3,351 22,522 3,469 (917) (118) (4.24%) (3.51%) Outpatients Follow Up 49,756 4,919 49,734 4, % 1.36% Outpatient Procedures 12,405 2,149 12,677 2,259 (272) (111) (2.19%) (5.16%) Non Tariff 503,392 21, ,826 21,402 (22,434) 2 (4.46%) 0.01% Total 645,171 72, ,260 73,746 (23,089) (1,289) (3.58%) (1.78%) 5.2 Stockport The forecast position at Stockport NHSFT has deteriorated to a 221,000 overspend. This is due to the high volume of elective inpatients being treated above the planned levels. Discussions with the lead commissioner and the Trust indicate that this is expected to continue for the remainder of the financial year as waiting lists continue to be reduced. It is assumed that all other areas will continue in line with plan until year-end which means that the position will not improve from its current position. The month 8 position shows an overspend of 170, Sheffield Teaching Hospitals The position at Sheffield Teaching Hospitals has not changed from last month which means the forecast overspend of 1,000,000 remains the most likely year end position. The over performance seen earlier in the year hasn t continued so the year to date overspend of 957,000 isn t expected to move significantly. Table 5.3 shows the POD data at Sheffield Teaching Hospitals. 13

37 Table Sheffield Teaching Hospital Activity and Costs To Date by Point of Delivery POD Activity Plan Cost Plan '000 Activity Actual 5.4 East Cheshire Trust The latest activity data received from the Trust show a large overperformance in month which moves the year to date by 94,000. The CCG has worked with the Trust in November to review their referral data and have produced a joint forecast which shows a position of 106,000 overspent by the end of the financial year. 5.5 Other Acute NHS The movement in the Other Acute Providers NHS spend relates to Non Contracted Activity invoices. This type of activity does not require prior approval for individual patients under 50,000 which makes forecasting difficult. The invoices received to date are higher than those received in prior years for the same period which has led to the forecast year end position to deteriorate. The forecast position shows an expected overspend of 664,000 for the year which is 226,000 worse than last month. 5.6 Practice Prescribing The forecast for practice prescribing uses the PPA information and their latest published forecast figures. This shows a forecast year end overspend position of 524,000. The forecast position has worsened from last month and is driven by an increase in prescribing volumes. 5.7 Primary Care Co-Commissioning Cost Actual '000 Activity to Date Variance The primary care co-commissioning position is detailed in table 5.7: Cost to Date Variance '000 Activity Variance % Cost Variance % A&E 2, , % 4.70% Elective 4,227 3,393 4,720 3,956 (493) (563) (11.67%) (16.59%) Non Elective 1,155 2,450 1,085 2, % 0.70% Outpatients First 5, , % 7.38% Outpatients Follow Up 13,145 1,185 13,675 1,239 (530) (54) (4.04%) (4.54%) Outpatient Procedures 3, , (410) (81) (13.46%) (18.15%) Non Tariff 1,212 1,298 1,470 1,557 (258) (259) (21.33%) (19.98%) Cost and Volume Total 30,134 9,781 31,355 10,652 (1,221) (871) (4.05%) (8.91%) Cost Per Case 1,352 1,391 (39) Total 30,134 11,133 31,355 12,043 (1,221) (910) (4.05%) (8.18%) 14

38 Table 5.7 Primary Care Co-Commissioning Detail Annual Budget YTD Budget YTD Actual YTD Variance Year End Forecast Variance '000 '000 '000 '000 '000 Premises Cost Reimbursement 5,106 3,421 3, Other Premises Costs Dispensing/Prescribing Doctors 1, Enhanced Services 1,881 1,234 1, General Practice - GMS 5,707 3,801 3, General Practice - PMS 16,136 10,752 10,753 (1) 0 Other GP Services QOF 4,205 2,820 2,820 (0) 0 Co-Commissioning Reserves General Practice - APMS 2,186 1,557 1, Total Primary Care Co Commissioning 37,360 24,857 24, The NHS England Primary Care team manage the transactions and payments for primary care co-commissioning. 5.8 Continuing Healthcare (CHC) A Financial Service Improvement Plan is in place with the Arden & GEM CHC team with actions to improve system access for CCG staff, on-going data quality validation for reporting and NHSE benchmarking and review the process in place across the county. As part of the recent data quality validation of joint funded cases a review of the responsible commissioners was undertaken. The impact has now been reflected in the year to date and year end forecast positions. Over the next month the CCG will work with the Arden & GEM CHC team to review the top 20 high cost patients to ensure that a review has taken place in line with guidance and that the care is still clinically appropriate, as well as cost effective. The quarter 2 NHS England benchmarking data released in November has highlighted that the CCG is a significant outlier in terms of the number of CHC packages approved, both joint funded with the County Council and fully funded by the CCG. The sample looks at 209 commissioning organisations and the CCG is ranked as the 7 th highest CCG with regards to joint funded packages. This equates to 58 joint funded packages per 50,000 population compared to the average of 12 packages in the rest of the sample. The CCGs fully funded packages are ranked 27 th out of 209 with 32 packages per 50,000 population compared to an average of 19 packages per 50,000 in the rest of the sample. A review of the historic joint funded packages has been agreed to look at the decision process behind the joint funding agreement and the reasoning behind the financial percentage split. A meeting is being held on the 12 th December with the new service provider who will take over from Arden & GEM from April The aim is for the new provider to gain insight into the current service provision, what works well and identify any problem areas and ongoing 15

39 work which may cross over from the current Service Improvement Plan and require input from April. There is a considerable amount of risk within the CHC forecast which currently shows a forecast overspend of 1,218, Contingencies and Reserves The CCG has a target underspend of 4,076,000 which has been agreed with NHS England. The CCG holds this as a separate reserve. The CCG holds an in year risk contingency totalling 2,210,000 to mitigate financial risk within the financial plan and in year risk of adverse variances against budget. The risk contingency was fully used earlier in the year. CCGs are required to hold a non recurrent reserve of 1% of their resource (based on the original planned allocation) which they are not permitted to use. The CCG is therefore showing this reserve as uncommitted although NHS England retains control of how and when it will be utilised. Table 6.1 sets out the contingencies held by the CCG: Table 6.1 Contingencies and Reserves Held Uncommitted Planned underspend 4,076 4,076 In-Year Risk Contingency 2, % Non Recurrent Reserve 4,289 4,289 Non Recurrent Measures (3,642) 0 6,933 8,365 Total as a % of Resource Limit 1.57% 1.89% In light of the challenging financial position all underspends return to the control of the Chief Finance Officer and any additional investment must be signed off by the Chief Finance Officer. 7 CCG Cash Management In addition to the CCG having a resource limit it also has to operate within a maximum cash drawdown envelope. The maximum cash drawdown is the CCG s share of NHS England s cash limit. The CCG can drawdown up to this total into the CCG GBS (Government Banking System) account to pay its commitments, for example commissioned healthcare and staff costs. The estimated maximum cash drawdown amount currently stands at 446,250,000. During the period April to November the CCG has drawn (including topsliced cash for prescribing) 301,986,000 of its available cash limit which equates to 67.67% of the current available cash. 16

40 In November there was a national exercise looking at the working capital requirements of CCGs. The CCG requested additional cash limit of 7m and this has been confirmed by NHS England and is included within the updated maximum cash drawdown amount. The CCG held a cash balance in its bank of 0.63% of the monthly drawdown as at 30 th November This was in line with the NHS England cash target of less than 1.25%. 8 Statement of Financial Position As a statutory body the CCG has to adhere to International Financial Reporting Standards (IFRS) and best practice indicates that certain financial statements need to be reported to the Governing Body on a regular basis. Table 8.1 details the CCG Statement of Financial Position. Table 8.1 North Derbyshire CCG - Statement of Financial Position Closing Balance 30th November 2016 Closing Balance 31st October 2016 Movement in Period `000 `000 `000 Non Current Assets Plant, Property and Equipment Intangible Assets Total Non Current Assets Current Assets Inventories Receivables 11,557 11, Cash at Bank / OPG Total Current Assets 11,614 11, Current Liabilities (Due within 1 year) Payables (24,377) (25,507) 1,130 Provisions for Liabilities and Charges Borrowings Total Current Liabilities (24,377) (25,507) 1,130 Net Current Assets / (Liabilities) (12,763) (14,111) 1,348 Non Current Liabilities Payables Provisions for Liabilities and Charges Total Non Current Liabilities Total Assets / (Liabilities) (12,763) (14,111) 1,348 Tax Payers Equity General Fund (12,763) (14,111) 1,348 Revaluation Reserve Total Tax Payers Equity (12,763) (14,111) 1,348 17

41 9 Better Payments Practice Code The CCG has a responsibility to meet the Better Payments Practice Code (BPPC). This focuses on the speed at which the CCG pays its invoices to the private sector and to other NHS organisations. The target is to pay 95% of invoices, in terms of value and volume, within 30 days. The CCG is currently meeting all four cumulative targets and expects this to continue for the remainder of the year. November s results showed continuous good performance on NHS invoices and a good improvement on the Non NHS invoices which had previously been reported as being below the CCG s expectation. 10 Aged Debt Table 10.1 shows the level of debt owed to the CCG and the length of time this debt has been outstanding. Table 10.1: Aged Debtors performance Non NHS NHS Not Yet Overdue Overdue 1-30 Days Overdue 31 Days + Not Yet Overdue Overdue 1-30 Days Overdue 31 Days + Volume Value 369, ,011 41, ,980 44,983 19, QIPP The CCG set a challenging QIPP target of 12,958,000 for At month 8 the full year QIPP forecast stands at 9,735,000 and 5,877,000 has been delivered to date. Table 11.1 below shows the split between QIPP delivered against the original programmes as identified by the Programme Management Office (PMO) along with the additional transactional QIPP identified during the year. 18

42 Table 11.1: QIPP Plan Programme Original Planned Delivery '000 Updated Planned Delivery '000 Year to Date Planned Delivery '000 Actual Year to Date Delivery '000 Variance '000 Balance to be Delivered '000 Acute 7,433 2,315 3,804 1,114 (2,690) 1,201 Mental Health (204) (1) Community Health 1, (336) 209 Continuing Care Primary Care Services 1,690 1,996 1,131 1,122 (9) 874 Other Programme Services Primary Care Co-Commissioning Running Costs (22) QIPP per PMO 11,143 5,363 6,132 2,960 (3,172) 2,261 Acute 0 1, ,020 1, Mental Health Community Health Continuing Care 1,815 1,814 1,208 1, Primary Care Services Other Programme Services Primary Care Co-Commissioning Running Costs Total of transactional QIPP 1,815 4,376 1,208 2,918 1,710 1,600 QIPP Total 12,958 9,739 7,340 5,878 (1,462) 3,861 A number of non recurrent QIPP savings have been identified which partially offset the slippage on the planned schemes. However, as these additional savings are predominantly non recurrent they offer a temporary in year solution but do not help the underlying position and mean the QIPP requirement for and beyond is going to be even more challenging. 12 Running Costs The CCG has a Running Cost allocation in of 6,329,000 which is a 0.2% reduction from the previous year. NHS England have calculated CCGs running cost allocations based on population figures from the Office of National Statistics rather than the patients registered at GP Practices. The patients registered at GP practices in North Derbyshire are 292,248 (per NHS England January 2016). The latest forecast expects this year s running cost to underspend by 180,000. This underspend on running costs will offset overspends within programme areas. Table 12.1 identifies the forecast CCG running costs and Table 12.2 shows the running cost and head count per directorate. Table 12.1: Running Costs CCG Population Running Costs / Head 000 Available Funds 286,824 6,

43 Table 12.2: Running Costs by Directorate Annual Annual Actual FOT Plan Plan YTD / Head / Head WTE WTE Board and Management Team Transformation & Commissioning Finance Nursing & Quality NHS Property Services Arden & GEM Running Costs Underlying Position The underlying position is a measure to calculate the CCG s anticipated overall non recurrent spend from recurrent resources and is reported monthly to NHS England. The CCG s underlying position has been recalculated and now stands at (1.18%) as shown below in table 13.1 This is a change from the previous month and reflects the level of in-year benefits which has been applied to support recurrent spending above initial plans. Table 13.1: Current Underlying Position Recurrent funding used non recurrently '000 1% Non Recurrent Reserve 4, % Risk Reserve 2,209 APMS additional costs 188 Contribution to national CHC risk share 422 Non Recurrent QIPP delivery (3,496) Other Non Recurrent Benefits supporting the position (8,743) Total (5,131) Recurrent Resource Limit 436,045 Percentage used non Recurrently (1.18%) 14 Virement Tables 14.1 to 14.3 show the budget virements for the period 1st August 2016 to 30th November Overall the CCG budget has reduced by 119,000 during this period as a result of resource allocations and adjustments. 20

44 Table 14.1 Virement to 30th November Programme Annual Annual Budget 30th Budget 31st November July 2016 Annual Budget Movement Comment '000 '000 '000 Acute Services Chesterfield Royal Hospital FT 125, ,052 0 Stockport FT 22,224 22,224 0 Sheffield Teaching Hospitals FT 19,861 19,861 0 EMAS 8,274 8,274 0 East Cheshire NHS Trust 5,361 5,361 0 Royal Derby Hospital FT 2,749 2,749 0 Central Manchester University Hospitals 1,826 1,826 0 Sheffield Children's Hospital FT 1,403 1,403 0 University Hospital of South Manchester 2,001 2,001 0 Derbyshire Community Health Service NHS FT 6,513 6,513 0 Other Acute Providers - NHS 5,974 5,974 0 Other Acute Providers - Non NHS 9,046 8, Claremont and One health. Previously classed as specialist and commisioned by NHS England. CCG now holds the budget for these. Non Urgent Patient Transport 2,448 2, , , Mental Health Services Derbyshire Healthcare FT 23,064 23, Community Practitioner Nurse. DCHS FT 14,270 14,270 0 Other Mental Health Providers 7,007 6, k futures in mind. 152k eating disorders. 63k childrens and young persons waiting times. 44,341 43, Community Services DCHS NHS Trust 32,898 32,898 0 Other Community Providers 2,404 2,404 0 Hospices 2,739 2,749 (10) Identified 10k budget that is no longer required. Moved to reserves. Voluntary Sector Individual Funding Requests Oxygen Contract Better Care Fund 11,436 11, ,958 50,968 (10) Primary Care Local Enhanced Services 3,668 3, GPs funded for winter pressures. Basket of Services 3,790 3,790 0 Practice Prescribing 45,014 45,014 0 Central Prescribing Out of Hours 4,574 4,599 (25) Addition of funding for A&E streaming service which had not been in contract baseline as it was funded non-recurrently in Primary Care Other Co-Commissioning 37,360 37, ,828 95, Continuing Health Care Continuing Health Care 17,759 17,759 0 Funded Nursing Care 2,956 2,956 0 Continuing Health Care Children 1,505 1,505 0 Arden & GEM CHC SLA 1,138 1, ,358 23,358 0 Operational Costs (Non-Running Costs) Transformation & Commissioning Nursing & Quality Property Services Arden & GEM Integrated Care Programmes Management Team ,525 1,525 0 In-Year Contingencies and Reserves In-Year Contingency & Allocations (3,642) (1,320) (2,322) Budget moved from reserves to contract areas above. 490k reduction in allocation for overseas visitors. 1% Non Recurrent Reserve 4,289 4,289 In-Year Risk Contingency 2,210 2,210 0 Control Total 4,076 4, ,933 9,255 (2,322) Total Programme Resources 435, ,794 (119) Allocations received 21

45 Table 14.2 Virement to 30th November Running Costs Annual Annual Budget 31st Budget 31st July 2016 July 2016 Annual Budget Movement Comment '000 '000 '000 Operational Costs (Running Costs) Board And Management Team 1,518 1,518 0 Transformation & Commissioning 1,893 1, Movmement between Transformation and Finance Finance 1,350 1,370 (20) Movmement between Transformation and Finance IM&T Nursing & Quality Arden & GEM 1,127 1,127 0 NHS Property Services Total Admin Resources 6,329 6,329 0 Table 14.3 Virement to 30th November Total Annual Budget 31st July 2016 Annual Budget 31st July 2016 Annual Budget Movement '000 '000 '000 Comment Total Programme Resources 435, ,794 (119) Allocations received Total Admin Resources 6,329 6,329 0 Total CCG Resources 442, ,123 (119) Allocations received 15 Recommendations The Governing Body Assurance Committee is asked to receive and approve the report. Darran Green Interim Chief Finance Officer 22

46 2016/17 CCG Assurance Framework Dashboard The CCG Assurance Framework is designed to give assurance that CCGs are delivering quality and outcomes for patients, both locally and as part of the national standards, as well as being the basis for assessing that they are continuously improving from the start point of authorisation. 23

47 2. CCG Assurance Framework Dashboard The delivery dashboard measures the overall performance of NHS North Derbyshire CCG and is fed by a number of indicators outlined in the CCG Assurance Framework Report. The delivery dashboard results will inform the formal check point meetings with NHS England on a quarterly basis and informal monthly meetings. 2.1 NHS Constitution NHS North Derbyshire CCG Chesterfield Royal Hospital Foundation Trust Stockport Foundation Trust Derbyshire Community Health Services NHS Trust Sheffield Teaching Hospitals Foundation Trust Exception Reported Indicator Name Period Standard / Plan Current Month Current Quarter Year To Date Current Month Current Quarter Year To Date Current Month Current Quarter Year To Date Current Month Current Quarter Year To Date Current Month Current Quarter Year To Date Referral To Treatment Waiting Times (RTT) For Non-Urgent Consultant-Led Treatment Referrals To Treatment Incomplete Pathways - % Within 18 Weeks Number of 52 Week+ Referral To Treatment Pathways - Incomplete Pathways Oct-16 92% 92.9% 92.9% 93.2% 92.4% 92.4% 93.2% 91.5% 91.5% 91.2% 96.0% 96.0% 96.4% 93.7% 93.7% 93.0% Oct Diagnostic Test Waiting Times A&E Waiting Times Diagnostic Test Waiting Times - Proportion Over 6 Weeks Oct-16 1% 0.7% 0.7% 1.0% 0.8% 0.8% 0.8% 0.3% 0.3% 0.5% 0.0% 0.0% 0.0% 0.3% 0.3% 1.8% A&E Waiting Time - Proportion With Total Time In A&E Under 4 Hours Oct-16 95% 91.5% 91.5% 89.6% 91.8% 91.8% 88.1% 77.6% 77.6% 79.1% 100.0% 100.0% 100.0% 85.6% 85.6% 89.0% Number Of Trolley Waits In A&E Oct

48 NHS North Derbyshire CCG Chesterfield Royal Hospital Foundation Trust Stockport Foundation Trust Derbyshire Community Health Services NHS Trust Sheffield Teaching Hospitals Foundation Trust Exception Reported Indicator Name Period Standard / Plan Current Month Current Quarter Year To Date Current Month Current Quarter Year To Date Current Month Current Quarter Year To Date Current Month Current Quarter Year To Date Current Month Current Quarter Year To Date Cancer Waits - 2 Week Waits (2WW) All Cancer Two Week Wait - Proportion Seen Within Two Weeks Of Referral Breast Symptoms Two Week Wait - Proportion Seen Within Two Weeks Of Referral Oct-16 93% 94.8% 94.8% 94.4% 93.3% 93.3% 93.6% 95.7% 95.7% 96.8% 94.4% 94.4% 94.3% Oct-16 93% 98.6% 98.6% 97.4% 100.0% 100.0% 98.2% 98.3% 98.3% 98.6% 99.4% 99.4% 98.2% Cancer Waits - 31 Days Cancer 31 Day Waits - First Treatment Administered Within 31 Days Of Diagnosis Cancer 31 Day Waits - Subsequent Surgery Within 31 Days Of Decision To Treat Cancer 31 Day Waits - Subsequent Drug Treatment Within 31 Days Of Decision To Treat Cancer 31 Day Waits - Subsequent Radiotherapy Within 31 Days Of Decision To Treat Oct-16 96% 98.1% 98.1% 98.3% 98.0% 98.0% 99.5% 98.5% 98.5% 98.1% 98.3% 98.3% 96.7% Oct-16 94% 100.0% 100.0% 96.8% 100.0% 100.0% 98.6% 100.0% 100.0% 100.0% 97.5% 97.5% 97.1% Oct-16 98% 100.0% 100.0% 99.6% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.9% Oct-16 94% 90.0% 90.0% 94.6% 95.7% 95.7% 97.1% Cancer Waits - 62 Days Cancer 62 Day Waits - First Treatment Administered Within 62 Days Of Urgent GP Referral Cancer 62 Day Waits - First Treatment Administered Within 62 Days Of Screening Referral Cancer 62 Day Waits - First Treatment Administered Within 62 Days Of Consultant Upgrade Oct-16 85% 70.5% 70.5% 79.7% 68.6% 68.6% 81.8% 87.6% 87.6% 89.4% 80.6% 80.6% 79.7% Oct-16 90% 89.5% 89.5% 93.8% 90.5% 96.8% 94.4% 100.0% 100.0% 100.0% 92.6% 93.9% 93.5% Oct-16 N/A 60.0% 60.0% 88.0% 100.0% 100.0% 85.7% 72.0% 72.0% 85.5% 89.7% 89.7% 77.2% NHS North Derbyshire CCG East Midlands Ambulance Service Ambulance Response Exception Reported Indicator Name Ambulance - Proportion Of Category A (Red 1) Calls With Response Within 8 Minutes Ambulance - Proportion Of Category A (Red 2) Calls With Response Within 8 Minutes Ambulance - Proportion Of Category A Calls With Transport At Scene Within 19 Minutes Period Standard / Plan Current Month Current Quarter Year To Date Current Month Current Quarter Year To Date Oct-16 75% 62.1% 62.1% 66.3% 67.8% 67.8% 68.9% Oct-16 75% 61.3% 61.3% 62.2% 46.8% 46.8% 55.8% Oct-16 95% 84.8% 84.8% 86.3% 84.5% 84.5% 85.2% Chesterfield Royal Hospital FT Stockport FT Ambulance Turnaround Exception Reported Indicator Name Ambulance Handover Time - Ambulance Handover Delays Of Over 30 minutes Ambulance Handover Time - Ambulance Handover Delays Of Over 1 Hour Period Standard / Plan Current Month Current Quarter Year To Date Current Month Current Quarter Year To Date Oct-16 Reduction Oct-16 Reduction

49 NHS North Derbyshire CCG Derbyshire Healthcare FT Talking Mental Health (Derbyshire Healthcare IAPT) Trent PTS Insight Healthcare Exception Reported Indicator Name Period Standard / Plan Current Month Current Quarter Year To Date Current Month Current Quarter Year To Date Current Month Current Quarter Year To Date Current Month Current Quarter Year To Date Current Month Current Quarter Year To Date CPA follow up within 7 days 16/17 Q2 95% 100.0% 97.6% 95.2% 96.3% Dementia diagnosis rate Oct-16 67% 71.9% 71.9% 71.1% Mental Health Plan 1.50% 1.50% 10.50% IAPT - Number Entering Treatment As Proportion Of Oct-16 Estimated Need In The Population Actual 1.9% 1.9% 13.7% IAPT - Proportion Completing Treatment That Are Moving To Recovery Oct-16 50% 55.2% 55.2% 54.6% 53.0% 53.0% 53.6% 51.9% 51.9% 54.3% 53.3% 53.3% 51.2% IAPT - % Waiting 6 Weeks Or Less - Treated Patients Oct-16 75% 89.7% 89.7% 82.6% 90.0% 89.1% 89.9% 61.5% 58.9% 55.3% 95.7% 88.4% 88.7% IAPT - % Waiting 18 Weeks Or Less - Treated Patients Oct-16 95% 100.0% 100.0% 99.7% 99.1% 98.6% 99.1% 100.0% 100.0% 99.6% 100.0% 100.0% 100.0% Early Intervention In Psychosis - % Of Patients Who Have Started Treatment Seen Within 2 Weeks Early Intervention In Psychosis - % Of Patients Who Are Waiting For Treatment Waiting Less Than 2 Weeks Oct-16 50% 100.0% 100.0% 87.0% 51.3% 51.3% 63.2% Oct-16 50% 80.0% 80.0% 84.2% 50.0% 50.0% 59.3% 2.2 Health Outcomes NHS North Derbyshire CCG Chesterfield Royal Hospital Foundation Trust Stockport Foundation Trust Derbyshire Community Health Services NHS Trust Sheffield Teaching Hospitals Foundation Trust Exception Reported Indicator Name Period Standard / Plan Current Month Current Quarter Year To Date Current Month Current Quarter Year To Date Current Month Current Quarter Year To Date Current Month Current Quarter Year To Date Current Month Current Quarter Year To Date Safe environment and protecting from avoidable harm Healthcare Acquired Infection (HCAI) Measure: MRSA Infections Healthcare Acquired Infection (HCAI) Measure: C-Diff Infections % of adult hospital admissions, admitted within the month assessed for risk of VTE on admission Oct Oct Q2 Plan Actual % 96.9% 96.8% 94.4% 94.7% 99.7% 99.8% 94.2% 93.8% Mixed Sex Accommodation Cancelled Ops Mixed Sex Accommodation Oct Cancelled Ops for non-clinical reasons rebooked >28 days Q

50 2.3 Better Care Fund Delayed Transfer of Care - Monthly Performance Delayed transfer of care from hospital per 100,000 (average number of days delayed per month) Data Source Period Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Delayed Transfers Of Care 2014/ data released monthly by NHS 2015/16 England - Part B - Days Delayed 2016/ Trend Delayed Transfer of Care - Quarterly Performance Against Plan Delayed transfer of care from hospital per 100,000 (average number of days delayed per month) Data Source Delayed Transfers Of Care data released monthly by NHS England - Part B - Days Delayed Period 2014/15 Q1 2014/15 Q2 2014/15 Q3 2014/15 Q4 2015/16 Q1 2015/16 Q2 2015/16 Q3 2015/16 Q4 2016/17 Q1 2016/17 Q2 Actual BCF Plan 2016/17 Q3 2016/17 Q Trend Non-Elective Admissions - Monthly Performance Non-Elective Admissions (General & Acute) - Number of episodes Data Source Period Org Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec DCC NDCCG DCC Monthly Activity Return data 2015 NDCCG released monthly by NHS DCC England 2016 NDCCG DCC 2017 NDCCG Trend Non-Elective Admissions - Quarterly Performance Non-Elective Admissions (General & Acute) - Number of episodes Data Source Period 2014 Q Q Q Q Q Q Q Q Q Q Q Q Q1 Monthly Activity Return data released monthly by NHS England Actual Original Data / Trend Admissions to residential and nursing care homes Permanent admissions of older people (aged 65 & over) to residential and nursing care homes per 100,000 population Data Source Period Q1 Q2 Q3 Q4 BCF Plan 2014/15 Adult Social Care Outcomes Framework Data Submitted 2015/ Quarterly by Local Authorities 2016/ Trend Reablement/ rehabilitation services Proportion of Older People (65 & 2014/ % 86.6% 79.0% 87.1% 81.7% Over) Who Were Still At Home 91 Adult Social Care Outcomes Days After Discharge From Framework Data Submitted 2015/ % 89.4% 82.4% 73.6% 82.5% Hospital Into Reablement / Quarterly by Local Authorities Rehabilitation Services 2016/ % 86.0% Dementia Rate of Dementia Diagnosis Data Source Period Org Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar BCF Plan DCC 59.2% 59.4% 60.0% 58.8% 58.7% 59.2% 60.2% 61.4% 64.2% 64.5% 65.5% 67.3% 2014/15 67% NDCCG 59.0% 58.9% 59.6% 57.5% 57.4% 57.9% 59.5% 60.5% 63.0% 64.1% 64.9% 66.6% Dementia Prevalence Data DCC 71.1% 69.2% 71.2% 72.0% 70.6% 72.0% 72.1% 72.0% 69.9% 70.7% 69.5% 71.8% from the Primary Care 2015/16 68% NDCCG 67.9% 64.5% 68.1% 69.3% 68.8% 69.6% 69.3% 69.5% 64.5% 69.6% 68.7% 75.7% Webtool DCC 72.1% 71.8% 72.0% 72.3% 72.4% 72.8% 73.1% 2016/17 71% NDCCG 72.4% 71.3% 71.2% 68.1% 71.2% 71.7% 71.9% Trend Data Source Period Jul '13 - Mar '14 Jan-Sept '14 Jul '14 - Mar '15 Jan-Sept '15 Jul '15 - Mar '16 Jan-Sept '16 Jul '16 - Mar '17 Jan-Sept '17 Trend Patient Experience GP Patient Survey - Q32: In the last 6 months, have you had enough support from local services/organisations to help manage your long-term condition GP Patient Survey Results DCC 70.3% 70.8% 70.4% 70.5% 70.2% NDCCG 71.3% 73.1% 72.4% 72.6% 72.3% BCF Plan 65.9% 66.2% 66.50% 27

51 2.4 Finance No Indicator Green Amber Red Performance at Month 8 1 Plan year to date (variance to plan and % of YTD allocation) Positive variance to plan or negative variance <=0.1% >0.1% <0.5% >=0.5% M8 plan = 2,717k, M8 actual = 2,717k Month 8 RAG Rating G Comments On course with plan 2 Plan full year (variance to plan as % of allocation) Positive variance to plan or negative variance <=0.1% >0.1% <0.5% >=0.5% Full year plan is 4,076k. CCG forecasting to deliver 4,076k which is 0.92% of the allocation G 3 QIPP year to date delivery >= 95% >= 75% <95% <75% Plan = 7,340k, delivered 5,877k to date which is 80.07% A The full year forecast has been revised to less than the plan 4 QIPP full year forecast >= 95% >= 75% <95% <75% The original full year QIPP plan was 12,958k. This has been revised down to 9,735k which is 75.13% A As above Primary Indicators 5 Clear identification of risks against financial delivery and mitigations Mitigations equal to or greater than risks Risks not fully mitigated and if they were to materialise the CCG would not be in deficit or would be in deficit up to 1% of allocations Risks not fully mitigated and, if they were to materialise, the CCG would be in deficit greater than 1% of allocation Risk reserve of 2,210k held. At month 8 risks are expected to be fully mitigated G Risks fully mitigated 6 Running costs <=RCA N/A >RCA Running Cost allocation is 6,329k. The CCG Running Cost spend is expected to be within the allocation G 7 Underlying recurrent surplus on exit of 2015/16 >=1% <1.0% surplus Surplus >=0% 8 Financial position meets the 2016/17 surplus planning requirement >=1% surplus forecast >= breakeven and <1% surplus forecast <0% (1.18%) reported at month 8. This is an underlying deficit. Deficit Forecast Surplus is 0.92% of allocation G R QIPP slippage and the use of non recurrent savings to support the financial position mean the CCG has a underlying deficit in The 2017/18 plan returns the underlying positon back to a surplus. 9 Planned usage of non-recurrent headroom funds in line with business rules >= 1% >= 0.7% <1% <0.7% 1% G Supporting Indicators 10 BPPC performance invoices paid within Better Payment Practice Code >= 95% >= 75% <95% <75% All 4 cumulative measures >95% for the year G All targets achieved 11 Cash utilisation <=1.25% >1.25% <2% >=2% CCG held a cash in bank balance of 0.63% of the monthly drawdown G NHS England require CCG's to hold cash in bank of less than 1.25% of monthly drawdown 28

52 3. Exception Reports Exception reports are provided where NHS North Derbyshire CCG is failing in the latest reporting period (with the exception of ambulance performance which is at provider level). RTT Waits over 52 weeks for Incomplete Pathways Author: Responsible Lead: Michelle Anthony, Head of Acute Commissioning Simon Harris, Assistant Chief Transformation Officer What is the problem? NHS North Derbyshire CCG had 1 patient who did not receive their treatment within 52 weeks. The patient is waiting for Upper Gastrointestinal Surgery, and has been offered previous dates, unfortunately the patient did not want to bring treatment forward. The patient had a TCI date for the 18/11/2016 and has now received treatment and been removed from the waiting list. What are we doing about it and is it working? What actions have been completed in the last month? NHS North Derbyshire CCG will apply the contract penalty contained within the Quality Schedule. What actions will be taken, going forward? North Derbyshire CCG continues to actively monitor patients waiting longer than 40 weeks for treatment. Are we assured? Recovery due by: Contractual Rigour Applied: Green All known actions have been explored and undertaken Amber Some actions have been explored Red Insufficient action have been undertaken CCG Assurance of achieving recovery: Green Assured achieved in line with timescales Amber Partially assured partially achieved in line with timescales Rating: Green Rating: Green Red Not assured not achieved to timescale or no timescale provided 29

53 A&E Waiting Times Total Time in A&E under 4 hours Author: Responsible Lead: Deborah Louch, Head of Commissioning of Urgent Care Simon Harris, Assistant Chief Transformation Officer What is the problem? North Derbyshire CCG (NDCCG) failed to meet the national standard during October for the 12 th consecutive month. Underperformance can be attributed predominantly to underperformance at Chesterfield Royal Hospital NHS Foundation Trust (CRHFT), Stockport Foundation Trust (SFT) underperformance is also impacting on NDCCG performance. CRHFT - This is the twelfth consecutive month of underperformance at the trust. The performance for the month of October was 91.8%. The trust saw 6690 attendances and had 551 breaches. This was a result of high acuity patients, 4 ward areas with confirmed NoroVirus loss of 11 beds currently, a reduction in the number of discharges, closure of local rehab beds due to infection control which impacted upon patient flow throughout the Trust and delays to patients awaiting transfer of care into Nursing homes. Unvalidated current position at CRH (as at ) weekly ED performance (75.4%), November (88.6%) and December month to date (77.1%). Current bed state (Black Opel 4), pressures in pediatrics due to high number of GP referrals. The acuity of patients remains High leading to increase length of stay. Reduction in numbers of discharges due to reduce no of patients MFFD. Additional actions being taken include opening extra capacity (72 beds plus 16 outliers in surgery), cancelling of elective activity, the discharge Hub working with Adult Social care & DCHS to facilitate discharges, ICPT asked to review patients in areas with Norovirus. Patients isolated when side rooms available. Communications to GPs and also to general public via social media re other options to access right care required for current condition STHFT The target of 95% was not achieved for October. The trajectory was 93.5% and the actual performance for October was 85.6%. STHFT confirmed that the main factors currently contributing to 4 hour breaches were workforce and leadership issues. STHFT performance continues to exhibit sufficient inconsistency to warrant Sheffield CCG (SCCG) seeking further assurance and a Contract Performance Notice has been issued to STHFT. SFT - Performance in October was 77.6%% which was behind the NHSI trajectory. Attendances above expected levels (264 per day) with sustained high levels of delayed transfers of care. What are we doing about it and is it working? What actions have been completed in the last month? CRHFT The streaming service saw 760 patients during October % of all patients are streamed away from ED by being either treated by primary care on site, referred onwards to somewhere external to the Trust, or self-care/no treatment. From the 1 st November the ED Streaming service has been increased so this will see an upturn as it will 30

54 be 13 hours a day, 7 days a week. A total of 69 additional beds have been opened to assist with patient flow. 5 extra beds have also been opened on CDU/EDU after a number of desks have been removed from the units. The Discharge Hub is working with Adult Social care & DCHS to facilitate discharges. Medical Consultants have been taken off SPA time to focus on inpatients care and discharges. STHFT A Remedial Action Plan (RAP) was submitted to SCCG on the 9 th October SCCG has carefully reviewed the RAP but is unable to agree the RAP without further development by STHFT. SCCG have now received the amended RAP and are in the process of reviewing the content. SCCG will respond to STHFT and share this response with Associates. SFT - Work is currently taking place, including: non emergency patients coming through the emergency department being seen onsite by a GP expanding the emergency department to 22 cubicles - seven extra proactive management and escalation once a patient has been waiting 2.5 hours using the clinical decision unit (CDU) beds for patients requiring a watch/wait for results approach to free the space they might otherwise occupy in the emergency department Due to increased pressure in ED the Trust opened an additional 12 medical beds and 7 beds on the PIU have also been used to accommodate medical patients What actions will be taken, going forward? CRHFT Following further Exec to Exec discussions with the trust a short term strategy has been agreed to improve A&E performance. This strategy includes a CRHFT operational delivery group for the Recovery Plan which has responsibility for delivery of the resilience plan via the 5 national work streams and 1 internal work stream which report into the CRHFT weekly operational meeting. From January 2016 a monthly A&E Operational Delivery Group consisting of Operational Leads across all NDCCG Providers. The group will be chaired by NDCCG and will be responsible for monitoring A&E performance. If there are any issues that the group cannot resolve they will be escalated to the A&E Delivery Board via an action log. The trust is aiming to get sustainable A&E performance delivery by March The Trust plans to outsource some elective work, open additional bed capacity, improve flow management with bed meetings taking place at least 3 times a day with a focus on embedding the safer bundle principles and good engagement with partner organisations to facilitate discharge. STHFT SCCG have now received a summary matrix from SFHFT. The matrix details the projects (21 in total) currently in place to deliver the trajectory.once SCCG have reviewed the RAP again they will respond to STHFT and share their response with Associates. SFT A revision to the NHSI trajectory has been submitted for Q3 which is pending approval. In the long term, new models of care are being designed to reduce the high number of attendances to the emergency department, but managing them elsewhere. This is part of the multi-specialty community provider development which should transform care (this is still under development). Emergency care improvement programme (ECIP) team review will be incorporated into a 31

55 wider whole system review in Stockport, which will be the formal start of a twelve month support programme. All areas now have local A&E Delivery Boards which began to meet in September These groups have a particular focus on ED and attendance is senior level from all organisations from health and social care. Are we assured? Recovery due by: CRH are aiming to get sustainable A&E performance delivery by March 2017 with a trajectory of sustained improvement from September A&E performance for the month of October was above the trajectory on the recovery plan. The Recovery Action Plan (RAP) submitted by CRH outlines recovery of performance by March 2017, with a trajectory of sustained improvement from September The trust is currently delivering against trajectory for October with performance at 91.8% against the trajectory of 87%. Unvalidated data for November also identifies the trust as delivering with performance of 88.6% against a plan of 88.5%. SFT Have submitted a revision to the NHS Improvement (NHSI) trajectory for Q3:- Revised Trajectory Pending Approval Oct-16 Nov-16 Dec STHFT SCCG will review the summary matrix received and refer to the relevant project documentation for additional information. Where STHFT already meet the standards and guidelines this could be noted and then SCCG could then physically go and see/test to receive assurance the recommendations or changes are already operational. Contractual Rigour Applied: Green All known actions have been explored and undertaken Rating: Amber Some actions have been explored Red Insufficient action have been undertaken CRH Green STHFT Green SFT - Green CCG Assurance of achieving recovery: Green Assured achieved in line with timescales Rating: Amber Partially assured partially achieved in line with timescales Red Not assured not achieved to timescale or no timescale provided CRH Green STHFT Green SFT Red 32

56 East Midlands Ambulance Service Ambulance Response Times Red 1 Calls With Response within 8 Minutes Red 2 Calls With Response Within 8 Minutes A19 Calls with Response Within 19 Minutes Author: Responsible Lead: Stephanie DeCelis, Assistant Director of Ambulance Commissioning Simon Harris, Assistant Chief Transformation Officer What is the problem? EMAS achieved the locally agreed regional performance trajectory in November for Red 1 (70.0% against the 67.5% trajectory), however they failed to achieve the Red 2 and A19 trajectories (58.9% and 84.3% against the 61.6% and 86.6% trajectories respectively). Please note that these are the un-validated positions for November, validated data was not available at the time of reporting. Year to date EMAS are not achieving the agreed regional performance trajectory for Red 2 or A19. In Derbyshire, the division failed to achieve the divisional performance trajectory for all three standards. 33

57 Red activity has been increasing month on month with the red activity equating to over 52% of all calls in November. Last year this ratio remained fairly consistent at c45%. The increase in Red activity means that more calls need to be responded to within 8 minutes which is causing EMAS operational pressure. The year to date Red conversion rate in Derbyshire is 49.6%. In October, there were 454 WTE frontline positions in post, with 24 vacancies, the breakdown of these can be seen below; Paramedic (including TL/CTM/ECP) Technicians (including trainee technicians) ECA In Post Vacancies North Derbs South Derbs Derbyshire The Derbyshire Division is continuing with local and national recruitment. The newly employed staff will require further supernumerary shifts and mentorship hours before becoming fully operational, therefore the full effects of the recruitment plan may not be fully realised until Q1/2 during 2017/18. There was an internal ECA to Technician courses held in September. The Division is expecting 21 newly qualified technicians to be operational by the end of Quarter Three 2016/17. Handover delays continue to cause EMAS operational pressures with the total hours lost in November being 6,753, the highest it has been all year and a 2.9% increase on last November. In Derbyshire during October (November data not yet available), delays greater than one hour at Chesterfield Royal equate to 1.7% of the total conveyances to the hospital, and Royal Derby equate to 0.9% of total conveyances to the hospital. What are we doing about it and is it working? What actions have been completed in the last month? EMAS continue with the increased capacity in the Clinical Assessment Team (CAT) desk, and continues to maintain the number of voluntary and private ambulance providers in order to increase operational capacity. Assurance has been given at the Partnership Board that this level of additional capacity will continue until substantive staff are in place and operational. 34

58 A successful overseas recruitment campaign took place in early October. It is expected that successful applicants will be employed towards the end of the contractual year although not fully operational until early 2017/18. Work is continuing with the Police and Fire services in regards to working together to provide additional Community First Responders (CFRs). These are volunteers working in the community and are trained in life support including the use of defibrillators. Due to EMAS financial position, they were selected as one of the 20 turnaround trusts in the country. SSG has been working with EMAS for a number of months in reviewing their internal processes to identify and release efficiencies. SSG has now completed this work and EMAS have agreed to share the outputs with commissioners. The Dispatch on Disposition Pilot was extended to all Ambulance Trusts on 5th October. This allows up to an additional 180 seconds for calls (excluding Red 1s) to be triaged. This extra triage time will enable Emergency Operations Centre (EOC) to determine the most clinically appropriate response required for the patient. This will allow EMAS to manage their resources more efficiently and effectively. Card 35 was introduced on 7th September. Since being introduced Red activity has increased significantly especially in Nottinghamshire. Information has been shared with all Commissioners for them to review. What actions will be taken, going forward? The Contract Finance review continues to progress. Deloittes will be sharing a final draft report on 7 th December. The agreed outputs from this review will be considered in the contract negotiations. An Emergency Care Practitioner (ECP) is crewing up with staff to highlight areas where they could assist in reducing conveyance to ED. There will also be the opportunity for the ECP to promote the alternative care pathways available in Derbyshire. The pilot is to run through December initially. The Derbyshire division is working with the intermediate care team in Eckington during the next few months which has the aim of reducing conveyance and improving patient experience. The Division are continuing to recruit and is expecting 21 newly qualified technicians to be operational by the end of Quarter Three 2016/17. EMAS and each division has a winter plan in place and Derbyshire will be providing additional triage units in the City for a number of key dates through December. There will also be additional 4X4 vehicles placed in the rural parts of the County in preparation for adverse weather. The Derbyshire division continue to review missed responses in order to understand the reasons for delayed responses in order to aid learning. Outcome (i.e. impact): It is expected that all the actions being taken will improve efficiencies, financially and operationally for EMAS so that we see an improvement in performance. Are we assured? 35

59 Recovery due by: The agreed regional contractual trajectory does not deliver national performance in 2016/17 however the revised stretched performance trajectory delivers Red 1 at the end of the year, with an improved position for Red 2 and A19. During December, the stretched trajectories will be reviewed and revised, although will not be contractually binding. Please insert RAG ratings according to the RAG Keys for both of the following assurance measures: Contractual Rigour Applied: Green All known actions have been explored and undertaken Amber Some actions have been explored Red Insufficient action have been undertaken CCG Assurance of achieving recovery: Green Assured achieved in line with timescales Amber Partially assured partially achieved in line with timescales Rating: Green Rating: Red Red Not assured not achieved to timescale or no timescale provided 36

60 Cancer 62 Day Waits First Treatment Administered Within 62 Days of Urgent GP Referral Author: Responsible Lead: Michelle Anthony, Head of Acute Commissioning Simon Harris, Assistant Chief Transformation Officer What is the problem? NHS North Derbyshire CCG did not achieve the 85% national target in September, as predicted it failed to meet this again during October (70.5%). Underperformance relates to 26 breaches of this target, which are detailed as follows: 14 patients were Inter Patient Transfers (IPTs) between the first seen and first treated Trust, from Chesterfield Royal Hospital NHS Foundation Trust to Sheffield Teaching Hospitals Foundation Trust. 1 patient was seen as an IPT between Chesterfield Royal Hospital NHS Foundation and treated at the Leeds NHS Foundation Trust 7 patients were seen and treated at Chesterfield Royal Hospital NHS Foundation Trust 2 patients were seen at Stockport NHS Foundation Trust and treated at University Hospital of South Manchester NHS Foundation Trust 1 patient was seen and treated at Central Manchester NHS Foundation Trust 1 patient was seen as an IPT between East Cheshire NHS Trust and treated Christie NHS Foundation Trust What are we doing about it and is it working? What actions have been completed in the last month? Chesterfield Royal Hospital FT North Derbyshire CCG have served a Performance Notice on the Trust related to this target, the CCG have asked for the 62 day Improvement Plans for Breast, Colorectal, Lung, Gynecological, Head and Neck, Upper GI, Dermatology and Urology. The trajectories of achieving the target, has been requested at all disease sites and overall Trust level. As mentioned in the previous months report, Chesterfield Royal Trust NHS Foundation Trust are already working on the polling of 7 day slots on e-referral systems and the sustainability / implementation of this; analysis to provide diagnostics support required; GPs to utilise 2ww referral pro forma and analysis of sufficient one-stop capacity etc. What actions will be taken, going forward? Chesterfield Royal Hospital FT The Improvement Plan and trajectories has been received by North Derbyshire CCG. The initial recovery action plan has been return to the trust for further clarity on the issues impacting on current service delivery and mitigating actions. Are we assured? Recovery due by: Please insert RAG ratings according to the RAG Keys for both of the following assurance 37

61 measures: Contractual Rigour Applied: Green All known actions have been explored and undertaken Amber Some actions have been explored Red Insufficient action have been undertaken CCG Assurance of achieving recovery: Green Assured achieved in line with timescales Amber Partially assured partially achieved in line with timescales Rating: Green Rating: Amber Red Not assured not achieved to timescale or no timescale provided 38

62 Cancer 31 Day Waits Subsequent Radiotherapy within 31 Days of Decision to Treat Author: Responsible Lead: Michelle Anthony, Head of Acute Commissioning Simon Harris, Assistant Chief Transformation Officer What is the problem? NHS North Derbyshire CCG did not achieve the 94% target, with October resulting in 90%. Underperformance relates to 4 breaches of this target, which are detailed as follows: 2 patients exercised patient choice 1 patient had complex planning pathway for treatment 1 patient was unable to have their treatment, because the consultant was unable to outline on time, due to sick leave Overall, Sheffield Hospital Teaching Foundation Trust did achieve the target, resulting in 95.7%. What are we doing about it and is it working? What actions have been completed in the last month? This was not applicable last month as Sheffield Teaching Hospital Foundation Trust achieved this target. Outcome (i.e. impact): What actions will be taken, going forward? This target is commissioned by NHS England and has been brought to Kate Gatherer for their attention to take forward to address. Are we assured? Recovery due by: Contractual Rigour Applied: Green All known actions have been explored and undertaken Amber Some actions have been explored Red Insufficient action have been undertaken CCG Assurance of achieving recovery: Green Assured achieved in line with timescales Amber Partially assured partially achieved in line with timescales Red Not assured not achieved to timescale or no timescale provided Rating: TBC by NHS England Rating: TBC by NHS England Recommendations 39

63 Cancer 62 Day Waits First Treatment administrated within 62 days of Screening Referral Author: Responsible Lead: Michelle Anthony, Head of Acute Commissioning Simon Harris, Assistant Chief Transformation Officer What is the problem? NHS North Derbyshire CCG did not achieve the 90% target, with October resulting in 89.5%. Underperformance relates to 1 breach of this target: 1 patient exhibited (non-cancer) breast symptoms cancer not initially suspected What are we doing about it and is it working? What actions have been completed in the last month? This was not applicable last month as Chesterfield Royal Hospital Foundation Trust achieved this target Outcome (i.e. impact): What actions will be taken, going forward? This target is commissioned by NHS England Public Health and this has been brought to Nikki Henson s attention to take forward. Are we assured? Recovery due by: Contractual Rigour Applied: Green All known actions have been explored and undertaken Amber Some actions have been explored Red Insufficient action have been undertaken CCG Assurance of achieving recovery: Green Assured achieved in line with timescales Amber Partially assured partially achieved in line with timescales Red Not assured not achieved to timescale or no timescale provided Rating: TBC by NHS England Rating: TBC by NHS England 40

64 Local Performance Indicators A number of local performance indicators have been identified by the CCG as key in achieving the CCG priorities. These are presented here to enable ongoing monitoring. 41

65 4. Local Performance Indicators The measures identified in the table below have been shown separately to the CCG Assurance Framework report as they are not part of the nationally defined framework. Measure 1 Delayed Transfers of Care Standard Year Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD % 5.2% 3.6% 3.4% 2.6% 4.0% 2.0% 1.5% 0.9% 1.8% 1.5% 1.5% 2.7% CRHFT <3.5% % 1.6% 1.4% 1.5% 0.8% 1.3% 0.9% 2.2% 1.9% 1.8% 2.2% 1.9% 1.6% Delayed Transfers of care DCHS <=12.5% (Local Target as community hospital) % 1.4% 1.6% 1.6% 1.1% 2.3% 1.7% % 9.5% 7.1% 6.7% 6.5% 6.6% 10.0% 5.9% 7.5% 7.0% 6.3% 4.6% 7.3% % 7.4% 6.7% 7.4% 6.2% 7.7% 6.1% 4.8% 6.5% 8.4% 11.3% 11.8% 7.9% % 6.7% 7.6% 5.2% 6.4% 7.1% 6.5% Measure 2 EMAS Handovers Standard (< 15mins) Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar :29 20:40 19:29 19:52 20:02 20:32 19:27 19:25 20:42 20:45 20:40 20:13 CRHFT :11 20:24 20:22 20:35 22:30 21:40 21:56 21:23 20:38 19:58 22:20 23:33 Average EMAS Handover Time :19 21:35 23:17 22:40 22:00 23:15 22: :18 21:34 19:07 18:11 18:07 18:15 18:04 19:17 26:54 23:36 21:41 20:17 SFT :18 18:08 19:01 20:28 20:28 21:36 21:50 25:39 25:46 27:05 28:43 28: :44 25:47 23:19 25:32 29:59 Pre Hospital handovers from EMAS to CRH are still an issue and the position in September and October has got worse. EMAS continue to indicate that patient handover as a reason for their underperformance although they have not approached the CCG to support any discussions with CRH. Commissioners offered support at the most recent EMAS Commissioner Contract Meeting. ACTIONS 1. The CCG has contacted EMAS to ask what support is needed and this will be followed up at the EMAS Contract meeting. 2. Stockport CCG has been asked when improvement will be seen at SFT. 3. Derbyshire GM (Martin Watts) has been attending RDH and CRH randomly to confirm and challenge attendances. 4. An ECP is crewing up with staff to highlight areas that their role could assist to promote ED avoidance. There is also the opportunity for the ECP to promote the alternative care pathways available in Derbyshire. The pilot is to run for 1 month initially and be based in the South of the region. 5. Work has begun with the Intermediate Care Team based around Eckington with a view to EMAS and them working together. The aim is similar to that of Hardwick area in reducing conveyance to hospital and improving patient experience. This work is moving forward with the next meeting scheduled in October with the aim of implementing change. 6. As part of the local CQUIN which is to reduce conveyances to type 1 and type 2, EMAS are reviewing the attendances to review whether they were appropriate or not. EMAS has stated that only a very small number of conveyances could have been avoided. 42

66 Measure 3 NHS Derbyshire Monthly Update % of calls abandoned after 30 seconds % of calls answered in 60 seconds Sep-16 Aug-16 Sep-15 Sep-16 Aug-16 Sep % 0.8% 1.5% 97.6% 96.7% 92.0% 43

67 Measure 4 NHS North Derbyshire CCG and Provider Workforce Indicator Dashboard Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Number of Staff ND CCG (WTE) DCHS DHU ND CCG (in month) % 0.8% 0.0% 1.0% 1.4% 0.4% 2.1% CRHFT 13.8% 13.3% 13.4% 13.0% 13.0% 11.4% Stockport 11.1% 11.5% 11.9% 12.1% 12.3% 14.2% 15.7% Staff Turnover (12 month rolling figure) DCHS 9.7% 10.8% 11.2% 11.4% 10.1% 9.9% 9.5% DHU total 1.1% 1.9% 2.6% 2.1% 2.8% 3.2% 2.8% 111 Total 0.9% 3.8% 5.0% 3.8% 2.8% 3.4% 4.4% Call advisers 1.4% 5.0% 7.6% 5.9% 5.5% 4.9% 6.5% Nurse advisers 0.0% 4.5% 2.8% 1.2% 1.3% 1.3% 1.1% ND CCG 98.6% 98.9% 97.9% 96.8% 98.5% 98.5% 97.8% CCG National Average 97.6% 97.8% 97.4% Data not available - 3 Month Data lag Staff Attendance CRHFT Stockport Acute Trust National Average DCHS 94.6% 94.7% 95.2% 96.0% 95.8% 96.3% 96.2% 96.1% 96.2% 96.4% 96.4% 96.3% 95.8% 96.1% 96.3% 96.2% Data not available - 3 Month Data lag 95.1% 95.3% 95.7% 95.7% 95.7% 95.1% 95.2% Community Provider National Average 95.8% 95.8% 95.6% Data not available - 3 Month Data lag DHU % 89.5% 88.4% 93.3% 89.3% 92.9% 90.5% Staff with appraisal completed (% compliance) CRHFT (rolling 12 months) DCHS Stockport DHU 68% 71% 71% 71% 77% 73% 92% 93% 91% 92% 92% 90% 88% 85% 86% 89% 92% 94% 95% 95% 4% 8% 14% 25% 28% 64% 63% This data has been obtained direct from providers in order to illustrate performance against a range of workforce indicators. Whilst there are a number of outstanding items, data is currently being sourced with the aim that all measures will be monitored monthly. With regards to DHU, the appraisal figure is low at the moment as the appraisal window runs from April-September each year. The number of completed appraisals will increase over the next few months, building up to a figure >90% by September 16. Whereas the other organisations are measured on a 12 month rolling basis. 44

68 Measure 5 GEM Performance The CCG receives a monthly KPI dashboard from Arden & GEM CSU detailing their performance. During October, all service levels received a green except CHC. KPI Level Performance is also reported below, on an exception basis. Many of the new KPIs are now in place, including Continuing Health Care. Overall Service Performance - October 16 CHC IFR MCE Collaborative Contracting Equality, Inclusion & Human Rights Customer Contact and Complaints Health and Safety Business Continuity Finance HRBP and People Services Strategic IT Programmes Information Governance IT Information Services Clinical Procurement Transactional Procurement Continuing Health Care KPI Target RAG Score Compared to previous month Annual review of current cases or more frequently as necessary. 85% 76% Issues remain with data quality and performance of CHC and NDCCG continue to work with Arden & GEM CSU on the service improvement plan. The CHC procurement has been finalised and approved by Governing Bodies in October 16. Issues/ Actions The new contract has been awarded to Midlands and Lancashire CSU. Arden & GEM have produced an exit and mobilisation plan for the transition to the new provider from 1st April The Chief Nurse Officer is leading on the mobilisation and service improvement plan to ensure that patient safety and quality and CHC staff are not compromised. KPI Target RAG Score Compared to previous month FNC referrals will have a review within 12 months or at agreed specific interval. 85% 74% New KPI 45

69 Programme Assurance Board 46

70 5.1 Programme Assurance Board Programme Assurance Report November 2016 report This report is presented to the Governing Body Assurance Committee (GBAC) to provide a progress summary of the projects delivering the North Derbyshire CCG QIPP Efficiencies Programme as presented to the attendees of Programme Assurance Board (PAB). This report aims to provide assurance to GBAC that there is an auditable process with detailed position statements against each project which demonstrates decisions taken relating to benefit realisation, quality and time. The QIPP Programme for the CCG is organised and monitored through the Programme Assurance Office and reports to the Programme Assurance Board (PAB) Key Themes 20 projects identified to deliver QIPP Programme In November 2016, 36.56% of target has been achieved 36.56% Assured Savings 45% have high/extreme risks identified 0% have no risks attached 20% have not been updated in November 2016 GBAC receives monthly information linked to the performance of the QIPP Programme to enable members to monitor on-going performance and provide assurance. Due to technical difficulties with epmo that occur the week prior to the lockdown date. There are no exception reports this month. Project breakdown (See Appendix A) 47

71 Exception Reported Project Title Last updated Are the milestones on track? Is the project meeting it's KPIs? Project Risks Project Issues MSK Nov-16 Yes No High No Issues Neurological Nov-16 Yes No Moderate No Issues Trauma and Injuries Nov-16 Yes No High No Issues Respiratory Nov-16 Yes No High No Issues Glaucoma Nov-16 Yes No Low No Issues Falls Partnership Service / FIRST Service Nov-16 Yes No High No Issues Generic Drugs and Patents Nov-16 No Yes Prescribing Switches and Practice Level Support Nov-16 No Yes No Risk attached No Risk attached No Issues No Issues Rebates Nov-16 No Yes Low No Issues QIPP Projects Optimise Nov-16 No Yes High Low IV Therapy Step Down Nov-16 No No High Extreme Rapid Assessment Interface & Discharge (RAID) Nov-16 No N/A High Low Contract Levers Nov-16 Yes No Moderate No Issues Disinvestment Nov-16 Yes No Low No Issues First To Follow Ups Nov-16 Yes No No Risk attached No Issues Invoice Validation Nov-16 Yes No High No Issues Reduction in Fas Nov-16 Yes No Low No Issues High Cost Patients Nov-16 Yes No Moderate No Issues ED Streaming Service Nov-16 Yes Yes No Risk attached No Issues Running Cost Reductions Nov-16 Yes No High No Issues Exception Reported Project Title Last updated Are the milestones on track? Is the project meeting it's KPIs? Project Risks Project Risks Dementia Support Worker / Primary Care MH Worker Nov-16 Yes N/A High No Issues Non- QIPP Projects Diabetes Better Blood Sugars Nov-16 No N/A Extreme No Issues Diabetes Type 1 Structured Education Nov-16 No N/A Extreme No Issues Dysphagia Oct-16 Yes No Moderate No Issues Hello Mummy Diary Nov-16 No Yes Low No Issues Lymphoedema Service for non-cancer patients Oct-16 No No No Risk attached No Issues 48

72 Quality Report This report provides an overview of performance against key quality standards, ensuring that the CCG meets its corporate objective to put quality at the heart of all services we commission. 49

73 6.1 Quality News Derbyshire Wide Quality Assurance The four CCGs across Derbyshire have worked to agree a Derbyshire Wide Quality Schedule for all Provider contracts. Members of all four Clinical Quality Teams have also worked to agree the quality element of the new Derbyshire Wide Integrated, Quality, Performance and Finance Report and are now planning a deep dive schedule of specific areas to be examined across the region over 2017/ Chesterfield Royal Hospital (CRHFT) CRHFT Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) - Audit April to June 2016 Following the Care Quality Commission (CQC) inspection of CRHFT in 2015, the Trust were directed to ensure that all of their DNACPR forms were completed accurately and were compliant with the Trust s policies. The Trust carries out quarterly audits and the results from the time period of April 2016 to June 2016 have shown much improvement from the previous quarter and past audits that were seen at the QAG. The CCG will continue to monitor for improvements. Quarter 2 Quality schedule and CQUIN evidence Quarter 2 evidence was received from the Trust in a timely manner, and has now been assessed by the contracting and clinical quality team. Commissioners will meet with the Trust as per agreed quality assurance processes to confirm the end of quarter position, but the Trust has provided good evidence for the majority of the required areas. In relation to the CQUINs the Trust has achieved compliance other than against the national CQUIN relating to Timely identification and treatment for sepsis in the acute setting where they have achieved 56% against a target of 70%, but improvement has been noted. The Clinical quality team will continue to monitor performance against this. Winter Planning The Deputy Chief Nurse has been attending the Trust operational meetings to discuss their winter plans and ED performance from a quality perspective. The Trust Director of Nursing is involved in these meetings and it is clear that patient safety and quality of care is clearly 50

74 reflected in decisions around staffing of additional winter wards. The CCG will continue to attend these meetings. The CCG is working with the Trust to encourage use of the community IV service which has received increased funding across both DCHSFT and CRHFT this year, to date the numbers of patients discharged to the community on IV therapy has not been increasing. This has been escalated to both Providers and through the CCG. Safe staffing The table below demonstrates the fill rates for the Trust by both day and night shift staffing levels split by registered and non-registered nursing staff. Serious Incident Standards The Clinical Commissioning Group s Clinical Quality Team continue to work closely with Providers to support improvements in timeliness of reporting, closure of serious incidents and the quality of investigation reports received. Further detail is outlined in the report below. 51

75 Serious Incidents Year to date, the Trust have reported a total of 35 serious incidents. The table below outlines the types of incidents reported. Incident Type Sep- Oct- Nov- Total YTD Pressure ulcer meeting SI criteria Sub-optimal care of the deteriorating patient meeting SI criteria Slips / Trips / Falls meeting SI criteria Surgical/invasive procedure incident meeting Diagnostic incident including delay meeting SI criteria (including failure to act on test results) Treatment delay meeting SI criteria Maternity/Obstetric incident meeting SI criteria Medication incident meeting SI criteria Major incident/ emergency preparedness, resilience and response/ suspension of services HCAI/Infection control incident meeting SI Pressure Ulcer Incidents 52

76 Number of pressure ulcers developed/deteriorated which have been reported onto the Trust DATIX system. Q1 Jul- Aug-16 Sept-16* Q2* Oct-16* Incident Type Total 16 Total Pressure Ulcer Grade Pressure Ulcer Grade Pressure Ulcer Grade Overall total *figure not available within CRHFT Quality Assurance Committee Papers from Healthcare Acquired Infections HCAI Q1 Total Q2 Total Oct-16 MRSA Trust Assigned MSSA (post 48 hr) E-coli (all cases) C difficile (post 72 hr) 0 2 2* *CRHFT Has an objective of 31 Clostridium difficile cases for 2016/17. As of this report they stand at 4 cases. Safety Thermometer The Safety Thermometer records the prevalence of harm on a particular day each month and should be used alongside other data such as incident data to measure the quality of care. The measures included are pressure ulcers, falls and urinary tract infections in patients with a catheter in situ. Please see the tables below for the 2016/17 Safety thermometer data. 53

77 99.0% 98.5% 98.0% 97.5% 97.0% 96.5% 96.0% 95.5% 95.0% Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 National Trustwide In November 2016, CRH had a total of 50 patients with harms (old and new): There were 17 new harms 49 patients had one harm and one patient had two harms The national figure for harm free care is currently 97.9%. In November, 96.5% of patients at CRHFT had no new harms which takes them below the national average. Falls Falls Q1 Sept-16 Q2 Total Oct-16 Total Falls resulting in 2 Not available Not available Not available within CRHFT 54 Comments

78 severe harm or death November QAC board papers Total slips, trips and falls Q1 Total Sept-16 Q2 Oct-16 Total N/A Derbyshire Community Health Services (DCHSFT) Safe staffing The table below demonstrates the fill rates for the trust by both day and night shift staffing levels split by registered and non-registered nursing staff. Reviewing individual hospitals and wards is unremarkable. DCHS have reported a slight rise in the levels of vacancy; this has led to a slight upturn in the usage of bank and agency staff across their services. Serious Incident Standards The Clinical Commissioning Group s Clinical Quality Team continue to work closely with Providers to support improvements in timeliness of reporting, closure of serious incidents 55

79 and the quality of investigation reports received. Further detail is outlined in the report below. Serious Incidents Year to date the Trust have reported a total of 31 serious incidents. The table below outlines the types of incidents which have been reported. Incident Type Sep-16 Oct-16 Nov-16 Total YTD Pressure ulcer meeting SI criteria Slips/trips/falls meeting SI criteria Medical equipment/ devices/disposables Pressure Ulcer Incidents Number of pressure ulcers developed/deteriorated which have been reported onto the Trust DATIX system. Incident Type Q1 Total Q2 Total Oct-16 56

80 Pressure Ulcer Grade Pressure Ulcer Grade Pressure Ulcer Grade Overall total The above figures do not include 13 potential grade three pressure ulcers and eight suspected deep tissue injuries. NB these figures represent Derbyshire as a whole Focused Actions Being Taken DCHS continues to pilot pressure mapping devices. It is reported that initial feedback is that this initiative has been received very positively by care staff as it prompts them to move patients more frequently as they can see an early indication of increased pressure over bony prominences because of changes in colour to body map. DCHS report that there is evidence of increased uploading of photographs onto SystmOne, and discussions have been had with IT on exploring options as to how we can monitor this against Tissue Viability Response times. Tissue Viability Matron has sent out a communication requesting that photographs are taken and uploaded onto SystmOne within 24 hours of identifying the tissue damage. Safety Thermometer The Safety Thermometer records the prevalence of harm on a particular day each month and should be used alongside other data such as incident data to measure the quality of care. The measures included are pressure ulcers, falls and urinary tract infections in patients with a catheter in situ. Please see the tables below for the 2016/17 Safety thermometer data. 57

81 Falls Falls resulting in major harm or death (inpatient) Falls Q1 Total Jul-16 Aug-16 Sept-16 Q2 Average Falls resulting in 0.13% 0.13% 0.24% severe harm % Oct % DCHS report that the increase in injurious falls appears to be directly attributable to a small cohort of patients who have had multiple falls. These individuals are being supported with clear care plans and direct supervision. Community Falls reported Derbyshire wide Severity Jul-16 Aug-16 Sept-16 No Injury Minor injury/harm Significant injury/harm Major injury/harm Death

82 6.4 Derbyshire Health United (DHU) Serious Incident Standards The Clinical Commissioning Group s Clinical Quality Team continue to work closely with Providers to support improvements in timeliness of reporting, closure of serious incidents and the quality of investigation reports received. Further detail is outlined in the report below. During the last quarter, serious incidents have significantly reduced. The Assistant Chief Nurse regularly gives feedback on the reports reviewed and these have greatly improved to a high standard. 6.5 Primary Care Serious Incident Standards The Clinical Commissioning Group s Clinical Quality Team continue to work closely with Providers to support improvements in timeliness of reporting, closure of serious incidents and the quality of investigation reports received. 59

83 When serious incidents occur, the National Health Service (NHS) has a responsibility to ensure that there are systematic measures in place for safeguarding people, property, NHS resources and reputation. This includes responsibility to learn from these incidents to minimise the risk of them happening again. All providers of NHS funded care services - for which the CCG is lead commissioner - are required to comply with the CCG Serious Incident Policy and other relevant national policies in reporting serious incidents. When significant events are classified as a serious incident, it is a contractual requirement that independent contractors report the incident to the CCG using the guidance and forms provided. The CCG has put a process in place to support commissioned services to comply with the CCG Serious Incident Policy. The CCG will support practices in the identification of Serious Incidents and Patient Safety Incidents. For events categorised as Patient Safety Incidents, the practice will be asked to conduct an internal Audit and report learning from the audit to the CCG. For events categorised as Serious Incidents, the CCG will work alongside the practice to support the completion of a Route Cause Analysis. The CCG will report findings to NHS England via StEIS. Further detail is outlined in the report below. CQC Update 60

84 All of the CCG s membership practices have been visited. Three further reports have been published this month following visits by the CQC. There is one outstanding report; the final summary will be included with an overall summary of key themes presented to the Primary Care Co Commissioning Committee in January Goyt Valley Medical and Dental Practice received an overall rating of Outstanding. Summary of key findings include: Patients overwhelmingly told us they received excellent care and were treated with compassion, dignity and respect. They also said they were involved in their care and decisions about their treatment. This was corroborated by the outcomes of the latest national GP patient survey, friends and family test results, and CQC comment cards. There was an effective system in place for the reporting and recording of significant events. Learning was applied from events to enhance the delivery of safe care to patients. Clinicians kept themselves updated on new and revised guidance and discussed this at clinical meetings. Staff assessed patients needs and delivered care in line with current evidence based guidance. Feedback from patients we spoke with on the day, and from CQC comment cards, demonstrated that people had excellent access to GP appointments. We saw evidence of an active programme of clinical audit that reviewed care and ensured actions were implemented to enhance outcomes for patients. The practice planned and co-ordinated patient care with the wider health and social care multi-disciplinary team to deliver effective and responsive care and keep vulnerable patients safe. Regular meetings took place to discuss and review patients needs. The practice had an appraisal system in place and supported staff training and development. The practice team had the skills, knowledge and experience to deliver high quality care and treatment. Longer appointments were available for those patients with more complex needs, and there was greater flexibility in offering appointments for vulnerable patients such as those with a learning disability. The practice had good facilities and was well-equipped to treat patients and meet their needs. The premises were accessible for patients with impaired mobility. There was a clear leadership structure in place and the practice had a governance framework which supported the delivery of good quality care. Regular practice 61

85 meetings occurred, and staff said they felt valued and that GPs and managers were approachable and always had time to talk with them. The partnership had a clear vision for the future of the service, and was engaged with their Clinical Commissioning Group (CCG) in order to progress this. The practice had an open and transparent approach when dealing with complaints. Information about how to complain was available, and improvements were made to the quality of care as a result of any complaints received. The practice patient participation group (PPG) was active and helped to champion the patient voice to influence developments within the practice. The CQC saw the following areas of outstanding practice: The nurse practitioners provided on-the-day assessment and care for patients presenting with new and acute conditions, and minor illnesses. They undertook home visits and one provided regular input at a local care home for patients with dementia. This alleviated pressure on GPs allowing them more time for complex consultations and produced positive outcomes for patients. For example, input to the care home demonstrated effectiveness through the reduction in contacts with the out of hours service and hospital admissions. Over a 12 month period, hospital admissions fell from 67 to 43, and contact with the out of hours service reduced from 23 to 17 patients. There was also a decrease in falls at the home from 56 between January to March 2014, to 24 in the corresponding period the following year. The practice directly employed a mental health support worker. Data for emergency admissions for mental health over a three year period showed low figures for the practice. These were the lowest within their locality and one of the lowest within their CCG. The practice were able to provide evidence that over the last two years, only four of 22 patients at high risk of hospitalisation had been admitted, with two of the admissions being outside of the practice s direct control. The practice demonstrated a responsive approach by taking account of the needs of their local population, and not just their registered patients. This enabled services to be delivered closer to patient s homes. Areas for improvement: Review the need to take emergency medicines on home visits, or consider a risk assessment to be completed for this. 62

86 Hartington Surgery received an overall rating of Outstanding. Summary of key findings include: Importance was placed in treating patients with dignity and respect. The practice had recently received the Derbyshire Dignity Campaign Award, an initiative developed by the local County Council. Overall feedback from patients was extremely positive with regards the care and services they received. Patients said they were treated with compassion, dignity and respect, and were involved in decisions about their care and treatment. Patient survey satisfaction scores in respect of care and how they were treated were significantly above local and national averages. Feedback from community based staff we spoke with, was consistently positive with regards to the high levels of care provided by the practice team. The services were delivered in a way to ensure flexibility, choice and continuity of care. The appointment system and services were flexible to meet the needs of patients. Most patients told us they were able to access appointments or telephone consultations in a way, and at a time that suited them. The standard appointment times for all clinical staff with the exception of locum GPs, had been extended from 10 to 15 minutes for each patient. This meant that the clinical staff had more time to assess patient s needs, and provide advice and support. Patients lived over a vast rural area. The practice had a small staff team who lived in the area, and had a wealth of local knowledge and knew their patients well. The practice had close links with the local community and worked in partnership with other services to meet patients needs. The practice provided a range of services on site to enable patients to be treated locally and in response to their needs. For example, the provision of 24 hour cardiac monitoring (including interpretation) is funded by the practice in response to patients needs. The premises were on one level and provided good access and facilities for patients, and were well equipped to meet their needs. There was an open and transparent approach to safety. Effective systems were generally in place to keep patients safe, including the management of medicines. There was evidence of quality improvement including clinical audits. The culture and leadership empowered staff to carry out lead roles and to drive continuous improvements. 63

87 The practice had a highly motivated, experienced and cohesive staff team to enable them to deliver well-led services. The culture supported learning and innovation. The commitment to learning and the development of staffs skills was recognised as essential to ensuring high quality care. Staff development was encouraged and we saw how individuals had taken on new roles with the support of senior staff. The practice actively sought the views of patients and staff, which it acted on to improve the services. The patient participation group (PPG) had been established 27 years, and continued to influence practice developments. The PPG worked in partnership with the practice and were actively involved with many aspects of the practice s work. Complaints were listened to and acted on to ensure that appropriate learning and improvements had taken place. CQC saw several areas of outstanding practice including: In response to the problems associated with rural isolation and lack of local services, a practice nurse provided a home assessment service and health checks, for elderly, housebound and vulnerable patients. This helped to identify health or social issues that may not have been reported, and ensure patients needs were met. The practice population included a large farming community. The staff team had built up strong relationships with the farming families, to increase their willingness to access support and health services locally. The practice worked closely with the Farming Life Centre, a local charity dedicated to improving the quality of life of farmers and rural communities through its services. Ashgate Medical Practice received an overall rating of Good. Summary of key findings include: There was an effective system in place for the reporting and recording of significant events. The practice had adapted a system from a neighbouring practice termed learning opportunities to share (LOTS) to encourage incident reporting at all levels within the practice. This encouraged staff to raise events, however minor or significant, with the resulting impact of issues increasingly being reported. Learning was applied from all events to enhance the delivery of safe care to patients. Staff assessed patients needs and delivered care in line with current evidence based guidance. 64

88 A regular programme of clinical audit and research reviewed patient care and ensured actions were implemented to improve services as a result. The practice planned and co-ordinated patient care with the wider multi-disciplinary team to deliver effective and responsive care to keep vulnerable patients safe. The practice had an effective appraisal system in place, and was committed to staff training and development. The practice team had the skills, knowledge and experience to deliver high quality care and treatment. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. The practice analysed and acted on the patient and staff feedback they received, and worked with a proactive Patient Participation Group (PPG) to enhance patient experience. Information about how to complain was readily available to patients. Improvements were made to the quality of care as a result of any complaints received. Results from the national GP survey and feedback from patients we spoke with during the inspection demonstrated some dissatisfaction with the appointment system. The practice was aware that access was problematic and had taken action to address this. This matter remained under review by the practice as they strove to improve access. Longer appointments were available for those patients with more complex needs. A GP triaged calls and ensured that any patient requiring an urgent appointment was seen on the same day. There were elements of the practice s quality monitoring arrangements, and the actions taken to reduce risks, that required strengthening. For example, the practice had not arranged for Disclosure and Barring Service (DBS) checks on two staff that had been trained to act as chaperones. In addition, some medicines management issues such as the checking of medicine expiry dates lacked sufficient oversight and required more robust management. However, the practice took immediate action to rectify these issues. The practice had modern purpose-built facilities that were well-equipped to treat patients and meet their needs. There was a clear leadership structure in place and the practice had a governance framework which supported the delivery of good quality care. Regular practice meetings occurred, and staff said that the GPs and managers were approachable and always had time to talk with them. 65

89 The practice had a clear vision for the future and the aspirations of the partners were in line with the CCG strategy of delivering high quality care closer to the patient s home. CQC saw the following area of outstanding practice: The practice had commenced an in-house pharmacy pilot project from September This placed a prescribing community pharmacist within the practice for four days each week. The pharmacist had made 2,173 patient contacts between September 2015 and April 2016, approximately 75% of which were face to face consultations. This had a significant impact in releasing additional GP consultation capacity, and providing expert advice and support to patients and the practice team with regards to medicines related issues. Areas for improvement are: Consider the frequency and oversight of regular reviews for emergency medicines so that they are available when needed. Review procedures to monitor prescriptions, including the destruction of prescriptions assigned to a named GP after leaving the practice. Ensure the practice cold chain policy is implemented, supported by staff training, and with regular monitoring arrangements to provide assurance that it is being followed. Review procedures to ensure all staff who act as a chaperone receive appropriate DBS clearance. 6.6 Never Events and Level 2 Serious Incident Investigations Never Events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented that have been laid down by the Department of Health. Level two incidents are considered to be high risk and require a comprehensive investigation report and action plan. These must be monitored by the Quality Assurance Group to full completion. There has been one potential Never Event during November. This was in relation to a retained foreign object post foot surgery. Once the investigation has been completed, upon the review of the report, the CCG will make a decision on the classification of the incident. 66

90 6.7 Stockport FT The Safety Thermometer records the prevalence of harm on a particular day each month and should be used alongside other data such as incident data to measure the quality of care. The measures included are pressure ulcers, falls and urinary tract infections in patients with a catheter in situ. Please see the tables below for the 2016/17 Safety thermometer data. 6.8 Patient Experience Lay Reference Group (LRG) The LRG met on 25th November 2016 where the group discussed five key topics covering Continuing Health Care (CHC), proposed consultation on gluten-free food, East Midlands Ambulance Service update, Performance Programme Update, and Sustainability Transformation Plan update. Feedback and comments made in the meeting included: CHC: Members felt that the new CHC specification allowing delegated responsibility for out of hours support for patients who are identified as needing CHC services was unclear. Outcome: This will be flagged and actioned by Suzanne Pickering and feedback to the December meeting. 67

91 Performance Programme: Members agreed that the new Derbyshire wide performance and quality plan would be an improvement but were interested to see that the data is used to identify hotspots in the system and that it would be good to have the headline report on one sheet. One member commended the system for having a falling level of Methicillin Resistant Staphylococcus Aureus and C-Difficile cases. Outcome: NHS England Delivery Manager (Vicky Johnson) agreed to come to speak to the group at a future meeting around Performance measures across the Midlands. Also Laura Joy - Deputy Chief Nurse for the CCG will give more detail as to how patient experience will be shared in the future via the Performance and Quality Dashboard which will replace the existing Quality Report in the New Year. One member has joined the GP (Primary Care) Dashboard meeting group. Gluten-free Food Consultation: The group on the whole supported Option One and felt that gluten free food did not need to be provided on prescription. One member felt that families with low income and three children requiring gluten free food would be disadvantaged financially if the proposal went ahead. Another member replied that a gluten free diet can be maintained without using any of the products provided via the prescription. EMAS: Simon Harris (SH) gave a presentation on the EMAS contract and how it is managed. The slides included an outline of the service, local initiatives and the issues affecting performance. It was recognised that there had been significant under performance against targets. SH gave an outline of eight items that had led to under performance. Better Care Closer to Home: Last week saw the close of the Better Care Closer to Home Clarification period. The response to the clarification questionnaire has been very much less than the consultation period. In total around 50 people completed the clarification form as opposed to over 1,500 for the consultation response form. The process of considering the responses from both periods has begun and is being analysed by an independent academic from UEA. Recommendations and appropriate mitigations will be checked and finalised at a cross system review at the beginning of 2017 and then presented to a joint Governing Body in February Review of Patient Experience: The 360 Review Team is in the process of evaluating the patient experience process in operation in NDCCG. On next page see the overview of NDCCG Patient Experience Model which is now being considered by the audit team: 68

92 Overview of the NDCCG Patient Experience Model Lay Reference Group Commissioning Project Groups Patient Participation Groups (PPGs) Network PPG Meetings Specialist Groups Health Panel Patient Groups Quality Assurance Mechanisms Quality Visits Provider Quality Assurance Groups QAG Call Reviews Quality Schedule Commissioning Concerns Complaints PALS Healthwatch reports Enquires website Commissioning Concerns and other Reports Consultation and Political Feedback Health Improvement and Scrutiny Committee Local Councillors Public and Stakehodler Meetings Focus groups Drop in sessions Questionnaires Telephone Online enquirers Workshops MPs Patient Experience Committee (PEC) Quality Assurance Groups Primary Care Delivery Group (PCDG) Project Delivery Group (PDG) Quality Report Governing Body Assurance Group (GBAC) Primary Care Co- Commissioning Group (PCCCG) Patient Story Governing Body All Team NDCCG NHS England 69

93 6.9 Mental Health The following chapter focuses on the key areas that are monitored and reported through the Quality Assurance Group (QAG) and the integrated performance and activity report for the contract with Derbyshire Healthcare Foundation Trust (DHcFT) Cost Improvement Programme (CIP) The CIP impact upon quality is carefully monitored each month to ensure that any cost improvements have quality impact assessments completed and that the CCG are sited on any quality risk issues. DHcFT has no red flags for quality at this point. 7 day follow-up exceptions Evidence suggests that people with mental health problems, especially those with severe and enduring mental illness are at particular risk of suicide and that people are particularly vulnerable in the period immediately after they have been discharged from a mental health inpatient ward so this area is closely monitored. CCG Name Discharge Discharge Comments Date Ward NHS NORTH 26 OCT HARTINGTON Followed up on day 8 DERBYSHIRE 2016 UNIT CCG PLEASLEY WARD ADULT Out of area The CCG continues to monitor the number of North Derbyshire residents that are placed out of area for acute mental health admissions via a weekly report that tracks these individuals. The Provider has recently appointed a senior staff member to review all Psychiatric Intensive Care Unit (PICU) placements and as part of the remit will also review out of area acute placements. At the time of writing NDCCG has one person in an Out of Area Acute bed following an admission on 27/11/16. 70

94 Numbers of NDCCG individuals in locked settings continue to fluctuate. There are currently 18 individuals in Locked Services following two discharges to community care settings this month. There is one potential admission in discussion at this time. NDCCG currently has two patients in a PICU and one discharge in November. Improving Access to Psychological Therapies recovery rate At the time of writing North Derbyshire CCG continues to exceed the 75% wait time target for % of patients that waited under four weeks (82.5%), % of patients that waited under six weeks (94.7%) and meets the target of % of patients that waited under 18 weeks (target 95%; NDCCG 95%) North Derbyshire CCG Level Performance Dashboards (DHCFT) This dashboard contains only the indicators that the Trust can easily breakdown to CCG level. The dashboard provides assurance that both the Monitor and Schedule four performance indicators are being met for the North Derbyshire population in all areas other than Crisis gatekeeping, Consultant Does Not Attend (DNA) and Consultant Trust Cancellations. NHS NORTH DERBYSHIRE CCG Performance Dashboard Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Trend - NHSI Targets - CPA 7 Day Follow Up 95.00% % % % 96.30% 96.15% 86.36% 95.83% - CPA Review in last 12 Months (on CPA > 12 Months) 95.00% 96.39% 97.12% 96.08% 95.47% 96.91% 95.71% 95.32% - Delayed Transfers of Care 7.50% 1.96% 1.87% 1.00% 0.00% 0.00% 0.00% 0.00% - Data Completeness: Identifiers 97.00% 99.69% 99.66% 99.71% 99.71% 99.73% 99.72% 99.70% - Data Completeness: Outcomes 50.00% 95.28% 95.49% 95.20% 95.09% 94.70% 95.15% 95.37% - 18 Week RTT Less Than 18 Weeks - Incomplete 92.00% 99.07% % 98.67% 98.33% 97.22% 94.12% 96.67% - Clostridium Difficile Incidents Crisis GateKeeping 95.00% % % % % % % 90.00% - IAPT Referral to Treatment within 18 weeks 95.00% % % % 98.80% % 99.47% % - IAPT Referral to Treatment within 6 weeks 75.00% 90.68% 88.72% 93.71% 89.22% 92.17% 90.96% 88.02% - Early Intervention in Psychosis RTT Within 14 Days 50.00% 87.50% % % 70.00% 90.00% 60.00% % - Schedule 4 Contract - Consultant Outpatient Appointments Trust Cancellations (Within 6 Weeks) 5.00% 7.29% 3.32% 2.00% 1.62% 3.60% 4.23% 5.16% - Consultant Outpatient Appointments DNAs 15.00% 13.33% 13.00% 13.57% 16.28% 16.44% 18.38% 15.07% - Under 18 Admissions To Adult Inpatient Facilities Inpatient 28 Day Readmissions 10.00% 6.90% 0.00% 3.85% 6.06% 0.00% 4.00% 3.57% - MRSA - Blood Stream Infection Mixed Sex Accommodation Breaches Week RTT Greater Than 52 weeks Actions are in place and reported via DHCFT: DNAs The rate of DNAs was above the target threshold once again. Where mobile numbers are recorded on Paris text message reminders are sent Consultant cancellations 71

95 The main reasons given for cancellation were consultants being absent from work and clinics booked in error. Associate Clinical Directors to review cancellation reasons and discuss with consultant concerned where the reason does not appear valid, if applicable. List of clinic cancellation reasons has been agreed and added to Paris by IM&T to enable easier reporting and monitoring. IM&T have adapted Paris to enable the recording of cancellation reasons for individual appointments, not just whole clinics. ASD Performance DHCFT has recruited additional staff in October to undertake assessments so the situation should improve. As a one off request from the CCGs, the Trust has included a breakdown of Autism Diagnosis (ASD) waits by CCG CCG Apr 16 May 16 Jun 16 Jul 16 Aug 16 Sept 16 Oct 16 North No. Waiting Derbyshire Average CCG Wait (Wks) Max Wait (Wks) Min Wait (Wks) Focus Line Rethink Mental Illness is one of the leading mental health charities in the UK. 72

96 Their goal is a better life for everyone affected by mental illness. They provide help, hope, and support, advice and information, and fight discrimination and campaign for better services. Focusline is a mental health helpline run by Rethink Mental Illness for over 12 years. Their support workers are experienced mental health workers, trained in how to support someone with an illness that is upsetting and difficult to deal with for themselves and for people around them. Derbyshire commissioners are starting a trial to have mental health recovery workers from Focusline work within the 111 offices to take calls from people affected by mental illness from Derbyshire residents. The trial commenced during November with the aim is that the service is fully operational early in the New Year. Mental health recovery focuses someone on making sense of their illness and creating a recovery plan based on what works for them, empowering someone to manage their illness. They work with adults aged 18 or over, and will offer callers around 30 minutes of solution and recovery focused support. 73

97 Quality Premium 2016/17 The quality premium was introduced nationally in 2013/14 to reward CCG s for improvements in the quality of the services that they commission and for associated improvements in health outcomes and reducing inequalities. This report provides a high level assessment of CCG performance year to date. It should be noted that payment is largely dependent on end of year achievement. As such, some data is not available at the present time and the report should therefore be viewed in this context. 74

98 The purpose of this dashboard is to give NHS North Derbyshire CCG an insight into their current progress against the Quality Premium requirements for 2016/17. The full potential value of the Quality Premium is 1,400,000 based on NHS North Derbyshire CCG's current registered population of 280,000 patients, though the actual amount awarded is dependent on fulfilling the criteria stated below. There are 2 sections; Quality Premium Measures, passing these makes up the initial value of the Quality Premium. NHS Constitutional Rights & Pledges, failing these will result in a percentage reduction. These factored together create the total quality premium amount applicable. Please note that, in the case of annual measures, our final position will not be available until summer NHS North Derbyshire CCG Quality Premium In-Year Dashboard The purpose of this dashboard is to give NHS North Derbyshire CCG an insight into their current progress against the Quality Premium requirements for 2016/17. The full potential value of the Quality Premium is 1,400,000 based on NHS North Derbyshire CCG's current registered population of 280,000 patients, though the actual amount awarded is dependant on fulfilling the criteria stated below. There are 2 sections, Quality Premium Measures, passing these makes up the initial value of the Quality Premium, and NHS Consitutional Rights & Pledges, failing these will result in a percentage reduction in the sub-totalled value of the Quality Premium Measures. These factored together create the total quality premium amount applicable. Quality Premium Measures Threshold for Achievement Period Target YTD Current YTD Performance Forecast RAG Rating % Of QP Potential Value Forecast Value Cancers Diagnosed At Early Stage 4% Improvement in 2016 calendar year vs 2015 calendar year 2015/16 Q % 20% 280,000 0 Increase In The Proportion of GP Referrals Made By E-Referrals Meet 80% by March 2017 Sep-16 80% 77.1% 20% 280,000 0 Overall Experience Of Making A GP Appointment 3% increase from July 2016 publication Jul % 20% 280,000 0 Improving Antibiotic Prescribing: a) Reduction In The Number Of Antibiotics Prescribed In Primary Care Improving Antibiotic Prescribing: b) Reduction In The Proportion Of Broad Spectrum Antibitoics Prescribed In Primary care Reduction of 1% or greater from 2013/14 to 2015/16 Reduction of 10% or greater from 2013/14 to 2015/16 or below 11.3% (England Median) Sep Sep % 140, ,000 Cancer - Receiving first definitive treatment within two months of urgent referral from GP Increase to 86% in 2016/17 Oct-16 86% 79.7% 10% 140,000 0 Maternity - % of women known to be smokers at time of delivery Reduce to 12% in 2016/17 #REF! 12% #REF! 10% 140, ,000 Mental Health - Reported numbers of dementia on GP registers as a % of estimated prevalence Increase to 70% in 2016/17 Oct-16 70% 71.1% 10% 140, ,000 Sub-Total 100% 1,400, ,000 NHS Constitution Rights & Pledges Threshold for Achievement Period Target YTD Current YTD Performance Forecast RAG Rating % Of Deduction Potential Deduction Forecast Deduction (E.B.3) Referrals To Treatment Incomplete Pathways - % Within 18 Weeks 92% or greater monthly average for 2015/16 Oct-16 92% 93.2% 25% 105,000 0 (E.B.5) A&E Waiting Time - Proportion With Total Time In A&E Under 4 Hours 95% or greater for 2015/16 Oct-16 95% 89.6% 25% 105, ,000 (E.B.6) All Cancer Two Week Wait - Proportion Seen Within Two Weeks Of Referral 93% or greater for 2014/15 Oct-16 93% 94.4% 25% 105,000 0 (E.B.15.i) Ambulance - Proportion Of Category A (Red 1) Calls With Response Within 8 Minutes 75% or greater for 2014/15 Oct-16 75% 68.9% 25% 105, ,000 Total Deduction (to be subtracted from Quality Premium Total 100% 420, ,000 Grand Total 210,000 RAG Rating Key: Indicator currently achieving / has achieved the Quality Premium requirements Indicator currently not achieving Quality Premium requirements but in a position where achievement is still possible Indicator has failed to meet Quality Premium requirements or is in a position where it will be not be achieved 75

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100 ND CCG Governing Body Assurance Committee 19th December 2016 Paper E NORTH DERBYSHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY ASSURANCE COMMITTEE Report Title: Purpose: Diabetes transformation funding application To outline the plans to bid for funding for transformation funding for diabetes Item No: 8 Objective: 1. Background and context Transformation funding for Diabetes- bidding process In line with the Planning Guidance, the CCGs have access to transformational funds to deliver improvements in diabetes treatment and care focussing on the following areas: Improving uptake of structured education by both the prevalent and newly diagnosed population Improving the achievement of the NICE recommended treatment targets (HbA1c, cholesterol and blood pressure) and driving down variation between CCGs and between GP practices Reducing amputations by improving the timeliness of referrals from primary care to a multi-disciplinary foot team for people with diabetic foot disease Reducing length of stay for inpatients with diabetes by the provision of Diabetes Inpatient Specialist Nurses (DISNs) The proposed share of the national funding available is as follows: Structured education - 10m Treatment targets- 17m Multi-Disciplinary Footcare Teams (MDFTs)- 8m Diabetes Inpatient Specialist Nursing Teams (DISNs) - 8m This funding is for transformation funding in 2017/18 and provisionally in 2018//19 subject to confirmation. There is no capital funding available only revenue funding. The documentation was received on 12 th December with a submission date of 18 th January. The NDCCG values Patient-Focus, Integrity, Courage and Responsiveness inform our decision making and behaviours 1

101 ND CCG Governing Body Assurance Committee 19th December 2016 Paper E Sites will be notified of the outcome of the bids in March The guidance states that bids will be accepted from individual CCGs or groups of CCGs on behalf of an STP but the bid must be submitted via the STP. Bids have to be agreed via the relevant governance processes for each partner. A Senior Responsible Officer, clinical lead and implementation leads across the partners within a bid should be identified. Why it s important- the scale of the challenge The QOF data (2015/16) indicates there are currently 59,447 patients (17+) diagnosed with diabetes across the four Derbyshire CCGs an average prevalence of 7.33% (range from 6.87% in North Derbyshire CCG to 8.50% in Hardwick). This is above the England average (6.55%)and this figure is rising year on year. Using the latest National Cardiovascular intelligence Network projection figures, the estimated 2015 figures are even higher - for North Derbyshire CCG the estimate is 21,951 (8.7%), for Hardwick CCG is 7,621 (9%), for Erewash 6807 (8.4%) and Southern Derbyshire 37,591 (8.5%). According to the 2015 Director of Public Health Annual Report for Derbyshire, in Derbyshire 68.8 percent of adults are classed as overweight or obese. This is higher than the East Midlands regional figures at 66.7 percent and higher than the national figures for England at 64.7 percent. The proposed bid The achievement of the 3 targets and uptake of structured education are both indictors in the CCG improvement and assessment framework and therefore one of the key measures against which the CCGs is assessed. All four CCGs in Derbyshire are below the national average in terms of achievement of the 3 targets and also in terms of people with diabetes who attended a structured education course (although this is an issue for all areas and is in part a data coding issue which we have put plans in place to address). Three of the four CCGs (North Derbyshire, Hardwick and Erewash) are assessed as needs improvement with Southern Derbyshire CCG identified as greatest need for improvement. CCG current performance: CCG % achievement of all 3 targets (HbA1c, BP and cholesterol) (15/16 data) % participation in NDA (target >=90%)* North Derbyshire 38.3% 91.4% 4% The NDCCG values Patient-Focus, Integrity, Courage and Responsiveness inform our decision making and behaviours % attending structured education ** 2

102 ND CCG Governing Body Assurance Committee 19th December 2016 Paper E Hardwick 36.1% 93.8% 7.4% Erewash 36.1% 83.3% 3.7% Southern Derbyshire 36.6% 63% 3.4% *source15/16 National Diabetes Audit data ** source 14/15 National Diabetes Audit data In North Derbyshire and Hardwick CCGs, there has been very little financial investment in Diabetes over the last few years and although the CCG Governing Body approved the implementation and funding of a new model for Diabetes, this was unable to be progressed due to the financial challenges faced by the CCG and competing priorities at the time. Erewash CCG have been piloting a community based clinic. The Erewash Diabetes Service is a Consultant led MDT clinic with DSN, Dietician and HCA input. It is recognised however, that there are other areas in the Diabetes pathway that need to be strengthened in order to improve in areas such as the three key treatment targets, structured education attendance and major amputations. This funding provides an opportunity to test out and pilot some of these plans. The proposed bid is still in development as the guidance has only just been received, but intends to focus on implementing a combination of elements from the original plan in the North of the county along with elements from the plans in Southern Derbyshire and Erewash CCGs. The focus is mainly on elements which require non-recurrent funding or where the funding will provide an opportunity to robustly pilot ideas which, if successful and in line with priorities at the time, would then seek recurrent funding or mainstreaming within existing services. The CCGs intend to bid for funding jointly for most of the first 3 areas (achievement of the 3 targets, structured education and reduction in amputations) and possibly also for Diabetes Inpatient Specialist Nurses. This is still in discussion across the CCGs. The plans are at a high level as follows: 3 treatment targets 1. More streamlined referral to place based lifestyle services to ensure earlier access to appropriate interventions. 2. Implementation of a diabetes management quality scheme to improve achievement of the targets at practice level. Individual practice targets would need to be agreed with the practice in response to an initial audit. 3. Upskilling primary care to manage more complex patients by offering opportunities for joint clinics, backfill for secondments to shadow DSNs, training, mentoring, education etc. 4. Roll out of telephone consultant or DSN advice for Diabetes to support primary care (in line with the STP plan) 5. Backfilling Practice Nurses already at the agreed competency level to deliver the enhanced level of care at Place, with DSN mentorship. SDCCG plan to deliver this The NDCCG values Patient-Focus, Integrity, Courage and Responsiveness inform our decision making and behaviours 3

103 ND CCG Governing Body Assurance Committee 19th December 2016 Paper E as a proof of concept with the aim of reducing secondary care appointments. Structured education 1. Commission additional short-term capacity to meet some unmet demand e.g. patients who have never attended a programme 2. Development and roll out of education sessions to carers of diabetics of learning difficulties, dementia and also nursing home staff 3. Marketing campaign for patients to increase awareness of the importance of structured education including prescription pads 4. Funding for taster sessions for patients to better understand the benefits of attending the structured education 5. Develop an audit plan to review effectiveness of the two programmes in Derbyshire 6. Provision of ad-hoc training for primary care colleagues to better understand the programme to support conversations with patients. Improving timely access to Diabetes Multi-disciplinary Footcare Teams (MDTs) Rather than focussing on investment in Acute MDTs which are already at capacity, the plan is to focus around increasing capacity in community footcare teams by reducing acute follow-ups via a number of mechanisms. Options being considered include: 1. Possible expansion of the pilot of the 3D silhouette system which allows podiatry teams to track and monitor changes to foot ulceration and get remote advice from the acute teams 2. Piloting the TCC-EZ casting system for foot ulcers at CRH in conjunction with DCHS community podiatrists 3. Roll out of community MDTs to other areas in line with Whitworth and High Peak model which enables faster access to minor amputations where appropriate. 4. Roll out of a more robust urgent footcare problems system with s triaged within 24 hours by diabetic specialist podiatrists to ensure patients are managed within the most appropriate setting and referred on if necessary to community or acute MDTs. 5. Train the trainer sessions for footcare screeners and other staff e.g. LA support staff in people s homes Key matters for consideration If the CCGs were successful we would need: -a joint Derbyshire-wide Diabetes implementation group to lead and oversee the work on behalf of the CCGs and providers -Input from across the CCGs -GPs, Public Health representation and Senior Commissioning Managers and the wider Diabetes clinical project teams including podiatry and Diabetes education as appropriate. If the pilot schemes are successful, further funding/investment required would have to be The NDCCG values Patient-Focus, Integrity, Courage and Responsiveness inform our decision making and behaviours 4

104 ND CCG Governing Body Assurance Committee 19th December 2016 Paper E reviewed against other CCG/STP priorities at the time. It would also need to be looked at in the context of commissioning diabetes differently possibly with a pathway-based approach with commissioning based on outcomes rather than activity which may then enable continuation of some of this work. 3. Financial Impact Resource investment: PH, GPs +/- PNs as required, CCG commissioning staff to support development of and roll out of the plans. RoI: Reduced clinical variation; better health outcomes for patients. 4. Analysis of Risk The CCG risks are minimised as the bids are primarily focussed around using the funding to test different ways of working or addressing short-term problems. The main resource needed is commissioning, clinical and managerial capacity to deliver the plans across the STP organisations. There may be issues in terms of delivery by practices and providers for a number of reasons and if successful, the CCG leads would need to work through this with practices and providers. These include but are not limited to: The practices are at already under pressure and may not engage in the quality improvement scheme however, this builds on what they are already doing for QOF. The Structured Education element of the bid centres on increased provision of DAY and XPERT courses. This is dependent on DCHS being able to recruit more educators. The availability of these educators is a risk to delivery of this element of the bid. However DCHS have stated that they have people available who have expressed an interest in working in this area. Specifically there must be educators available in the evenings and at weekends to make the courses more accessible to patients. 5. Equality Impact Please describe how this report and/or the services described within it aid the CCG in achieving the objectives of the Equality Delivery system, namely: Better health outcomes for all: The plans should reduce variation in terms of the key areas of diabetes with clinicians focussing on activities that enhance patient outcomes; there is potentially less harm & patient outcomes achieved more quickly Improved patient access and experience: the plans aim to improve clinical outcomes and provide more robust pathway for acute diabetic footcare supporting more rapid access to appropriate patients. Empowered, engaged and well-supported staff: This proposal is designed to enhance professionalism, enthusiasm and morale. Inclusive leadership at all levels: This project would engage and join those with interests and expertise across the healthcare community. 6. Recommendations It is recommended that GBAC: The NDCCG values Patient-Focus, Integrity, Courage and Responsiveness inform our decision making and behaviours 5

105 ND CCG Governing Body Assurance Committee 19th December 2016 Paper E 1. Support the CCGs in their joint application for funding for improving diabetes services for patients including the funding of ongoing clinical input and allocation of commissioning resource if successful. Author: Sally Baughen, Head of Planned Care Sponsor: Ben Milton, CCG Chair Date: The NDCCG values Patient-Focus, Integrity, Courage and Responsiveness inform our decision making and behaviours 6

106 ND CCG Governing Body Assurance Committee Meeting 19th December 2016 Paper F NORTH DERBYSHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY ASSURANCE COMMITTEE MEETING Report Title: 19th December 2016 HR Policies Relocation Policy and Travel and Expenses Policy Item No: 9 1. Background and context This paper provides the Governing Body Assurance Committee with the CCG s Relocation Policy and the Travel and Expenses Policy. 2. Key matters for consideration Relocation Policy The Relocation policy was reviewed and approved by the Remuneration Committee on the 26 th September The Relocation Policy for new North Derbyshire CCG employees. The purpose of the Relocation policy is to set out the qualifying criteria, support and compensation for employees to enable them to move with their work. The policy ensures compliance with HMRC policy and guidance as well as the provision of reasonable relocation packages for employees making appropriate use of funds. The Relocation Policy will be reviewed every two years or sooner if necessary to comply with any changes in legislation or if required for other reasons. Travel and Expenses Policy The HR Team have produced the policy together with the CCG and is consistent across the 4 Derbyshire CCG s. The Travel and Expenses policy ensures that all employees understand the process when claiming expenses for travel and expenses. It also provides managers with a clear equity and transparent process to follow. Travel is an integral part of the work of many of CCG staff and it is right that expenses incurred in travelling should be reimbursed. Sections 17 & 18 of the Agenda for Change NHS Terms & Conditions of Service Handbook provides for the reimbursement of staff for mileage allowances and subsistence cost. 1

107 ND CCG Governing Body Assurance Committee Meeting 19th December 2016 Paper F The purpose of this policy is to provide: A structured framework to claiming travel expenses; Practical guidance to staff and managers on process and procedure; To ensure that travel expenses are claimed in a consistent, accurate and timely way; Guidance on mileage allowance. The Travel and Expenses policy is for all employees of North Derbyshire Clinical Commissioning Group and includes Governing Body and Lay Members. 3 Financial Impact Relocation Policy Any cost incurred beyond 8,000 will be the employee s responsibility. 4. Analysis of risk The policies ensure consistent and fair treatment for all CCG staff. 5. Equality Impact Please describe how this report and/or the services described within it aid the CCG in achieving the objectives of the Equality Delivery system, namely: The documents meet all requirements and include an Equality statement and Equality analysis. Better health outcomes for all: Improved patient access and experience: Empowered, engaged and well-supported staff: Inclusive leadership at all levels: 6. Recommendations The Governing Body Assurance Committee is asked to approve the Relocation Policy and the Travel and Expenses Policy.. Author: Suzanne Pickering, Head of Governance Sponsor: Darran Green, Interim Chief Finance Officer Date: 12 th December

108 Travel & Expenses Policy Travel & Expenses Policy V1 FINAL Page 1 of 16

109 Policy Title: Description of Amendment(s): This policy will impact on: Financial Implications: Travel & Expenses Policy New Policy for NHS North Derbyshire CCG employees All NHS North Derbyshire CCG Staff on Agenda for Change Terms and Conditions No change Policy Area: FINANCE Version No: 1 Issued By: Author: Arden & GEM HR Business Partners Sponsor: Head of Governance Chief Finance Officer Effective Date: Review Date: October 2018 (Or sooner if necessary to comply with any changes in legislation or if required for other reasons) APPROVAL RECORD Consultation: Committees / Groups / Individual Consultative Committee Date Approved by Committees: Specialist Advice (if required) N/A Management / Staff Side Consultative Committee Governing Body Governing Body Assurance Committee 19 th December 2016 Revision History Version Revisions Date Travel & Expenses Policy V1 FINAL Page 2 of 16

110 ASSISTANCE WITH THE APPLICATION OF THIS POLICY AND UPDATES This policy has been prepared so as to reflect the law as at 1st October The policy will require periodic review to reflect subsequent changes to the law. Changes to employment law have generally been made on 1 February, 1 April and 1 October in any given year. For advice and assistance in relation to the application of this policy and to obtain updates please contact: Your line manager in the first instance or Arden & GEM Human Resources Business Partners. This policy has been prepared by North Derbyshire Clinical Commissioning Group in partnership with Beachcroft LLP and Arden & GEM Human Resources Business Partners. Travel & Expenses Policy V1 FINAL Page 3 of 16

111 Contents 1. EQUALITY STATEMENT DUE REGARD POLICY Policy Statement Principles TRAVEL EXPENSES Eligible Miles Car Allowance Reserve Rate Lease Cars (if applicable) Motorcycle Allowance Pedal Cycles Passenger Rate Other Allowances Call Out Training Courses/Conferences/Events Excess Mileage Bulky Equipment Public Transport SUBSISTENCE Overnight Accommodation OTHER EXPENSES Expenses of Candidate for Appointment Reimbursement of Sundry Expenses Patient User Groups and Non-Employees PROCEDURE Travel and Expenses Claims Form Submission Methods of Payment E-Pay Authorisation Exemptions MONITORING AND REVIEW ASSOCIATED LOCAL DOCUMENTATION 10 Appendix 1 TAX AND NATIONAL INSURANCE LIABILITIES FROM 1 ST 11 JUNE 2016 Appendix 2 ELIGIBILITY MILEAGE. 13 Appendix 3 MILEAGE RATE. 14 Appendix 4 AUTHORISATION TO CLAIM EXCESS MILEAGE. 15 Appendix 5 SUBSISTENCE RATES 16 Travel & Expenses Policy V1 FINAL Page 4 of 16

112 1. EQUALITY STATEMENT North Derbyshire Clinical Commissioning Group aims to design and implement policy documents that meet the diverse needs of our services, population and workforce, ensuring that none are placed at a disadvantage over others. It takes into account current UK legislative requirements, including the Equality Act 2010 and the Human Rights Act 1998, and promotes equal opportunities for all. This document has been designed to ensure that no-one receives less favourable treatment due to their protected characteristics of their age, disability, sex (gender), gender reassignment, sexual orientation, marriage and civil partnership, race, religion or belief, pregnancy and maternity. Appropriate consideration has also been given to gender identity, socio-economic status, immigration status and the principles of the Human Rights Act. In carrying out its function, NDCCG must have due regard to the Public Sector Equality Duty (PSED). This applies to all activities for which NDCCG is responsible, including policy development, review and implementation. 2. DUE REGARD 2.1 This policy has been reviewed in relation to having due regard to the Public Sector Equality Duty (PSED) of the Equality Act 2010 to eliminate discrimination; harassment; vicitimisation; to advance equality of opportunity; and foster good relations between the protected groups. 3. POLICY 3.1 POLICY STATEMENT Travel is an integral part of the work of many of CCG staff and it is right that expenses incurred in travelling should be reimbursed. Sections 17 & 18 of the Agenda for Change NHS Terms & Conditions of Service Handbook provides for the reimbursement of staff for mileage allowances and subsistence cost. To view the Agenda for Change NHS Terms & Conditions of Service Handbook go to the NHS Employers web site at and look for the terms of conditions handbook. The purpose of this policy is to provide: A structured framework to claiming travel expenses; Practical guidance to staff and managers on process and procedure; To ensure that travel expenses are claimed in a consistent, accurate and timely way; Guidance on mileage allowance. This policy and procedure is for all employees of North Derbyshire Clinical Commissioning Group and includes Governing Body and Lay Members, and very Senior Managers. 3.2 PRINCIPLES Travel & Expenses Policy V1 FINAL Page 5 of 16

113 3.2.1 The purpose of this policy and procedure is to outline the rules set out by the Clinical Commissioning Group for the reimbursement of travel and expenses that are necessarily incurred by any individual engaged on business approved by the organisation The primary purpose of travel and subsistence allowances is to reimburse the necessary costs of meals, accommodation and travel arising as a result of official duties away from home The rates and conditions are, where appropriate those set out in the relevant Terms and Conditions Handbooks, or otherwise agreed by the organisation This document is mandatory and applies to all staff on Agenda for Change Terms and Conditions Any abuse of this policy will be investigated and may result in disciplinary action being taken under the CCG s Disciplinary Policy Travel and expenses claims are subject to Tax and National Insurance Liabilities as detailed in Appendix TRAVEL EXPENSES 4.1 ELIGIBLE MILES Staff will be reimbursed for miles travelled in the performance of their duties for the CCG which are in excess of the home to agreed work base return journey. Eligible miles are normally those travelled from the agreed work base and return. However, when the journey starts at a location other than the agreed work base e.g. home, the eligible miles will be as set out in Appendix CAR ALLOWANCE All car mileage will be reimbursed at one of two Standard Rates for car drivers registered with the CCG regardless of the vehicle size. The mileage rate is dependent on car usage. For current mileage rates please refer to Agenda for Change Section 17 Mileage Allowances or contact Arden and GEM HR (see Appendix 3). 4.3 RESERVE RATE Any member of staff who does not register their vehicle with the CCG will be reimbursed at the Reserve Rate for any mileage claimed. The reserve rate is also implemented for specific reasons for travel such as excess mileage due to NHS merger or organisational change, temporary moves or secondment, attending non-job specific training courses or for call out. 4.4 LEASE CARS (If Applicable) For former NHS employer/organisation Lease Cars that transferred to a CCG on 1 st April 2013 the mileage rate will be that at the point of transfer until the scheme expires. The mileage rate for cars on the CCG lease car scheme shall be as set as part of that Travel & Expenses Policy V1 FINAL Page 6 of 16

114 agreement. 4.5 MOTORCYCLE ALLOWANCE Members of staff using a motorcycle for official journeys will be reimbursed a mileage rate as set out in Agenda for Change Section 17 Mileage Allowances (see Appendix 3). 4.6 PEDAL CYCLES Members of staff using a pedal cycle for official journeys will be reimbursed a mileage rate as set out in Agenda for Change Section 17 Mileage Allowances (see Appendix 3). 4.7 PASSENGER RATE When members of staff travel together on CCG business and separate claims would otherwise be made, the driver may claim a passenger allowance as set out in Agenda for Change Section 17 Mileage Allowances. The name and designation of all passengers must be shown on the claim form. Passenger allowance is not payable to lease car drivers (see Appendix 3). 4.8 OTHER ALLOWANCES Staff will be reimbursed the reasonable train, toll and costs when on CCG business on production of a valid receipt. Taxi fares and any reasonable gratuity shall be payable only in cases of urgency or in other cases in which transport is reasonably required and an adequate public service is not available, but where these conditions are not fulfilled employees using taxi shall be entitled to claim the sum they would have paid had they travelled by public service vehicle. These expenses are not subject to tax and national insurance. 4.9 CALL OUT Any member of staff called out to return to work following the normal completion of their shift will be paid at the Reserve Rate TRAINING COURSES/CONFERENCES/EVENTS All employees attending manager approved job specific training courses, conferences or events are eligible to claim mileage over and above home to work mileage on the Standard Rate. Course trainers providing training at a base other than their normal work base will claim mileage over and above home to work mileage on the rate that they are registered to receive EXCESS MILEAGE Where there is a compulsory requirement for an employee to change their base of work on a temporary or permanent basis (e.g. a merger of NHS employers, acceptance of another post as an alternative to redundancy, change of work base) the employee may be reimbursed their extra daily travelling expenses for a period of four years from the date of transfer. Mileage will be reimbursed at the Reserve Rate or through the submission of receipts, the cost of public transport. Excess mileage authorisation form is set out in Appendix 4. Travel & Expenses Policy V1 FINAL Page 7 of 16

115 If a member of staff who is claiming excess travel subsequently moves home they must complete a new Excess Travel Authorisation Form in order that the new mileages may be calculated and adjusted accordingly from the date of their change of address. They must also inform their manager of the change of address and ensure that any excess mileage payment received is appropriately reduced or stopped as appropriate with effect from the date of the change of address. Failure to do this may result in the CCG taking disciplinary action under the CCG s Disciplinary Policy. If a member of staff who is claiming excess travel subsequently voluntarily changes role within the CCG and is issued with a new contract or a variation to their contract, their excess mileage payment will be stopped with effect from the date of the change BULKY EQUIPMENT Where, at the requirement of the employer, an employee carries heavy or bulky equipment in a private car, an allowance at the rate specified in Agenda for Change Section 17 Mileage Allowances for journeys on which the equipment is carried. (The equipment must be either of a weight that is unreasonable to be carried or alter the seating capacity of the vehicle) PUBLIC TRANSPORT Public Transport If an employee uses public transport for business purposes the cost of bus fares and standard rail fares will be reimbursed. Whenever reasonable to do so, travel for work should be undertaken by utilising public transport e.g. by train. 5 SUBSISTENCE Any member of staff who is required to be away from home for business purposes may claim for additional costs that are incurred, up to the limits set by the CCG. For current subsistence rates please refer to Agenda for Change Annex N Subsistence Allowances or contact Arden and GEM HR. Claims will be reimbursed on the basis of original receipts that must be attached to all claims. Copy receipts are acceptable if agreed by the manager but these payments will be subject to income tax deductions. The organisation will not pay for the cost of any alcoholic beverages. 5.1 OVERNIGHT ACCOMMODATION If a member of staff stays overnight in a hotel, or other similar accommodation, for business purposes that have been approved by their manager, the overnight costs for bed and breakfast will be reimbursed up to the limits set by the CCG. In exceptional circumstances where accommodation is not available within the agreed limit, the employee should seek the most competitive rates and ensure that these are approved by the line manager prior to the expenditure being incurred. Any claims that exceed the agreed limit must be clearly noted to show that prior approval for the expenditure has been given. The cost of up to two further day time meals may be reimbursed in any 24 hours, up to the maximum of the appropriate meals allowance as detailed in Appendix OTHER EXPENSES 6.1 EXPENSES OF CANDIDATE FOR APPOINTMENT Travel & Expenses Policy V1 FINAL Page 8 of 16

116 Please refer to the Recruitment and Selection Policy. Any expenses paid will be in line with current rates at the time under Agenda for Change. 6.2 REIMBURSEMENT OF SUNDRY EXPENSES In exceptional circumstances it may be necessary for a member of staff to purchase sundry items which may be required in order to carry out their duties. The budget manager must give prior approval for all such expenditure and original receipts must accompany the claim for reimbursement. The CCG would not expect sundry items to be purchased if they could be obtained through the normal purchasing procedure. 6.3 PATIENT USER GROUPS AND NON EMPLOYEES A member of the general public attending Patient User Group or equivalent meetings at the request of the CCG is eligible for reimbursement of travel expenses. Where this is by car, expenses should be paid at the public transport rate. The Mileage/Expense claim form (Appendix 8) should be completed and signed by the person claiming. The completed claim form should be checked and authorised by the approved CCG Manager before being passed to Financial Services for payment. 7. PROCEDURE 7.1 TRAVEL AND EXPENSES CLAIMS FORM SUBMISSION All employees required to use their own vehicle for business purposes will have to provide the following documentation which will be copied and added to the employee s personal file. The documents must be kept up to date at all times. Driving Licence (paper and photo card) Car Insurance including business use Car Tax MOT Completed V5C Vehicle Registration Form 7.2 METHODS OF PAYMENT Expenses payments will be made monthly with salary payments. All completed claim forms should be submitted by 1st working day of month following claim for payment in the next month s salary. Payment will be withheld or delayed if the necessary documentation is not completed and appropriate procedures followed. It is the manager s/budget holder s responsibility to ensure that staff are made aware of the correct procedure to follow for the claiming of expenses. 7.3 E-Pay With the exceptions of claims for the month of February and March, all claims should be made within 3 months of the expense taking place. Only claims to be made after the March payroll can be submitted after the financial year-end. Failure to do so may result in the claim being forfeited. The Chief Finance Officer will make a decision based on the facts available and their decision shall be final. Expenses payments will only be authorised if they are submitted on e-pay to the Travel & Expenses Policy V1 FINAL Page 9 of 16

117 appropriate line manager within the allocated time period and accompanied by scanned copies of receipts (except for mileage). 7.4 AUTHORISATION Only E-Pay submissions authorised by the designated manager will be accepted for payment. 7.5 EXEMPTIONS There will be no reimbursement of: Parking fines Speeding fines Vehicle running costs or additional personal motoring costs, (the mileage allowance is set at a level to include these) The CCG forbids the use of handheld mobile phones whilst driving. 8. MONITORING AND REVIEW This Policy is subject to frequent review in line with Agenda for Change NHS Terms and Conditions of Service in line with the publication of the AA Guides indicating motoring costs. Amendments to mileage allowances will only take place if rates increase or decrease by 5%. Date of review Date of impact April / May 2014 July 2014 November 2014 January 2015 In addition the policy and procedure will be reviewed periodically by Human Resources in conjunction with operational managers and Trade Union representatives. Where review is necessary due to legislative change, this will happen immediately. The implementation of this policy will be audited on an annual basis by CCG Leadership Team. 9. ASSOCIATED LOCAL DOCUMENTATION Disciplinary Policy Agenda for Change Handbook Travel & Expenses Policy V1 FINAL Page 10 of 16

118 APPENDIX 1 TAX AND NATIONAL INSURANCE LIABILITIES FROM 1 ST JUNE 2016 For details of HM Revenue and Customs guide to personal Taxable Allowances and Rates Mileage reimbursement is a payment from your employer that can be subject to tax and national insurance deductions on the whole amount. However if the payment is clearly for costs incurred in the performance of an employee s duties then tax relief can be obtained. If you are reimbursed for travel that is not considered to have been undertaken in the course of an employee s duties, then there will be no tax relief available and the full amount will be considered as income and subject to tax and national insurance accordingly. HMRC operate an Approved Mileage Allowance Payment (AMAP) which enables tax free reimbursement. Table 1 below provides information for the tax year 2016/17 as an example for guidance only as these may be revised at any time dependent on government policy. The total miles travelled, regardless of the rate at which they are reimbursed, will be reported to the Inland Revenue at the end of the financial year in order that taxable benefit can be calculated. The taxable benefit will feature on each employee's P11d if you are not covered under the taxed at source ararngement. Table 1 AMAP rates Type of vehicle Cars up to 10,000 miles Cars over 10,000 miles Motorcycle Bicycle Tax year 45p per mile 25p per mile 24p per mile 20p per mile Any queries relating to your tax position should be directed to your local tax office Type of payment Tax liability National Insurance liability Business Miles The tax free allowance is deducted from the amount paid and tax is due on the balance, this is reported on the P11d or Taxed at Source (TAS) in-line with the individual arrangment for your CCG. Deducted on profit element of mileage Travel & Expenses Policy V1 FINAL Page 11 of 16

119 Type of payment Tax liability National Insurance liability Reserve Rate The tax free allowance is deducted from the amount paid and tax is due on the balance, this is reported on the P11d or Taxed at Source (TAS) in-line with the individual arrangment for your CCG. Deducted on profit element of mileage Excess travel Passengers Pedal Cycles Course/Study Travel (now Reseve Rate) Home to base travel Other travelling expenses e.g. parking, toll charges Subsistence and other reimbursements If the change of base is permanent there is a liability for tax which will be deducted from pay.//there is no liability if the change is temporary for less than 24 months. / As with tax The tax free allowance is deducted from the amount paid and tax is due on the balance, this is reported on the P11d or Taxed at Source (TAS) in-line with the individual arrangement for your CCG. / No liability The tax free allowance is deducted from the amount paid and tax is due on the balance, this is reported on the P11d or Taxed at Source (TAS) in-line with the individual arrangment for your CCG. The tax free allowance is deducted from the amount paid and tax is due on the balance, this is reported on the P11d or Taxed at Source (TAS) in-line with the individual arrangment for your CCG There is a liability for tax which will be deducted from pay. Provided that these are supported by receipts there is no tax liability Provided that the expense is receipted and is a reimbursement of amounts actually paid, there is no tax liability As with tax No liability No liability No liability As with tax As with tax As with tax Travel & Expenses Policy V1 FINAL Page 12 of 16

120 APPENDIX 2 ELIGIBILITY MILEAGE Eligible mileage illustrative example In this example the distance from the employee s home to the agreed base is 15 miles Journey (outward) Distance Eligible miles Home to base Home to first call Home to first call Journey (return) Last call to base Last call to home Last call to home 15 miles Less than 15 miles More than 15 miles Less than 15 miles More than 15 miles None Eligible mileage starts after 15 miles have been travelled Eligible mileage starts from home, less 15 miles Eligible mileage ends at base Eligible mileage ends 15 miles from home Eligible mileage ends 15 miles from home Travel & Expenses Policy V1 FINAL Page 13 of 16

121 APPENDIX 3 Mileage Rates Rates will be reviewed twice a year April / May (to match release of AA Guides) and again in November. Should rate calculation amend mileage costs either up or down by 5% this will be amended to affect mileage claims from July onwards (after April/May) or January (following November). Type Standard Rate Up to 3500 miles Standard rate Over 3500 miles Reserve Rate All eligibility miles All Eligibility miles Car 56p 20p 28p Motor Cycle 28p Pedal 20p Passenger 5p Bulky 3p Travel & Expenses Policy V1 FINAL Page 14 of 16

122 APPENDIX 4 AUTHORISATION TO CLAIM EXCESS MILEAGE Where there is a compulsory requirement for an employee to change their base of work on a temporary or permanent basis e.g. a merger of NHS employers, acceptance of another post as an alternative to redundancy, change of work base, the employee may be reimbursed their extra daily travelling expenses for a period of four years from the date of transfer. Mileage will be reimbursed at the reserve rate or through the submission of receipts, the cost of public transport. Travel & Expenses Policy Para 4.11 This form is to be completed by the claimant and authorised by their line manager. Name Home Address Old Base New Base Date of Change Protection Period start and end dates EXCESS MILEAGE CALCULATION Daily return mileage from home to present base Daily return mileage from home to future base Excess miles (difference between present and future return mileage) I attend work at present on...occasions each week and will be attending for work at my new base on...occasions each week. I certify that the above information is correct and accurate and that I will immediately inform the CCG of any further change of address whilst in receipt of excess mileage so that the excess mileage amount can be checked and, if required, amended from the date of address change. I acknowledge that it is my responsibility to ensure that any excess travel payments I receive is recalculated should I change address. I understand that failure to do this may lead to disciplinary action in line with the CCG s Disciplinary Policy. Claimant s signature Date Authorising Manager signature Date Travel & Expenses Policy V1 FINAL Page 15 of 16

123 APPENDIX 5 Subsistence rates 1. Night allowances: first 30 nights - Actual receipted cost of bed and breakfast up to a maximum of Night allowances in non-commercial accommodation - Per 24 hour period: Night allowances: after first 30 nights Married employees and employees with responsibilities equivalent to those of married employees: Maximum amount payable: Employees without responsibilities equivalent to those of married employees and those staying in non-commercial accommodation Maximum amount payable: Day meals subsistence allowances Lunch allowance (more than five hours away from base, including the lunchtime period between 12:00 pm to 2:00 pm) 5.00 Evening meal allowance (more than ten hours away from base and return after 7:00 pm) Incidental expenses allowance (this allowance is subject to a tax liability) Per 24 hour period: Late night duties allowance (this allowance is subject to a tax liability) Per 24 hour period: 3.25 Travel & Expenses Policy V1 FINAL Page 16 of 16

124 Relocation Policy NHS North Derbyshire Clinical Commissioning Group Relocation Policy v1.0 Page 1 of 17

125 NHS North Derbyshire Clinical Commissioning Group Relocation Policy Policy Title: Supersedes: Description of Amendment(s): This policy will impact on: Financial Implications: Relocation Policy All previous Relocation Policies All staff No change Policy Area: HR Version No: 1 Issued By: Governance Team Author: Document Reference: Effective Date: Review Date: HR Services Arden & GEM and North Derbyshire CCG Executive Team (Or sooner if necessary to comply with any changes in legislation or if required for other reasons) APPROVAL RECORD Consultation: Approved by Committees: Revision History Version Revisions Committees / Groups / Individual Consultative Committee Trade Unions Specialist Advice (if required) Management / Staff Side REMCOM Governing Body Assurance Committee Date N/A Aug /09/ /12/2016 Date NHS North Derbyshire Clinical Commissioning Group Relocation Policy v1.0 Page 2 of 17

126 ASSISTANCE WITH THE APPLICATION OF THIS POLICY AND UPDATES This policy has been prepared so as to reflect the law as at 1 st June The policy will require periodic review to reflect subsequent changes to the law. Changes to employment law have generally been made on 1 February, 1 April and 1 October in any given year. For advice and assistance in relation to the application of this policy and to obtain updates please contact: Your line manager in the first instance, or Arden & GEM HR Business Partners. NHS North Derbyshire Clinical Commissioning Group Relocation Policy v1.0 Page 3 of 17

127 Table of Contents 1. EQUALITY STATEMENT 5 2. POLICY STATEMENT PRINCIPLES APPLICATION AND SCOPE ROLES AND RESPONSIBILITIES ELIGIBILITY CRITERIA RELOCATION SUPPORT AUTHORISATION PROCESS MONITORING DUE REGARD. 13 APPENDIX 1 APPLICATION IN PRINCIPLE FOR RELOCATION EXPENSES APPENDIX 2 RELOCATION EXPENSES AGREEMENT NHS North Derbyshire Clinical Commissioning Group Relocation Policy v1.0 FINAL Page 4 of 17

128 1. EQUALITY STATEMENT 1.1 North Derbyshire Clinical Commissioning Group aims to design and implement policy documents that meet the diverse needs of our services, population and workforce, ensuring that none are placed at a disadvantage over others. It takes into account current UK legislative requirements, including the Equality Act 2010 and the Human Rights Act 1998, and promotes equal opportunities for all. This document has been designed to ensure that no-one receives less favourable treatment due to their protected characteristics of their age, disability, sex (gender), gender reassignment, sexual orientation, marriage and civil partnership, race, religion or belief, pregnancy and maternity. Appropriate consideration has also been given to gender identity, socio-economic status, immigration status and the principles of the Human Rights Act. In carrying out its function, North Derbyshire CCG must have due regard to the Public Sector Equality Duty (PSED). This applies to all activities for which North Derbyshire CCG is responsible, including policy development, review and implementation. 2. POLICY STATEMENT 2.1. North Derbyshire CCG is committed to retaining, developing and supporting its employees The purpose of this document is to set out the qualifying criteria, support and compensation for employees to enable them to move with their work This policy ensures compliance with HMRC policy and guidance as well as the provision of reasonable relocation packages for employees making appropriate use of public funds. 3. PRINCIPLES 3.1. North Derbyshire CCG would not normally expect to pay removals and relocation expenses unless there are exceptional circumstances and a costbenefit analysis provided to support such payment It is important to support and sustain local communities and as such it should normally be demonstrated that sufficient measures have been taken to recruit from the local area To provide appropriate means to reimburse reasonable additional costs incurred on permanent relocation to the CCG location To make proper use of public funds, exercising due economic considerations, consistent with what is necessary to progress the business To ensure consistent and fair treatment of all applications. NHS North Derbyshire Clinical Commissioning Group Relocation Policy v1.0 FINAL Page 5 of 17

129 3.6. To comply with all statutory and contractual requirements, e.g. equalities legislation, the Data Protection Act 1998 and HMRC rules for reimbursement of relocation and travel expenses To provide clarity about tests of reasonableness based on: a) increased travel costs and time; b) differences in the housing market, specifically prices between the old and new locations; c) impact on individual employees circumstances, e.g. a family situation, such as caring responsibilities or educational requirements for children. 4. APPLICATION AND SCOPE 4.1. This policy applies to all new employees of North Derbyshire CCG Staff employed on Medical and Dental terms and conditions of employment and any other employees who are not covered by the NHS Terms and Conditions of Service Handbook (Agenda for Change) should read this policy in conjunction with their contract of employment. 5. ROLES AND RESPONSIBILITIES 5.1. Employees are responsible for: a) Complying with the requirements of this document; b) Notifying their line manager if their partner is in receipt of any financial assistance for relocation; c) Keeping their line manager informed of progress with relocation; d) Requesting and making available to North Derbyshire CCG, receipts for any incurred expenses; e) Familiarising themselves with HMRC tax rules regarding relocation expenses; f) Understanding that all entitlements to reimbursement within this policy, will count towards the overall maximum of 8,000 allowance, (unless otherwise stated); g) Understanding that costs incurred beyond 8,000 are their own responsibility; NHS North Derbyshire Clinical Commissioning Group Relocation Policy v1.0 FINAL Page 6 of 17

130 h) Submitting their application within three months of commencement in the new post Line managers are responsible for: a) Complying with this policy and procedure and gaining approval in principle at an early stage from the Finance Directorate; b) Identifying the potential need to offer relocation support for specific posts, whether as a result of organisational change, employee development, or a recruitment exercise; c) Establishing the eligibility of specific employees to receive relocation support; d) Discussing this policy with affected employees as early as possible, e.g. during the interview process, or at the point an offer of employment is made; e) Providing a written cost-benefit analysis to the Remuneration Committee/ Director that demonstrates the organisational benefit and justifies the outlay of public funding; f) Checking each relocation claim and keeping track of the running total to ensure the approved amount is not exceeded The HR Business Partner and People Services Team are responsible for: a) Providing appropriate advice, support and guidance on the application of this document; b) Ensuring legal and procedural updates/amendments are incorporated into this policy as required and through the appropriate mechanisms Trade Unions are responsible for: a) Engaging in the development, review and monitoring of this policy; b) Supporting their members throughout this process. 6. ELIGIBILITY CRITERIA a) North Derbyshire CCG new employees may be eligible for financial assistance with their relocation, subject to approval from the Remuneration Committee, where section 6.1 and the following applies and they are required to change their sole or main residence as a result of starting their employment with North Derbyshire CCG; or NHS North Derbyshire Clinical Commissioning Group Relocation Policy v1.0 FINAL Page 7 of 17

131 b) For employees appointed from overseas, re-imbursement will only be calculable from the point of entry into the UK. 6.1 Criteria: a) Eligible employees must be able to demonstrate that every effort is being made to obtain suitable substantive accommodation in the new area. Under normal circumstances, this will involve selling their current property and buying accommodation near their new base; verified evidence from estate agents may be requested. North Derbyshire CCG will not offer bridging loans; b) All expenses claimed must be receipted and itemised and will not be paid in advance of expenditure. Claims for expenses incurred may be submitted monthly on an on-going basis until the agreed allowance amount has been met; c) Where more than one employee is relocating to the same address, only one claim for relocation expenses can be made; d) If the employee is moving with someone who is also eligible to claim relocation expenses separately from another employer, they must notify their line manager. The line manager may then, in consultation with the other employer, decide to share the costs of the relocation; e) The employee s existing home is not within reasonable daily travelling distance of the new workplace; this includes consideration of the length of time to travel; f) The employee s new home is within reasonable daily travelling distance of the new workplace, which is normally within 50 miles from their base location for the purposes of the new role. 7 RELOCATION SUPPORT 7.1 Elements of relocation assistance The maximum allowance for relocation expenses connected with buying, selling or renting a new home is 8,000. Subject to the organisation reimbursing the expenses, this is exempt from tax and national insurance contributions (NIC) if an employee moves home, in order to: take up a new job with a new employer; take up a new job with their existing employer; continue their current job but at a new location. NHS North Derbyshire Clinical Commissioning Group Relocation Policy v1.0 FINAL Page 8 of 17

132 7.1.2 All entitlements to reimbursement within this policy, will count towards the agreed allowance, up to a maximum of 8,000, unless otherwise stated. Costs incurred beyond the agreed allowance, and/or before the allowance is agreed, are the responsibility of the employee In all cases the anticipated expenses required by an employee to relocate will be collated by their line manager and submitted to the Remuneration Committee. A limit, up to the 8,000 maximum allowance will then be set and agreed and confirmed to the employee in writing in advance of any expenses being incurred Specific items that can be claimed within the agreed allowance: For visits prior to taking up residence in the new area - costs of one return visit from home to the base location, for a maximum of two nights duration, may be reimbursed; All travelling expenses and subsistence allowances for the employee, their partner and dependents, as appropriate, will be paid in line with the Travel and Expenses Policy. 7.2 Rentals Reimbursement for items under this section will be deducted from the agreed allowance ( 8,000 maximum) This policy also covers those who might not be homeowners but are renting or living with family/friends. In these situations, reasonable expenses incurred in the course of sourcing appropriate rented accommodation, may be provided. As these costs are likely to be significantly cheaper than those associated with selling and buying a property, requests to cover rental costs will be dealt with, according to individual circumstances. In cases where employees are moving between rented accommodations, the level of support will be adjusted proportionately and agreed subject to individual circumstances Applicants may be eligible for all or part of their rental deposit to be paid for and this will depend on the standard, size, type or location of the rental property in line with market conditions. In the event that the employees move properties, they would be required to repay a proportion of the deposit, subject to any deductions by the landlord for reasonable wear and tear Applicants may be eligible for a contribution for their first rental down payment in circumstances where, for example, they may be required to continue payments for a short period at their old rental property, and are required to commence their post whilst the old tenancy agreement comes to an end. Under normal circumstances however, payment for on-going rent at the new rental address would not be payable under the provisions of this policy. NHS North Derbyshire Clinical Commissioning Group Relocation Policy v1.0 FINAL Page 9 of 17

133 7.3 Subsistence prior to moving to new location a) Reimbursement for items under this section will be deducted from the agreed allowance ( 8,000 maximum); b) Subsistence will be reimbursed as per the Travel and Expenses policy; c) In line with HMRC guidance, where a child stays behind at the old location or is sent ahead to the new location in order to ensure continuity of education, usually in order to complete or start GCSE, A Level or equivalent courses, tax and NIC exemption may be available for the child's costs of travel and subsistence. The conditions are that the child: must be a member of the employee's family or household and must be under 19 at the beginning of the year of assessment in which the job move takes place. d) After the employee has commenced their new role they may claim either travelling expenses to the new role from their old home, OR travelling expenses for visits home, depending on the situation as follows; e) Reimbursement will be limited to six months in the first instance, although this period may be extended by up to a further three months with the approval of the Remuneration Committee, in consultation with the Chief Finance Officer; the agreed limit (maximum 8,000) still applies in these situations. 7.4 Legal fees a) Reimbursement for items under this section will be deducted from the agreed allowance ( 8,000 maximum); b) For eligible employees buying or selling a property in order to relocate, certain legal fees will normally be reimbursed (inclusive of VAT payable), as outlined on the HMRC website. 7.5 Relocation of furniture and personal effects a) Reimbursement for items under this section will be deducted from the agreed allowance ( 8,000 maximum); b) Relocation costs and, if necessary, the storage of effects for a reasonable period (normally six months), may be reimbursed. Three competitive tenders must be obtained in writing and submitted to the Remuneration Committee, with the lowest of the three quotations normally being reimbursed. NHS North Derbyshire Clinical Commissioning Group Relocation Policy v1.0 FINAL Page 10 of 17

134 7.6 Temporary accommodation expenses a) Reimbursement for items under this section will be deducted from the agreed allowance ( 8,000 maximum); b) Where an employee has been unable to move home, and the old property remains unsold and they decide to take temporary accommodation in the new area, their expenses may be reimbursed as follows: Where private accommodation is used, either the rent may be reimbursed, or the night allowance subsistence rate, or the actual continuing commitments, where pre-approval is given by the Remuneration Committee in consultation with the Chief Finance Officer; Alternatively, members of employees who unavoidably incur regular expenses in respect of accommodation previously occupied in the old area, which remains unsold, concurrently with accommodation expenses in the new area, will be given assistance with such expenses. The types of costs incurred would normally be mortgage, building insurance, council tax, water rates, etc. These expenses would be subject to sufficient evidence being produced and approval being given by the Remuneration Committee in consultation with the Chief Finance Officer. c) It is expected that reimbursement of subsistence allowances will normally be paid for a maximum of six months and not in excess of the overall 8,000 maximum allowance. This period may be extended, subject to approval by the Remuneration Committee in consultation with the Chief Finance Officer. However, the expenses must be incurred before the end of the year of assessment following the one in which the employee starts the new job; d) Where an employee is living in temporary accommodation in the new area, the cost of one advance standard class return visit home per week may be reimbursed. 7.7 Tax and Her Majesty s Revenue and Customs (HMRC) a) The extent of the financial reimbursement is equivalent to a tax-free maximum value of 8,000, in line with the HMRC limit; b) Employees determined to be eligible are responsible for any statutory income tax and national insurance liability incurred as a result of receiving the relocation expenses; c) As the relocation is job related the 8,000 is exempt from tax provided that certain conditions are met, including that the new property is the employee s main residence; NHS North Derbyshire Clinical Commissioning Group Relocation Policy v1.0 FINAL Page 11 of 17

135 d) In order to receive tax relief, under HMRC rules, expenses must be incurred, before the end of the tax year following the tax year in which the employee starts their new job (a tax year runs from 6 April one year to 5 April the next). The date of the actual home move is immaterial. For example, where a person starts a role on 1 January 2016, the expenses must be incurred before 31 March Incomplete or abandoned relocations a) Any legal costs, survey fees, etc., incurred in an unsuccessful attempt to purchase property may be reimbursed at the discretion of North Derbyshire CCG; b) Both the Remuneration Committee and the Chief Finance Officer must be satisfied that the reason the purchase was abandoned is acceptable and that any costs in relation to the work done are reasonable; c) Where the abandonment relates to an adverse structural survey, a copy of the surveyor s report must be submitted with the expense claim form; d) Where an employee fails to relocate, then all of the expenses they have claimed up to that point would become taxable (see paragraph 7.7). Employees who have decided to no longer relocate will be expected to repay all relocation expenses within a 3-month period. 7.9 Repayments employees leaving the organisation a) Employees who voluntarily leave the organisation within two years of their start date, will normally be required to repay a proportion or all of the expenses reimbursed as follows: Leaving date Amount to be repaid Within 6 months of starting 100% Within 6 to 12 months 75% Within 1 to 2 years 50% 8. AUTHORISATION PROCESS 8.1 Managers should discuss with the Finance team at an early stage (e.g. following interview) any potential request for relocation expenses for their potential employees, and the Remuneration Committee will be required to provide in principle authorisation, before the affected potential new employee receives any confirmation. Copies of all agreed relocation packages should be retained by the Finance team to ensure an organisation wide monitoring process is maintained. NHS North Derbyshire Clinical Commissioning Group Relocation Policy v1.0 FINAL Page 12 of 17

136 8.2 Once authorised in principle, the manager will pass a copy of the policy and the application form to the new employee, and explain the process, helping the new employee to complete the relevant application form. 8.3 Expenses claimed will be paid via the monthly payroll process. Please refer to the Travel and Expenses Policy. 9. MONITORING 9.1 The Finance team will monitor compliance of this policy. 9.2 This policy and procedure will be reviewed periodically by North Derbyshire CCG. When a review is necessary due to legislative change, this will happen immediately. 10. DUE REGARD 10.1 In carrying out its function, North Derbyshire CCG must have due regard to the Public Sector Equality Duty (PSED). This applies to all activities for which North Derbyshire CCG is responsible, including guidance development, review and implementation. Evidence that due regard has been given is shown in sections 4.1and 7 of this policy. NHS North Derbyshire Clinical Commissioning Group Relocation Policy v1.0 FINAL Page 13 of 17

137 Appendix 1 North Derbyshire CCG Application in Principle for Relocation Expenses Please complete the following questionnaire and return to your line manager/appointing officer. You will be notified in writing as to what expenses are claimable. Applicant details Name of applicant New post and location Detail of previous post Name of previous employer Address Telephone number Line manager HR Details of new post Job title Salary Full or part time Date of appointment Length of contract (must be in excess of 2 years to be eligible) Appointing Manager Details of accommodation in area of previous employment Current address Telephone number NHS North Derbyshire Clinical Commissioning Group Relocation Policy v1.0 FINAL Page 14 of 17

138 Was accommodation rented or owneroccupied? Was accommodation totally unfurnished? If unfurnished, did accommodation consist of more than 1 main room? If the property is owner occupied, do you intend to sell? Do you intend to purchase a property in the area for employment with North Derbyshire CCG? Details of accommodation in area of new employment (if applicable) New address (or address intended to move to) I certify that the information I have given is correct to the best of my knowledge and belief. Signed Date NHS North Derbyshire Clinical Commissioning Group Relocation Policy v1.0 FINAL Page 15 of 17

139 Appendix 2 TO BE SENT ON NHS NORTH DERBYSHIRE CCG HEADED PAPER Relocation Expenses Agreement This agreement is between ("you") and NHS North Derbyshire CCG ("the CCG") and forms part of the terms and conditions of your contract of employment dated Relocation Expenses 1. Subject to production of VAT receipts or other appropriate evidence of payment, the CCG shall reimburse you up to a maximum of ("Relocation Expenses") in respect of costs incurred by you in relocating to accommodation within a reasonable daily travelling distance of the CCG's offices at Scarsdale, Nightingale Close, off Newbold Road, Chesterfield, Derbyshire S41 7PF. Relocation Expenses may include removal, legal and estate agent fees or other associated costs incurred as a result of relocating. 2. The VAT receipts or other appropriate evidence of payment referred to in clause 1 shall be submitted to the Chief Finance Officer for approval. Once approved the Relocation Expenses will be paid to you in your salary. Taxation and tax indemnity 3. The Relocation Expenses shall be paid without deduction of income tax and National Insurance contributions to the extent that the Relocation Expenses qualify for the exemption set out in Chapter 7 of Part 4 of the Income Tax (Earnings and Pensions) Act 2003 and Part 8 of Schedule 3 of the Social Security (Contribution) Regulations 2001 (SI 2001/1004) respectively. 4. You shall indemnify the CCG on a continuing basis in relation to any income tax and National Insurance contributions (save for employers' National Insurance contributions), including any related interest, penalties, costs and expenses, which may be incurred by the CCG if the exemption referred to in clause 3 does not apply. Repayment obligation 5. Except in the circumstances set out in clause 9 below, you shall repay the CCG as follows: NHS North Derbyshire Clinical Commissioning Group Relocation Policy v1.0 FINAL Page 16 of 17

140 5.1. if you cease employment during the period of the first 6 months after the expenses payment made by the CCG under this clause, 100% of the Relocation Expenses shall be repaid; or 5.2. If you cease employment more than 6 months but no more than 12 months after the expenses payment made by the CCG under this clause, 75% of the Relocation Expenses shall be repaid; or 5.3. if you cease employment more than 12 but no more than 24 months after the expenses payment made by the CCG under this clause, 50% of the Relocation Expenses shall be repaid. 6. Thereafter, no repayment shall be required. 7. Under clause [insert] of your contract of employment you are required to provide 8 weeks notice to terminate your employment. The CCG will recoup the Relocation Expenses from your salary during your notice period and in 2 equal repayments each month. 8. The CCG reserves the right to vary clause 7 with your agreement. 9. Clause 5 shall not apply if: 9.1. the CCG terminate your appointment in breach of your contract of employment; or 9.2. you terminate your appointment in response to a fundamental breach of contract by the CCG. I confirm that I understand the contents of this agreement and I certify that relocation expenses are not recoverable in part or full from any other source by my partner or myself and that the information I have given is correct to the best of my knowledge and belief. Signed by:.. Dated:.. Signed by:.. For and on behalf of North Derbyshire CCG NHS North Derbyshire Clinical Commissioning Group Relocation Policy v1.0 FINAL Page 17 of 17

141 ND CCG Governing Body Assurance Committee 19th December 2016 Paper G NORTH DERBYSHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY ASSURANCE COMMITTEE 19th December 2016 Report Title: Security Policy Statement Item No: 10 Purpose: To approve the Policy Statement for Security 1. Background and context The overriding principle for security management is to support North Derbyshire CCG in providing a high quality service through a safe and secure environment that protects staff, patient and visitors, their property and the physical assets of the organisation. As a minimum, the CCG must comply with legislation and work with NHS Protect to raise the standards of the service. North Derbyshire CCG commissions its Security Service from 360 Assurance and works closely with the Local Security Manager Specialist. 2. Key matters for consideration NHS Protect has a clear framework for managing security from a national level downwards. As part of this, the CCG is required to complete an annual Security Management Self Review Tool (SRT) Assessment which demonstrates and evidences compliance across the NHS Protect Standards. The overall score for North Derbyshire CCG was green and was submitted to NHS Protect on the 30 th November As part of the evidence for the SRT the CCG is require to have an approved Security Policy Statement. The policy statement sets out the objectives for security and is underpinned by a Security Manual. The Security Management Framework is consistent across the 4 Derbyshire CCG s. 3. Financial Impact None Directly 4. Analysis of Risk None Directly 5. Equality Impact Please describe how this report and/or the services described within it aid the CCG in achieving the objectives of the Equality Delivery system, namely: The NDCCG values Patient-Focus, Integrity, Courage and Responsiveness inform our decision making and behaviours 1

142 ND CCG Governing Body Assurance Committee 19th December 2016 Paper G Better health outcomes for all: None Directly Improved patient access and experience: None Directly Empowered, engaged and well-supported staff: None Directly Inclusive leadership at all levels: None Directly 6. Recommendations The Governing Body Assurance Committee is asked to approve the Security Policy Statement. Author: Sponsor: Suzanne Pickering, Head of Governance Darran Green, Interim Chief Finance Officer Date: 12 th December 2016 The NDCCG values Patient-Focus, Integrity, Courage and Responsiveness inform our decision making and behaviours 2

143 Security Policy Statement

144 Security Policy Statement The North Derbyshire CCG security objectives are: The personal safety at all times of its staff, patients, contractors and visitors The protection of property against fraud, theft and malicious damage The delivery of Security services The prevention and detection of offences within Organisation boundaries Working with other agencies/organisations for the prevention and detection of offences The provisions of the policy statement apply variously to all staff, including full and part-time; students; clinical and non-clinical; directly employed and contractor members of staff. This policy does not cover incidents of patient-on-patient or staff-on-staff violence and aggression issues. These will be covered by the Local Security Manager Specialist (LSMS) & Human Resources respectively. This policy does not affect the rights of any individual to take independent action following abuse or an assault, for example by contacting the Police. VIOLENCE AND AGGRESSION Personal Safety The Organisation recognises the importance of promoting and maintaining the personal Safety of staff, patients and visitors. To fulfil these responsibilities the Organisation will ensure that appropriate arrangements are in place for the personal safety of the above against: Physical Assault Non - Physical Assault Lone Working SECURITY Assets of the Trust and the property of staff, patients and visitors The Organisation recognises the importance of protecting its assets and the property of Staff, Patients and visitors. To fulfil these responsibilities the Organisation will ensure appropriate arrangements are in place for the protection of assets and the property of Staff, Patients and visitors against: Theft Burglary Criminal Damage Communications and training The Organisation will educate train and inform employees to understand and undertake their role in preventing, controlling and reducing the Organisation s concerns with security related

145 issues. Impact information will be provided both internally and externally using all available media solutions as appropriate to raise awareness of specific issues. Security manual A Security manual has been produced which will work alongside this policy statement as a live document to assist all staff in Security procedures. The manual will be reviewed 3 yearly and updates will be added when required. A notification to all staff will be sent out on amendment of the manual. This will include the Organisations CCTV code of practice and Information Commissioners Office compliance. PROCESS FOR MONITORING COMPLIANCE North Derbyshire CCG commissions its Security Services from 360 Assurance and works closely with the LSMS to ensure that the CCG is compliant. REFERENCES CCTV Code of Practice (Revised edition 2008) Data Protection Act 1998 Health and Safety at Work Act 1974 Human Rights Act, 1998 Management of Health and Safety Regulations, 1999 NHs Protect Security manual and Guidance Regulation of Investigator Powers Act 2000 NHS Security Management Service Publications: A Professional Approach to Managing Security in the NHS 2003 Conflict Resolution Training Guidance 2004 Directions to NHS Bodies on Measures to Deal with Violence Against NHS staff 2003 (Amendment) Directions 2006 Directions to NHS Bodies on Security Management Measures 2004 (Amendment) Directions 2006 NHS Security Management Manual (restricted access to Security Director and SMS only) Non-Physical Assault Explanatory notes 2004 Not alone A Guide for the Better Protection of Lone Workers in the NHS

146 Appendix 1 - DUTIES The Chief Officer is ultimately responsible for ensuring the health, safety and security of all staff and ensuring that this policy is effective. Chief Finance Officer (CFO) The SMD has delegated responsibility for the CCG s security management arrangements (including the provision of monitoring and protection systems) and is the CCG s nominated Security Director Local Security Management Specialist (LSMS) The LSMS is responsible for the development and co-ordination of the CCG s security management arrangements. The LSMS will lead on the day to day work to tackle offences and act as the focal point for the provision of advice and support within the organisation in respect of security management. Managers in accordance with trust Risk Policies should: Carry out risk assessments of their service and that their staff are suitably trained for security, and, violence and aggression Staff Staff must protect the safety of themselves and their colleagues along with the property of the CCG, staff and visitors Committee The Organisations Governing Body Assurance Committee is responsible for receiving, reviewing and providing recommendations on all security matters in line with current guidance prepared by 360 Assurance and addressed to NDCCG directors or officers are prepared for the sole use of the CCG and no responsibility is taken by 360 Assurance or the LSMS staff member to any director or officer in their individual capacity. No responsibility to any third party is accepted as the report has not been prepared for, and is not intended for, any other purpose and a person who is not a party to the agreement for the provision of between the CCG and 360 Assurance dated 1 st April 2016 shall not have any rights under the Contracts (Rights of Third Parties) Act The appointment of 360 Assurance does not replace or limit NDCCG own responsibility for putting in place proper arrangements to ensure that its operations are conducted in accordance with the law, guidance, good governance and any applicable standards, and that public money is safeguarded and properly accounted for, and used economically, efficiently and effectively.

147 21 st Century Plan Delivery Group Meeting Notes Decision, issues and actions Monday 14 th November 2016, 08.30am 10.00am Robert Robinson Room, Scarsdale Present In attendance Apologies Ben Milton, North Derbyshire CCG (BM) Steve Allinson, Chief Executive ND CCG, Chair of Meeting (SA) Tracey Allen, Chief Executive DCHS (TA) Clive Newman, Hardwick CCG (CN) Eleanor Rutter, Public Health Consultant, DCC (ER) Simon Morritt, Chief Executive, CRH (SM) Ifti Majid, DCHFT (IM) Simon Stevens, DCC representing Joy Hollister. Stella Wiggin, North Derbyshire CCG (Notes) Beverley Smith, Chief Transformation Officer (BS) Isobel Fleming, DCC Joy Hollister, DCC No Item Discussion and agreed action Who By When 1. Chairs Introduction BM welcomed everyone to the meeting including Simon Stevens who was representing Joy Hollister. The main aim of the meeting was to update on the issues around the clarification period of the Consultation. The minutes of the meeting held on 10 October 2016 were agreed as a true record. 2. Matters Arising There were no matters arising from the minutes. Page 3 Item 3, IM/BM action - complete. 3. Update on Consultation Where are we now? CN gave an update on the consultation period, highlighting discussions from the last CWHG regarding media coverage adding there was nothing to address in the meeting. BM confirmed that it had been low key to date, though not an insignificant event. High Peak Radio broadcast the event and had carried out interviews with Debbie Austin and Ben explaining the errors. SA added he had attended briefings with the Matlock League of Friends and local MP s. TA confirmed a number of DCHS staff events had been put on but no-one had attended. 21C Plan Delivery Group (14 November 2016) Page 1 of 3