Is there a conflict of interest associated with this N report? PATIENT ENGAGEMENT:

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1 Agenda Item: 4.6 REPORT TO: GOVERNING BODY MEETING DATE: 26 September 2016 REPORT TITLE: Sub Committee Summary SUMMARY OF REPORT: This report summarises each Sub-Committee meeting of the Governing Body. Full copies of all minutes are available from the Board Secretary on request. The report identifies: Items requiring approval from the Governing Body Advises on delegated decisions taken Reports on key decisions Highlights items of particular interest or potential risk. REPORT RECOMMENDATIONS: a. Ratify and endorse the delegated decisions taken by the Sub Committees; b. Receive the monitoring information on key decisions; c. Be advised of the items of particular interest or risk; d. Receive the Stakeholder Committee minutes for information. FINANCIAL IMPLICATIONS: None REPORT CATEGORY: Tick Formally Receipt Action the recommendations outlined in the report. Debate the content of the report Receive the report for information AUTHOR: Anne MacLeod Corporate Administration Manager Report supported & approved by your Senior Y Lead PRESENTED BY: Angela Brown Director of Corporate Business OTHER COMMITTEES/ GROUPS CONSULTED: Content discussed at Local Delivery Group, Quality & Safety Committee & Primary Care Committee. EQUALITY ANALYSIS (EA) Has an EA been completed in respect of this report? N RISKS: Have any risks been identified / assessed? Y CONFLICT OF INTEREST: Is there a conflict of interest associated with this N report? PATIENT ENGAGEMENT: Has there been any patient engagement associated Y with this report? PRIVACY STATUS OF THE REPORT: Can the document be shared? Y Which Strategic Objective does the report relate to Tick 1 Commission the right services for patients to be seen at the right time, in the right place, by the right professional. 2 Optimise appropriate use of resources and remove inefficiencies. 3 Improve access, quality and choice of service provision within Primary Care 4 Work with colleagues from Secondary Care and Local Authorities to develop seamless care pathways Page 1 of 9

2 NHS EL CCG Governing Body 26 September 2016 Agenda Item: 4.6 SUB COMMITTEE SUMMARY OF BUSINESS 1. INTRODUCTION 1.1 This report summarises each sub-committee of the Governing Body and identifies: Items requiring approval from the Governing Body Advises on delegated decisions taken Reports on key decisions Highlights items of particular interest or potential risk. Full copies of the minutes are available from the Board Secretary on request. 2. SUB COMMITTEES 2.1 Audit Committee: 15 August Chair : David Swift The minutes of the 15 August 2016 are attached in full at Appendix A. 2.2 Local Delivery Group: 11 July Chair : Jackie Hanson 8 August 2016 meeting cancelled The Group discussed issues relating to the following areas: a. Items requiring approval from the Governing Body : NONE b. Delegated decisions requiring ratification by the Governing Body : NONE c. Reporting on key decisions Financial Position Members received a verbal update on the financial positon which confirmed the ELHT contract was forecasting a full year overspend of 5.7m. However the forecast was based on 2 months activity and a more accurate position would be available in September. It was agreed that the CCG would not commit any further resource and further discussion would take place at the Senior Management Team. Performance Update Members discussed the summary performance report which confirmed that all contracts are now signed and the team are working through the variations in the ELHT contract. E-referrals had remained static for the last few months and this was to be reviewed. Data issues attributed to the Referral to Treatment breaches were being addressed through the Quality Surveillance Group. Deep Vein Thrombosis Pathway The report outlined options for creating a new Community based DVT Service for Blackburn with Darwen and East Lancashire CCGs, as part of a broader programme of transformation of ambulatory care condition pathways. A robust evaluation of the current service had been undertaken in partnership with ELHT which evidenced that a new service could be provided closer to home which would increase efficiency, improve patient pathways and experience and provide mutually Page 2 of 9

3 beneficial savings to both the Provider and Commissioner. Following discussion, Members supported a service redesign which would be a community based model, GP and nurse led 5 day service, based on locality access hubs across the Pennine Lancashire (PL) footprint. Proposed Out of Hospital Model Members received an update on the new models of care across PL which included urgent care, integrated care and locality development. There was a request that intermediate care pharmacies and hospitals are involved early in the process to reduce the likelihood of re-admission relating to inadequate or incomplete medicines. Further discussions were required regarding the impact of the proposals and a there would be further discussions at a future meeting. It was confirmed that funding was in place for the Pathfinder scheme and Members supported the proposal to extend this scheme. Age UK Care Programme Business Case Members received a business case requesting the continuation of funding for the Age UK Integrated Care Programme. The service was commissioned to compliment and provide additional resource to the Integrated Neighbourhood Teams to support patients with non-clinical needs. Clinicians have seen the benefits of the programme, however it was recognised that an evaluation of the programme was not yet available and in view of this funding could not be agreed recurrently. Following discussion, Members supported Option 3 to extend the current service to March 2017 with the existing staff resource, followed by review when the outcome of the evaluation is available. DEXA Procurement Model The report provided details of the re-procurement of the community DEXA Service for EL and BwD CCGs and outlined options for consideration in support of the Contract Award recommendation. The model went out to tender in April 2016 and two tenders being received. It was reported that financial clarification discussions had taken place with Provider B and a revised pricing structure had been submitted. Following discussion, Members supported the preferred option to award the contract to Provider B. Mobilisation Plan for the EL Integrated Diabetes Service The report provided details of the mobilisation plan for the EL Integrated Diabetes Service model which was developed with key stakeholders across both provider and commissioner organisations with patient involvement. The new service model had received support from clinicians, managers and patients and would be delivered from September The service is designed to reduce waiting times, save money and reduce staffing costs and will utilise GPs to strengthen the hub. Dermatology Specification The report provided assurance that a robust exercise has taken place to develop an Intermediate Dermatology Service specification, as agreed by the Governing Body in March The specification was designed through comprehensive codesign, clinical and patient engagement and had been enhanced following previous discussions. Members agreed to formally sign off the service specification. LDG Reconfiguration Members had previously discussed the future reconfiguration of LDG meetings which would be more locality focused, commencing in September. It was agreed that further discussions are required to clarify arrangements as to whether meetings would take place within the locality or at Walshaw House. Page 3 of 9

4 Mandate for Mental Health The report provided an update on the PL Mental Health (MH) workstreams and their alignment to the Lancashire and South Cumbria work. Five hypotheses for MH had been developed over three workshops and translate to the working objectives which have been assigned to the PL MH Commissioning Team to progress the PL change programme. COPD Pathway Developments Members received a presentation outlining developments in services for people with COPD and described the scale of the challenge in Pennine Lancashire, outlined progress to date and next steps. Update on Individual Funding Request (IFR) Policy Development Members were advised that the overarching policies had been agreed by the GB and would be published on the CCGs website and included in local contracts. There had been a delay in finalising the procedural documents to support the policy and these would be presented to a future meeting. d. Items of particular interest or risk : NONE 2.3 Quality & Safety Committee: 13 July & 10 August Chair : Michelle Pilling The Group discussed issues relating to the following areas: a. Items requiring approval from the Governing Body : NONE b. Delegated decisions requiring ratification by the Governing Body : NONE c. Reporting on Key Decisions: 13 July 2016 Integrated Business Report Members received a comprehensive report outlining contract performance, quality premium and quality indicators and key issues were highlighted. Serious Incident Review Group Recommendations During June reports were submitted by provider organisations for review, of which 5 were approved and the remainder were returned to the provider for clarifications. In addition, 15 extension requests had been received from ELHT during the period and approved. An extraordinary meeting of ELHTs Serious Incidents Requiring Investigation Panel was to be held to review the number of reports requiring extensions. The report also provided a summary of StEIS incidents up to end June Soft Intelligence Update : Q1 2016/17 During Q1 there were a total of 59 service issues reported, of which 16 have been closed and 43 are currently being actioned. An analysis of the themes and trends was included in the report, noting there has been an increase in the quality and timeliness of responses by ELHT which has enabled responses to be provided by Connect in much shorter timeframes. Retrospective Previously Unassessed Periods of Care (PuPOC) The report provided an update in relation to Individual Patient Activity (IPA) and mitigating actions planned. Forecasting indicates that the CCG will be below trajectory from July but will recover the positon in August The risk remains on the CCG Corporate Risk Register and continues to be monitored through the Page 4 of 9

5 Lancashire IPA Board to ensure this effort is maintained and mitigating actions taken. Healthcare Associated Infections (HCAI) Report The report provided an update, confirming there were no new cases of MRSA identified during May 2016 and the CCG remains at 0 cases against a zero tolerance objective. Three cases of C-Diff were identified during the period, 2 of which were acute apportioned and 1 was community apportioned. There were also 31 cases of E-Coli reported during May and full details and analysis of trends were included within the report. ELHT CQUIN Reconciliation Q4 2015/16 ELHT had challenged the Q4 CQUIN payment decision, as agreed by Members in May Members discussed and agreed a response to the points raised confirming that following further consideration and for the same reasons, the same conclusion had been reached. Prescribing & Medicines Optimisation Strategy & Work Plan 2016/17 Members received the CCGs Medicines Optimisation Strategy and Work Plan 2016/17. The Committee considered this was a very comprehensive report but felt patient experience and outcomes should be included together with a digital approach. MIAA Safeguarding Audit Actions Members received an updated action plan following the MIAA Audit of Safeguarding. Risk Management Policy & Strategy The Policy and Strategy had been updated to show the development of a new process for updating, monitoring and progressing the current risk management workstream, including the risk register, assurance framework and responsibilities of the Risk Management and Information Governance Committee. This will provide enhanced assurance to the Q&SC, Audit Committee and ultimately the Governing Body. 10 August 2016 PL Quality Meeting with BwD CCG Members were advised of a proposal to align a number of functions across both EL and BwD CCGs and following a review it was identified that the Safeguarding, Quality and Medicines Management teams can work together across both organisations, reducing pressures on staff and limit duplication. As part of this alignment it was agreed to establish a joint Quality Committee with BwD CCG. A paper had been presented to both Governing Bodies outlining key themes and a Quality Directorate workshop had been held to review the areas that overlap and discuss the benefits of working together. Draft Terms of Reference had been prepared for the PL Quality Committee and would be formally presented to the first meeting on 28 September Work had begun to develop a joint agenda and Michelle Pilling would Chair the Committee for the first 6 months. Members agreed this was a positive move and a significant step towards working together. It was agreed to write to providers regarding the change to the structure of the team functions and to request any comments regarding assurance processes. Page 5 of 9

6 Integrated Business Report Members received a comprehensive report outlining contract performance, quality premium and quality indicators and key issues were highlighted. Serious Incident Review Group Recommendations During July 2016, 12 reports were submitted by provider organisations, of which 4 were approved for closure, 2 were returned to the provider organisation for clarification and 1 required an internal CCG action. The remaining 5 reports were reviewed in a virtual SIRG meeting and comments will be reflected in the next report. During the period, 10 extension requests were submitted by ELHT and approved. The report also provided a summary of StEIS incidents up to end July Concerns were expressed regarding the timeliness of responses and this had been formally raised with ELHT. Retrospective PuPOC Claims The CCG was below trajectory at the end of July, however the CSU had advised that all cases should be concluded by the end of September It was noted that the number of referrals to the Ombudsman had increased as families receive the outcome of their assessments. Further discussions would take place to understand the extent of the issues within the CHC team. Risk Management Update Members received the Risk Management update and Corporate Risk Register which confirmed there were 23 open risks on the Register, six of which were new risks added to the register since the last report. The extreme and significant risks on the register had all have been reviewed and action plans updated. Following discussion regarding a number of the risks, the recommendations in the report were approved. Freedom of Information Q1 Report A total of 48 FOI requests had been received during the period April to June 2016, of which 42 had been responded to within the statutory timescale and 2 had been outside the timeframe. Four cases remained active and were within the 20 day time limit. The Chair asked for future reports to include benchmarking against previous years. EL Complaints Q1 Report The report outlined the Q1 position for all complaints and patient feedback from the Patient Advice & Liaison Service. There had been 42 contacts during the period which was an increase of 11 compared to the previous quarter and the report provided an analysis of the complaints and enquiries received. This was the first report of its kind and further discussion would take place with the CSU Complaints Team to action the feedback received and arrange for information from Healthwatch Lancashire to be included. Healthcare Associated Infections (HCAI) Report The report provided an update, confirming there were no new cases of MRSA identified during June 2016 and the CCG remains at 0 cases against a zero tolerance objective. Four cases of C-Diff were identified during the period, 2 of which were acute apportioned and 2 was community apportioned. There were also 19 cases of E-Coli reported during June and full details and analysis of trends were included within the report. It was reported that the July data indicated a case of MRSA had been investigated and allocated to ELCCG. There were a number of actions and lessons learned, particularly for the Care Home, GP and District Nurse involved. Members acknowledged the report and the work undertaken. Page 6 of 9

7 GP Safeguarding Champions The report outlined the reasons for the development of the GP Safeguarding Champions model and why this is being implemented across the primary care sector. The report was in its infancy but there is liaison within localities to consider how the model could best support primary care. Clinical colleagues felt that GPs would require dedicated time to complete this work and consideration would be given as to whether the model could be part of the Primary care Quality Framework. It was also noted that the Safeguarding Champion need not be a GP, but could be a Practice Manager or Practice Nurse, provided they had the necessary skills to support the work. The model had received a mixed response from localities but had been well received within nursing and care homes. It was agreed that further discussion would take place with localities. Emergency Planning Policies & Plans Emergency Planning Policies and Plans had been fully updated to align with partner organisation policies and to ensure that the CCG is compliant with NHS England requirements. All policies had been reviewed and approved by the Senior Management Team. Following discussion, there was a need to confirm whether Emergency Preparedness, Resilience and Response elements are included in contracts or grant agreements with the third sector. d. Items of Particular Interest or Risk : NONE 2.4 Primary Care Committee : 18 July & 15 August Chair : Naz Zaman The Group discussed issues relating to the following areas: a. Items requiring approval from the Governing Body : NONE b. Delegated decisions requiring ratification by the Governing Body : NONE c. Reporting on Key Decisions 18 July 2016 New Models of Care Update The presentation provided an overview of the 12 week consultation which closed on 8 July It was reported that 2,129 responses had been received via an online survey and paper surveys via GP surgeries. Responses confirmed high levels of agreement with the proposed changes and key themes were outlined. There was also praise for the current walk-in centre arrangements and strong view that it should not close. It was noted that a petition was expected from Hyndburn but had not yet been received and further discussions would also take place to discuss the impact in Hyndburn. A more detailed analysis of the data would be presented to the September meeting of the Committee and the Governing Body. Members paid tribute to the Communications Team for their input. Over 75s Evaluation Report Members received an evaluation of the Over 75 schemes across localities during 2015/16. Localities were asked to develop their own service model based on their identified priorities to improve services for older people and those with complex needs. Each locality developed a slightly different scheme and the report provided examples of good practice, particularly where additional specialist staff have been employed to support the schemes. It was recognised that good practice has developed as a result of the funding and Members supported the recommendation for localities to work together to develop a core offer across EL, based on the good practice highlighted to ensure consistency across all localities. Page 7 of 9

8 Integrated Neighbourhood Team (INT) Update The report provided an evaluation of the INT Service which commenced during 2015/16. Key findings identified that the model was in place in all localities with the exception of Burnley, who are currently in the recruitment phase and due to commence in October. Excellent feedback had been received from all services, particularly the MH pilot in Ribblesdale and Pendle localities. A number of improvements were outlined and discussions were ongoing to develop the service model going forward. Members supported the recommendation to develop an EL INT Service Proposal with full costings and outcome measures. Zero Tolerance Update on New Service Proposals for Lancashire The report provided details of a revised Zero Tolerance Patient Scheme service model and the procurement of a single provider under an APMS contract agreement. The current service was not viable and a number of providers had indicated their wish to serve notice to cease provision. It was proposed that the revised model would be delivered as a hub based, single point of access model, to be located across identified sites within the five Local Development Plan areas and would be signed off by delegated committees within CCGs. Members supported the recommendations and discussion would take place with Federations to consider opportunities in the interim. 15 August 2016 Primary Care Transformation Update Members received a presentation outlining the role of the Transformation Team which is funded by NHS E to support Lancashire CCGs to deliver sustainable high quality primary care. The national, regional and local team structure was outlined and how the Team feeds into local groups, aligning the national agenda with local ambition to enable delivery. Work is also ongoing with Federations towards integrated models of care, leading to the implementation of the GP Forward View. New Models of Primary Care Update Members received a draft commissioning proposal to develop the model for extended access to primary care. This would be managed in 4 stages which were outlined as the governance structure, locality commissioner engagement, patient engagement and the establishment of a Provider Collaboration and Service Design Group with effective links into Locality Provider Forums to develop a detailed service delivery model. Next steps and milestones were outlined and plans would be put in place to test the model in early December to support winter pressures. General Practice Resilience Programme The report provided details of the General Practice Resilience Programme announced as part of the GP Forward View. The guidance aims to deliver a menu of support to help practices become more sustainable and resilient, better placed to tackle challenges they face now and into the future and securing continuing high quality care for their patients. The CCG and LMC are to draft a letter to be issued to identified practices. Meeting Dates Members were asked to consider moving the meeting date from Monday to Tuesday to ensure there is clinical input. It was also suggested that meetings take place bi monthly. It was agreed to review meeting dates and a revised meeting schedule would be issued. d. Items of Particular Interest or Risk : NONE Page 8 of 9

9 2.5 Locality Steering Group Summaries : Chair GP Clinical Leads Locality summaries are attached at Appendix B. 3. STAKEHOLDER COMMITTEES The following Stakeholder Committee minutes are attached at Appendix C for information. Health & Wellbeing Board: 13 June 2016 EL Health & Wellbeing Partnership: Pennine Lancashire System Leaders Forum : 20 July RECOMMENDATIONS Members are asked to: a. Ratify and endorse the delegated decisions taken by the Sub Committees; b. Receive the monitoring information on key decisions; c. Be advised of the items of particular interest or risk; d. Receive the Stakeholder Committee minutes for information. ANGELA BROWN Director of Corporate Business Page 9 of 9