City Integrated Commissioning Board

Transcription

1 Meeting-in-common of the City & Hackney Clinical Commissioning Group and City of London Corporation City Integrated Commissioning Board Meeting on Tuesday 23 May, 09:30-11:30 Tomlinson Centre, Queensbridge Road, E8 3ND Item no. Item 1. Agreement of Chair and Noting of Membership Lead and action for boards Chairs For discussion and agreement Documentation 1.1 Agreement of Chair and Noting of Membership Page No. Time 1-3 9:30 2. Apologies/introductions Chair Verbal - 9:35 3. Integrated Commissioning Governance Chair For noting Integrated Commissioning Governance Structure ICB Terms of Reference, Member Role Descriptions and Scheme of Delegation For noting ICB Terms of Reference ICB Member Role Descriptions Scheme of Delegation Conflicts of Interest Policy Statement and Register of Interests Protocol for Meetings in Public For noting and adoption Conflicts of Interest Policy Statement Register of Interests For approval 3.3 Protocol for Meetings in Public Transformation Board Terms of Reference For approval Transformation Board Terms of Reference Alignment of Workstream Budgets and Update on Section 75 Paul Haigh For discussion 5. Care Workstream Update Paul Haigh For discussion and approval 4.1 Alignment of Workstream Budgets 4.2 Section 75 Update 5.1 Strategic Framework 5.2 Integrated Commissioning Workstream Asks Workstream Dashboard

2 6. Care Workstream Assurance Process Devora Wolfson 5.4 Big Ticket Items 6 Assurance Process Further Developments on Smoking Cessation and Making Every Contact Count 8. Follow up from the Development Session For discussion and approval Jayne Taylor / Gareth Wall For discussion Devora Wolfson 7 Smoking Cessation Verbal Minutes of the Transformation Board 10. ICB Forward Plan and ICB Meeting Dates For noting Chair For noting Chairs / Matt Hopkinson For discussion and agreement 11. Questions from the Public Chair For discussion 12. Reflection on the ICB meeting Chairs 9.1 Minutes of Transformation Board, April ICB Forward Plan 10.2 ICB Meeting Dates Verbal Verbal For discussion 13. Any Other Business Chair Verbal

3 Paper 1 Title: Agreement of ICB Chair and Noting of Membership Date: 23 May 2017 Lead Officer: Author: Paul Haigh, City & Hackney Clinical Commissioning Group (CCG) Neal Hounsell, Assistant Director of Commissioning and Partnerships (CoLC) Matt Hopkinson, Integrated Commissioning Governance Manager, C&HCCG Committee(s): City Integrated Commissioning Board, 23 May 2017 Public / Nonpublic Public Executive Summary: The Integrated Commissioning Board (ICB) is a meeting in common between the City of London Corporation (CoLC) Integrated Commissioning Committee and the NHS City & Hackney Clinical Commissioning Group (CCG) Integrated Commissioning Committee. Membership The membership of the CoLC Committee is as follows: Dhruv Patel Chair, Community and Children s Services Committee (Chair of the CoLC Committee) Joyce Nash Member, Community and Children s Services Committee Randall Anderson, Deputy Chair, Community and Children s Services Committee The membership of the CCG Committee is as follows: Clare Highton - Chair of the CCG (Chair of the CCG Committee) Honor Rhodes - CCG Governing Body Lay Member Paul Haigh - CCG Chief Officer Members have been delegated authority from their statutory bodies and are responsible for all decision-making within their respective committees, but have no authority outside their own committee. When meeting in common, the members of the CoLC Committee shall be in attendance at the meeting of the CCG Committee, and the members of the CCG Committee shall be in attendance at the meeting of the CoLC Committee. ICB Page 1

4 Paper 1 Besides the members, the following shall be expected to attend the meetings of the Board, contribute to all discussion and debate, but will not participate in decisionmaking: Gary Marlowe - CCG Governing Body GP Philippa Lowe - CCG Chief Financial Officer Neal Hounsell - Assistant Director of Commissioning and Partnerships (Authorised Officer for COLC) Peter Kane - City of London Corporation Chamberlain In addition the following will have a standing invitation to attend the meetings of the Board, contribute to all discussion and debate, but will not participate in decisionmaking: COLC/LBH Director of Public Health A person nominated by the Chief Financial Officers of the CCG and COLC Janine Aldridge - City of London Healthwatch Chair of the ICB In order to facilitate meetings in common, the ICB Terms of Reference state that one of the two Committee Chairs should function as the overall Chair of the ICB, and that this arrangement should rotate on a six monthly basis, thus: the Chair of the CCG Committee shall lead and facilitate the discussions of the Board for the first six months after its formation; and the Chair of the COLC Committee shall perform the same role for the following six months. Thereafter the role shall swap between the two Chairs, with each performing it for six months at a time. The Integrated Commissioning Board is asked to AGREE that Dr Clare Highton should act as Chair of the City Integrated Commissioning Board from May to October Cllr Dhruv Patel will act as Chair for the subsequent six months from November Recommendations: The Integrated Commissioning Board is asked: To NOTE the membership of the Integrated Commissioning Board To AGREE that Dr Clare Highton should act as Chair of the City Integrated Commissioning Board from May to October 2017, in line with the Terms of Reference. Links to Key Priorities: The key aims and objectives of Integrated Commissioning are aligned to the delivery of priorities in the City Joint Health & Wellbeing Strategy. ICB Page 2

5 Paper 1 Specific implications for City and Hackney N/A Patient and Public Involvement and Impact: N/A Clinical/practitioner input and engagement: N/A Impact on / Overlap with Existing Services: N/A Supporting Papers and Evidence: None. Sign-off: City of London Corporation Neal Hounsell, Assistant Director of Commissioning and Partnerships City & Hackney CCG - Paul Haigh, Chief Officer ICB Page 3

6 Paper 3.0 Title: Integrated Commissioning Governance Date: 23 May 2017 Lead Officer: Author: Paul Haigh, City & Hackney Clinical Commissioning Group (CCG) Neal Hounsell, City of London Corporation (CoLC) Matt Hopkinson, Integrated Commissioning Governance Manager, C&HCCG Committee(s): City Integrated Commissioning Board, 23 May 2017 Public / Nonpublic Public Executive Summary: In February 2017 the City & Hackney Clinical Commissioning Group Governing Body, the London Borough of Hackney and the City of London Corporation each agreed to establish a collaborative model for the closer integration of commissioning between the three statutory bodies in partnership, commencing in April Central to this collaboration, is the establishment of the Integrated Commissioning Boards (ICBs), which are to function as committees of the statutory bodies with delegated authority to make decisions and direct commissioning work in certain areas as defined by the terms of reference. Appendix shows the overall structure of integrated commissioning governance. The Integrated Commissioning Board is asked to note, adopt and approve the governance documents as set out in the following papers: Paper 3.1 Integrated Commissioning Board Terms of Reference, Roles of ICB Members and Scheme of Delegation Paper Conflicts of Interest Policy Statement and Register of Interests Paper 3.3 Protocol for Meetings in Public Paper 3.4 Transformation Board Terms of Reference ICB Page 4

7 Paper 3.0 Recommendations: The Integrated commissioning Board is asked: to NOTE the City ICB Terms of Reference; to NOTE the ICB Member Role Description; and to NOTE the Scheme of Delegation; to ADOPT the Policy Statement on Conflicts of Interest to NOTE the Register of Interests To APPROVE the Protocol for Meetings in Public to APPROVE the draft Terms of Reference for the Hackney & City Health and Social Care Transformation Board. Links to Key Priorities: The key aims and objectives of Integrated Commissioning are aligned to the delivery of priorities in the City Joint Health & Wellbeing Strategy. Specific implications for City and Hackney The governance arrangements will help to ensure that integrated commissioning is developed in a way that meets the specific needs of Hackney residents and City residents and workers and that City and Hackney specific delivery models are developed where appropriate. Patient and Public Involvement and Impact: Extensive consultation and engagement was carried out jointly by the CCG and local authorities in preparing proposals for integrated commissioning. A full record of this activity was reported to the Governing Body of the CCG on 31 March 2017 (Agenda Item 8c, Appendix 2) and is available at: Clinical/practitioner input and engagement: Extensive consultation and engagement was carried out jointly by the CCG and local authorities in preparing proposals for integrated commissioning. A full record of this activity was reported to the Governing Body of the CCG on 31 March 2017 (Agenda Item 8c, Appendix 2) and is available at: Impact on / Overlap with Existing Services: N/A ICB Page 5

8 Paper 3.0 Supporting Papers and Evidence: Paper Integrated Governance Structure Diagram Paper 3.1 Integrated Commissioning Board Terms of Reference, Roles of ICB Members and Scheme of Delegation Paper Conflicts of Interest Policy Statement and Register of Interests Paper 3.3 Protocol for Meetings in Public Paper 3.4 Transformation Board Terms of Reference Sign-off: City of London Corporation - Neal Hounsell, Assistant Director of Commissioning and Partnerships City & Hackney CCG - Paul Haigh, Chief Officer ICB Page 6

9 Governance Structure for Integrated Commissioning London Borough of Hackney City of London Corporation Paper Each ICB makes recommendations to its respective LA on aligned fund services Each LA agrees an annual budget and delegation scheme for its respective ICB (with C&H CCG) Delegated decision making for pooled budget Receive financial reports Agree outcome improvements and progress across the system Delivery of HWB strategies Care workstreams Workstreams report into and make recommendations to JTB Includes: CYP Prevention Planned Unplanned City and Hackney Transformation Board Recommends contracts with primary care Recommendation and advice Implementation of decisions Recommends contracts with primary care Hackney Integrated Commissioning Board City of London Integrated Commissioning Board Meets in common to ensure alignment Recommendations for aligned fund services Each year agrees budget and scheme of delegation (with local authority) Hackney HWB City of London HWB Primary care contracts committee/s City and Hackney CCG ICB Page 7

10 1. The ICBs The Hackney ICB is a meeting in common of members from the CCG Integrated Commissioning Committee and LBH Integrated Commissioning Committee Member: Role on board: Reports to: Cllr Jonathan McShane Cllr Antoinette Bramble Cllr Geoffrey Taylor Clare Highton Lead member for Health, Social Care and Devolution Lead member for Children s services Lead member for finance and corporate services CCG Chair (Chair of the CCG Committee) LBH Cabinet LBH Cabinet LBH Cabinet CCG Governing Body Paul Haigh CCG Chief Officer CCG Governing Body Honor Rhodes CCG Governing Body Lay Member CCG Governing Body The City of London ICB is a meeting in common of members from the CCG Integrated Commissioning Committee and the Integrated Commissioning Subcommittee Member: Role on board: Reports to: Dhruv Patel Joyce Nash Chair, Community and Children s Services Committee COLC Member, Community and Children s Services Committee COLC Community and Children s Services Committee Community and Children s Services Committee Randall Anderson Deputy Chair, Community and Children s Services Committee COLC Clare Highton CCG Chair (Chair of the CCG Committee) CCG Governing Body Paul Haigh CCG Chief Officer CCG Governing Body Community and Children s Services Committee Honor Rhodes CCG Governing Body Lay Member CCG Governing Body ICB Page 8

11 2. City and Hackney Transformation Board and its working groups City and Hackney Transformation Board membership Working group SROs Unplanned Care Planned Care Prevention CYP IT Estates Communications CEPN/Workforce Primary Care Quality Board Tracey Fletcher Neal Hounsell Anne Canning Angela Scattergood Tracey Fletcher/Niall Canavan Philippa Lowe/Ian Williams Jon Williams/Catherine Macadam Deborah Colvin/Martin Kuper Mark Ricketts ICB Page 9

12 Paper 3.1 Title: Integrated Commissioning Board Terms of Reference, Scheme of Delegation and Member Role Description Date: 23 May 2017 Lead Officer: Author: Paul Haigh, City & Hackney Clinical Commissioning Group (CCG) Neal Hounsell, City of London Corporation (CoLC) Matt Hopkinson, Integrated Commissioning Governance Manager, C&HCCG Committee(s): City Integrated Commissioning Board, 23 May 2017 Public / Nonpublic Public Executive Summary: The Terms of Reference define the roles and responsibilities of the CCG Integrated Commissioning Committee and the CoLC Integrated Commissioning sub-committee meeting in common as the City Integrated Commissioning Board. The Terms of Reference set out rules for the conduct of meetings, including decision-making, matters of quorum and the management of Conflicts of Interest. The specific duties of members of the ICB are defined in the role description. Each member remains subject to the duties and obligations which attach to him/her in his/her capacity within the CCG or COLC. Both the Terms of Reference and the members role descriptions have been formally mandated by the City & Hackney CCG Governing Body and the CoLC Community and Children s Services Committee. The City Integrated Commissioning Board is asked to NOTE the Terms of Reference and members role description. The Scheme of Delegation defines the authority reserved and delegated within the governance arrangements for the Integrated Commissioning Fund established by the CCG and CoLC, consistent with the Financial Framework. These delegations are made to the CCG Integrated Commissioning Committee and the CoLC Integrated Commissioning sub-committee meeting in common. The CoLC Integrated Commissioning Sub-Committee has authority to make decisions on behalf of CoLC and the CCG s Integrated Commissioning Committee has authority to make decisions on behalf of the CGG, both in accordance with the terms of reference and this scheme of delegation and reservation. ICB Page 10

13 Paper 3.1 As outlined in Agenda Item 4 (S75 Update), there will be some minor revisions to the scheme of delegation including Other Primary Care Services no longer being part of the pooled budget. Other Primary Care Services will be within the Aligned budget with authority reserved to the CCG Governing Body. The Board is asked to note that an updated version of the Scheme of Delegation will be brought to the next meeting of the ICB. The City Integrated Commissioning Board is asked to NOTE the Scheme of Delegation. Recommendations: The City Integrated Commissioning Board is asked: to NOTE the City ICB Terms of Reference; to NOTE the ICB Member Role Description; and to NOTE the Scheme of Delegation; Supporting Papers: Paper City Integrated Commissioning Board Terms of Reference Paper ICB Member Role Description Paper NHS City & Hackney Clinical; Commissioning Group and City of London Corporation Integrated Commissioning Arrangements Scheme of Reservation and Delegation ICB Page 11

14 Paper 4.1 NHS CITY & HACKNEY CLINICAL COMMISSIONING GROUP AND THE CITY OF LONDON CORPORATION Terms of Reference of the City of London Corporation Integrated Commissioning Sub-Committee and the NHS City & Hackney Clinical Commissioning Group Integrated Commissioning Committee ( known collectively as the Integrated Commissioning Board ) The City of London Corporation ( COLC ) has established an Integrated Commissioning Sub- Committee ( the COLC Committee ) under its Community and Children s Services Committee. The NHS City & Hackney Clinical Commissioning Group ( the CCG ) has also established an Integrated Commissioning Committee ( the CCG Committee ). The COLC Committee and the CCG Committee shall meet in common and shall be known together as the Integrated Commissioning Board ( the Board ). The COLC Committee has authority to make decisions on behalf of COLC, which shall be binding on the authority, in accordance with these terms of reference and the scheme of delegation and reservation. The CCG Committee has authority to make decisions on behalf of the CGG, which shall be binding on the authority, in accordance with these terms of reference and the scheme of delegation and reservation. Except where stated otherwise (in which case the terms "the COLC Committee" and/or "the CCG Committee" or "the committees" are/is used), all references in this document to the Board refer collectively to the two committees described above. The Role and Responsibilities of the Board, as described below, are the roles and responsibilities of the individual committees insofar as they relate to the individual committee s authority. The CCG and COLC committees (i.e. "the Board") will manage the Pooled Fund element of the Integrated Commissioning Fund in the delivery of the Locality Plan. For Aligned Fund services the Committees act as an advisory group making recommendations to the CCG Governing Body or the COLC Community and Children's Services Committee. Role and Responsibilities of the Board The Board is the principal forum to ensure that commissioning improves local services and outcomes and achieves integration of service provision and of commissioning and delivers the North East London Sustainability and Transformation Plan (NEL STP). It is the forum for decision making and monitoring of activity to integrate the commissioning activities of the CCG and COLC (to the extent defined in the s75 agreement). The Board's remit is in respect of services that are Pooled Funds (including the Better Care Fund budgets) within the Integrated Commissioning Fund (ICF).The Board also has a remit with regard to Aligned Funds, whereby it is an advisory group making recommendations to the CCG Governing Body or the COLC Community and Children's Services Committee. The CCG and COLC shall determine the funds, and therefore the services, that are to be pooled or aligned at any time (and shall include requirements in respect of Better Care Fund budgets). Once defined, the remit will be stated in these Terms of Reference or in another appropriate document that is provided to the Board. 1 Annex 7 ICB Page 12

15 In performing its role the Board will exercise its functions in accordance with, and to support the delivery of, the City and Hackney Locality Plan and the City of London supplement and the North East London Sustainability and Transformation Plan (NEL STP). In carrying out its role the Board will be supported by the Transformation Board. The duties of the Board defined below are subject to its Scheme of Delegation and subject to the financial framework which outlines which budgets are pooled and which are aligned and the role of the Board in relation to each. Specifically, the Board will: Commissioning strategies and plans Lead the commissioning agenda of the locality, including inputs from, and relationships with, all partners Ensure financial sustainability and drive local transformation programmes and initiatives Determine and advise on the local impacts of commissioning recommendations and decisions taken at a NEL level Ensure that the Locality plan is delivering the local contribution to the ambitions of the NEL STP Lead the development and scrutiny of annual commissioning intentions as set out in the Integrated Commissioning Strategy, including the monitoring, review, commissioning and decommissioning of activities Provide advice to the CCG about core primary care and make recommendation to the CCG's Local GP Provider Contracts Committee Ensure that the locality plan delivers constitutional requirements, financial balance, and supports the improvement in performance and outcomes established by the Health and Wellbeing Board Promote health and wellbeing, reduce health inequalities, and address the public health and health improvement agendas in making commissioning recommendations Ensure commissioning decisions are made by the ICB in a timely manner that address financial challenges of both the in-year and longer term plans. Ensure that local plans can demonstrate their impact on City residents and City workers where appropriate. Service re-design Approve all clinical and social care guidelines, pathways, service specifications, and new models of care Ensure all local guidelines and service specifications and pathways are developed in line with NICE and other national evidence, best practice and benchmarked performance Drive continuous improvement in all areas of commissioning, pathway and service redesign delivering increased quality performance and improved outcomes Ensure that services are designed and delivered, using design lab principles i.e. codeveloped by residents and practitioners working together 2 Annex 7 ICB Page 13

16 Contracting and performance Oversee the annual contracting and planning processes and ensure that contractual arrangements are supporting the ambitions of the CCG and COLC to transform services, ensure integrated delivery and improve outcomes Oversee local financial and operational performance and decisions in respect of investment and disinvestment plans Stakeholder engagement Ensure adequate structures are in place to support patient, public, service user, and carer involvement at all levels and that the equalities agenda is delivered Ensure that arrangements are in place to support collaboration with other localities when it has been identified that such collaborative arrangements would be in the best interests of local patients, public, service users, and carers Ensure and monitor on-going discussion between the ICB and provider organisations about long-term strategy and plans Programme management Oversee the work of the Transformation Board including their work on the workstreams and enabler groups ensuring system wide implications are considered Ensure that risks associated with integrated commissioning are identified and managed, including to the extent necessary through risk management arrangements established by the CCG and COLC. Safeguarding In discharging its duties, act such that it supports the CCG and CoLC to comply with the statutory duties that apply to them in respect of safeguarding patients and service users. Geographical Coverage The responsibilities for the Board will cover the geographical area of the COLC. It is noted that there will need to be decisions made about how to address the issues of resident and registered populations across the CCG and COLC and city workers. Membership The membership of the COLC Committee shall be as follows: The Chairman of the Community and Children s Services Committee (Chair of the COLC Committee) The Deputy Chairman of the Community and Children s Services Committee 1 other Member from the Community and Children s Services Committee The membership of the CCG Committee shall be as follows: Chair of the CCG (Chair of the CCG Committee) CCG Governing Body Lay Member CCG Chief Officer 3 Annex 7 ICB Page 14

17 As the two committees shall meet in common, the members of the COLC Committee shall be in attendance at the meeting of the CCG Committee, and the members of the CCG Committee shall be in attendance at the meeting of the COLC Committee. The following shall be expected to attend the meetings of the Board, contribute to all discussion and debate, but will not participate in decision-making: CCG Governing Body GP CCG Chief Financial Officer The Director of Community and Children s services (Authorised Officer for COLC) The City of London Corporation Chamberlain The following will have a standing invitation to attend the meetings of the Board, contribute to all discussion and debate, but will not participate in decision-making: COLC Director of Public Health A person nominated by the Chief Financial Officers of the CCG and COLC Representative of City of London Healthwatch When the two committees are meeting in common as the Board, the Chair of the CCG Committee shall lead and facilitate the discussions of the Board for the first six months after its formation; and the Chair of the COLC Committee shall perform the same role for the following six months. Thereafter the role shall swap between the two Chairs, with each performing it for six months at a time. If the Chair nominated to lead and facilitate discussions in a particular meeting or on a particular matter is absent for any reason for example, due to a conflict of interests - the other Chair shall perform that role. If both Chairs are absent for any reason, the members of the COLC Committee and the CCG Committee shall together select a person to lead and facilitate for the whole or part of the meeting concerned. The membership will be kept under review and through approval from the CCG's Governing Body and the Community and Children s Services Committee; other parties may be invited to send representatives to attend the Board's meetings in an non-decision making capacity. The Board may also call additional experts to attend meetings on an ad hoc basis to inform discussions. Meetings The Board's members will be given no less than five clear working days notice of its meetings. This will be accompanied by an agenda and supporting papers and sent to each member no later than five clear days before the date of the meeting. In urgent circumstances the requirement for five clear days notice may be truncated. It is anticipated that the Board will routinely meet monthly. When the Chairs of the CCG and COLC Committees deem it necessary in light of urgent circumstances to call a meeting at short notice this notice period shall be such as they shall specify. 4 Annex 7 ICB Page 15

18 Meetings of the Board shall be held in accordance with partner s Access to Information procedures, rules and other relevant constitutional requirements. The dates of the meetings will be published by the CCG and COLC. The meetings of the Board will be held in public, subject to any exemption provided by law or any matters that are confidential or commercially sensitive.. This should only occur in exceptional circumstances and is in accordance with the open and accountable local government guidance (June 2014). There may be occasions where the Board for the City of London meets in common with the Board for the London Borough of Hackney to consider the same items of business. The terms of reference for the respective Boards still apply in such circumstances. Secretarial support will be provided to the Board and minutes shall be taken of all of the Board's meetings, with one set being prepared for each of the committees in common and submitted to the relevant forum as determined by the CCG and COLC. Agenda, decisions and minutes shall be published in accordance with partners access to Information procedures rules. Decisions made by the CoLC Committee may be subject to referral to the Court of Common Council in accordance with COLC s constitution. Executive decisions made by the CCG committee may be subject to review by the CCG's Governing Body and/or Members Forum in accordance with CCG's constitution. However, the CCG and COLC will manage the business of the Board, including consultation with relevant fora and/or officers within those organisations, such that the incidence of decisions being reviewed or referred is minimised. Decision making Each committee must reach its own decision on any matter under consideration, and will do so by consensus of its members where possible. If consensus within a committee is impossible, that committee may take its decision by simple majority, and the Chairman s casting vote if necessary. The COLC Committee and CCG Committee will each aim to reach compatible decisions. Matters for consideration by the two committees meeting in common as the Board may be identified in board papers as requiring positive approval from both committees in order to proceed. Any matter identified as such may not proceed without positive approval from both the COLC Committee and the CCG Committee. These decision-making arrangements shall be included in the review of these terms of reference as set out below. Quorum For the CCG committee the quorum will be two of the three members. For the COLC committee the quorum will be two of the three members. Conflicts of interests The partner organisations represented in the Board are committed to conducting business and delivering services in a fair, transparent, accountable and impartial manner. Board members will comply with the Conflicts of Interest policy statement developed for the ICBs, as well as the arrangements established by the organisations that they represent. 5 Annex 7 ICB Page 16

19 A declaration of interest will be completed by all members and attendees of the Board and will be kept up to date in line with the policy. Before each meeting the each member or attendee will examine the agenda to identify any matters in which he/she has (or may be perceived to have) an interest. Such interests may be in addition to those declared previously. Any such conflicts should be raised with the chair and the secretariat at the earliest possible time. The Chair will acknowledge the register of interests at the start of the meeting as an item of business. There will be the opportunity for any potential conflicts of interest to be debated and the chair (on the basis of advice where necessary) may give guidance on whether any conflicts of interest exist and, if so, the arrangements through which they may be addressed. In respect of the CCG Committee, the members will have regard to any such guidance from the Chair and should adopt it upon request to do so. Where a member declines to adopt such guidance it is for the Chair to determine whether a conflict of interests exists and, if so, the arrangements through which it will be managed. In respect of the COLC Committee, it is for the members to declare any conflicts of interests which exist (taking into account any guidance from the chair) and, if so, to adopt any arrangements which they consider to be appropriate. In some cases it may be possible for a person with a conflict of interest to participate in a discussion but not the decision that results from it. In other cases, it may be necessary for a person to withdraw from the meeting for the duration of the discussion and decision. Where the Chair (of either committee) or another person selected to lead and facilitate a meeting has a conflict of interests, the arrangements set out above (under Membership) shall apply. When considering any proposals relating to actual or potential contractual arrangements with local GP providers the Board will seek independent advice from the CCG Local GP Provider Contracts Committee who provide a scrutiny function for all such matters, particularly that the contract is in the best interests of local people, represents value for money and is being recommended without any conflict of interest from GPs. All declarations and discussions relating to them will be minuted. Additional requirements The members of the Board have a collective responsibility for the operation of the Board. They will participate in discussion, review evidence, and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view. They will take advice from the Transformation Board and from other advisors where relevant. The Board must operate within the schemes of delegation and financial framework agreed by the CCG and COLC, who remain responsible for their statutory functions and for ensuring that these are met and that the Board is operating within all relevant requirements. The Board may assign tasks to such individuals or committees as it shall see fit, provided that any such assignments are consistent with each parties relevant governance arrangements, are recorded in a scheme of delegation for the Board, are governed by terms of reference as appropriate, and 6 Annex 7 ICB Page 17

20 reflect appropriate arrangements for the management of any actual or perceived conflicts of interest. Reporting and relationships The Board will report to the relevant forum as determined by the CCG and COLC. The matters on which, and the arrangements through which, the Board is required to report shall be determined by the CCG and COLC (and shall include requirements in respect of Better Care Fund budgets). The Board will present for approval by the CCG and COLC proposals on matters in respect of which authority is reserved to the CCG and/or COLC (including in respect of aligned fund services). The Board will also provide advice to the CCG about core primary care and make recommendation to the appropriate CCG Committee. The Board will receive reports from the CCG and COLC on decisions made by those bodies where authority for those decisions is retained by them but the matters are relevant to the work of the Board. The Board will provide reports to the Health and Wellbeing Board and other committees as required. Review These terms of reference will apply for the year from 1 April 2017 to 31 March 2018, subject to their agreement by the 2 statutory organisations. The terms of reference will be reviewed not later than six months from initial approval and then annually thereafter, such annual reviews to coincide with reviews of the s75 agreements. [Insert dates of approval of these TOR at each relevant forum within the CCG and COLC] To be added 9 March Annex 7 ICB Page 18

21 NHS CITY & HACKNEY CLINICAL COMMISSIONING GROUP AND Paper CITY OF LONDON CORPORATION INTEGRATED COMMISSIONING BOARD ROLE DESCRIPTION FOR MEMBERS Introduction The Integrated Commissioning Board (ICB) has been established by NHS City and Hackney CCG (the CCG) and City of London Corporation (COLC) to be the principal decision making and monitoring forum for certain integrated commissioning functions. The ICB functions through two committees in common established by the CCG and COLC respectively, and through authority delegated by those organisations to the ICB. References in this document to the ICB refer in fact to the two committees in common, each called the ICB, established by the CCG and COLC respectively. This document defines the duties of the members of the ICB in that capacity. Each member remains subject to the duties and obligations which attach to him/her in his/her capacity within the CCG or COLC. Duties of the Chair The Chair of the ICB in conjunction with the ICB is responsible for i. Leading the ICB, ensuring it remains continuously able to discharge its duties and responsibilities as set out in its terms of reference ii. Assuring the statutory partner organisations that the ICB operates within the scheme of delegation, and the ToR and that the statutory obligations and responsibilities of the organisations are met; iii. Addressing any conflicts of interest in line with the conflict of interest policy statement for the integrated commissioning arrangements; iv. Ensuring that the ICB takes account of the views of the partner organisations and the Transformation Board when the ICB is making decisions; v. Supporting the building and development of the ICB and its individual members; vi. Ensuring that, through the appropriate support, information and evidence, the ICB is able to discharge its duties; vii. Ensuring that public and patients' views are heard and their expectations understood and, where appropriate as far as possible, met; viii. Ensuring that the Board is able to account to its local residents, patients, stakeholders, wider organisations and NHSE; and ix. Ensuring that the Board is accounting to and assuring COLC and the CCG that it is discharging the delegated functions in line with Delegation Agreement. The Chair must also comply with the duties of members set out below. GP Members Annex ICB 5 Page 19

22 i. Providing clinical leadership and insight to business of the ICB and commissioning decisions ii. Ensure effective two-way communications with constituent practices; iii. Ensures that CCG Member views are obtained and contribute to the business of the ICB, not the views of their own individual practice as a provider and ensure their accountability to members of the consortia; iv. Ensures that they perform their functions in line with their CCG roles and subject to CCG processes and policies, including the Conflicts of Interest policy. GP members must also comply with the duties of members set out below. Councillor Members i. Providing political leadership and insight to business of the ICB and commissioning decisions ii. Ensure effective two-way communications with COLC; iii. Ensures that the views of COLC are contributed to the business of the ICB; iv. Ensures that they perform their functions in line with their COLC roles and subject to COLC processes and policies; Councillor members must also comply with the duties of members set out below. Duties of Members Individual members must contribute to the ICB s discussions and decisions in relation to: Arrangements in place between the CCG and COLC to work together Strategies and plans to secure the engagement of patients, the public and other stakeholders The procurement process to select providers to deliver services identified in commissioning strategies and plans The appointment of providers to deliver services identified in commissioning strategies and plans Addressing any variance from targets in respect of the performance of providers and improvement of outcomes. Each member of the ICB shall: 1. Contribute to and with the other members take responsibility for agreeing and leading the overarching commissioning strategy for the local population and local services, along with individual strategies or plans for each service or clinical pathway when relevant; 4. Commit to and act at all times to promote the success of the integrated arrangements for the benefit of the CCG, COLC and the local population; 9. Comply with any statutory duties and other obligations which attach to him/her in his/her capacity within the CCG or COLC and their respective constitutions. Annex ICB 5 Page 20

23 10. Adopt the Nolan Principles and in particular act with highest standards of probity and integrity, and openly and transparently at all times. 11. Adopt, understand and comply with all legal and governance arrangements put into place by the CCG and COLC. 12. Comply with the provisions of the schemes of delegation for the ICB; 13. Attend all meetings of the ICB except in exceptional circumstances where prior notice of absence must be given to the Chair. 14. Liaise with colleagues within the CCG and COLC (as appropriate) to ensure that discussions and decisions can be progressed at ICB meetings with reasonable efficiency. 15. Contributing to building a shared vision of the aims, values and culture of the ICB 16. Recognise their individual role as existing either by virtue of an elected post or appointment, and attend to any formal responsibilities and obligations that attach to this status. Members must also abide by the requirements of the Conflicts of Interest statement. Terms No Member, with the exception of GPs elected onto the CCG governing body, shall be remunerated for his/her role on the ICB. Each Member may claim reasonable expenses from the CCG or COLC (as appropriate), in accordance with established policies. Each Member is appointed to the ICB for a period of one year. Should a named member no longer hold the position as listed in the terms of reference, he/she will be replaced on the ICB by their successor. Each Member is subject to the terms and conditions of their arrangements with their host organisation (either the CCG or COLC) and those agreements supersede this role description should any issue arise. Review This role description will be reviewed not later than six months from initial approval and then annually thereafter. DAC Beachcroft LLP 2 February 2017 Annex ICB 5 Page 21

24 Annex ICB 5 Page 22

25 Paper NHS CITY & HACKNEY CLINICAL COMMISSIONING GROUP AND CITY OF LONDON CORPORATION INTEGRATED COMMISSIONING ARRANGEMENTS SCHEME OF RESERVATION AND DELEGATION Introduction This document defines the authority reserved and delegated within the governance arrangements for the Integrated Commissioning Fund established by NHS City and Hackney CCG (the CCG) and City of London Corporation (CoLC). The authority defined in this document is consistent with (and is referenced to) the Financial Framework (FF). CoLC has established an Integrated Commissioning Sub-Committee of its Community and Children s Services Committee and the CCG has also established an Integrated Commissioning Committee. The CoLC Sub-Committee and the CCG Committee shall meet in common and shall be known together as the Integrated Commissioning Board ( the Board ). CoLCs Integrated Commissioning Sub-Committee has authority to make decisions on behalf of CoLC, which shall be binding on the authority, in accordance with its terms of reference and this scheme of delegation and reservation. The CCG s Integrated Commissioning Committee has authority to make decisions on behalf of the CGG, which shall be binding on the authority, in accordance with its terms of reference and this scheme of delegation and reservation. The authority of the CoLC Integrated Commissioning Sub-Committee is subject to referral to the Court of Common Council in accordance with the CoLCs constitution. The CCG's Integrated Commissioning Committee is subject to oversight from the CCG's Governing Body and Members such that they are assured that the Board does not breach any requirements. The integrated commissioning governance arrangements include the Transformation Board (TB). The purpose of the TB is to discuss issues among its members and to support the ICB in its role. No authority is delegated to the TB so it does not appear below; its role is limited to making recommendations to the ICB. This document distinguishes between "core primary care services", which are services commissioned by the CCG under authority delegated from NHS England, and "other primary care services" (such as enhanced services), have been and will continue to be commissioned directly by the CCG. Authority (for commissioning, procurement and other matters) in respect of core primary care services is reserved to the CCG's Primary Care Commissioning Committee; authority in respect of all other primary care services is delegated to the ICB. ICB Page 23

26 Paper No. Description of authority reserved or delegated CCG Governing Body CCG Local GP Provider Contracts Committee CCG officers Community and Children s Services Committee CoLC Social Value Panel CoLC Integrated Commissioning Sub-Committee CCG Integrated Commissioning Committee Pooled Budgets and Services 1. Determine the budgets (and therefore services) that are pooled (to include Better Care Fund) at any time Authority to approve Authority to approve 2. Determine the amount of the Integrated Commissioning Fund that is allocated to commissioning management and administration support. Authority to approve Authority to approve 3. Approve the Integrated Commissioning Strategy (ICS) for services within the pooled budget Authority to approve Authority to approve 4. Approve a commissioning strategy or plan for each service or pathway identified in the ICS and included in the pooled budget Authority to approve Authority to approve ICB Page 24

27 Paper No. Description of authority reserved or delegated CCG Governing Body CCG Local GP Provider Contracts Committee CCG officers Community and Children s Services Committee CoLC Social Value Panel CoLC Integrated Commissioning Sub-Committee CCG Integrated Commissioning Committee 5. Approve the design of services identified in the ICS and included in the pooled budget, including pathways, specifications and models of care. Authority to approve (Refer to FF 34) Authority to approve (Refer to FF 34) 6. Approve expenditure from the pooled budget, including Better Care Fund budgets. Authority to approve (Refer to FF 38.3) Authority to approve (Refer to FF 38.3) 7. Approve the procurement process to select providers to deliver services identified in the ICS and within the pooled budget To be consulted prior to proposals to Integrated Commissioning Sub- Committee Authority to approve Authority to approve 8. Approve the appointment of providers to deliver services identified in the ICS and within the pooled budget To be consulted prior to proposals to Integrated Commissioning Sub- Committee Authority to approve for Authority to approve for 9. Approve contracts with providers selected to deliver services identified in Authority to approve. (Refer to Authority to approve (Refer to FF 38.3) ICB Page 25

28 Paper No. Description of authority reserved or delegated CCG Governing Body CCG Local GP Provider Contracts Committee CCG officers Community and Children s Services Committee CoLC Social Value Panel CoLC Integrated Commissioning Sub-Committee CCG Integrated Commissioning Committee the ICS and within the pooled budget FF 38.3) 10. Approve action to address any variance from targets in respect of the performance of providers. Authority to approve Authority to approve 11. Approve the arrangements for the CCG and LBH to work together, including the role of the Transformation Board and any supporting committees or work programmes. Authority to approve Authority to approve 12. Approve strategies and plans to secure the engagement of patients, the public and other stakeholders. Authority to approve Authority to approve Aligned Budgets and Services 13. Approve the commissioning strategy for aligned budgets and services. Authority to approve Authority to approve ICB Page 26

29 Paper No. Description of authority reserved or delegated CCG Governing Body CCG Local GP Provider Contracts Committee CCG officers Community and Children s Services Committee CoLC Social Value Panel CoLC Integrated Commissioning Sub-Committee CCG Integrated Commissioning Committee 14. Approve a commissioning strategy or plan for each aligned service or pathway. Authority to approve Authority to approve 15. Approve the design of aligned budget services, including pathways, specifications and models of care. Authority to approve Authority to approve 16. Approve the procurement process to select providers to deliver aligned budget services. Authority to approve Authority to approve To be consulted prior to proposals to Community and Children's Services Committee 17. Approve the appointment of providers to deliver aligned budget services. Authority to approve Authority to approve To be consulted prior to proposals to Community and Children's Services Committee 18. Approve contracts with providers selected to deliver aligned budget services. Authority to approve. (Refer to FF 38.3) Authority to approve (Refer to FF 38.3) Core Primary Care ICB Page 27

30 Paper No. Description of authority reserved or delegated CCG Governing Body CCG Local GP Provider Contracts Committee CCG officers Community and Children s Services Committee CoLC Social Value Panel CoLC Integrated Commissioning Sub-Committee CCG Integrated Commissioning Committee Services 19. Approve the commissioning strategy Authority to approve 20. Approve a commissioning strategy or plan for each service Authority to approve 21. Approve the design of services, including pathways, specifications and models of care Authority to approve 22. Approve the procurement process to select providers to deliver services Authority to approve 23. Approve the appointment of providers to deliver services Authority to approve 24. Approve contracts with providers selected to deliver services Authority to approve 25. Approve the establishment or Authority to approve ICB Page 28

31 Paper No. Description of authority reserved or delegated CCG Governing Body CCG Local GP Provider Contracts Committee CCG officers Community and Children s Services Committee CoLC Social Value Panel CoLC Integrated Commissioning Sub-Committee CCG Integrated Commissioning Committee merger of GP practices 26. Approve discretionary payments Authority to approve 27. Approve the design of local incentive schemes Authority to approve Other Primary Care Services 28. Approve the commissioning strategy Authority to approve Authority to approve 29. Approve a commissioning strategy or plan for each service Authority to approve Authority to approve 30. Approve the design of services, including pathways, specifications and models of care Authority to approve Authority to approve 31. Approve the procurement process to select providers to deliver services Authority to approve Authority to approve 32. Approve the appointment of providers to deliver services Authority to approve Authority to approve ICB Page 29

32 Paper No. 33. Description of authority reserved or delegated Approve contracts with providers selected to deliver services CCG Governing Body CCG Local GP Provider Contracts Committee CCG officers Community and Children s Services Committee CoLC Social Value Panel CoLC Integrated Commissioning Sub-Committee Authority to approve CCG Integrated Commissioning Committee Authority to approve [Insert dates of approval by the CCG's Governing Body and the relevant committee or officer in CoLC] DAC Beachcroft LLP 6 March 2017 ICB Page 30

33 Paper 3.2 Title: Policy Statement on Conflicts of Interest and Register of Interests Date: 23 May 2017 Lead Officer: Paul Haigh, City & Hackney Clinical Commissioning Group (CCG) Neal Hounsell, City of London Corporation (CoLC) Author: Matt Hopkinson, Integrated Commissioning Governance Manager, C&HCCG Committee(s): City Integrated Commissioning Board, 23 May 2017 Public / Nonpublic Public Executive Summary: This paper asks the Integrated Commissioning Board to adopt the Conflicts of Interest Policy Statement setting out arrangements to address any conflicts of interests which arise for individuals involved in integrated commissioning. The policy statement was approved by the statutory bodies as part of the overall Integrated Commissioning Governance arrangements, and it is consistent with the policies and procedures of the Clinical Commissioning Group, City of London Corporation and the London Borough of Hackney. In line with the policy, the members of the Board and attendees have submitted declarations of interest, which are reflected on the register included in the papers. The updated register will form a standing item on the Board agendas. At this point in the meeting, and at the start of each subsequent meeting, the Chair will ask all members to declare any interests in the business on the agenda for the meeting, and any potential conflicts should be discussed and decisions taken on how to proceed. Recommendations: The Integrated Commissioning Board is asked: To ADOPT the Policy Statement on Conflicts of Interest To NOTE the Register of Interests Supporting Papers and Evidence: Paper Policy Statement on Conflicts of Interest Paper Integrated Commissioning Board Register of Interests ICB Page 31

34 Paper 3.2 ICB Page 32

35 Paper NHS CITY & HACKNEY CLINICAL COMMISSIONING GROUP, LONDON BOROUGH OF HACKNEY AND CITY OF LONDON CORPORATION INTEGRATED COMMISSIONING ARRANGEMENTS CONFLICTS OF INTERESTS POLICY STATEMENT 1. Introduction, Purpose and Application of this Policy 1.1 This document is a policy statement to set out arrangements to address any conflicts of interests which arise for individuals involved in the integrated healthcare commissioning arrangements established by NHS City & Hackney Clinical Commissioning Group (the CCG), London Borough of Hackney (LBH) and City of London Corporation (CoLC). 1.2 This policy applies only to the integrated commissioning arrangements. It is consistent with the policies and procedures established by the CCG, LBH and CoLC for the purposes of their activities generally, and it takes account of the statutory duties that apply to individuals involved in the integrated commissioning arrangements. However, in the event of any inconsistency between this policy statement and the arrangements established by the CCG, LBH or CoLC, or between this policy statement and the statutory duties (and the arrangements put into place to ensure compliance with them) applying to others involved, those other arrangements and duties shall take precedence. 2. Context 2.1 NHS City & Hackney Clinical Commissioning Group (the CCG), London Borough of Hackney (LBH) and City of London Corporation (CoLC) have agreed to work together to integrate commissioning of healthcare services for the populations that they serve. The integrated commissioning arrangements are set out in two s75 agreements, one between the CCG and LBH and the other between the CCG and CoLC, a Financial Framework, and an Information Framework, all to come into effect from April The integrated commissioning will be delivered through governance arrangements, described below, approved by the CCG, LBH and CoLC. 3. Integrated Commissioning Arrangements 3.1 The s75 agreements enable the pooling of budgets to create an Integrated Commissioning Fund; the ICF includes funds that are pooled and others in respect of which commissioning will be aligned (where pooling of budgets is not permitted). The integrated commissioning generally, and the management of the pooled budgets specifically, will be managed by two Integrated Commissioning Boards (ICBs), one for the CCG and LBH and the other for the CCG and CoLC. The ICBs are supported by a Transformation Board. ICB Page 33

36 3.2 Each ICB is, in legal terms, two "committees in common" of the CCG and the respective Local Authority. Under this arrangement the CCG and the Local Authority each establish a committee with exactly the same membership, remit and terms of reference. The two committees (embodied in the same individuals) meet together, effectively as a single forum. Decisions of the committees in common bind both organisations, within the scope of the committees in common's remit. The ICBs have delegated authority to approve commissioning strategies and plans, to procure service providers and to commit expenditure (from the pooled funds) on behalf of the CCG, LBH and CoLC. All members are expected to work in the interest of patients and service users within the wider health and social care system. 3.3 The Transformation Board (TB) is a forum for discussion of service requirements and commissioning plans in the LBH and COLC areas. The TB has no delegated authority so will take no decisions other than to agree recommendations to the ICBs. As the TB has no delegated authority, recommendations made by it shall in fact simply be a shared view of the individual members, each of whom shall individually be authorised to do so by his or her respective appointing organisation. The TB comprises representatives from the CCG, LBH, CoLC, provider organisations (including two NHS Foundation Trusts), Healthwatch for LBH and CoLC, and voluntary sector partners. All members are expected to work in the interest of patients and service users the wider health and social care system. 4. Duties of Partners' Representatives 4.1 This policy statement has been put into place to address any conflicts of interests that arise in the integrated commissioning arrangements, principally in the work of the ICBs and the TB. Any such conflicts of interests must be addressed in the context of statutory duties that apply to the individuals concerned, as explained below. 4.2 The CCG has a duty to manage any conflicts of interests that arise in the discharge of its functions. This statutory duty recognises that conflicts of interests are likely to arise in the CCG because it comprises member (GP) practices from whom it commissions services. In that context it is unlikely to be able to avoid conflicts of interests. The CCG is required to put arrangements into place to manage conflicts of interests, adopting a proportionate approach; these arrangements are defined in the CCG's Conflicts of Interest Policy dated November Local authority members must comply and declare interests in accordance with the COLC/LBH Code of Conduct and The Relevant Authorities (Disclosable Pecuniary Interests) Regulations Any interests should be declared prior to sitting on the Board and at the start of a meeting at which they are relevant. Any LBH member who has a pecuniary interest in a matter to be considered at a meeting is prohibited from participating in any discussion or vote on the matter and must leave the meeting room for the duration of the discussion and vote. ICB Page 34

37 4.4 The membership of the TB includes the Chief Executives and Medical Directors of two NHS Foundation Trusts, Homerton Hospitals NHS Foundation Trust and East London NHS Foundation Trust. Each executive director of a NHS Foundation Trust has a statutory duty to "avoid a situation in which he has, or can have, an interest which conflicts, or possibly may conflict, with the interests of the Trust". Compliance with the duty is a matter for the executive directors representing the NHS Foundation Trusts on the TB, not the TB, the CCG, LBH, or CoLC. However, since it will not be sufficient to manage any conflicts of interests that arise for the executive directors - they must be avoided this is likely to be material to the work of the TB in developing recommendations to be put to the ICBs so it is recognised here and is reflected in the arrangements set out below. 5. Conflicts of Interests 5.1 A conflict of interests is a set of circumstances that creates a risk that an individual s ability to apply judgment or act in one role is, or could be, impaired or influenced by a secondary interest. 5.2 It is recognised that conflicts of interests are to some extent inevitable in any commissioning of healthcare and particularly in complex arrangements such as integrated commissioning between the CCG, LBH and CoLC. 5.3 It is important to effectively address conflicts of interests. Not only can actual conflicts of interests bring decision-making into disrepute and may undermine robust decision-making, but the perception of conflicts of interests may be enough to cause concern on the part of stakeholders. This can lead to reputational damage and undermine public confidence in the integrity of organisations. A failure to recognise a conflict of interests can give the impression that the organisation or individual is not acting in the public interest. There is also a potential risk of legal challenge to decisions made by public bodies. If a decision-maker has a conflict of interest then the decision is potentially vulnerable and could be overturned on judicial review. 5.4 All partners represented on the ICBs and the TB are committed to conducting business and delivering services in a fair, transparent, accountable and impartial manner. 5.5 Definitions of Interests 5.6 Due to the wide range of matters to be addressed by the ICBs and the TB, combined with the multiple interests held by the members of the ICBs and the TB, it is not possible to define here all the circumstances in which conflicts of interests may arise but two are set out below for particular attention. ICB Page 35

38 5.6.1 Personal Interests (a) (b) (c) (d) A conflict of interests may arise for a member of one of the ICBs or of the TB where his or her personal interests conflict with the role of the ICB or TB. It is noted that because the ICBs are committees of the CCG and either LBH or CoLC respectively, each member of an ICB owes a duty to act in the best interests of both the CCG (and whichever of LBH or CoLC is also a party to the ICB in question). It is possible that the personal interests of a member of an ICB may conflict with his/her duties as described here. Since the TB is not a committee of (and may not bind) either the CCG, LBH or CoLC, no member of the TB owes any duties (in that capacity) to the TB or the CCG, LBH or CoLC. There may, however, be circumstances in which the personal interests of a member conflict with matters addressed by, and/or recommendations made by, the TB. The following is a non-exhaustive list of the types of personal interests that may arise: (i) (ii) (iii) (iv) Financial (or pecuniary) interests: This is where an individual may get direct financial benefit from the consequences of a decision. Financial interests include, but are not limited to, interests in: any employment, trade profession or vocation; sponsorship; contracts; land; licenses; corporate tenancies; and securities. Non-financial professional interests: This is where an individual may obtain a non-financial professional benefit from the consequences of a decision, such as increasing their professional reputation or status or promoting their career. Non-financial personal interests: This is where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit. Indirect interests: This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a decision. ICB Page 36

39 (v) Each member of CoLC must also declare any other interests as defined in the Code of Conduct for Members, including paragraph 7 of that document (which may also be one of the types of interests defined at (i)to (iv)above) Conflicts of Duties (a) The ICBs function as committees in common, as described in 3.2 above. Under this arrangement it is possible that a member's duties to the partner organisation that he/she represents will conflict with his/her duty to the other partner organisation (of which the ICB is a committee). For example, for the ICB that is a committee in common of the CCG and LBH, it will meet as a committee of the CCG (and simultaneously as a committee of LBH) and in such meetings the officers of LBH owe duties to LBH as their employer but owe simultaneous duties to the CCG because they are members of the ICB as a committee of the CCG's Governing Body. In this example, in any circumstances in which the interests of the CCG and LBH are not aligned, the members of the ICB are likely to have a conflict of interests. (b) In respect of the TB, conflicts of duties may arise in particular for the executive directors who represent the two NHS Foundation Trusts involved in the arrangements Such conflicts of duties may arise from the general statutory duty which each of the executive directors (of the NHS Foundation Trusts) has "to act with a view to promoting the success of the corporation so as to maximise the benefits for the members of the corporation as a whole and for the public". Conflicts of interests may also arise for other providers. Whilst no member of the TB owes a duty to it (because it is not a committee of either the CCG, LBH or CoLC), there may be circumstances in which the recommendations made by the TB disadvantage one or both of the NHS Foundation Trustssuch that the executive directors are unable, if they participate in a decision to make such a recommendation, to comply with this general statutory duty. This principle will apply equally to other providers (although the representatives of those other providers may have duties that are different from those applying to the Foundation Trust executive directors). It is recognised that these are complex matters so it may be necessary to take advice in each case for example, from governance professionals within the participating organisations or from external professional advisors. ICB Page 37

40 6. Addressing Conflicts of Interest 6.1 All voting and non-voting members of the ICBs and all members of the TB are expected to declare any interests that are relevant to the work and decisions of the ICBs or TB; where a member is in doubt, they should always declare an interest. For each member of CoLC, any interests declared must include interests of any spouse or civil partner of a member, or any person with whom a member is living as if husband, wife or civil partner. The role description for ICB members contains a statement on individual s responsibility to manage Conflicts of Interest. 6.2 Individuals must take responsibility and be accountable for assessing whether they have an interest in any matter relating to the role of the ICBs or the TB. Members must consider the types of interests defined above but must also consider whether any other types of interests exist and conflict with the work of the ICBs or TB. All declarations of interest must be made as soon as reasonably practicable and in any event no later than 28 days after the interest is identified 6.3 All members must upon appointment to their roles on the ICBs or TB complete a register of interests form (attached to this policy) and return it to integrated Commissioning Governance Manager; declarations will be added as necessary to the registers of interests maintained by the CCG, LBH and CoLC (in accordance with the organisations' own policies) and will be published on the websites of the organisations concerned. All members will be asked to update their declaration on a six monthly basis, with individuals responsible for updating within 28 days of any changes to their circumstances. 6.4 If any member of the ICBs or TB identifies a perceived conflict in another member of the board, they should declare this. 6.5 Addressing Conflicts of Interests in Meetings The following process will apply at all ICB and TB meetings: Every ICB and TB meeting will receive details of the declarations of the relevant members and attendees with its meeting papers Before each meeting each member will examine the agenda to identify any matters in which he/she has an interest. Such interests may be in addition to those declared previously The chair will acknowledge the record of interests at the start of the meeting. Notwithstanding the record of interests included in the papers and acknowledged by the chair, the chair will ask all members to declare any interests in the business on the agenda for the meeting. There will be the opportunity for any potential conflicts of interests to be debated and a ICB Page 38

41 7. Advice decision will be made on how to address them; all declarations and discussions relating to them will be minuted The Chair of a meeting has ultimate responsibility for deciding whether a conflict of interests exists in any matter and for determining the appropriate action that will be taken to address it. The action will be consistent with the duties attached to the individual with the conflict of interests in each case. For the TB, particular account will be taken of the statutory duty which the executive directors of the NHS Foundation Trusts have to avoid a situation in which they have, or can have, an interest which conflicts or possibly may conflict with the interests of the NHS Foundation Trusts that they represent. In some cases it may be possible for a person with a conflict of interests to participate in a discussion but not the decision that results from it. In other cases it may be necessary for a person to withdraw from the meeting for the duration of the discussion and decision When the chair has a conflict of interests relating to an agenda item, the Deputy Chair will assume the chair. Where the Deputy Chair is unavailable or is conflicted a quorum of the members will by consensus select from among their number a chair for the whole or part of the meeting concerned All discussions about conflicts of interests and any decisions and actions taken to address them will be minuted. 7.1 It is recognised that the integrated commissioning arrangements are such that there may be complex matters to determine in respect of conflicts of interests. Advice will be sought from appropriate sources, which may be governance professionals within the participating organisations or external professional advisors. For the CCG, the Conflicts of Interests Guardian will be consulted when appropriate (according to that person's role). 8. Procurement and awarding contracts 8.1 The ICBs recognise that conflicts of interests may arise in relation to the commissioning or procurement of services. Appropriate measures are taken to effectively prevent, identify and remedy conflicts of interests arising in the conduct of procurement procedures in order to avoid any distortion of competition and to ensure equal treatment of everyone involved in our procurement process. This includes keeping a record of how any conflicts of interests are managed and a full register of procurement decisions. ICB Page 39

42 8.2 Any recommendation to award a contract to a GP provider organisation (as defined by CCG policy) will be scrutinised by the CCG Local GP Provider Contracts Committee. 8.3 Any recommendations relating to primary care commissioning will be subject to approval by the CCG Local GP Provider Contracts Committee and will be subject to the formal policies and procedures of the CCG. 9. Review of Policy 9.1 This policy will be reviewed at least annually (alongside the annual review of the governance arrangements for integrated commissioning). ICB Page 40

43 ICB Page 41

44 REGISTER OF MEMBERS PECUNIARY AND OTHER INTERESTS Name: Signature: Date: PART A MEMBERS PECUNIARY INTERESTS i) Any employment, office, trade, profession or vocation carried on by you for profit or for gain. Please provide details of your role, the name of the organisation, and the address. Member: Spouse / Civil Partner / Living as such: ICB Page 42 10

45 ii) The name of any person or body or organisation, other than the CCG, LBH or CoLC, who has made a payment or provision of any other financial benefit to you in respect any expenses incurred in carrying out your duties as a Member or any election expenses. Member: Spouse / Civil Partner / Living as such: iii) Any contract for goods, services or works made between the CCG, LBH, CoLC (or any other partner or provider organisation) and you, or a body or organisation in which you have a beneficial interest, which is to be executed and yet to be discharged. Member: Spouse / Civil Partner / Living as such: Chair: Dr Clare Highton Chief Officer: Paul Haigh ICB Page 43

46 iv) Any land in the area of Hackney and the City of London in which you have a beneficial interest. Member: Spouse / Civil Partner / Living as such: v) Any land in the area of Hackney and the City of London for which you have a licence (alone or jointly with others) to occupy for 28 days or longer. Member: Spouse / Civil Partner / Living as such: Chair: Dr Clare Highton Chief Officer: Paul Haigh ICB Page 44

47 vi) Any land where the landlord is Hackney or the City of London and you, or a body or organisation in which you have a beneficial interest, are the tenant. Member: Spouse / Civil Partner / Living as such: vii) The name of any person or body or organisation who has a place of business or land in the area of Hackney and the City of London, and in whom you have a beneficial interest in a class of securities of that person or body that exceeds the nominal value of 25,000 or one hundredth of the total issued share capital (whichever is the lower). Member: Spouse / Civil Partner / Living as such: Chair: Dr Clare Highton Chief Officer: Paul Haigh ICB Page 45

48 PART B MEMBERS OTHER NON-PECUNIARY INTERESTS i) Any body or organisation of which you are a member or in a position of general control or management and to which you are appointed or nominated by the C&HCCG, CoLC or LBH. ii) Any body or organisation (a) exercising functions of a public nature; (b) directed to charitable purposes; (c) one of whose principal purposes includes the influence of public opinion or policy (including any political party or trade union); (d) relevant to your role as a Member of the Council or CCG Governing Body; (e) fraternal or sororal society; (f) Livery company, City Company without Livery, Guild or Company seeking Livery; (g) professional or trade association; of which you are a member or in a position of general control or management. Chair: Dr Clare Highton Chief Officer: Paul Haigh ICB Page 46

49 iii) Any GP Practice within the City of London or the London Borough of Hackney which which you are a registered patient. This form must be signed and submitted to the Integrated Commissioning Governance Manager, Matt Hopkinson (matthewhopkinson@nhs.net; ). The information submitted will be held by NHS City and Hackney CCG to comply with the policies of the CCG, the London Borough of Hackney and the City of London Corporation. This information may be held in both manual and electronic form in accordance with the Data Protection Act Information may be disclosed to third parties in accordance with the Freedom of Information Act 2000 and published in registers held by the CCG and the Local Authorities. NOTE: MEMBERS MUST REGISTER DETAILS OF ANY NEW PECUNIARY OR OTHER INTEREST WITHIN 28 DAYS OF BECOMING A MEMBER, OR BECOMING AWARE OF THE INTEREST. Chair: Dr Clare Highton Chief Officer: Paul Haigh ICB Page 47

50 Integrated Commissioning May 2017 Register of Interests Paper Forename Surname Date of Declaration Position / Role Nature of Business / Organisation Nature of Interest / Comments Type of interest Paul Haigh 23/03/2017 Transformation Board Member - CHCCG City & Hackney CCG Chief Officer Pecuniary Interest CoLC ICB Member - CHCCG NHS England Spouse is Regional Director of People & Organisational Indirect interest Development (London) LBH ICB Member - CHCCG Hackney Health & Wellbeing Board Board Member Non-Pecuniary Interest City of London Health & Wellbeing Board Board Member Non-Pecuniary Interest NEL STP Board Board Member Non-Pecuniary Interest N/A Resident of Westminster & Registered with Westminster GP Non-Pecuniary Interest Penny Bevan 25/03/2017 Transformation Board Member - DPH, LBH & CoLC London Borough of Hackney Director of Public Health Pecuniary Interest Neal Hounsell City of London Corporation Director of Public Health Pecuniary Interest Association of Directors of Public Health Member Non-Pecuniary Interest British Medical Association Member Non-Pecuniary Interest Faculty of Public Health Member Non-Pecuniary Interest National Trust Member Non-Pecuniary Interest 23/03/2017 Transformation Board Member - CoLC City of London Corporation Acting Director of Community and Children s Services Pecuniary Interest CoLC ICB Member - CoLC Hackney Volunteer & Befriending Service Volunteer Non-Pecuniary Interest n/a Tenant - De Beauvoir Road, Hackney Non-Pecuniary Interest n/a Registered with the De Beauvoir Practice Non-Pecuniary Interest Janine Adridge 30/03/2017 Transformation Board Member - Healthwatch City of London Healthwatch City of London Officer Pecuniary Interest Royal College of Pathologists Public Affairs Officer Pecuniary Interest ICB Page 48

51 Forename Surname Date of Declaration Position / Role Nature of Business / Organisation Nature of Interest / Comments Type of interest Clare Highton 23/12/2016 Transformation Board Member - CHCCG City & Hackney CCG Chair Pecuniary Interest CoLC/CCG ICB Chair LBH ICB Member - CHCCG Body and Soul Daughter in Law works for this HIV charity. Indirect interest CHUHSE Sorsby and Lower Clapton Group Practice's are members Pecuniary Interest GP Confederation Local residents Lower Clapton Group Practice (CCG Member Practice) Sorsby and Lower Clapton Group Practice's are members and Pecuniary Interest shareholders Myself and extended family are Hackney residents and Non-Pecuniary registered at Hackney practices, 2 grandchildren attend a local Interest school. Partner at a GMS and an APMS practices which provide a full Pecuniary Interest range of services including all GP Confederation and the CCG's Clinical Commissioning and Engagement contracts, and in addition child health, drug, minor surgery and anticoagulation clinics. We host CAB, Family Action, physiotherapy, counselling, diabetes and other clinics. The buildings are leased from PropCo, and also house community health services. The practices are members of CHUHSE and the GP Confederation. Lower Clapton is a teaching, research and training practice, and I am a GP trainer. I am a member of the BMA and Unite. One partner is a member of the LMC. Sorsby Group Practice (CCG Member Practice) Partner at a GMS and an APMS practices which provide a full Pecuniary Interest range of services including all GP Confederation and the CCG's Clinical Commissioning and Engagement contracts, and in addition child health, drug, minor surgery and anticoagulation clinics. We host CAB, Family Action, physiotherapy, counselling, diabetes and other clinics. The buildings are leased from PropCo, and also house community health services. The practices are members of CHUHSE and the GP Confederation. Lower Clapton is a teaching, research and training practice, and I am a GP trainer. I am a member of the BMA and Unite. One partner is a member of the LMC. Tavistock and Portman NHS Trust N/A Husband is Medical Director of Tavistock and Portman NHS FT which is commissioned for some mental health services for C&H CCG. Daughter is a trainee Psychiatrist, not within the City and Hackney area. Non-Pecuniary Interest Non-Pecuniary Interest ICB Page 49

52 Forename Surname Date of Declaration Position / Role Nature of Business / Organisation Nature of Interest / Comments Type of interest Philippa Lowe 22/12/2016 Transformation Board Member - CHCCG CoLC ICB Attendee - CHCCG LBH ICB Attendee - CHCCG City & Hackney CCG Joint Chief Finance Officer Non-Pecuniary Interest Honor Rhodes 05/04/2017 Member - City / Hackney Integrated Commissioning Boards GreenSquare Group Board Member, Group Audit Chair and Finance Committee member for GreenSquare Group, a group of housing associations. Greensquare comprises a number of charitable and commercial companies which run with co-terminus Board. Non-Pecuniary Interest NHS Oxford Radcliffe Hospital Member of this Foundation Trust Non-Pecuniary Interest PIQAS Ltd Director at PIQAS Ltd, dormant company. Non-Pecuniary Interest Tavistock Relationships Director of Strategic Devleopment Pecuniary Interest The School and Family Works, Social Enterprise Special Advisor Pecuniary Interest Oxleas NHS Foundation Trust Spouse is Tri-Borough Consultant Family Therapist Indirect interest Early Intervention Foundation Trustee Non-Pecuniary Interest n/a Registered with Barton House NHS Practice, N16 Non-Pecuniary Interest Gary Marlowe 06/04/2017 GP Member of the City & Hackney CCG Governing Body City & Hackney CCG Governing Body GP Member Pecuniary Interest De Beauvoir Surgery GP Partner Pecuniary Interest City & Hackney CCG Planned Care Lead Pecuniary Interest Hackney GP Confederation Member Pecuniary Interest British Medical Association London Regional Chair Non-Pecuniary Interest n/a Homeowner - Casimir Road, E5 Non-Pecuniary Interest City of London Health & Wellbeing Board Member Non-Pecuniary Interest Local Medical Committee Member Non-Pecuniary Interest Unison Member Non-Pecuniary Interest CHUHSE Member Non-Pecuniary Interest ICB Page 50

53 Forename Surname Date of Declaration Position / Role Nature of Business / Organisation Nature of Interest / Comments Type of interest Dhruv Patel 28/04/2017 Chair - City of London Corporation Integrated n/a Landlord Pecuniary Interest Commissioning Sub-Committee Clockwork Pharmacy Group SSAS, Amersham Trustee; Member Pecuniary Interest Clockwork Underwriting LLP, Lincolnshire Partner Pecuniary Interest Clockwork Retail Ltd, London Company Secretary & Shareholder Pecuniary Interest Clockwork Pharmacy Ltd Company Secretary Pecuniary Interest DP Facility Management Ltd Director; Shareholder Pecuniary Interest Clockwork Farms Ltd Director; Shareholder Pecuniary Interest Clockwork Hotels LLP Partner Pecuniary Interest ICB Page 51

54 Forename Surname Date of Declaration Position / Role Nature of Business / Organisation Nature of Interest / Comments Type of interest Capital International Ltd Employee Pecuniary Interest Land Interests - Pecuniary Interest 8/9 Ludgate Square Victoria Park Road Well Street Mare Street 1-11 Dispensary Lane Securities - Pecuniary Interest Fundsmith LLP Equity Fund Class Accumulation GBP East London NHS Foundation Trust Governor Non-Pecuniary Interest City of London Academies Trust Director Non-Pecuniary Interest The Lord Mayor's 800th Anniversary Awards Trust Trustee Non-Pecuniary Interest City Hindus Network Director; Member Non-Pecuniary Interest Aldgate Ward Club Member Non-Pecuniary Interest City & Guilds College Association Life-Member Non-Pecuniary Interest The Society of Young Freemen Member Non-Pecuniary Interest City Livery Club Member and Treasurer of u40s section Non-Pecuniary Interest The Clothworkers' Company Liveryman; Member of the Property Committee Non-Pecuniary Interest Diversity (UK) Member Non-Pecuniary Interest Chartered Association of Buidling Engineers Member Non-Pecuniary Interest Institution of Engineering and Technology Member Non-Pecuniary Interest City & Guilds of London Institute Associate Non-Pecuniary Interest Association of Lloyd's members Member Non-Pecuniary Interest High Premium Group Member Non-Pecuniary Interest Avanti Court Primary School Chairman of Governors Non-Pecuniary Interest Joyce Nash 06/04/2017 Member - City Integrated Commissioning Board City of London Corporation Deputy Pecuniary Interest Newman Practice Registered Patient Non-Pecuniary Interest Feltmakers Livery Company Lifemember of Headteachers' Association Non-Pecuniary Interest Peter Kane 12/05/2017 Attendee - City Integrated Commissioning Board City of London Corporation Chamberlain Pecuniary Interest ICB Page 52

55 Paper 3.3 Title: Protocol for meetings in Public Date: 23 May 2017 Lead Officer: Paul Haigh, City & Hackney Clinical Commissioning Group (CCG) Neal Hounsell, City of London Corporation (CoLC) Author: Matt Hopkinson, Integrated Commissioning Governance Manager, C&HCCG Committee(s): City Integrated Commissioning Board, 23 May 2017 Public / Nonpublic Public Executive Summary: The partners (the Clinical Commissioning Group, the City of London Corporation and the London Borough of Hackney) are committed to working in partnership with the citizens and communities of Hackney and the City to improve existing services and develop new services to meet their needs. In keeping with this, meetings of the Integrated Commissioning Board shall be held in public. This paper sets out a proposed protocol for meetings in public, covering public involvement and questions, publication of agenda papers and minutes, and the approach to confidential business. Recommendations: The Integrated Commissioning Board is asked: To APPROVE the Protocol for Meetings in Public Protocol for Meetings in Public In February 2017 the City & Hackney Clinical Commissioning Group Governing Body, the London Borough of Hackney and the City of London Corporation each agreed to establish a collaborative model for the closer integration of commissioning between the three statutory bodies in partnership, commencing in April Central to this collaboration is the establishment of the Integrated Commissioning Boards (ICBs), which are to function as committees of the statutory bodies with delegated authority to make decisions and direct commissioning work as defined by the terms of reference. The ICBs meet in common (that is to say, at the same time and place with a shared agenda) on a monthly basis. ICB Page 53

56 Paper 3.3 The partners are committed to working in partnership with the citizens and communities of Hackney and the City to improve existing services and develop new services to meet their needs. All citizens living in the London Borough of Hackney and the City of London have the right to: i) Find out what key decisions are due to be taken by the Integrated Commissioning Boards (ICBs); ii) Have access to information, agendas and papers relating to ICB meetings and decisions, in accordance with the law and the constitutions of the three commissioning bodies; iii) Attend and record ICB meetings except where confidential or exempt information is likely to be disclosed and the meeting or part of the meeting is therefore held in private; iv) See records of decisions taken by the ICBs, and to be given reasons for those decisions, in accordance with the law and the Constitutions of the statutory bodies; Meetings of the ICB will be held in public and citizens may raise questions relevant to the agenda as set out below. Public Involvement in Discussions Meetings of the Integrated Commissioning Boards are held in public, but are not public meetings. The public right is to attend and hear the Board discussions but they have no right to join in the discussions unless invited to do so by the Chair. Questions Members of the public may pose questions relevant to the agenda at the start of the meeting. Where appropriate and at the discretion of the Chair, members of the public may also be invited to ask questions as part of the discussion of an agenda item. This is to ensure that the Board considers all the business it needs to on its agenda and so that the Chair can manage a well-run and respectful meeting. Members of the public may also submit questions in writing to the Chair or one of the members of staff in attendance. Questions may also be sent by to matthewhopkinson@nhs.net. Responses will be given during the meeting, or in writing as appropriate. Agenda Papers and Minutes Meeting agenda papers and the draft minutes of previous meetings will be published on the websites of the City & Hackney CCG, London Borough of Hackney and the City of London Corporation, five clear working days in advance of each meeting. Once minutes have been approved by the Board, they will be published on the websites separately. Meetings in Private ICB Page 54

57 Paper 3.3 The Integrated Commissioning Boards may, from time to time, be required to consider items of business which are confidential. Such items may be considered in a private session at the end of the meeting or in a separate extraordinary meeting. Papers for confidential discussions will be restricted and will not be made accessible to the public. Private business items are defined by the Constitutions and Publication Schemes of the three statutory bodies, in line with the Freedom of Information Act 2000 and the Model Publication Scheme drawn up by the Information Commissioner. The Chair will make the final decision on whether an In private session is required. ICB Page 55

58 Paper 3.4 Title: Hackney & City Health and Social Care Transformation Board Terms of Reference Date: 23 May 2017 Lead Officer: Paul Haigh, City & Hackney Clinical Commissioning Group (CCG) Neal Hounsell, City of London Corporation (CoLC) Author: Matt Hopkinson, Integrated Commissioning Governance Manager, C&HCCG Committee(s): City Integrated Commissioning Board, 23 May 2017 Public / Nonpublic Public Executive Summary: As part of the Integrated Commissioning arrangements, the partners (the Clinical Commissioning Group, the City of London Corporation and the London borough of Hackney) have the establishment of the Hackney & City Health and Social Care Transformation Board, to bring the providers and commissioners together, along with Public and Patient Involvement (PPI) and Healthwatch representatives, to develop and deliver local plans and make recommendations to the ICBs. The report presents the draft Terms of Reference for the Transformation Board, for approval. The Terms of Reference were reviewed by the Transformation Board on 7 April 2017 and comments have been incorporated into the version presented below. Minutes of the first meeting of the Transformation Board are presented to the Integrated Commissioning Board for noting under Item 9. Recommendations: The Integrated Commissioning Board is asked: APPROVE the draft Terms of Reference for the Hackney & City Health and Social Care Transformation Board Supporting Papers and Evidence: Paper Hackney & City Health and Social Care Transformation Board Terms of Reference ICB Page 56

59 Paper NHS City & Hackney Clinical Commissioning Group, London Borough of Hackney and City of London Corporation Integrated Commissioning Fund Transformation Board Terms of Reference Overview The Transformation Board (the Board) is a working group of the Integrated Commissioning Boards (ICBs) established respectively by NHS City & Hackney Clinical Commissioning Group (the CCG) and London Borough of Hackney (LBH) and by the CCG and City of London Corporation (COLC). The Board is a forum for discussion of service requirements and commissioning plans in the LBH and COLC areas, with the aim of making separate recommendations to each ICB reflecting the needs of each area unless it is more appropriate to make combined recommendations. The Board has no delegated authority so will take no decisions other than to agree recommendations to the ICBs. As the Board has no delegated authority, recommendations made by the Board shall in fact simply be a shared view of the individual members, each of whom shall individually be authorised to do so by his or her respective appointing organisation. The Board will link to, and receive commissioning and service inputs from the CCG's consortia, Healthwatch within LBH and COLC, patient and public involvement groups, and other partners across the area to inform its plans. It will: provide advice and recommendations to each ICB in a timely manner as appropriate reflecting the needs of each, to ensure that the local health and social care economy achieves performance requirements and remains in financial balance; make recommendations on plans required to improve health and social care outcomes for local people and achieve the locality plan; Take responsibility for the redesign, transformation and integration of services, overseeing and coordinating the system workstreams make recommendations on changes to contractual arrangements to achieve the plans and deliver integrated service provision; and ensure that plans achieve the Health and Wellbeing strategies of LBH and COLC, meet the statutory responsibilities of the commissioners, deliver the local contribution to the North East London Sustainability and Transformation Plan (NEL STP) and in doing so have regard to the need to reduce inequalities and improve outcomes. Accountability and Reporting The Board is accountable to the ICBs and it will submit recommendations to them for debate and approval. Scope The Board's remit is in respect of services that are within the Integrated Commissioning Fund (ICF), i.e. pooled fund services, and others, and i.e. aligned fund services that are excluded from the ICF. The CCG, LBH and COLC shall determine the funds, and therefore the services, that are to be pooled 1 ICB Page 57

60 Paper 4.3 and aligned at any time. Once defined, the remit will be stated in these Terms of Reference or in another appropriate document that is provided to the Board. The Board shall make no decisions on any matter other than to make recommendations to the ICBs in respect of all services within its remit. For pooled funds the ICBs shall have delegated authority to make the necessary commissioning and procurement decisions. For aligned funds, or funds that are otherwise excluded from the pooled fund, the ICBs shall make recommendations to the CCG, LBH and COLC as appropriate. The Board shall make recommendations to the ICBs in respect of primary care or local GP providers; where these cover core primary care, the authority to make decisions rests with the CCG's Local GP Provider Contracts Committee. Where these relate to other services to be commissioned from primary care providers the ICBs will seek independent advice and scrutiny on the Board s proposals from the CCG Local GP Provider Contracts Committee. The Board is responsible for ensuring that there are robust delivery arrangements in place which fully integrate and align services to achieve improved outcomes and achieve financial balance. The Board has agreed 4 key work-streams to organise our work prevention, unplanned care, children and young people, and planned care and a number of enabler work-streams to ensure that the infrastructure is in place to achieve our local delivery arrangements. All of these workstreams and groups report to the Board and operate under the direction of the Board. The Board also has a responsibility to recommend to the ICBs the amount of the ICF that should be spent on commissioning management and administrative support, ensuring that this represents value for money when assessed against resident-facing services. Objectives To support the ICBs by discussing issues and making recommendations to enable the ICBs to: Commissioning strategies and plans Lead the commissioning agenda of the locality, including inputs from, and relationships with, all partners Ensure financial sustainability and drive local transformation programmes and initiatives Determine and advise on the local impacts of commissioning recommendations and decisions taken at a NEL level Ensure that the Locality plan is delivering the local contribution to the ambitions of the NEL STP Lead the development and scrutiny of annual commissioning intentions including the monitoring, review, commissioning and decommissioning of activities and making recommendations on these to the ICBs Provide advice to the ICBs in respect of primary care to enable the ICBs to make recommendations, where necessary, to the CCG's Local GP Provider Contracts Committee 2 ICB Page 58

61 Paper 4.3 Ensure that the locality plan delivers constitutional requirements, financial balance, and supports the improvement in performance and outcomes established by the Health and Wellbeing Boards Promote health and wellbeing, reduce health inequalities, and address the public health and health improvement agendas in making commissioning recommendations Ensure commissioning decisions are made by the ICBs in a timely manner that address financial challenges of both the in-year and longer term plans Ensure that local plans can demonstrate their impact on City ad Hackney residents and where appropriate City workers, are suitably tailored to meet the different needs of the 2 geographical areas. Service re-design Review and recommend for approval all clinical and social care guidelines, pathways, service specifications, and new models of care. This will include new or revised pathways which support the movement of services into the community, contain demand and achieve service integration. In providing this support to the ICBs the Board will identify where there are material changes to existing arrangements, and therefore will advise on all contractual and financial enhancements or amendments as well as ensuring delivery and implementation Ensure all local guidelines, service specifications and pathways are developed in line with NICE and other national evidence, best practice and benchmarked performance Drive continuous improvement in all areas of commissioning, pathway and service redesign delivering increased quality performance and improved outcomes Ensure that services are designed and delivered, using design lab principles i.e. codeveloped by residents and practitioners working together. Contracting and performance Oversee the annual contracting and planning processes and ensuring that contractual arrangements are supporting the ambitions of the CCG, LBH and COLC to transform services, ensure integrated delivery and improve outcomes Oversee local financial and operational performance and decisions in respect of investment and disinvestment plans Oversee generally the implementation of the ICBs' decisions in respect of commissioning and procurement of services to ensure that objectives are achieved. Stakeholder engagement Ensure adequate structures are in place to support patient, public, service user, and carer involvement at all levels and that the equalities agenda is delivered, Ensure that arrangements are in place to support collaboration with other localities when it has been identified that such collaborative arrangements would be in the best interests of local patients, public, service users, and carers Ensure and monitor on-going discussion between the ICBs and provider organisations about long-term strategy and plans. 3 ICB Page 59

62 Paper 4.3 Programme management Oversee the work of the work-streams and enabler groups, including agreeing Terms of Reference and workplans, reviewing progress against action plans and ensuring system wide implications are considered Ensure that risks associated with integrated commissioning are identified and managed, including to the extent necessary through risk management arrangements established by the CCG, LBH and CoLC. Integrated Commissioning Arrangements An annual review will be undertaken of the integrated commissioning arrangements, including the operation of the s75 agreements, the Integrated Commissioning Fund and shall make recommendations to the ICBs. Membership The membership of the Board is as follows:-. Chief Executive of LBH Tim Shields Chief Executive Officer and Medical Director of o Homerton University Hospital NHS Foundation Trust Tracey Fletcher and Martin Kuper o East London NHS Foundation Trust Richard Fradgley and Paul Calaminus o City & Hackney GP Confederation Deborah Colvin and Laura Sharpe o CHUHSE Nigel Wylie and Victoria Holt Chair and Chief Officer of the CCG Clare Highton and Paul Haigh Director of Public Health for LBH and COLC Penny Bevan Director of Adult Services- London Borough of Hackney Simon Galczynski Assistant Director Commissioning & Partnerships - City of London Corporation Neal Hounsell Assistant Director People City of London Corporation Chris Pelham Group Director of Neighbourhoods and Housing- London Borough of Hackney Kim Wright Head of Early Years - London Borough of Hackney Angela Scattergood City of London Healthwatch Janine Aldridge Hackney Healthwatch Jon Williams / Paula Shaw / Heather Finlay Chief Executive of Hackney Community and Voluntary Sector Jake Ferguson A person nominated by the Chief Financial Officers of the CCG, LBH and COLC Philippa Lowe / Ian Williams / Mark Jarvis CCG Lay member for PPI Catherine Macadam Local Pharmaceutical Committee Chair Raj Radia Members of the Board may nominate a single named individual to act as a deputy, who will have the same role and representative authority in the meetings at which he/she is present. Nominated deputies are as follows: City & Hackney Clinical Commissioning Group David Maher, Deputy Chief Executive and Haren Patel, GP Governing Body Member 4 ICB Page 60

63 Paper 4.3 Hackney Community & Voluntary Sector - Jackie Brett, Director of Communities & Partnerships Homerton University Hospital Foundation Trust Daniel Waldron City of London Corporation Simon Cribbens GP Confederation - Dr Stephanie Coughlin (for D. Colvin) and Janet McMillan (for L. Sharpe) The Chair will be the Chief Executive of LBH. The vice chair will be a local authority director/ccg Chief Officer. The vice chair will be elected by members of the Board on an annual basis. The membership will be kept under review as the provider landscape develops and the Board can decide to include other significant local providers in its membership by agreement of the ICBs. The members are expected to represent the area of responsibility for which they are a member of the Board. It is the responsibility of all those present to uphold the Nolan Principles and to comply with all other relevant requirements. Attendees The following individuals may attend the Board's meetings and are expected to contribute to discussions but shall not participate in decisions (to make recommendations): Work-stream leads CCG GP Consortia leads and CCG Programme Board leads as required Conflicts of interests The partner organisations represented in the Board are committed to conducting business and delivering services in a fair, transparent, accountable and impartial manner. Nevertheless, partners recognise the potential for conflicts of interest to arise, in particular for providers where there are discussions about service delivery and contractual arrangements. Board members will comply with the Conflicts of Interest policy statement developed for integrated commissioning as well as the arrangements established by the organisations that they represent. A declaration of interest will be completed by all members and attendees of the Board and will be kept up to date in line with the policy. Before each meeting the each member or attendee will examine the agenda to identify any matters in which he/she has (or may be perceived to have) an interest. Such interests may be in addition to those declared previously. Any such conflicts should be raised with the chair and the secretariat at the earliest possible time. The chair will acknowledge the register of interests at the start of the meeting as an item of business. There will be the opportunity for any potential conflicts of interest to be debated and the chair (on the basis of advice where necessary) may give guidance on whether any conflicts of interest exist and, if so, the arrangements through which they may be addressed, although this is ultimately a matter for the individuals concerned. Particular account will be taken of the statutory duty which the executive directors of the NHS Foundation Trusts have to avoid a situation in which they have, or can have, an interest which conflicts or possibly may conflict with the interests of the NHS Foundation Trusts that they represent. In some cases it may be possible for a person with a conflict of interests to participate in 5 ICB Page 61

64 Paper 4.3 a discussion but not the decision that results from it. In other cases it may be necessary for a person to withdraw from the meeting for the duration of the discussion and decision. When the chair has a conflict of interests relating to an agenda item which obliges them to withdraw, the members of the board will select from among their number a chair for the whole or part of the meeting. All declarations and discussions relating to them will be minuted. The register of interests will be published on the CCG and Local Authority websites. Quoracy The meeting shall be quorate where there are at least eight of the members present. Of the 8 at least 3 must be clinicians, 1 of the local authority Directors, a representative from both LBH and CoLC, 1 of the CCG, and 1 of Healthwatch/CCG PPI lay member must be present. Meetings The Board's Members will be given no less than five clear working days notice of its meetings. This will be accompanied by an agenda and supporting papers and sent to each member no later than five clear days before the date of the meeting. It is anticipated that the Board will routinely meet monthly. When the Chair of the Board deems it necessary in light of urgent circumstances to call a meeting at short notice this notice period shall be such as s/he shall specify. Whilst the Board will not meet in public, minutes of each meeting will be submitted to the Integrated Commissioning Boards (which will meet in public). The Board recognises, however, that all information associated with it is subject to the Freedom of Information Act. Any member of the Board may participate in its meetings by telephone or video conference, provided that all members are able to hear each other such that they can contribute to discussions and decisions. Where it is necessary to deal with urgent business and it is not possible for the Board to meet, it may take decisions by written resolution with the prior agreement of the Chair. Any decisions taken by such means must be recorded in the minutes of the next scheduled meeting of the Board. Minutes shall be taken of all of the Board's meetings by the secretariat support and they shall be presented to the ICBs. Decision making The Board shall only take a decision on any matter (which shall be limited to decisions in respect of recommendations to the ICBs) where a consensus exists among its members. The Board shall not vote on any matter. 6 ICB Page 62

65 Paper 4.3 No organisation that is represented on the Board shall be bound by any decision of the Board (so no organisation that does not support a proposal to make a recommendation to the ICBs shall be bound to accept it or to have its name associated with it). Any decision by a provider organisation not to accept a decision to make a recommendation to the ICBs shall not prevent that organisation from agreeing subsequently to provide any services that are commissioned by the ICBs on the basis of the recommendation from the Board. Review of Terms of Reference These terms of reference will apply for the year from 1 April 2017 to 31 March 2018, subject to their agreement by the CCG, LBH and COLC. The terms of reference will be reviewed not later than six months from initial approval and then annually thereafter, such annual reviews to coincide with reviews of the s75 agreements. [Insert dates of approval of these TOR at each relevant forum within the CCG, LBH and COLC.] To be added 6 March ICB Page 63

66 Paper 4 Title: Update to S75 (including impact on scheme of delegation), and Alignment of Workstream budgets. Date: 23 and 24 May 2017 Lead Officer: Author: Anne Canning, London Borough of Hackney (LBH) Paul Haigh, City & Hackney Clinical Commissioning Group (CCG) Neal Hounsell, City of London Corporation (CoLC) Amaka Nnadi, Finance Consultant Committee(s): City Integrated Commissioning Board, 23 May 2017 Hackney Integrated Commissioning Board, 24 May 2017 Public / Nonpublic Public Executive Summary: In March, the CCG and Local Authorities (City of London Corporation and London Borough of Hackney) agreed to pool budgets via a section 75 agreement as part of integrated commissioning of health and adult social care (including Public Health). Signing of the actual agreement was paused mid-process due to NHS England s request to review the arrangement. Start date for the new arrangement was 1 st April and subsumed 3 pre-existing integrated commissioning agreements expiring on 31 st March The CCG and Local Authority partners sought legal advice and proposed interim measure to NHS England which was accepted on 8 th May. The proposal was to limit the pooled budget in the interim to pre-existing section 75 services and manage under governance developed for the 2017/18 section 75 arrangements. Since the original agreements, the CCG now has fully delegated authority from NHS England for commissioning core primary care services. Also, Improved Better Care Fund (ibcf) draft guidance has since been published with related budget allocations. The CCG and Local Authority partners are recommending the following: 1. Update of the 2017/18 integrated commissioning section 75 and financial framework documents to reflect interim arrangement to reduce scope of the pooled budget to the pre-existing integrated services below: a) Learning Disability Service (joint commissioning & delivery team). b) Integrated Independence Team to support care in the community. c) Better Care Fund (BCF) services Note: (a) and (b) above are between the CCG and London Borough of Hackney only. BCF arrangements are between the CCG and each of LBH and, CoLC. (c) ICB Page 64

67 Paper 4 2. Update of the schedule of integrated commissioning services to reflect the change in Pooled and Aligned split. Services within pre-existing integrated arrangements per above in the Pool, and all other service budgets to be moved to an Aligned pot. Commissioned services in the Aligned pot are still to be categorised under the relevant workstream thus aligned to one of: Aligned Planned care Aligned Unplanned care Aligned Prevention Aligned Children s & Young Peoples services Aligned Other (for corporate budgets and support budgets) 3. Include the ibcf new budget allocations for 2017/18 into the integrated commissioning Pool. 4. Update record of delegated authority to the Integrated Commissioning Boards and, authority reserved by the statutory organisations to reflect the above changes. Recommendations: The Integrated Commissioning Board is asked: To APPROVE recommendations presented in this report Links to Key Priorities: The key aims and objectives of Integrated Commissioning are aligned to the delivery of priorities in the City Joint Health & Wellbeing Strategy and the Hackney Joint Health & Wellbeing Strategy. Specific implications for City and Hackney N/A ICB Page 65

68 Paper 4 Patient and Public Involvement and Impact: The following consultations on Integrated Commissioning between the CCG and Local authorities have taken place: Consultations To date the engagement with external stakeholders including patients, providers and the public includes: - Health and Wellbeing Board - 11th January 2017 Statutory NHSE Area Team via the STP & London Devolution Board - Statutory Healthwatch Statutory Four quadrant engagement events in December 2016 facilitated through Healthwatch Consultation via the Transformation Board Articles in the Healthwatch newsletter Health & Social Care Scrutiny (CoLC) - Statutory Health in Hackney Scrutiny- 15th December 2016 Statutory STP Board via paper on Integrated Commissioning Plans presented Provider organisations Statutory Consultation via representatives of the Transformation Board Providers engagement events Impact of Integrated Commissioning Pooled budget reduced scope The totality of the Integrated Commissioning Fund remains largely unchanged except for the ibcf funding increase of c 8.7m for 2018/19 which is to be reflected. However, the split between pooled and aligned elements of the Integrated Commissioning Fund will now reduce significantly (from over 400m to just under 50m including the ibcf additional funding) when limited to only existing section 75 services. The interim arrangement agreed is to manage the revised integrated commissioning budgets using the governance and documentation developed for the full s75 agreements. As the current arrangement specifically only alters the split of pooled and aligned split in the interim, but still within the existing Integrated Commissioning Fund and no changes to the original governance process, additional patient & public involvement is not required. Clinical/practitioner input and engagement: Please see above. Impact on / Overlap with Existing Services: Please see above. ICB Page 66

69 Paper 4 Main Report Background and Current Position The integrated commissioning partners - City of London Corporation, London Borough of Hackney and NHS City & Hackney CCG governing bodies approved the proposed integrated commissioning arrangement (governance & section 75) in February Formal seal of the integrated commissioning section 75 deed by the CCG and Local Authority partners was paused mid-process due to NHS England s request to review the arrangements. The integrated commissioning section 75 agreement agreed by the partners subsumed pre-existing integrated commissioning agreements in operation for a number of years. These agreements were due for renewal on 01 April Pre-existing integrated commission arrangements between the CCG and London Borough of Hackney covered: 1. Learning Disability Service (joint commissioning and integrated delivery team). [Annual section 75 contract] 2. Integrated Independence Team to support care in the community. [3year service contract] 3. Better Care Fund (BCF) services. [Annual section 75 contract] Pre-existing integrated commission arrangements between the CCG and City of London Corporation was for. 1. Better Care Fund Services. [Annual section 75 contract] The City & Hackney Integrated Commissioning Partners proposal in the interim pause was to minimise risk to the 3 organisations and ensure compliance with regulatory obligations. The proposal to NHS England which was accepted on 8 th May was to: - pool budgets for pre-existing integrated services (see listed above) - use the governance and documentation developed for the original section 75 agreements for 2017/18 to manage these pooled budgets - all other services and budgets to be aligned - i.e. not at this stage formally pooled and not requiring section 75 agreement flexibilities to be utilised or the delegation of any functions from the CCG to the Local Authorities (or vice versa) - continue with interim arrangement pending NHS England s response to the information the partners have provided on our Integrated Commissioning plans In year, service budgets may be moved from Aligned to Pooled as provided for in ICB Page 67

70 Paper 4 the financial framework (clause 34: Budget Virements) of the section 75 arrangement. Movement of service budgets from Aligned to Pooled will generally be triggered by recommendation from the ICB to the statutory body. Actual budget transfer from any statutory body s aligned pot is on approval of the statutory organisation via the organisation s CFO. Since the original agreements between the partners, the CCG now has delegated authority from NHS England for commissioning primary care services. Additionally, improved Better Care Fund (ibcf) draft guidelines have been published along with related budget allocations to local authorities for 2017/18. Options 1. Do nothing The pre-existing section 75 agreements expired on 31 March 2017 and arrangements for these services were incorporated into the 2017/18 section 75 arrangements approved by the partners before the pause. Do nothing option poses a risk to the partners in respect of the contractual and governance arrangements for these services. Commissioned services need to be underpinned by a formal contract. 2. Separate contracts to cover the pre-existing section 75 services. This will involve setting up interim governance for what NHSE have said will be a short pause and would create multiple integrated commissioning funds and governance systems. Equalities and other Implications: N/A Proposals The following recommendations are proposed for approval by the Integrated Commissioning Board: 1. Update of the 2017/18 integrated commissioning section 75 and financial framework documents to reflect interim arrangement to reduce scope of the pooled budget to the pre-existing integrated services 2. Update of the schedule of integrated commissioning services to reflect the ICB Page 68

71 Paper 4 change in Pooled and Aligned split. Services within pre-existing integrated arrangements per above in the Pool, and all other service budgets to be moved to an Aligned pot. Commissioned services in the Aligned pot are still to be categorised under the relevant workstream thus aligned to one of: Aligned Planned care Aligned Unplanned care Aligned Prevention Aligned Children s & Young Peoples services Aligned Other (for corporate budgets and support budgets) 3. Include the ibcf new budget allocations for 2017/18 into the integrated commissioning Pool. 4. Update record of delegated authority to the Integrated Commissioning Boards and, authority reserved by the statutory organisations to reflect the above changes. Pending approval of the above recommendations from the ICB, these will be actioned and final form agreements presented to each integrated commissioning partner s governing body or agreed delegated representatives. Each organisation s governing body on approval of integrated commissioning arrangements and overarching Section 75 Agreement also agreed authority be delegated as follows: 1. LBH: Cabinet in February 2017 agreed integrated arrangements and delegated authority to Group Director, Finance and Corporate Resources and the Group Director, Children, Adults and Community Health to finalise and complete the Agreement and all other associated contractual documentation with the NHS City and Hackney Clinical Commissioning Group. 2. CoLC: Members in February 2017 gave approval for integrated commissioning arrangements with the CCG. This was agreed by Policy and Resources Committee and by the Department of Community and Children s Services Committee. The committees delegated authority to the Town Clerk and the Acting Director of Community and Children s Services Committee to finalise and complete the Agreement. 3. C&H CCG: The Governing Body approval in February 2017 and authority delegated to the Chief Financial Officer and the Chief Officer to finalise and complete the agreement, and feedback to ICB and Governing Body. ICB Page 69

72 Paper 4 Conclusion Following the pause from NHSE on the integrated commissioning arrangement between the CCG and Local Authorities, the agreed interim arrangement needs to be implemented. To this end, the interim arrangement must be reflected appropriately in the formal agreement (section 75), plus associated governance arrangements such as the scheme of delegated authority to the ICB and reserved authority by the statutory organisations. For workstream budget alignment, current assumptions and inclusion criteria for each workstream may be subject to some changes. Workstream budget alignment is part of a Care worksteam Assurance Review scheduled for July Supporting Papers and Evidence: None. Sign-off: London Borough of Hackney - Anne Canning City of London Corporation Neal Hounsell City & Hackney CCG Paul Haigh ICB Page 70

73 Title: Care Workstream Update Date: 23 and 24 May 2017 Lead Officer: Author: Paul Haigh, City & Hackney CCG Anne Canning, London Borough of Hackney Neal Hounsell, City of London Corporation Devora Wolfson: Integrated Commissioning Programme Director Committee(s): City Integrated Commissioning Board, 23 May 2017 Hackney Integrated Commissioning Board, 24 May 2017 Public / Nonpublic Public Executive Summary: The Strategic Framework for the Workstreams (Appendix 1) sets out the aims and objectives for integrated commissioning and the care workstreams, towards the goal of establishing an accountable care system across Hackney and the City. In support of this strategic direction, four care workstreams are being established for Unplanned Care, Planned Care, Prevention and Children & Young People to contribute to the delivery of our collective ambition. The workstreams will develop as accountable care systems in which NHS and local authority commissioners and providers take collective responsibility for delivering better patient and population outcomes and provide joined up, coordinated care. In return they are given far more flexibility over the way they operate. Appendix 2 presents the asks for the unplanned care, prevention and planned care workstreams and the accompanying dashboard for consideration and approval in principle, subject to final discussions with the workstream Senior Responsible Officers and Workstream Directors. These asks were endorsed by the Transformation Board on 12 May The Children and Young People Workstream will be developed in Summer 2017 and it is expected that the draft ask will be brought to the ICB for approval on 2 August Eight Big Ticket items have been identified (Appendix 3), each one aligned with one of the four care workstreams. These items have been identified as key opportunities to align commissioning and transform provision across Adult Social Care, Public Health and the CCG opportunities identified by all commissioners via joint planning work last year. The ICB is asked to approve the Big Ticket items and recommended them to the Health and Wellbeing Boards; thereby giving a mandate to Transformation Board and the workstreams to take these forward. ICB Page 71

74 Recommendations: The Integrated Commissioning Board is asked to: APPROVE the strategic framework for workstreams; APPROVE in principle the draft Asks for the Unplanned Care, Planned Care and Prevention Workstreams and the associated dashboard; APPROVE the Big Ticket Items and recommend them to the Health and Wellbeing Board. Links to Key Priorities: This report is aligned to the delivery of priorities in the City Joint Health & Wellbeing Strategy including: Good mental health for all Effective health and social care integration All children have the best start in life Promoting healthy behaviours and the delivery of Hackney Joint Health & Wellbeing Strategy including: Improving the health of children and young people Controlling the use of tobacco Promoting mental health Caring for people with dementia. Specific implications for City and Hackney N/a. Patient and Public Involvement (PPI) and Impact: All of the care workstreams will have PPI representation and patients and service users will be actively involved in the development of proposals. Clinical/practitioner input and engagement: All of the care workstreams will have clinical/practitioner representation and clinicians/practitioners will be actively involved in the development of proposals. ICB Page 72

75 Impact on / Overlap with Existing Services: N/A Supporting Papers and Evidence: Appendix 1 Strategic Framework for Workstreams Appendix 2 Draft Workstream Asks and Workstream Dashboard Appendix 3 Big Ticket Items Sign-off: London Borough of Hackney - Anne Canning, Group Director, Children, Adults and Community Health City of London Corporation - Neal Hounsell, Assistant Director of Commissioning and Partnerships City & Hackney CCG - Paul Haigh, Chief Officer ICB Page 73

76 ICB Page 74

77 Paper 5.1 Strategic Framework for Care Workstreams The NHS Five Year Forward View said: The traditional divide between primary care, community services, and hospitals largely unaltered since the birth of the NHS is increasingly a barrier to the personalised and coordinated health services patients need. Long term conditions are now a central task of the NHS; caring for these needs requires a partnership with patients over the long term rather than providing single, unconnected episodes of care. Increasingly we need to manage systems networks of care not just organisations. Out-of-hospital care needs to become a much larger part of what the NHS does. And services need to be integrated around the patient. As local partners we endorse this statement with the addition that social care is an integral part of the services needing to integrate around each patient and that we need ever closer working between the NHS and local government to achieve our aims for our communities. Aims and Objectives As a system we want to achieve the following and each workstream will need to contribute towards this collective ambition and delivery: Improve the health and wellbeing of local people with a focus on prevention and public health, providing care closer to home, outside institutional settings where appropriate, and meeting the aspirations and priorities of the 2 Health and Wellbeing strategies; Ensure we maintain financial balance as a system and can achieve our financial plans; Deliver a shift in focus and resource to prevention and proactive community based care; Address health inequalities and improve outcomes, using the Marmot principles in relation to the wider determinants of health and focusing on social value; Ensure we deliver parity of esteem between physical and mental health; Ensure we have tailored offers to meet the different needs of our diverse communities; Promote the integration of health and social care through our local delivery system as a key component of public sector reform; Build partnerships between health and social care for the benefit of the population; Contribute to growth, in particular through early years services; Achieve the ambitions of the NEL STP. The Framework Over the course of 2017/18 each workstream will contribute to the establishment of an accountable care system across Hackney and the City by April 2018 which demonstrably achieves and will continue to achieve our system aims and objectives. ICB Page 75

78 Paper 6.1 To do this the partners involved in each workstream (supported by the enabler groups ) will take collective responsibility for: Overseeing contractual performance and proposing changes to contractual arrangements Organising service delivery to achieve integration Developing and embedding innovative front line practice and delivery Implementing transformation initiatives Achieving local ambitions and those of NEL STP Delivering improvement in population health outcomes Delivering NHS Constitution and other standards and metrics Maintaining financial balance and delivering savings plans Workstreams to work together in a truly integrated way to address shared issues/common outcomes This will be achieved through work with clinicians, public and other stakeholders to develop and implement robust integrated delivery plans across local providers. Principles We will deliver our plans adhering to the following principles: Addressing the wider determinants of health to address underlying health inequalities, focusing both on direct service commissioning and influencing and advocacy in the wider system Enhanced primary care practices working together within each of the 4 quadrants and delivering population and preventative healthcare A fully integrated community health and social care team in each of the four quadrants building on the success of One Hackney and the City, alongside quadrant-based voluntary sector organisations delivering a range of social, wellbeing and public health services via social prescribing and integration with statutory services A physically integrated single point of coordination (SPOC) for crisis care Empowered patients equipped with skills and information to help them selfmanage, access the right services when needed, make informed decisions on the evidence and options for their care and who are active in the co-design of our service delivery arrangements and pathways Strong safe local hospital care delivering: o High quality 7 day services, integrated with mental health resources and networked with other local hospitals where necessary. o Fewer face to face outpatients - replaced by digital solutions. o Support and expert advice to primary and community care. o Demand management of tertiary service. o Reductions in variations between teams. o Minimal length of stay, thanks to good primary and community services which command universal clinical confidence. o Aligned clinical behaviours across primary community and secondary care, which see the community / home as the default and support the delivery of patient care plans. ICB Page 76

79 Paper 6.1 o Preventative interventions. We will measure the impact of this new way of working on delivering our aims and objectives, both in terms of integration of planning and decision making and the impact on the population. How we do this will form the basis of the external evaluation we are commissioning. In the meantime we will want to assess how the plans of each workstream are making progress in implementing this service model, their plans to improve health and care for the population and how they are operating within the framework outlined above. ICB Page 77

80 Paper 5.2 Ask of the Unplanned Care workstream The Unplanned Care Workstream is asked to establish an accountable care system for the delivery of unplanned care services for the people of Hackney and the City within the overall strategic framework. The unplanned care workstream will need to work closely with the other three care workstreams in order to ensure a system-wide approach is taken across the workstreams. The partners are expected to work collectively to Oversee the unplanned care delivery system Ensure a health and social care system wide approach to the delivery of initiatives Establish a robust governance arrangement to support collective delivery Manage service delivery within the unplanned care budget o o Redirect funding within the workstream that either improves service delivery or reduces cost (or both) Develop service delivery proposals across workstreams that reduce overall system costs Make suggestions to the statutory commissioners on changes to current contractual arrangements which would improve service delivery and secure performance and value for money Ensure the achievement of all performance standards and key performance indicators (KPIs) within existing contracts Deliver improvements in outcomes (both nationally mandated outcomes and additional locally relevant outcomes) Engage in organisational development offer to develop system leadership This will involve: Furthering integration across service provision in the City and Hackney Establish a strong collective delivery arrangement across the providers which fully integrates service provision and minimises duplication and overlap ICB Page 78

81 Paper 6.2 Ensure that the delivery arrangement works for both the Hackney health and social care system and City of London health and social care system Ensure that the health and social care system achieves high quality, patient led services which also secure best practice, reduce unwarranted variations and demonstrates value for money Demonstrate the local contribution to the delivery of the North East London STP plans and delivery of the NHS Five Year Forward View Objectives for 2017/18: Plan and deliver improvements and efficiencies in year (2017/18): Develop a proposition for the local face to face/home visiting service to complement the 111 clinical assessment service and local primary care, consult on this and prepare for mobilization once agreed by the Integrated Commissioning Boards Implement the local ambulatory care model to achieve reductions in length of stay and an integrated delivery model with primary and community services Management of mental health beds (management of mental health needs to include appropriate levels of bed occupancy and efficient use of inpatient beds and support the review of Continuing Care beds) Deliver a 500k Quality Improvement Productivity and Prevention (QIPP) against the baseline budget Deliver further QIPP via a focus on reducing length of stay/excess bed day costs at UCL and Barts Health and improving the access to and service available for City residents (including how Paradoc and the Integrated Independence Team interface with City reablement services to make more of an impact on admission avoidance and on Length of Stay (LOS)/discharge and improving the Community Health Services offer to City residents) Development of model for better use of Duty Doctor service (combined offer from Homerton and GP Confederation; Duty Doctor as an alternative to the Primary and Urgent Care Centre): to mitigate the increase in A&E attendances and spend. ICB Page 79

82 Paper 6.2 Ensure local compliance with initiatives outlined in the March 2017 NHS England/NHS Improvement letter regarding local A&E performance (further detail in information pack), and reiterated in the NHS Delivery Plan refresh 31 st March 2017: o Implement front door streaming o Implement the high impact change model for Delayed Transfers of Care o Achieve and maintain the 95% A&E performance standard (in line with agreed STF trajectory) The current NHS and Social Care metrics associated with this workstream are attached and the commissioners will want to agree with the system the improvements which will be achieved and the improvement trajectories for 2017/18. In particular during 2017/18 the system will be expected to: o Maintain or reduce the emergency admission rate for the year old group (ensuring activity levels stay within activity trajectory for total non-elective admissions submitted to NHS England) o Maintain or reduce levels of Delayed Transfers of Care o Maintain or reduce in the A&E attendance rate and in particular minor cases presenting to A&E (ensuring activity levels stay within trajectory for total A&E attendances submitted to NHS England) o Achieve the Better Care Fund metric targets Deliver national Continuous Quality Improvement Network (CQUIN) measures and targets on: o Proactive discharge o Sepsis screening o Cardio-metabolic assessment and treatment for patients with psychoses o Personalised care and support planning o Communication with the GP for patients admitted to mental health unit o Ambulance conveyance o 111 referrals Take forward the RightCare programme relating to Falls (pathway design meeting held, logic model/business case developed and implementation started by September, as per NHS England requirements more detail in information pack) Review all current services and plan improvements in outcomes from 2018/19 onwards: ICB Page 80

83 Paper 6.2 Manage the unplanned care budget and agree remedial action to be implemented on 1 April 2018 to bring the budget back into balance should Payment by Results (PbR) spend increase during 17/18 Review the current contract portfolio, performance within these and drivers of acute activity and make recommendations for any consolidation/alignment to services/contracts to improve patient outcomes, reduce inequalities, reduce avoidable unplanned care spend, maximize quality and efficiency from services and improve value Review the plans to ensure adequate Mental Health care in A&E by March 2018 (ensure that liaison services are core 24 compliant and delivery of national CQUIN) Agree system action plans to take forward the local big ticket items linked to this workstream: o End of life care (including improving access and provision of individualised care, quality and coordination of care, improvement in management of symptoms/pain, reducing unnecessary hospital admissions, increasing the number of people who die in their preferred place o Dementia (continue to delivery diagnosis standards and robust care planning support) Agree system action plans to take forward local transformation initiatives: o Enhanced Primary Care ( Quadrants ) o Single point of co-ordination o Discharge from hospital model, delivering national expectations (e.g. discharge to assess; trusted assessor) Linked with the above service delivery changes and/or transformation initiatives, model and agree improvement trajectories for mandated NHS and Social Care outcomes along with agreement on any additional decided local population health outcomes and trajectories attached for 2018/19 onwards Objectives for 2018/19: Deliver system action plans agreed above, alongside improvement in outcomes as per agreed trajectories Evidence impact of new delivery models implemented in 2017/18 on agreed metrics ICB Page 81

84 Paper 6.2 Manage the unplanned care budget within plan Agree remedial action if any deviation from plans QIPP (ask TBC) RightCare (ask TBC) Achieve nationally mandated CQUINs for 2018/19 ICB Page 82

85 Paper 6.2 Ask of the Planned Care workstream The Planned Care Workstream is asked to establish an accountable care system approach to planned care for the people of Hackney and the City within the overall strategic framework. The planned care workstream will need to work closely with the other three care workstreams in order to ensure a system-wide approach is taken across the workstreams. The partners are expected to work collectively to Establish a robust governance arrangement to support collective delivery Manage service delivery within the planned care budget: o Redirect funding within the workstream that either improves service delivery or reduces cost (or both) o Develop service delivery proposals across workstreams that reduce overall system costs Ensure a health and social care system wide approach to the delivery of initiatives Make suggestions to the statutory commissioners on changes to current contractual arrangements which would improve service delivery and secure performance and value for money Ensure the achievement of all performance standards and key performance indicators (KPIs) with existing contracts Deliver improvements in outcomes (both nationally mandated outcomes and additional locally relevant outcomes) Engage in organisational development offer to develop system leadership This will involve: Furthering integration across service provision in the City and Hackney Establish a strong collective delivery arrangement including mental health across the providers which fully integrates service provision and minimises duplication and overlap ICB Page 83

86 Paper 6.2 Ensure that the delivery arrangement works for both the Hackney health and social care system and City of London health and social care system Ensure that the health and social care system achieves high quality, patient led services which also secure best practice, reduce unwarranted variations and demonstrates value for money Demonstrate the local contribution to the delivery of the North East London STP plans and delivery of the NHS Five Year Forward View Objectives for 2017/18: Plan and deliver improvements and efficiencies in year (2017/18): Implement the Cancer Plan improvements with a focus on waiting times standards and earlier diagnosis (including delivery of the Quality Premium target for early diagnosis) Deliver the medicines management/optimization plans Deliver the agreed QIPP plans Develop a new cost effective operating model for Continuing Healthcare which delivers 17/18 QIPP and achieves national plan to deliver 85% of CHC assessments in the community (in line with national guidance in relation to Fast Track Continuing HealthCare and as per Quality Premium target) Implement the anticoagulation service once agreed by the Integrated Commissioning Boards Deliver national CQUIN measures and targets on: o Antibiotic prescribing (in addition to Quality Premium targets on antibiotic prescribing) ICB Page 84

87 Paper 6.2 o Advice and guidance services to GPs o E-referrals o Improving assessment of wounds Support the RightCare Programme relating to Neurology (pathway design meeting held, logic model/business case developed and implementation started by September, as per NHS England requirements more detail in information pack) The current NHS, Social Care and Public Health metrics associated with this workstream are attached and the commissioners will want to agree with the system the improvements which will be achieved and the improvement trajectories for 2017/18. In particular during 2017/18 the system will be expected to: o Maintain or improve admissions to residential and nursing care homes o Maintain or improve user satisfaction with social care services Institute a review programme for all current outpatient pathways and ensure that mental health is on each pathway Initiate a programme to increase use of diagnostics to support primary care based management and reduce duplication of unnecessary diagnostics Deliver mandated targets on Improved Access to Psychological Therapies (IAPT) (access, recovery, 6wk and 18wk waiting times, Quality Premium target on improving recovery for Black and Minority Ethnic (BAME) groups and access for over 65s), QIPP targets and deliver maintenance of waiting list backlog at zero and first appointment to second appointment waiting times, along with initiatives on employment advisor workstream with DWP, IAPT provision for pts with Long Term Conditions, new service for mild to moderate perinatal patients, interface with psychosexual Health Service, e-cognitive Behavioural Therapy (e-cbt). Review all current services and plan improvements in outcomes from 2018/19 onwards: Manage the planned care budget and agree remedial action to be implemented on 1 April 2018 to bring the budget back into balance should PbR spend increase during 17/18 ICB Page 85

88 Paper 6.2 Review the current contract portfolio, performance within these and drivers of acute activity and make recommendations for any consolidation/alignment to services/contracts to improve patient outcomes, reduce inequalities, reduce avoidable unplanned care spend, maximize quality and efficiency from services and improve value Reduce avoidable demand for elective care, including by actively managing medically unexplained symptoms, by maintaining or improving referral rates (increasing e-referrals) and reducing outpatient follow-ups develop a plan which will implement a radical approach to the current outpatient model and reduce face to face contact The workstream will need to develop a system action plan to take forward the big ticket item relating to housing Support STP plans around improving elective surgical outcomes and North East London model Develop a plan to address clinical practice variation across primary and secondary care Review the support offer to local care and nursing homes Develop a plan for future management of medicines management support Linked with the above service delivery changes and/or transformation initiatives, model and agree improvement trajectories for mandated NHS and Social Care outcomes along with agreement on any additional decided local population health outcomes and trajectories attached for 2018/19 onwards Improve care for those Learning Disabilities (improved screening uptake including cancer screening, increase employment and training opportunities, increase uptake of annual health reviews and health action plans, plan to address any areas of poor performance/gaps identified in latest Self Assessment Framework (SAF), deliver Transforming Care Partnership s local objectives to better support local people with challenging behaviour, input to strategic review of the current integrated Learning Disabilities service) Objectives for 2018/19: Deliver system action plans agreed above, alongside improvement in outcomes as per agreed trajectories (including NHS Constitution standards: Referral to Treatment and IAPT) ICB Page 86

89 Paper 6.2 Evidence impact of new delivery models implemented in 2017/18 on agreed metrics Manage the planned care budget within plan Agree remedial action if any deviation from plans/trajectories QIPP (ask TBC) RightCare (ask TBC) Achieve nationally mandated CQUINs for 2018/19 ICB Page 87

90 Paper 6.2 Ask of the Prevention workstream The Prevention Workstream is asked to establish an accountable care system approach to prevention for the people of Hackney and the City within the overall strategic framework. The prevention workstream will need to work closely with the other three care workstreams in order to ensure a system-wide approach is taken across the workstreams The partners are expected to work collectively to: Establish a robust governance arrangement to support collective delivery Ensure a system wide approach to the delivery of prevention initiatives Manage service delivery within the prevention budget o Redirect funding within the workstream that either improves service delivery or reduces cost (or both) o Develop service delivery proposals across workstreams that reduce overall system costs Make suggestions to the statutory commissioners on changes to current contractual arrangements which would improve service delivery and secure performance and value for money Ensure the achievement of all performance standards and key performance indicators (KPIs) within existing contracts Deliver improvements in outcomes (both nationally mandated outcomes and additional locally relevant outcomes) Engage in organisational development offer to develop system leadership This will involve: Furthering integration across service provision in the City and Hackney Establish a strong collective delivery arrangement across the providers which fully integrates service provision and minimises duplication and overlap ICB Page 88

91 Paper 6.2 Ensure that the delivery arrangement works for both the Hackney health and social care system and City of London health and social care system Ensure that the health and social care system achieves high quality, patient led services which also secure best practice, reduce unwarranted variations and demonstrates value for money Demonstrate the local contribution to the delivery of the North East London STP plans and delivery of the NHS Five Year Forward View Objectives for 2017/18: Plan and deliver improvements and efficiencies in year (2017/18): The current NHS, Social Care and Public Health metrics associated with this workstream are attached and the commissioners will want to agree with the system the improvements which will be achieved and the improvement trajectories for 2017/18. In particular during 2017/18 the system will be expected to: o Secure improvements in the CCG Improvement and Assessment Framework measures relating to diabetes and ensure a system wide approach to reduce the risk of Type 2 diabetes o Deliver Quality Premium target on smoking quitters Use the Right Care programme to support the local focus on Circulation (CVD) and Respiratory improving prevention programmes in place, management of existing conditions and preventing avoidable admissions (RightCare requirements: pathway design meeting held, logic model/business case developed and implementation started by September, as per NHS England directives more detail in information pack) ICB Page 89

92 Paper 6.2 Implement plans to secure delivery of the national CQUIN on screening, brief advice and referral for people who smoke and/or have high alcohol consumption Ensure an integrated approach to national plans to increase NHS Health Checks Support the local delivery of STP ambitions relating to workplace health, supporting healthy workplaces and giving healthy messages to workers (alongside delivering national CQUIN on staff health and wellbeing) Ensure progress towards making Homerton and ELFT smoke free Review all current services and plan improvements in outcomes from 2018/19 onwards: Review the current contract portfolio, performance within these and drivers of acute activity and make recommendations for any consolidation/alignment to services/contracts to improve patient outcomes, reduce inequalities, maximize quality and efficiency from services and improve value Develop system wide plans to reduce smoking prevalence and inequalities in smoking prevalence across the local population (and worker populations) Develop system wide plans to reduce childhood obesity In addition to the above, review current services and develop integrated plans to drive primary and secondary prevention (including risk factor management and early detection) of long term conditions in the local population Review current initiatives and recommend changes needed to secure a system wide approach to improving the management of long term conditions (LTCs; sickle cell, Cardiovascular Disease (CVD) / AF (Atrial Fibrilation), Diabetes, Chronic Obstructive Pulmonary Disease /asthma, hypertension, renal) including potential to apply the renal model to other LTCs ICB Page 90

93 Paper 6.2 Develop plans to increase self-management, access to self-care/advice and link social prescribing to other community based prevention initiatives to support primary prevention initiatives and those with LTC to manage their own health care and wellbeing The workstream will need to develop a plan during 2017 to take forward by April 2018 the big ticket item relating to employment (working with the Central London Forward Work and Health Programme) and specifically improving employment rates for those with Learning Disabilities and Mental Health problems Work with Planned Care workstream to improve uptake of all screening programmes and adult immunisations Develop system wide plans for health and social care organisations to work in a more integrated way to identify and support carers Build on existing wellbeing network/ 5 to Thrive work and suicide prevention plans to improve Mental Wellbeing and reduce rates of suicide Work across organisations, including voluntary sector, to reduce social isolation and the impact of this on health and wellbeing Increase the number of disabled people and those with complex health needs to benefit from a personal health budget Improve the accommodation pathway/care provided to rough sleepers Agree, and develop recommendations to implement, the local strategy for a whole systems approach to tackle alcoholrelated harm. Ensure the substance misuse shared care model with primary care continues to deliver positive outcomes, and improve the support available for young drug and alcohol users to quit by strengthening links with the criminal justice system and mental health services. Implement required improvements to the support available to substance misusers with complex needs, informed by the results of an evaluation of the Multiple Needs Service. ICB Page 91

94 Paper 6.2 Develop and implement system wide plans to reduce STI prevalence and improve the sexual health of the local population, including in high risk groups Linked with the above service delivery changes and/or transformation initiatives, model and agree improvement trajectories for mandated NHS and Social Care outcomes along with agreement on any additional decided local population health outcomes and trajectories attached for 2018/19 onwards Objectives for 2018/19: Deliver system action plans agreed above, alongside improvement in outcomes as per agreed trajectories Evidence impact of new delivery models implemented in 2017/18 on agreed metrics Agree remedial action if any deviation from plans QIPP (ask TBC) RightCare (ask TBC) Achieve nationally mandated CQUINs for 2018/19 ICB Page 92

95 Unplanned Care system dashboard Framework Significantly different to comparator NHSE trajectory A&E attendances number (SUS) Q3 16/ Local A&E attendances rate per 1000 popn (SUS) Q4 15/ IAF A&E performance 4 hr target Q3 16/ % 86.5% 85.3% 95% Local Attendance to admission ratio Q4 15/ NHSE trajectory Total non-elective admissions (SUS) BCF Non-elective admissions all ages, rate per 1000 popn Q4 15/ Local Non-elective admissions over 75s, rate per 1000 popn Q4 15/ IAF Emergency admissions for urgent care sensitive conditions Q4 15/ IAF Inequality in emergency admissions for urgent care sensitive conditions IAF Emergency admissions for chronic ambulatory care sensitive conditions IAF Inequality in emergency admissions for chronic ambulatory care sensitive conditions IAF Emergency bed day rate per 100,000 popn Q1 16/ Local Excess bed day rate Q3 16/ LAS targets Ambulance target: RED1 Jan % 66.70% 70.6% 75% LAS targets Ambulance target: RED2 Jan % 58.50% 63.4% 75% LAS targets Ambulance target: 19 mins Jan % 87.60% 92.7% 95% BCF DTOCs number - NHS blame Jan % 56.6% 59.8% BCF DTOCs number - SC blame Jan % 35.3% 37.2% IAF Rate of DTOCs per 100,000 popn Nov IAF % of deaths in hospital Q1 16/ % 47.1% 55.30% IAF (shared w ith Planned Care) Mental Health clinical priority area rating May-16 Performing Well IAF Mental Health Transformation: out of area placements for acute inpatient care Q2 2016/17 100% IAF People eligible for standard NHS Continuing healthcare per 50,000 Q2 16/ population IAF 1st episode psychosis accessing package of care within 2w Dec % 73.7% 74.0% 50% IAF Crisis care transformation indicator Q2 2016/17 95% IAF Dementia clinical priority area rating May-16 Top performing IAF % dementia pts with care plan reviewed in last 12m 2015/16 86% 80.1% IAF/ PHOF Estimated diagnosis rate for people with dementia Nov % 67.4% 79.6% 66.7% IAF Achievement of milestones in the delivery of an integrated urgent care service IAF/ PH OF Injuries from falls in those aged 65+ Jun ,985 1,543 ASCOF (shared w ith Planned Care) ASCOF ASCOF ASCOF (shared w ith Planned Care) Local ASCOF Indicator Permanent admissions to residential and nursing homes (per 100,000 popn) Proportion of older people (65 and over) who were offered reablement services following discharge from hospital Proportion of people still at home 91 days after discharge into reablement services Long-term support needs of younger adults/older adults met by admission to residential and nursing care homes, per 100,000 population Number of home care packages (short term/long term) Proportion of those that received shortterm service during the year where sequel was either no ongoing support or support of a lower level Latest data period City and Hackney Hackney City of London England London Cosmopolitan group Trend RAG rating, C&H: Trend ICB Page 93 Achieving target

96 Planned Care system dashboard Framework Against comparator group RTT RTT: % pts treated within 18 weeks - Homerton Q3 16/ % 88.9% 88.0% 92% NHSE trajectory Number of completed RTT admitted pathways Q3 16/ % 72.5% 76.1% NHSE trajectory Number of completed RTT non-admitted pathways Q3 16/ % 86.9% 89.9% NHSE trajectory Indicator Number new RTT pathways commenced Latest data period City and Hackney NHSE trajectory Total elective admissions (SUS) NHSE trajectory Total referrals (general and acute; GP/other; MAR data) Q3 16/ NHSE trajectory Consultant led 1st OP attendances (GP and other) Q3 16/ NHSE trajectory Consultant led FU OP attendances (GP and other) Q3 16/ IAF E-referral coverage Jul % 51.1% 29.5% 61% Cancer waits 62 day cancer target Q3 16/ % 82.0% 78.5% 85% Cancer waits 2 week cancer wait Q3 16/ % 95.15% 94.5% 93% IAF/ PH OF % of cancers diagnosed at stage 1 and % 50.7% 49.2% Hackney IAF Cancer survival % 70.2% 68.7% 75% Trend Achieving target IAF Cancer patient experience IAF People eligible for standard NHS Continuing healthcare per 50,000 population Q2 16/ IAF Learning Disabilities clinical priority area rating May-16 Needs improvement IAF Reliance on specialist inpatient care for people with a learning disability and/or autism Q2 2016/ IAF Proportion of people with a learning disability on the GP register receiving an annual health check 2015/ % 37.1% 47.4% ASCOF/PHOF Proportion of adults with a learning disability in paid employment ASCOF/PHOF Proportion of adults with a learning disability who live in their own home or with their family IAF Performing (shared w ith Unplanned Mental Health clinical priority area rating May-16 Well Care) IAPT IAPT access rate Q2 2016/17 4.6% 3.8% 4.6% 15% annual IAPT IAPT recovery rate Q2 2016/ % 48.5% 46.9% 50% IAPT IAPT: % of people seen within 6 wks Q2 2016/ % 88.8% 89.8% 75% IAF Appropriate prescribing of antibiotics in primary care Dec City of London England London Cosmopolitan group Trend RAG rating, C&H: IAF ASCOF ASCOF ASCOF ASCOF ASCOF ASCOF ASCOF ASCOF ASCOF ASCOF Appropriate prescribing of broad spectrum antibiotics in primary care Overall satisfaction of people who use services with their care and support Social care-related quality of life Proportion of people who use services and carers who find it easy to find information about services Proportion of people who use services who find it easy to find information about services Proportion of people who use services who feel safe Proportion of people who use services who have control over their daily life Proportion of people who use services who say that those services have made them feel safe and secure Proportion of people using social care receiving selfdirected support Proportion of people using social care who receive direct payments Proportion of adult social care users living at home Proportion of adults in contact with secondary ASCOF/PHOF mental health services who live independently, with or without support ASCOF/PHOF Proportion of adults in contact with secondary (shared w ith Prevention) mental health services in paid employment ASCOF (shared w ith Unplanned Permanent admissions to residential and nursing Care) homes (per 100,000 popn) ASCOF Long-term support needs of younger adults/older (shared w ith Unplanned adults met by admission to residential and nursing Care) care homes, per 100,000 population Proportion of people who use services who reported ASCOF/PHOF that they have as much social contact as they would (shared w ith Prevention) like Dec % 8.90% 9.4% 0.12 ICB Page 94

97 Prevention system dashboard Framework RAG rating: C&H Against Trend comparator IAF Diabetes clinical priority area rating May-16 Needs improvement IAF Proportion of people with diabetes achieving 3x treatment targets % 39.8% 39.5% IAF Proportion of people newly diagnosed referred to structured education % 5.7% 9.6% Local Diabetes aggregate measure (10x indicators) 2015/ % 91.3% 90.8% NHS OF People feeling supported to manage their LTCs Jul 2015-Mar % 64.3% 57.3% NHS OF Health related quality of life for people with LTCs Jul 2015-Mar NHS OF/ PH OF Premature mortality CVD NHS OF/ PH OF Premature mortality respiratory Local % of patients with hypertension in whom the last BP reading (in last 9m) is <150/90 mmhg 2015/ % 82.9% 82.0% Local % patients <80 with hypertension in whom the last BP reading is 140/90 mmhg or less Oct 2015-Sep % Local Heart failure aggregate measure (3x indicators) 2015/ % 95.0% 95.6% PHOF Number of smoking quitters (quit rate) Q / (49%) PHOF Local Local Local Local Local Local Local Local Local Local PHOF PHOF Smoking prevalence in adults % patients with LTC/MH condition who have had offer of smoking cessation support and treatment in last12m Rate of new STIs Gonorrhoea infection rate Re-infection rate Late HIV diagnoses Completion of drug treatment (opiate and non-opiate) Completion of alchol treatment Deaths from drug misuse Alcohol related admissions Adults with substance misuse treatment need who successfully engage in community-based structured treatment following release from prison % physically inactive adults % physically active adults 2015/ % 94.3% 96.3% PH OF % children classified as obese (shared w ith CYP) % 33.2% 40.5% IAF Personal health budgets (adults) Q2 2016/ IAF/ASCOF QoL for carers ASCOF Overall satisfaction of carers with social services Proportion of carers who report that they have been ASCOF included or consulted in discussion about the person they care for Proportion of carers who find it easy to find information ASCOF about services Proportion of carers who reported that they have as much ASCOF/PHOF social contact as they would like ASCOF ASCOF ASCOF ASCOF/PHOF (shared w ith Planned Care) ASCOF/PHOF (shared w ith Planned Care) Local Local Local Local Indicator Proportion of carers receiving self-directed support Proportion of people using social care receiving direct payment Proportion of carers receiving direct payments for support direct to carer Proportion of adults in contact with secondary mental health services in paid employment Proportion of people who use services who reported that they have as much social contact as they would like Number/% adults referred for safeguarding whose expressed outcomes are fully/partly met Increased % of rough sleepers who sleep out just once Reduced number of people deemed living on the streets Proportion of residents who feel safe/very safe Latest data period City and Hackney Hackney City of London England London Cosmopolitan group Trend ICB Page 95

98 Children and Young People system dashboard Framework Against comparator IAF Maternity clinical priority area rating May-16 Needs improvement IAF Neonatal mortality and stillbirths IAF Women s experience of maternity services % 79.7% 77.9% IAF Choice in maternity services % 65.4% 67.4% IAF/ PHOF Maternal smoking at delivery Q2 2016/17 2.8% 10.4% 4.1% IAF Personal health budgets - children NHS OF/ PH OF Breastfeeding initiation Q2 2016/ % 72.6% NHS OF/ PH OF Breastfeeding rates at 6-8 weeks 2014/ % Local % of births at birth centre Dec % <12% Local Planned/unplanned births at home Dec % >1% Local C section rate Dec % <35% Local Maternal mortality Indicator Latest data period City and Hackney NHS OF % of women booked by 12+6 *provisional data Q2 2016/ % 89.7% 80.6% <70% Local % of women booked by 10 weeks Dec % >40% PH OF Low birth weight babies Local Unplanned NICU admissions for term babies Dec <36 Local Childhood imms (DTaP/IPV/Hib by 5 years old within 16/17) 16/ % IAF CAMHS transformation indicator Q2 2016/17 90% Hackney City of London England London Cosmopolitan group PH OF % children classified as obese % 33.2% 40.5% Trendline RAG rating: Trend Achieving target ICB Page 96

99 Paper 5.3 BIG TICKET ITEMS ICB Page 97

100 OBJECTIVES Paper 6.3 Need system response - ie to achieve improvement in outcomes needs providers to work together Opportunities to align commissioning across ASC, PH and CCG opportunities identified by all commissioners via joint planning work last year Join up of public sector services Alignment with STP and local case for change (ie we currently do worse than England/NEL) Measures of success use these as part of evaluation of integrated commissioning Opportunities to test out how we work together and develop a system operating model, test out integrated commissioning model ICB Page 98

101 AREAS AND RESPONSIBILITIES Paper 6.3 Topic Why Lead workstream Quadrant working, single point of access, local response to 111 and hospital discharge End of Life Care Continuing health care Dementia - making all areas of the city and Hackney dementia friendly Self-care including access to advice and social prescribing Making every contact count for smoking, exercise and mental health and a focus on a system wide approach to smoking Employment, ways in to work and support for people with mental health, long-term conditions including learning disabilities Housing link to discharge, move on accommodation and housing for people with mental health and long-term conditions, including learning disabilities Already run workshops on 3 of the initiatives big transformation opportunities and building blocks for our ambitions. 111 we have to do; impact on hospital use HIH report; discussion at COL HWBB and co-production workshop?potential driver of acute activity; big patient wishes agenda Significant budget pressure and potential driver of hospital excess bed days Current HWBBs priority Big push from residents; opportunity to join up pathways and impact on primary/secondary prevention and social isolation Primary and secondary prevention agenda needs a system wide approach and all about behaviour change Medium term priority Rates of employment for those with MH and LTC are lower than London and England - New money/wider social value agenda Medium term priority Impact on hospital use Unplanned care Unplanned care Unplanned care Unplanned care Prevention Prevention Prevention Planned care ICB Page 99

102 Title: Care Workstreams Assurance Review Process Date: 23 May and 24 May 2017 Lead Officer: Paul Haigh, City & Hackney Clinical Commissioning Group) CCG Anne Canning, London Borough of Hackney (LBH) Neal Hounsell, City of London Corporation (CoLC) Author: Devora Wolfson: Integrated Commissioning Programme Director Committee(s): City Integrated Commissioning Board, 23 May 2017 Hackney Integrated Commissioning Board, 24 May 2017 Public / Nonpublic Public Executive Summary: A key construct for our integrated commissioning model is the four care workstreams. The CCG Programme Boards and Local Authority commissioning arrangements remain in place to manage all current commissioning activities but will transition to the new care workstreams over a period of time. However, before the current statutory organisations are comfortable to shift service redesign to the workstreams, they will need to be assured of: a robust operating model a clear governance framework adequate staff resources to undertake the work plans to ensure delivery of the north east London Sustainability & Transformation Plan (STP) and local plans the effective discharge of the statutory responsibilities of the 3 organisations through the new arrangements. This paper sets out the proposed the first 4 assurance review points through which the Care Workstreams will be required to pass in order to begin to reduce dual running of the partners governance arrangements. The 5 th assurance review point will be developed over the coming months. The assurance review process was endorsed by the Transformation Board on 12 May Recommendations: The Integrated Commissioning Board is asked to: APPROVE the overall care workstream assurance process including the first 4 review points; 1 ICB Page 100

103 Links to Key Priorities: This report is aligned to the delivery of priorities in the City Joint Health & Wellbeing Strategy including: Good mental health for all Effective health and social care integration All children have the best start in life Promoting healthy behaviours and the delivery of Hackney Joint Health & Wellbeing Strategy including:: Improving the health of children and young people Controlling the use of tobacco Promoting mental health Caring for people with dementia Specific implications for City and Hackney The assurance process will ensure that the care workstream plans effectively meet the specific needs of Hackney residents and City residents and workers. Patient and Public Involvement (PPI) and Impact: All of the care workstreams will have PPI representation and patients and service users will be actively involved in the development of proposals. The key lines of enquiry for each of the review points tests out clinical/practitioner engagement in design and delivery. Clinical/practitioner input and engagement: All of the care workstreams will have clinical/practitioner representation and clinicians/practitioners will be actively involved in the development of proposals. The key lines of enquiry for each of the review points tests out clinical/practitioner engagement in design and delivery. Impact on / Overlap with Existing Services: N/A 2 ICB Page 101

104 Main Report Introduction: As a system we want to work together to: 1. Improve the health and wellbeing of local people with a focus on prevention and public health, providing care closer to home, outside institutional settings where appropriate, and meeting the aspirations and priorities of the 2 Health and Wellbeing strategies; 2. Ensure we maintain financial balance as a system and can achieve our financial plans; 3. Deliver a shift in focus and resource to prevention and proactive community based care; 4. Address health inequalities and improve outcomes, using the Marmot principles in relation to the wider determinants of health and focusing on social value; 5. Ensure we deliver parity of esteem between physical and mental health; 6. Ensure we have tailored offers to meet the different needs of our diverse communities; 7. Promote the integration of health and social care through our local delivery system as a key component of public sector reform; 8. Build partnerships between health and social care for the benefit of the population; 9. Contribute to growth, in particular through early years services; 10. Achieve the ambitions of the NEL STP. We are looking for each workstream to contribute to the achievement of this ambition by: 1. Overseeing the delivery system within the service area 2. Developing a collective delivery arrangement across providers which fully integrates service provision and minimises duplication and establishing an accountable care system 3. Ensuring that the delivery arrangement works for both the Hackney system and City of London system 4. Achieving the financial savings and save money by joining up service provision and breaking down provider silos 5. Ensuring a system wide approach to the delivery of initiatives 6. Establishing robust governance arrangements to support collective delivery 7. Delivering improvements in outcomes 8. Engaging in organisational development offer to develop system leadership 9. Ensuring that the system achieves high quality, patient led services which also secure best practice, reduce unwarranted variations and demonstrates value for money 3 ICB Page 102

105 We are looking to the workstreams to deliver their plans through six models of care: Enhanced primary care practices working together within each of the 4 quadrants and delivering population health Quadrant-based voluntary sector organisations delivering a range of social, wellbeing and public health services via social prescribing and integration with statutory services A fully integrated community health and social care team in each of the four quadrants building on the success of One Hackney and the City A physically integrated single point of coordination (SPOC) for crisis care Empowered patients equipped with skills and information to help them selfmanage, access the right services when needed, make informed decisions on the evidence and options for their care and who are active in the co-design of our service delivery arrangements and pathways Strong safe local hospital care We have designed the following 5 stage assurance process (fifth stage to follow) to assess the state of readiness of the care workstreams to take on these responsibilities. Key to the assurance process, is agreeing the workstream ask or mandates. The process and timeline for this is set out below. 1. Draft asks sent to SROs and WDs - 20 April Drafts revised in light of initial feedback from SROs/WDs by 5 May Revised asks to TB for discussion - 12 May Asks to ICBs for outline approval 23/24 May Meetings with SROs/WDs for final discussions about asks late May/early June Discussions about the information WD require in relation to asks and information provided 4 ICB Page 103

106 The Assurance Review Points Assurance Review Point 1: SRO understanding of and sign up to the ask including scope and risks within it. A robust governance structure in place with effective PPI and clinical /practitioner engagement to enable competent and effective decision-making to be made. Review Date: July 2017 KLOE (key lines of enquiry) KLOE 1: Planning and delivery 1. Have the SRO and partners signed up to the ask and the 17/18 workstream deliverables and timelines? 2. Outline proposals and the rationale to move any budgets/contracts between workstreams and demonstrate sender/receiver support 3. Outline how you will continue to deliver the key metrics in 17/18 4. What propositions do you expect to make to the TB over the next 6 months? 5. Outline your initial thoughts about how to create a virtual team to support the delivery of the workstream asks KLOE 2: Financial planning, capability and performance 6. Demonstration of sufficient financial planning and financial capability to deliver the QIPP (Quality, Innovation, Productivity and Prevention) and required local authority savings. KLOE 3: Effective and robust decision-making 7. Describe the governance for the workstream including the board and reporting into the CCG and local authority internal governance structures. 8. Describe the decision making arrangements within the workstream and subcommittee/project structures? 9. How will the workstream manage and mitigate potential/perceived conflicts of interest? 10. How will the workstream agree and make recommendations to the TB? KLOE 4: Engagement in design and delivery 11. Describe the operating model between the SRO, the workstream director, the PPI lead, and the clinical/practitioner leads. 12. Describe the patient and clinical/ practitioner involvement in workstream subgroups or project groups? KLOE 5: Transformation 13. Outline your early thoughts on potential transformation in terms of the big ticket items in your workstream 14. Outline your thoughts about potential areas for co-production. 5 ICB Page 104

107 KLOE 6: Managing risk 15. Is there anything in the 17/18 asks that the workstream feel they are unable to deliver in year? Prerequisite information that will be provided to workstreams Key metrics for the workstream Information about potential staff that could be available to support the workstream Information required Written response showing understanding of the ask, signing up to the workstream deliverables timelines. And demonstrating capability to meet these. Workstream structure diagram with governance and decision-making clearly illustrated/communicated Workstream Board terms of reference including membership Lists of likely proposals to the TB in the next 6 months High level plans for achieving key metrics Proposed changes in workstream budgets and rationale, 6 ICB Page 105

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109 Assurance Review Point 2: Assurance of 17/18 workplans and financial plans and capability, management of risk, competence and capacity for delivery Review Date: September 2017 KLOE (key lines of enquiry) KLOE 1: Planning and delivery 1. Detailed plans for taking forward the 17/18 requirements including: Review process undertaken of existing plans? Which are the areas where you are planning significant change to/review of existing workplans and why? What milestones you expect to achieve over the next 3, and 9 months in your workplans? How will you ensure you will meet the public sector equality standards? Which proposals will you be bringing to the TB and when (refresh of information provided in the previous gateway)? Which additional staff are required on a full/part time basis to deliver the totality of the workstream ask? Have these staff been identified and are arrangements in place to deploy these staff? 2. Describe how you will provide the necessary information to statutory commissioners to support the assurance function both internally and externally? 3. Describe the key outcomes for 17/18 and your rationale for these? What are your proposed improvement trajectories for the key outcomes? 4. What difference will patients see as a result of your plans? 5. How are you addressing the specific needs of the City and Hackney? KLOE 2: Financial planning, capability and performance 6. Describe your plans to: Achieve financial balance in year Deliver 17/18 QIPP and local authority financial savings Address issues coming out of non-recurrent funding in 18/19 Deliver in year savings across the contract portfolio by closer provider collaboration KLOE 4: Engagement in design and delivery 7. Outline how patient and clinician/practitioner involvement has developed since the last review point 8. Outline where and how you intend to use co-production KLOE 5: Transformation 9. What are your plans for extending provider collaboration over the next 6 months? 10. Outline your plans to take forward the big ticket items which fall in your workstream 8 ICB Page 107

110 11. Outline the OD issues for your workstream over the next 12 months and how will you address these KLOE 6: Managing risk 12. Describe how you will provide the necessary information to support the statutory commissioners assurance function both internally and externally. 13. Are there any areas which the workstream will not be able to deliver in If so we will need to ensure this can be done elsewhere in the system. 14. How have workstream risks been identified and quantified what mitigation and management plans are in place for these what is the escalation process for these risks? KLOE 7: Contracting and commissioning 15. Describe the arrangements for performance management of existing contracts. 16. What is the escalation process is if performance does not meet targets/ expectations? Prerequisite information that will be provided to workstreams Reporting and assurance requirements issued by commissioners Full financial information from partners including non-recurrent funding for 18/19 Contract Information about performance of contracts Performance data and trajectories Information required Detailed work plans including schedule/programme with milestones and reporting dates Plan to develop big ticket item/s Description of improvement trajectories and proposed impact on patients and how you will measure progress Reporting and assurance plan to statutory commissioners Risk register including mitigation plans Escalation plan that details the process that will be followed should targets/expectations not be met Financial plan for the workstream including proposals in relation to nonrecurrent funding Proposals/proposed model for provider collaboration OD plan 9 ICB Page 108

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112 Assurance Review Point 3: Assurance of 18/19 workplans and financial plans and capability, transformation capability and competence and capacity for delivery Review Date: October 2017 KLOE (key lines of enquiry) KLOE 1: Planning and delivery 1. Describe the key outcomes for 17/18 and your rationale for these? What are your proposed improvement trajectories for these outcomes? 2. Provide an update on your workplans and trajectories for each 17/18 and 18/19 ask. 3. Describe progress with the big ticket items and next steps over the next 6 months? 4. Outline any performance management issues you have had to address so far and how you have gone about this. 5. How you will you ensure you will meet the public sector equality standards? 6. Describe how you will achieve you virtual team. KLOE 2: Financial planning, capability and performance 7. Outline your delivery of QIPP, and local authority savings and any risks and how these will be managed 8. Outline your financial plansfor2018/19 9. Outline what savings will be achieved in Q4 and in 18/19 as a result of your plans KLOE 4: Engagement in design and delivery 10. Outline how your patient and clinician involvement has developed since the last review point and the impact their input has had on your plans. 11. What are you plans for ongoing public involvement and engagement over the next 6 months? 12. Outline where and how you intend to use co-production KLOE 5: Transformation 13. Outline your early thoughts on potential transformation in terms of the big ticket items in your workstream KLOE 6: Risk management 14. Describe how you will provide the necessary information to support the statutory 11 ICB Page 110

113 commissioners assurance function both internally and externally. 15. Are there any areas which the workstream will not be able to deliver in If so we will need to ensure this can be done elsewhere in the system. 16. How have workstream risks been identified and quantified what mitigation and management plans are in place for these what is the escalation process for these risks? KLOE 7: Contracting and commissioning 17. What are your commissioning intentions for 18/ What do you plan to consult on and how will you do this 19. What notice needs to be served by the statutory commissioners on any current contractual arrangements to further deliver your plans? Prerequisite information that will be provided to workstreams Partners will need to provide full resource chart/availability in order for ` workstreams to plan their virtual teams Information required A Plan outlining response to the Strategic Frameworks for Workstreams (headlines) document including plans for moving to an accountable care system Report on 18/19 commissioning intentions detailing consultation plans, anticipated improvement trajectories Update report on workplans, trajectories, public, patient and clinical involvement for 17/18 Workplans and trajectories for 18/19 Update report outlining any performance management issues Updated financial plan showing savings for 17/18 and 18/19 Updated risk register Detailed plan for virtual team 12 ICB Page 111

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115 Assurance Review Point 4: Assure transformation capability and capacity. Review Date: Financial planning, capability and performance January/February 2018 KLOE (key lines of enquiry) KLOE 1: Planning and delivery 1. Describe your key transformation priorities for the next three years 2. Outline how your transformation proposals will help to deliver improvements the key metrics 3. Describe how these will meet the specific needs of the City and Hackney KLOE 2: Financial planning, capability and performance 4. Outline how your transformation priorities will deliver efficiencies within the system, help to manage future demand or deliver financial savings KLOE 4: Engagement in design and delivery 5. Describe how you have used co-production to develop your proposals 6. Have the proposals been tested with clinicians and practitioners 7. What are you plans for ongoing public involvement and engagement over the next 6 months? KLOE 5: Transformation 8. Describe how you will move towards greater provider collaboration in 18/ Describe how you will take forward the model outlined in the Strategic Frameworks for Workstreams (headlines) document. Using the 6 service model as your framework outline how your plans will achieve the model over the next 3-5 years. 10. What model/s of accountable care systems is your workstream considering? 11. How are you planning to develop your thinking on this? 12. Outline any new forms of contracting or commissioning the workstream is exploring 13. What might be the key benefits and risks to this? 14. Describe how the big ticket items will transform care in the longer-term 15. Outline any additional big ticket items your workstream is considering? KLOE 6: Risk management 16. What might be the key benefits and risks with these proposals? KLOE 7: Contracting and commissioning 17. Describe the contracting model/s or mechanism/s will be used for these transformation priorities Information required: PowerPoint presentation of plans and supporting documentation. Engagement plan 14 ICB Page 113

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118 Sign-off: London Borough of Hackney - Anne Canning, Group Director, Children, Adults and Community Health City of London Corporation - Neal Hounsell, Assistant Director of Commissioning and Partnerships City & Hackney CCG - Paul Haigh, Chief Officer ICB Page 116

119 Title: Smoking Cessation and Making Every Contact Count Date: 23 and 24 May 2017 Lead Officer: Author: Paul Haigh, City & Hackney Clinical Commissioning Group Anne Canning, London Borough of Hackney Neal Hounsell, City of London Corporation Jayne Taylor and Gareth Wall, Prevention Workstream Directors Committee(s): City Integrated Commissioning Board, 23 May 2017 Public / Nonpublic Hackney Integrated Commissioning Board, 24 May 2017 Public Executive Summary: Smoking is the main preventable cause of early death and health inequality. There is a strong evidence base for effective interventions to tackle smoking, which has led to significant reductions in smoking prevalence over the past 40 years. However, locally smoking rates remain relatively high and there are significant inequalities in prevalence and associated health harms between different population groups. The biggest short-term gains are to be had from supporting smokers in contact with the NHS to quit; the greatest long-term benefits will accrue from stopping young people from starting to smoke in the first place. Much of the success in tackling smoking to date (increasing prices, regulating sales/advertising, as well as implementing smoke free legislation) has been achieved through national action. However, there is also much we can do, and have done, locally. Currently, over 95% of local spend on this key priority area is on smoking cessation services. In comparison, very little resource is spent on wider tobacco control and preventing the uptake of smoking. Further, smoking cessation services are focused on outreach and community-based clinics, with a failure to routinely embed smoking cessation as treatment in all relevant health and care pathways. This paper sets out areas of work related to smoking cessation and tobacco control and our current services and spend for each. It also proposes some areas which could benefit from an integrated commissioning approach. ICB Page 117

120 Recommendations: The Integrated Commissioning Board is asked: To NOTE plans and timescale for recommissioning local stop smoking services To NOTE plans to develop proposals to increase access to cessation support for harder to engage smokers and those in contact with health and care services To CONSIDER current balance of spend between stop smoking services, prevention and wider tobacco control and provide a steer for developing future plans. Links to Key Priorities: Hackney s Joint Health and Wellbeing Strategy has a priority to Control the use of tobacco, with a renewed emphasis on stopping people from starting smoking as well as helping them to quit. The importance of tackling smoking features throughout the City of London Health and Wellbeing Strategy. Priority five of the strategy, promoting healthy behaviours has a particular focus on helping City workers and residents to quit and extending smoke free zones. The NHS Standard Contract requires all NHS Trusts to ensure that all premises, including grounds and vehicles, are smoke free by 31 December Further, mental health trusts (from April 2017) and acute trusts (from April 2018) are required to implement systems for recording of smoking status, offer of advice and support to quit and referral to local stop smoking services as part of the Commissioning for Quality and Innovation (CQUIN) incentive payment scheme. Specific implications for City and Hackney There is a strong focus in the City on delivering effective stop smoking services and wider tobacco control activity targeted at workers as well as residents. The City is also a national leader in piloting e-cigarettes as part of cessation support. In Hackney, the focus is on working with the Homerton to embed smoking cessation in care pathways, which has been successfully achieved with maternity services; ongoing support for both Homerton and East London Foundation Trust (ELFT) to implement fully smoke free estates; and tailoring approaches to address high levels of smoking in specific communities. ICB Page 118

121 Patient and Public Involvement and Impact: Ongoing monitoring and review of stop smoking services in Hackney and the City includes consulting with people who have attempted to quit, both successfully and unsuccessfully, in order to encourage others and learn from smokers experiences. Healthwatch are involved via the two Health and Wellbeing Boards, and also membership of the Hackney tobacco control stakeholder forum. In 2016, a survey of illegal tobacco use was conducted across five councils in North Central London (including Hackney) to better understand public views in relation to cheap tobacco. Clinical/practitioner input and engagement: Hackney Health and Wellbeing Board acts as the local Tobacco Control Alliance and includes representation from the CCG, Homerton University Hospital Foundation Trust, ELFT, the Local Pharmaceutical Committee, voluntary and community sector, as well as local authority members and officers. This is supported by the local tobacco control stakeholder forum which includes clinical and practitioner representation. In the City, strategic oversight of tobacco control is provided by the Healthy Behaviours Steering Group. Membership of this group includes the CCG, local GP and the lead provider of the City s stop smoking service contract. Impact on / Overlap with Existing Services: Proposals to embed smoking cessation as treatment will affect clinical care pathways at Homerton and ELFT. Proposals to implement very brief advice and making every contact count (MECC) requirements across all health and care services will impact on social care contracts. Any decision to shift spend from service provision towards wider prevention and tobacco control activity will require strengthened collaborative working with other local public services. ICB Page 119

122 Main Report Background and Context Effective tobacco control strategies have led to significant reductions in smoking prevalence, which has more than halved over the past 40 years in the UK (from almost 50% to just 17% today). Despite this, smoking remains the main preventable cause of death and accounts for half of the difference in premature mortality between the richest and poorest areas. Smoking causes various cancers, respiratory disease and heart disease. For every death caused by smoking, approximately 20 smokers are living with a smoking-related disease (including Alzheimer s disease, osteoporosis, reduced fertility, and sight loss). Smoking in pregnancy is a wellknown risk factor for poor foetal growth and low birth weight. Smoking prevalence is higher than average in Hackney, at 20-22% (between 43,000 and 47,000 people). Estimates are less reliable for the City, but there are probably between 600 and 1,300 resident smokers, as well as a high number of City workers who smoke. Other key facts about smoking in Hackney and the City are summarised in Table 1 below (more detail is available in the Lifestyle and behaviour chapter of the City and Hackney Health and Wellbeing Profile). Table 1: Key facts about smoking in Hackney and the City High prevalence groups Young people Health impacts Costs (annual)* Socio-economically disadvantaged (27% of people in routine and manual occupations in Hackney smoke) Mental illness and/or substance misuse (GP patients with serious mental illness 2x as likely to smoke than average, but <3% referred to stop smoking services) Men are more likely to smoke than women (28% vs 18%) Higher prevalence in Black Caribbean (male and female), Turkish (male), Irish (male) communities 8% of 15 year olds in Hackney report smoking regularly Smoking causes just over 200 deaths each year locally NHS = 7.7m Social care = 5.0m Businesses (smoking breaks & sick days) = 35m Local economy (lost productivity & fires) = 22m Total societal cost = 70m Plus 28 tonnes of waste ICB Page 120

123 Uptake of stop smoking services Attitudes to cheap/illicit tobacco 7% of Hackney smokers used local services in 2015/16 Most users of City services are workers not residents 52% of local survey respondents agree that the availability of cheap tobacco undermines attempts to quit 60% agree something should be done to stop sales * Based on number of resident smokers this significantly underestimates the productivity and business costs associated with smoking among City workers. A comprehensive tobacco control strategy requires action at multiple levels to tackle both demand and supply. This involves increasing prices (e.g. through tobacco duties), restricting availability (e.g. banning over the counter sales and vending machines, under age sales legislation), tackling social norms (through mass media campaigns and advertising restrictions), changing perceptions (e.g. through standardised packaging), as well as treating addiction. Many of these levers are held at national level, but there is much we can do locally. Figure 1 below summarises the main components of an evidence-based local tobacco control strategy. Figure 1: Components of an evidence-based local tobacco control strategy ICB Page 121

124 Current tobacco control activity across the seven key areas 1. Education and communication on the harms of smoking 2016/17 activity 2016/17 budget Hackney National Stop Smoking Day and Stoptober promotional campaigns, coordinated by Hackney council officers City of London National campaigns and promotion of stop smoking services (part of stop smoking service contract) coordinated by lead provider of stop smoking services contract 2. Preventing young people from starting smoking No allocated budget 6, /17 activity 2016/17 budget Hackney Young People s Education and Outreach Service delivers prevention sessions to primary and secondary schools across the borough on the health harms of smoking Healthier Hackney Fund pilot projects in 2016/17: o Chinese and Vietnamese community intergenerational project o Chain Reaction theatre production and workshops in 6 schools o Breathe Life educational programme for Orthodox Jewish boys o Project with former gang members in Haggerston, primarily targeting Turkish & Kurdish youth City of London Schools outreach undertaken by Health and Wellbeing Trainer (part of stop smoking service contract) 3. Reducing the supply of illicit and cheap tobacco 75,434 No explicit budget 2016/17 activity 2016/17 budget ICB Page 122

125 Hackney Working with Hackney Trading Standards to reduce supply, enforce smokefree legislation, and increase reporting of cheap/illegal tobacco April 2016: illegal tobacco seizures across 17 sites (in Hackney, Newham, Islington, Camden, Enfield) over 1.5 days - 19,140 cigarettes, 7.9kg hand rolling tobacco, 3.75kg other tobacco products Sub-regional work with 7 boroughs (Camden, Islington, Enfield, Haringey, Tower Hamlets, Waltham Forest, Newham) survey on availability and attitudes towards cheap/illegal tobacco Involved with pan-london illegal tobacco group with Public Health England, GLA, Police, HMRC, Trading Standards and Public Health colleagues in other boroughs Revoking of alcohol licenses for premises that violate rules on the display of tobacco products or are found to have sold illegal tobacco. City of London 12,707 (estimated staff time) Not perceived to be a problem in the City No budget 4. Promoting smoke free environments 2016/17 activity 2016/17 budget Hackney LBH smoke-free premises since 2013 ELFT forensic unit smokefree since Jan 2016; City & Hackney Centre for Mental Health since March 2016 (but compliance challenges) Homerton plans for fully smokefree estate by Jan 2018 Voluntary bans on smoking in children s play areas in parks and, in some parks, extended to cafes and other areas where children congregate Full smoke free park pilot planned for Homerton Row City of London City of London operates a smoke-free premises policy No ifs no butts campaign, in partnership with the Street Environment team, which aims to reduce smoking-related litter and incentivise offenders to quit Smoke free children s play areas 12,707 (estimated staff time) No explicit budget ICB Page 123

126 5. Motivating and assisting every smoker to quit 2016/17 activity 2016/17 budget Hackney Level 1 training on very brief advice / making every contact count (MECC) available to all frontline staff, including Fire Brigade officers, Physical Activity trainers, Clinical Navigators, estate-based Health Coaches, Residential Environmental Health Officers, substance misuse service providers, and others Level 2 training to be a stop smoking practitioner (intensive motivational support) provided to staff in ELFT, Family Nurse Partnership (FNP) and pharmacists City of London Access to the same Level 1 and Level 2 training as for Hackney above 32,092 16,667 ICB Page 124

127 6. High quality and effective stop smoking services 2016/17 activity 2016/17 budget Hackney Specialist primary care clinics provided by a central team across 9 GP Hub practices Community outreach (targeting demographic groups with known high levels of smoking prevalence) and services aimed at in/out patients (including maternity) Pharmacy service, available in 23 pharmacies across the borough A central telephone and online triage service for residents to access the Hackney Stop Smoking service; distribution of marketing materials and social media management City of London Delivered as part of an integrated tobacco, alcohol and substance misuse support service (Square Mile Health) - stop smoking services are provided through specialist clinics run by Queen Mary University London and currently all 16 pharmacies across the City 7. Smoking cessation in pregnancy 1,078, , /17 activity 2016/17 budget Hackney Carbon Monoxide validation of smoking status and op-out referral at booking, 38 weeks, birth and 8 month visits All Family Nurse Partnership nurses trained as Level 2 stop smoking advisers Specific protocol for maternity referrals within the Hackney stop smoking central triage service (for GP Hubs, pharmacies or maternity clinics) City of London Following the introduction of this new approach (in Q3 2016/17), the number of maternity referrals into local stop smoking services increased from 80 (with 2 successful quit attempts) in Q2, to 113 (22 successful quit attempts) in Q3. Support to pregnant smokers provided through specialist stop smoking clinics (e.g. at St Barts Hospital and The Neaman GP practice), as part of core stop smoking service contract 12,707 (estimated staff time) No explicit budget ICB Page 125

128 Overview of current patterns of spend versus opportunity Figure 2 below shows that most of the current investment locally (as elsewhere) is in supporting a relatively small number of smokers to quit (in 2015/16, around 3,000 smokers accessed Hackney stop smoking services, and just under 400 accessed City services). As described previously, provision of evidence-based, appropriately targeted stop smoking services is an essential component of any local comprehensive tobacco control strategy, but it is important to keep the balance of spend under review to ensure that we are not missing important opportunities elsewhere. Figure 2: Allocation of tobacco control budget in Hackney and the City The biggest short-term gains from tackling smoking are to be had by helping smokers in contact with the NHS to quit (net savings to the NHS are expected within four years if NICE guidance on smoking cessation in acute, maternity and mental health services are implemented in full). However, the biggest long-term savings will be generated from preventing people from starting to smoke in the first place. We know from national data that 60% of smokers start before the age of 18, and 80% before the age of 20. Given the relatively young age profile of the local population, with almost 23, year olds living in Hackney in the City, this represents a large cohort of young people who may be at risk of long-term tobaccorelated health harms and a significant opportunity to target preventative interventions to reduce these risks. Options 1. Do nothing - re-commission existing stop smoking services (at contract end) with an effective and accessible offer, but with limited investment in wider tobacco control (to de-normalise smoking and prevent people taking up the habit) and little emphasis on smoking cessation as a core component of treatment within ICB Page 126