Newham CCG Board Part I. Meeting 8 th February pm 3.20pm Committee Rooms Newham CCG 4th Floor Unex Tower, 5 Station Street, London E15 1DA

Transcription

1 Newham CCG Board Part I Meeting 8 th February pm 3.20pm Committee Rooms Newham CCG 4th Floor Unex Tower, 5 Station Street, London E15 1DA 1

2 ACRONYM AC ACC A&E APMS AQP BDG Bart's / BHT BAF BMA BCP C&MCC CCC CQC CAG CCG CQRM CQUINs CSU CHN CHS CPD CCU DTOC DoH DRSS DES DASL ELFT EMIS web EPR EPCS EPCT FOI GMC GMS GP HoT HWT ICC IMT IMCA IG ITU MEANING Audit Committee Acute Commissioning Committee Accident & Emergency Alternative Provider Medical Services (a type of Primary care contract) Any qualified provider Board Development Group Barts Health NHS Trust Board Assurance Framework British Medical Association Business Continuity Plan Children & Maternity Commissioning Committee Community Commissioning Committee Care Quality Commission Clinical Academic group Clinical Commissioning Group Clinical Quality Review Meeting Commissioning for Quality and Innovation (Payment Framework) Commissioning Support Unit Community Health Newham Directorate Community Health Systems Continuing Professional Development Critical Care Unit Delayed Transfers of Care Department of Health Diabetes Retinopathy Screening Service Direct Enhanced Service Drug and Alcohol Service in London East London Foundation Trust Egton Medical Information Systems (System that records patient consults) Electronic Patient Record Extended Primary Care Service Extended Primary Care Team Freedom of Information General Medical Council General Medical Services (a type of Primary care contract) General Practitioner Heads of Terms (Contract Summary) Healthwatch Integrated Care Committee Information Management and Technology Independent Mental Capacity Advocate Information Governance Intensive Therapy Unit 2

3 ITT KPI LD LD SAF LAP LAs LCFS LES LMC LAS LBN MM MHCC MPIG NICE NUH NHSE NELCSU NCCG OOH PC PC PCCC PALS PPE PPG PREM PROM PMS PCT PHE QC QOF QIPP RAID RAG RC RTT R&D RLH SPR SPA TOR TIC TDA TSCL TST UCWG UCC UCC WELC Invitation to Tender Key Performance Indicator Learning Disability Learning Disability Self-Assessment Framework Local Area Partnership Local Authorities Local Counter Fraud Specialist Local enhanced service Local Medical Committee London Ambulance Service London Borough of Newham Medicines Management Mental Health Commissioning Committee Minimum Practice Income Guarantee National Institute of Health and Care Excellence Newham University Hospital NHS England North East London Commissioning Support Unit Newham Clinical Commissioning Group Out of hours Procurement Committee Practice Council Primary Care Commissioning Committee Patient Advice and Liaison Service Patient and Public Engagement Patient and Public Group Patient Reported Experience Measure Patient Reported Outcome Measures Personal Medical Services (a type of Primary care contract) Primary Care Trusts Public Health England Quality Committee Quality Outcome Framework (Assessor Validation Reports) Quality, Innovation, Productivity and Prevention Rapid Assessment Interface Discharge Red, Amber, Green Remuneration Committee Referral to Treatment Research & Development Royal London Hospital Service Program Review Single Point of Access Terms of reference Transformation and Innovation Committee Trust Development Authority Transforming Services Changing Lives Transforming Services Together Urgent Care Working Group Urgent Care Centre Urgent Care Centre Waltham Forest, East London and City (Integrated Care Programme) 3

4 Whipps X / WX Whipps Cross Hospital WTE Whole Time Equivalent 4

5 Newham Clinical Commissioning Group Board Meeting Part I Wednesday 8 th February :30pm 3:20pm Committee Rooms, 4 th Floor Unex Tower 5 Station Street, Stratford E15 1DA No. Time Item Page Author 1. Administration & Updates pm pm pm pm pm Welcome, Introductions, Apologies and Declarations of Interest Minutes of the Part I meeting 14 th December 2016 Part I Action Log Chair s Actions Chief Officer s Report 2. Patient & Public Engagement pm 3. Strategic Items for Approval pm pm pm pm pm Verbal Chair Chair Chair Chair S Gilvin Questions Verbal Chair Board Assurance Framework Quality Report Finance & QIPP Report Constitutional change recommendations of the Governance Working Group Governance Conflicts of Interest / Gifts, Hospitality and Anti-Fraud and Bribery / Sponsorship Policies meetings schedule to be advised 7 14 Verbal S Sanghera C Vyas C Whitton S Sanghera S Sanghera Date of next meeting 12 th April

6 Statement of advice on declaring interests at NCCG meetings Guidance All attendees are asked to declare any interest they have in any agenda item before it is discussed or as soon as it becomes apparent be that before or at the meeting. If during the course of a meeting an interest not previously declared is identified, this must be declared at that time. The record of a declared interest is the interest declared verbally at the meeting. An attendee cannot refer to interests already declared on the register of interests or an interest already declared at a previous meeting. There is no such thing as an ongoing interest. The minutes of the meeting will detail all declarations made and any relevant responses and/or action taken. Direct Financial Interest If you have a direct financial interest in any matter on the agenda you must not participate in any discussion or vote on that matter. If you do so you may be committing a criminal offence, as well as a Breach of the Conflict of Interest Policy and the CCG Code of Conduct. The individual should leave the meeting (including any public seating area) during consideration of the matter. Indirect Financial Interest You are required to make a verbal declaration of the existence and nature of any Indirect Financial Interest. Any Member who does not declare these interests in any matter when they apply may be in breach of the Policy and Code of Conduct. Other Interest You are required to declare an interest where a decision in relation to the business of the meeting might reasonably be regarded as affecting your well-being or financial standing, or a member of your family, or a person with whom you have a close association with to a greater extent than it would affect the majority of the GPs or other Board Members. If in doubt you should assume that a potential conflict of interest exists. Action upon declaration of an interest at a meeting For direct financial interests you must leave the meeting for that item For indirect financial interests and for other interests the action required will vary dependent upon the interpretation of the extent and influence of the interest and may involve; o leaving the meeting, o remaining at the meeting and not voting or speaking, o remaining at the meeting and both speaking and voting Chairs ruling For the avoidance of doubt the Chairs decision on a declaration of interest and its management is final 6

7 Item 1.2 Newham Clinical Commissioning Group (NCCG) Minutes of the Part I meeting of the Board held on Wednesday 14 th December 2016, 13.30pm pm Committee Rooms Unex Tower Stratford Present: Elected Voting Members Dr Prakash Chandra Dr Stuart Sutton Dr Muhammad Naqvi Dr Ambady Gopinathan Dr Rima Vaid Dr Bapu Sathyajith Appointed Voting Members Wayne Farah Andrea Lippett Fiona Smith Hazel Trotter Steve Gilvin Chad Whitton Grainne Siggins Appointed Non-Voting Members: Michael Rich Dr Ashwin Shah In attendance: Selina Douglas Chetan Vyas Satbinder Sanghera Mike Sims Dr Angela Wong Natalie Mizen Dee Parker Chair Elected GP Representative Newham CCG Deputy Chair Elected GP Representative Newham CCG Joint Deputy Chair Elected GP Representative Newham CCG Elected GP Representative Newham CCG Elected GP Representative Newham CCG Elected GP Representative Newham CCG Vice-Chair, Lay Member Patient & Public Engagement Newham CCG Lay Member Remuneration Newham CCG Registered Nurse NCCG Practice Manager Representative Newham CCG Chief Officer Newham CCG Chief Finance Officer Newham CCG Director of Adult Social Services LBN Newham CCG Healthwatch Member Co-opted Member Newham CCG Deputy Chief Officer Newham CCG Director of Quality & Development Newham CCG Director of Partnerships and Governance Newham CCG Board Secretary Newham CCG Cancer Clinical Lead BHT Director of RTT Performance and Improvement Head of Performance Acute MDT WEL CCGs 1 Administration and Updates 1.1 Welcome, Introduction, Apologies for Absence & Declarations of Interest The Chair welcomed all to the meeting. Apologies were given for: Dr Clare Davison Elected GP Representative Newham CCG 7

8 1.1.3 Rizwan Hasan Secondary Care Consultant Newham CCG Meradin Peachey Director of Public Health LBN Newham CCG There were no declarations of interest. 1.2 Minutes of the Part I meeting 12 th October Part I Action Log The minutes were approved as an accurate record of the meeting Accountable Care System Board training has been planned - completed Patient story and BHC review implications - completed Domestic Abuse training in Primary Care- planned - completed Increase in children s attendance at A&E; awaiting QTR 2 and 3 dataoutstanding BAF changes- completed Adult community DNA rate benchmarking- completed. 1.4 Chairs Actions There were no actions to report. The Chair gave condolences on the recent passing of Sir Robert Dolan, ELFT, and John Lock, SLGC. The Chair asked Board Members to improve on attendance at Board Development session which had recently slipped. The Chair reminded officers that Board Reports must be issued in a timely manner. 1.5 Chief Officer s Report S Gilvin introduced a report for information updating the Board on: Progress on the Contracting Round for Revision of the Newham CCG Operating Plan for GP Five Year Forward View TST Programme CQC Inspection of Newham University Hospital The Board raised the following issues; GP Five Year Forward View- whether the 170,000 had been allocated was a total sum to cover the Vulnerable Practice Programme, the Practice Resilience Scheme and the Practice Development Programme. S Gilvin confirmed that this was the case. That in terms of the contracting round with BHT there was clearly a significant risk to the existing proposed financial envelope if any arbitration process had to be invoked meaning savings would be required elsewhere. The Report was noted 8

9 2 Patient and Public Engagement 2.1 Questions There were no questions to the Board from members of the public. 3 Strategic Items for Approval 3.1 London Health and Care Devolution S Gilvin introduced a report for decision asking the Board to; 1. Note progress and the timescales to the next Devolution agreement for London, building on the commitments and priorities agreed in December Review and provide any comments on the current proposals as they support specific Devolution Pilot requests and enable the potential to devolve certain powers across London partners, including CCGs. 3. Support the development of the final Devolution agreement(s) and delegate authority to a named individual (i.e. Newham CCG Chair) to agree and sign the agreement on behalf of the CCG. S Gilvin clarified that; The report was being considered by all London CCGs in November and December. The proposal was based upon a tripartite agreement between Local Authorities, Councils and the Mayor of London Office. That the proposed memorandum of understanding (MOU) would not contain any governance authorities devolving existing powers. That in terms of clear specific local impacts for Newham the proposal would have positive implications for estates and the prevention agenda by way of licensing powers. The Board requested that a commitment be sought to include, within the principles, a commitment to sustainable development that was linked to population growth. The Board agreed; To support the development of a final Devolution Agreement and delegate authority to the Chair to sign the final agreement on behalf of the CCG North East London Sustainability & Transformation Plan (NEL STP) S Gilvin introduced a report for information asking the Board to note and comment on a revised STP summary, an updated narrative and the updated eight delivery plans. The Board made the following comments; That the STP Board should consider the development of a single statement on consultation rather than different boroughs; commissioners or providers developing their own in isolation. That a lack of clarity still seemed to remain in relation to where decision or reports were being endorsed as opposed to approved. That STP signalled a shared responsibly for local health economies, moving away from traditional clear divisions between commissioners and providers, and that the CCG should be mindful of this in its overall commissioning approach going forward. 9

10 That the plan I would still benefit from a little more commentary on links to the Prevention agenda. That there remained some concern on the level of resources being set aside for public consultation The Board noted that a further report would be received in February. The Report was noted Operating Plan Submission S Douglas introduced a report for discussion asking the Board to delegate authority for the final submission of the Operating Plan to the Chair of the Board and Chief Officer. S Gilvin advised that; The CCG was still awaiting NHSE feedback on the first draft submission returned 24 November The risk area for the CCG on constitutional standards were on achieving targets relating to first outpatient appointments by e- referrals and the provision of wheelchairs to children. The risk areas for the CCG on achieving the 9 Must Do s were on A&E waiting times and Referral to Treatment Time (RTT) standard. The Board noted that; Work was already underway with ELFT on ensuring compliance with the wheelchair target. The new eating disorder services was designed to align with the required target times. The Board agreed; To delegate authority for the final Operating Plan submission on 23 December 2016 to the Chair and Chief Officer Governing Body Structure and Constitutional change S Sanghera introduced a report for decision asking the Board to; Agree new terms of reference for Executive, Remuneration and Quality/ Performance/Finance Committees. Delegate the Executive Committee to approve the terms of reference for the Commissioning Committee. Adults and Children Integrated Health and Care Boards and Better Care Fund Delivery Groups. Agree other constitutional changes. S Sanghera clarified that; In terms of the election process the proposal was to publish a list of eligible voters six months prior to election but produce a fixed list three months before it took place. That two further areas still required the Constitution Working Groups review; the methodology for rotation of retirement as well as maximum terms of office and the overall numbers and roll of Clinical Leads. The Medicines Management Committee had dual reporting lines; to the Executive Committee in terms of delivery and the QPF Committee in terms of 10

11 assurance The Board made the following comments; That the proposed changes now formalised within the structure relating to partnership working were welcomed. That the current Executive Remuneration and Quality Committees should be permitted to make any final comments on the terms of reference proposed. The Board noted that a further report on outstanding items would therefore need consideration in the New Year. The Board agreed; The recommendation for a revised Governing Body Structure. The terms of reference for the Executive Remuneration and QPF Committees, delegating any final changes to those Committees. To delegate authority to the Executive Committee to approve the terms of reference for the Commissioning Committee, Adults and Children Integrated Health and Care Boards and Better Care Fund Delivery Group. The recommended Constitutional revisions Newham CCG Board Assurance Framework (BAF). S Sanghera introduced a report for decision asking the Board to approve the current Risk Rating for the BAF, specifically asking the Board to review risks that had missed their actions/mitigation dates and or were currently rated as high risk; NHS Constitution Standards Primary Care GP Federation MSK, Children, Adults and Urgent Care Centre commissioning Mental Health Urgent Care The Board made the following observations; That the next version of the BAF and report should detail where risks are increasing or not improving, how and where that might impact upon other risks. (Action CCG151: S Sanghera) That the BAF will require re mapping in relation to the revised governance structure. (Action CCG151: S Sanghera) That the BAF should also indicate what the end of year projected rating is thought to be as well as current and target ratings. (Action CCG151: S Sanghera) That the Board should hold a development session that would revisit its risk appetite position since this was currently not defined. (Action CCG152: C Vyas) The Board agreed; The current Risk Rating for the BAF Finance & Qipp Report C Whitton introduced a report for decision asking the Board to approve the CCG month 7 financial report and position. 11

12 3.6.2 C Whitton advised that; At Month 7 the CCG total resource allocation was 481,002,000 with planned expenditure, including reserves of 474,502,000 generating a surplus of 6,500,000 (1.5%). And the projected QIPP delivery was currently on track. The Board agreed; The Month 7 Finance Report Quality Report S Sutton introduced a report for decision asking Board to approve the actions taken by Newham CCG or CSU on behalf of Newham CCG in relation to the Red and Amber RAG rated Quality Indicators reported on an exception basis and approve the assurances provided in relation to the other Quality matters. S Sutton reported the following as key underperforming areas for three main providers although referred to other provider indicators in the report as well; Barts Health Red rated areas 17 Mixed Sex Accommodation breaches reported across Barts Health with 0 (zero) reported for Newham site 33% of Amber Alerts were actioned within 10 working days and the report outlines the work being undertaken with the Trust MRSA rated as Red due to the zero tolerance approach adopted nationally on this, 4 case reported September none on the Newham site Friends and Family Test A&E response rate is at 1.7% and the report outlining the actions taken by the Trust and CCG East London Foundation Trust Mental Health Red rated areas None reported East London Foundation Trust Community Health Red rated areas Safeguarding Children compliance Level 1 at 66% below the 85% target S Gilvin clarified that CQC inspection results for Royal London and Whipps Cross Hospitals would be published on 15th December 2016 and that Newham University Hospital s was expected to be published at the end of January. The Board requested that some form of benchmarking analysis against other CCGs for CQC inspection of GP Practices be made available if possible. (Action C Vyas) The Report was noted Board Performance Framework including RTT deep dive S Douglas introduced a report for monitoring asking the Board to discuss the performance of providers in relation to a range of indicators contained with the report. The Board also received a presentation on BHTs Clinical Harm Review Process, including all 52 week breach patients from Dr A Wong and N Mizen. 12

13 The Board commented that the system implemented by DR A Wong was clearly clinically robust as well as noting that BHT consultants were increasingly taking responsibility for the management of their own waiting lists. The Board noted it remained BHTs intention to introduce the Cerner Millennium Upgrade on the NUH site in 2017 which may present a potential risk to patient care and the CCG will discuss with BHT the risk management of this process. The Report was noted 13

14 Newhan CCG Board Action Log Part I - 8/2/17 ITEM highlighed items represent a recommendation to remove from register Action reference Meeting date CCG148 12/10/2016 Minute reference Action Owner Update Report back on findings on why there has been a significant increase in children's attendance at A&E S Sanghera Full data now received since last reported on in December and is under analysis BAF cover report being revised to include: CCG151 14/12/2016 BAF and report to detail where risks are increasing or not improving, how and where that might impact upon other risks, remapping in relation to the revised governance structure and indicate what the end of year projected rating is thought to be as well as current and target ratings S Sanghera - heatmap to demonstrate risk priorities - where risks are increasing/decreasing and the reason - end of year projection as well as current and orginal targets - BAF risks mapped against our strategic objectives to highlight some potential risk links and interdependencies. - BAF risks mapped against our revised governance structure ahead of a proposed 1 March 2017 go live date CCG152 14/12/ Hold a development session that would revisit its risk appetite position C Vyas Planned for April

15 Board 8 th February 2017 Title: Chief Officer s Report Agenda item: 1.5 Author: Presented by: Contact for further information: Steve Gilvin Chief Officer Newham CCG Steve Gilvin Chief Officer Newham CCG Steve Gilvin Chief Officer Newham CCG Date paper finalised: 1 st February 2017 Action requested: Executive summary: Note the report The report provides an update on work undertaken by the CCG team since the last Board meeting including: Progress on the Contracting Round for Revision of the Newham CCG Operating Plan for North East London STP CQC Inspection of Newham University Hospital Newham has its First CQC Rated Outstanding GP Practice GP Five Year Forward View Assessment of CCG s Patient and Public Engagement Flu Immunisation Improving Access to Primary Care How does this fit with Newham CCG Strategy: Where has the paper been already presented? Impact on risk: The above areas of work relate to key objectives of the CCG in relation to quality and safety of commissioned services, public engagement, primary care development, and improving outcomes for our population. N/A Key risks relating to these areas of work are contained within the Board Assurance Framework. 15

16 Item 1.5 Newham CCG Board Meeting: 1 st February 2017 Chief Officer Report 1. Progress on the Contracting Round for The CCG was able to meet the NHS England planning guidance requirement to agree two year contracts with our key NHS providers, covering the financial years and by 23 rd December Contracts were successfully negotiated and agreed with Barts Health NHS Trust and East London Foundation NHS Trust for both mental health and community health services. The contracting round this year was undertaken in the context of the North East London Sustainability and Transformation Plan and the aim of achieving financial sustainability for all NHS providers in the STP footprint. Each contract was agreed with a number of assumptions regarding the levels of commissioner QIPP and provider CIPs. A mechanism has been agreed through the STP to jointly review these plans during February and March to provide mutual assurance around the levels of finance and activity that will flow through those contracts so that commissioner and provider positions are aligned. 2. Revision of the Newham CCG Operating Plan for The CCG submitted an updated Operating Plan on 23rd December 2016 in line with national guidance. The operating plan set out how the CCG will meet all of the 9 national must-dos: Implement STPs to ensure the system is on track for full achievement by Deliver financial control totals both at CCG and STP level Ensure the sustainability of General Practice by implementing the General Practice Forward View Deliver the 4-hours A & E standard Deliver the NHS constitution 18 week referral to treatment time standard Improve cancer services including delivery of 62 day standard for beginnings treatment and improving early diagnosis and one year survival rates Deliver the Mental Health Five Year Forward View including standards in relation to IAPT, dementia and treatment for psychosis Improve outcomes for people with Learning Disabilities including the Transforming Care programme Improve quality in all NHS organisation particularly those in special measures The CCG s operating plan is compliant with delivering these programmes with the exception of the two national standards that Barts Health NHS Trust are currently not meeting i.e. A & E waiting time standard which the Trust is failing due to the performance on the RLH and Whipps sites and Referral to Treatment Time standard where the Trust is not currently reporting due to data quality issues. The CCG agreed with the Trust a plan to move to return to reporting against the 18 week standard during Quarter 3 of

17 3. North East London Sustainability and Transformation Plan The North East London (NEL) STP developed a more detailed submission which was made on 21st October This version of the plan has now been published on the STP website along with a summary document. The STP is an umbrella plan which is based on delivery of the Transforming Services Together programme that the CCG has committed to delivering and our local Borough based plan. The emphasis has now switched to engagement with stakeholders on the content of the STP and delivery of the key components of the plan. A more detailed engagement plan is being developed. Newham CCG has begun local discussions in the Borough with partner agencies and will utilise our patient and public engagement platforms to engage on the plan. Further work is focused on the key themes in the plan including development of the transformation programmes based on the two devolution pilots and the Transforming Services Together programme, a North East London approach to delivery of the GP Five Year Forward View, and providers working together to improve productivity. There has also been work on the governance arrangements and a Memorandum of Understanding is currently being redrafted after partner organisations have been consulted. This will set out the arrangements for oversight of the programme.. 4. CQC Re-inspection of Newham University Hospital The CQC undertook a reinspection of the Newham University Hospital site in November The CQC report on the visit is expected in March The reports on the reinspections of the Royal London Hospital and Whipps Cross Hospital sites were published in January The Royal London rating has moved to a Requires Improvement rating from an Inadequate and whilst Whipps Cross Hospital has still been rated inadequate there are significant improvements in the rating of the majority of domains that demonstrate significant improvement in the quality of care provided at the site compared with the original inspection. An overall rating for the Trust will be reviewed in the light of the NUH rating when it is published during March. 5. Newham has its First CQC Rated Outstanding GP Practice The CQC have just confirmed their assessment of the Woodgrange Medical Practice and have rated the practice as Outstanding. There are very few GP practices in London that have been given this judgment by the CQC and this is only the second practice in north East London to receive this rating. This is a testament to the hard-work and dedication of all of the GP, clinical and non-clinical staff at the practice and we have sent congratulations to the practice for this achievement. The report is expected to be published on the CQC website shortly. 17

18 6. GP Five Year Forward View Newham CCG is currently working to ensure that the allocation received to support the practice resilience programme outlined in the GP Forward View is committed n The resources received included allocations under the vulnerable practice programme, the practice resilience scheme and the practice development programme and total approximately 170,000 for The CCG, working in partnership with Newham Health Collaborative, was successful in bidding for funding through the GP Forward View resources for 28 practices to take part in the Productive General Practice programme. The CCG has been awarded early adopter status for NHS England s Releasing Time for Care programme. This programme is designed to help practices release time for both clinical and non-clinical staff through a range of proven interventions to help release time for clinical work. Each practice will receive six hands-on sessions in practice plus four group-based learning sessions. This is an early example of how collaborative working between the CCG and NHC will secure support for General Practice in Newham. 7. Patient and Public Engagement NHS England has assessed each CCG s delivery of its statutory obligations in relation to both its collective and individual duty to involve patients and the public. Newham CCG received its assessment in January 2017 and has been rated Good for both its collective and individual duties. This continues Newham s strong tradition of commitment to working with our local communities to ensure that patients and the public are involved in the planning and the delivery of health care. 8. Flu Immunisation Programme The annual flu immunisation programme runs until 31 st January and the latest figures suggest that Newham GPs have again, for the third year running, achieved the best performance against the flu immunisation programme of all CCGs in London. The final figures will be known at the end of the month and will be published. The flu immunisation programme is particularly important as we come into that period of the winter when flu viruses are more prevalent and therefore the risk to health of older people and others in at risk groups is greatest. This is an important public health achievement which also impacts on the workload of primary and secondary care during flu outbreaks. 9. Access Offer As reported in December the CCG has received funding of over 500,000 from NHS England to develop extended hours access for General Practice. The CCG has invested these resources in a 6.30pm to 8pm Monday to Friday service and an 8 am to 8 pm Saturday and Sunday service across 2 hubs and this service is now live 18

19 The service has been commissioned from Newham Health Collaborative working in partnership with the Newham GP Out of Hours Co-operative to deliver this scheme. The service is delivered from a range of sites spread evenly across the Newham footprint providing bookable appointments during the hours set out above. The expectation is that practices cover the bulk of core hours between 8 and 6.30 pm while a model of groups of practices providing appointments through a hub will cover the 6.30pm -8 pm period. This service opened from 1 st December for the Monday to Friday extended hours in the evenings and the weekend service went live in January. Steve Gilvin Chief Officer 1 st February

20 Board 8 February 2016 Title: Newham CCG Board Assurance Framework (BAF) Agenda item 3.1 Author: Jason Clarke, Information Governance & Risk Lead, Newham CCG Presented by: Satbinder Sanghera, Director of Partnerships & Governance Newham CCG Contact for further information: Satbinder Sanghera, Director of Partnerships & Governance, Newham CCG; Satbinder.sanghera@newhamccg.nhs.uk; This Paper is for: Decision Action required: The report highlights the following BAF risks that have missed their mitigation actions / and or are currently high risk rated, for the Board to review and comment: NHS Constitutional standards STP Primary Care GP Federations Adult Community Services and Urgent and Emergency Care recommissioning Transforming Services Together Care closer to home Finance Performance and activity levels of acute and non acute provider The report also asks the Board to note the changes to the risk scoring for the following risks: BAF.03, BAF.03.01, BAF.04, BAF and BAF The Board is requested to note the proposed next steps identified in section 4. The Board is requested to approve the current risk ratings for the 2016/17 BAF. Executive summary: The Board is asked to approve the updates provided in relation to the key CCG strategic risks. The format of the report has been updated to include an indicator for each risk as to whether the risk is increasing or improving and also a projected year end rating is detailed in the narrative. These changes are in response to the discussion at the Board in December. 20

21 Supporting papers: Appendix 1 BAF Risk Review and Analysis report How does this fit with Newham CCG Strategy: Values: Accountability and responsibility Where has the paper been already presented? No previous presentation to any meeting. Risk: A failure to operate a risk management system would expose the organisation to the risk of inadequate governance arrangements and inadequate management and mitigation of the key risks that may hinder the CCG achieving its stated priorities. Equality Impact: The CCG has a strong and unequivocal commitment to promoting equality for all our communities. We believe that Newham CCG should be an exemplar of good practice and able to demonstrate consistently that we are innovative and at the forefront of pushing boundaries for greater equality. We think that our approach to patient and public engagement provides a blueprint for our work because our PPE work has now begun to be mainstreamed across all commissioning activity. We consider equalities to be integrally linked to quality and our PPE approach and over the next year we will be looking to how we can mainstream within quality and PPE, our equalities objectives. The CCG expects that the next stage of our PPE work will focus on a more flexible approach intrinsically linked to commissioning activities and that equalities will be central to that, likewise the work on quality processes and indicators and improvement will encompass equalities considerations. The CCG has reviewed the EDS2 (Equality Delivery System) that sets out the CCG s Equality Objectives, undertake an equalities analysis of policies and services and set out the work that we will be undertaking with patient, stakeholders and providers. The Board has started the process to agree a revised Equalities Strategy will commit the CCG to SMART actions underlined with the approach identified above that will aim to ensure that equalities is embedded within the organisation. A key action will be to communicate to all commissioning committees their responsibility in relation to equalities impact assessments and targets and to monitor their compliance. Following agreement of the plans and actions, the Director of Partnerships and Governance will provide a quarterly report to the Executive on progress and implementation. Stakeholder engagement: None. 21

22 Financial Implications CCG faces reputational and financial risks if risks identified in this paper are not sufficiently mitigated. Plans outlined in this paper address these issues however inherent financial risk remains. 1. Introduction and Background 1.1 Introduction The BAF is the primary mechanism by which the Board of NHS Newham CCG is appraised and updated on material risks which may affect the CCG s ability to deliver its strategic objectives as set out in the Operating Plan. 2. Key Considerations BAF heat map: The following heat map presents a visual projection of each BAF risk against our 5x5 risk matrix The above diagram highlights where key priority risks are, and the Board are asked to note the current position of each BAF risk and seek assurances that the direction of travel indicates that the risks are decreasing throughout the year. The following risks remain unchanged during 2016/17: BAF.01 Failure to meet NHS Constitutional standards Current rating 16 (High) Management leads response: The Trust continues to fail to meet the A&E target and is not reporting against the RTT standard, whilst consistently meeting the Cancer and Diagnostic targets. The RTT standard is a major concern and the Trust are not expected to be in a position where they are able to return to reporting until the end of Q2 2017/18. The Trust has established a RTT Recovery Board where the CCG and NHS England and NHS Improvement are represented to review progress against their plan to improve data quality to be able to return to reporting and to 22

23 meet the standard BAF.02 Failure to operationalise the STP to secure a financially sustainable balanced East London Health economy Current rating 16 (High) Management leads response: The STP submitted in October 2016 has been agreed by the partners. The plan went to NHSE and NHSI on 21st October as originally proposed and the feedback from NHSE and NHSI has been positive to date with detailed feedback expected shortly. The MOU to support the STP governance arrangements has been drafted and is currently being consulted on with comments due by the end of January This is based on the work of the Governance sub-group. Operating plans have been agreed for 2017/19 and the STP programme are now triangulating the plans from partners. It is expected that this risk will be in position to decrease over the coming month BAF.06 Failure to effectively integrate health & social care Current rating 16 (High) Management leads response: The CCG is currently working jointly on the Building Healthy Communities programme with adult social care. The collaborative commissioning structure has been agreed by the Remuneration Committee. The CCG has developed a Better Care Fund Delivery Group forward plan and continues to make quarterly submissions to NHSE, which have been assured as Good BAF Failure to develop a Primary Care Strategy that is adequately resourced to service Newham residents and secure a sustainable and viable GP Federation Primary Care Current rating 16 (High) Management leads response: Primary Care development sessions have been held for the Board and regular reports are made to the Primary Care Commissioning Committee with progress in between reviewed by SMT BAF Failure to develop a Primary Care Strategy that is adequately resourced to service Newham residents and secure a sustainable and viable GP Federation GP Federation Current rating 16 (High) Management leads response: The business case from the Newham Health Collaborative (NHC) was submitted and approved with conditions at the PCCC. NHC were unsuccessful in appointing a substantive Chief Executive following external recruitment exercises. Interim arrangements have been put in place to support the Federation and this includes a secondment of a senior CCG Finance team member. A package of support is currently being negotiated with NHC BAF Failure to deliver the stated TST benefits including quality and financial efficiency: - Care Closer to Home Current rating 16 (High) Management leads response: TST has now been aligned with the Operating Plan and the STP. An interim internal delivery plan has been agreed whilst we await full implementation of the revised CCG resourcing structure for Commissioning. 23

24 BAF Failure to transform services through re- commissioning (children, adults, UCC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised adults Current rating 16 (High) Management leads response: Route to market for adults, children and urgent care centre is being presented to the February Board BAF Failure to transform services through re- commissioning (children, adults, UCC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised UCC Current rating 16 (High) Management leads response: The specification for UCC/111 is in final draft format. Preparation is in place to present to Part III Board in March/April Route to market for adults, children and urgent care centre is being presented to the February Board BAF Failure to transform services through re- commissioning (children, adults, UEC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised MSK Current rating 16 (High) Management leads response: The structured collaboration process has been agreed by the Board. Contract signing ad mobilisation scheduled for end Feb 17 with a go live date is set for 1 April Risk direction of travel: The following risk ratings have been reduced since the last report: BAF.03 Failure to effectively monitor performance and activity levels of acute and nonacute providers. Reason for the change: The overall BAF risk 03 has been reduced in line with the supporting risks and which are both now a BAF Failure to effectively monitor performance and activity levels of acute providers. The below image indicates the direction of travel for BAF Reason for the change: The implementation of the activity query notice (AQN) process has improved the robustness and accuracy of the monitoring process. This helps to inform the discussions held at the monthly SPR meetings which are chaired by the NHS Newham CCG Chief Officer. This risk is expected to achieve the year-end target risk rating of 8. 24

25 2.2.3 BAF 04 Failure to effectively monitor the quality of commissioned services for all healthcare providers Reason for the change: The internal controls have been reviewed and some now fully effective as a result of the controls overtime demonstrating improvements. For example CQRMs are effective in highlighting areas of progress as well as areas for improvement. The CQRM holds providers to account and monitors progress to improve the quality of care being delivered BAF Failure to effectively monitor the quality of commissioned services for Barts Health Reason for the change: The internal controls have been reviewed and some are now regarded as fully effective as a result of the controls overtime demonstrating improvements. For example the CQRM reviews the progress made against the CQC Quality Improvement Plan and the meeting holds the provider to account on the delivery and impact of the Quality Improvement Plan for the Newham site BAF Failure to effectively monitor the quality of commissioned services for East London Foundation Trust Reason for the change: The internal controls have been reviewed and some are now regarded as fully effective as a result of the controls overtime demonstrating improvements. For example the CQRM has held the provider to account on Adults Mental Health re-admission rates, and as a result have seen improved performance in relation to the number of patients being re-admitted. 3.0 Risk alignment 3.1 The following table identifies which BAF risks are linked to each of our strategic objectives. This is a piece of work we are undertaking to ensure that the links and interdependencies between our BAF risks are appropriately identified. This will allow the Board to be assured that any associated impact of a risk increase or decrease to a BAF risk is appropriately considered by the relevant management lead: 25

26 Strategic Objective BAF Risk 1. To ensure community health services are responsive, located at the heart of our communities and able to meet the current and future needs of the population. 2. To develop a primary care system that is modern, accessible and robust enough to care for the local population now and into the future. BAF.04 BAF.07 BAF.03 BAF To ensure our population can access effective, high quality urgent and emergency care in and out of hospital 4. To develop a strong and sustainable acute system that places the needs of the patient at the heart of its design. BAF.03 BAF.04 BAF.05 BAF.04 BAF.05 BAF.08 BAF To be central to a whole system approach working across traditional boundaries to effectively tackle health inequalities and make a positive impact on the health and social care economy of East London. BAF.06 BAF Staff and clinical leaders are equipped with the skills and expertise to enable the delivery of the CCG s priorities and commissioning agenda. BAF To review and improve the existing governance structures to ensure they effectively support the delivery of our corporate and strategic objectives and our statutory duties. BAF.01 BAF.02 BAF The following table highlights our current BAF risks and the lead committee within the new governance structure. The lead committee will be responsible for assuring the Board that the risks are appropriately managed, the controls and actions in place are effectively monitored, managed and scrutinised. BAF risk BAF 01 Failure to meet NHS constitutional standards. Lead committee Quality, Performance and Finance Committee BAF.02 Failure to operationalise the STP to secure a financially sustainable balanced East London Health Executive Committee 26

27 Economy. BAF.03 Failure to effectively monitor performance and activity levels of acute and non-acute providers. Quality, Performance and Finance Committee BAF.04 Failure to effectively monitor the quality of commissioned services for all healthcare providers. Quality, Performance and Finance Committee BAF.05 Failure to meet the CCG s financial targets for 2016/17 and 2017/18. Quality, Performance and Finance Committee BAF.06 Failure to effectively integrate health & social care. The Commissioning Committee BAF.07 Failure to develop a Primary Care Strategy that is adequately resourced to service Newham residents and secure a sustainable and viable GP Federation. Primary Care Commissioning Committee BAF.08 Failure to deliver the stated TST benefits including quality and financial efficiency. Commissioning Committee BAF.09 Failure to transform services through recommissioning (children, adults, UCC and MSK) and that inter dependencies with NHS 111 and other recommissioned services are not realised. Commissioning Committee BAF.10 Failure to implement the improvements in agreed corporate governance structure. Executive Committee BAF.11 Failure to equip staff, the Board and clinical leaders with the skills, knowledge and expertise to enable the delivery of the CCG s priorities and commissioning agenda. Executive Committee When the BAF for 2017/18 is finalised, the new risks will be mapped against the committee structures and this will be highlighted in each update report to the Board. 4. Next steps To ensure that we are continually developing our risk management approach with the CCG, work is currently ongoing in the following areas and we are undertaking the following actions: BAF 2017/18 We are currently undertaking a review of potential BAF risks for 2017/18 to ensure that the risks 27

28 identified are appropriate and the wording accurately reflects the risk to our potential inability to comply with our strategic objectives. However, this exercise will need further guidance from the Board to determine CCG priorities for 2017/18. Work is being undertaken with our Executive Leads to identify any new and emerging potential risks that may need to be reflected as part of our 2017/18 BAF and we are looking at the risks identified with other local CCGs to ensure that the nature, and number, of our BAF risks is consistent with other local health organisations Risk appetite and tolerance: A risk appetite and tolerance matrix has been developed and will be taken to our upcoming Board development session to ensure that the Board are involved setting our risk appetite from 2017/18 onwards. This will ensure that the Board have a greater level of assurance regarding the effectiveness of our internal controls and how we undertake mitigating actions to effectively plug any identified gaps in control Board development session Risk management and Board assurance has been included on our Board development forward planner. The aim of the session will be to ensure that the Board are adequately informed on how to implement the BAF in the most effective way in order to obtain the greatest degree of assurances that our risk management processes are effective and robust Revised committee structures For risk management to be effectively embedded within the culture of the CCG, the Board should seek adequate assurances from its sub-committees that risk management is prioritised and managed. Committees should be scrutinising the risks linked to their individual work streams and escalating these appropriately when they become high risk and the Board should be sighted. ly risk management at committee level will ensure that the link between operational and strategic is developed and the Board are assured that the risk controls in place are fit for purpose. We are working to ensure that each Committee develops an annual forward plan that includes risk management. 28

29 Board Assurance Framework Document information Version Version 4.0 Chair: Dr Prakash Chandra Accountable Officer: Steve Gilvin 1 29

30 Contents 2. Purpose and Scope Board Assurance Framework Risk Management Governance Strategic Objectives Risk Identifiers Newham CCG Risk Grading Matrix Risk Rating Matrix Common abbreviations used in the BAF

31 2. Purpose and Scope 2.1 Board Assurance Framework The primary purpose of the Newham CCG Board Assurance Framework (BAF) is to: 1) Act as a mechanism for alerting and appraising the Board of the main risks to achieving to the CCG in terms of achieving strategic objectives as set out in the Operating Plan 2) List, evaluate and provide assurance to the Board regarding the mitigations in place to the reduce the likelihood or impact of the risk 3) Summarise to the Board the remedial or proposed actions that further mitigate the likelihood or impact of the risk The BAF is also an important document for providing external assurance (to NHS England, Internal Audit and patients and public) that the CCG is sighted on its risks and has a robust system of internal control. 2.2 Risk Management Governance Risk Management is embedded in Newham CCG s Governance Structure:- The Audit Committee is responsible for scrutinising the group s Risk Management policies and procedures. Accountable to the group s Board, the Committee provides the Board with an independent and objective view of the group s financial systems, financial information and compliance with laws, regulations and directions governing the group in so far as they relate to finance. The Executive Committee is responsible for approving internal control arrangements, risk sharing and pooling agreements. The Chief Officer is responsible for approving the group s arrangements for business continuity and emergency planning. The Chief Finance Officer is responsible for approving the group s Counter Fraud, Security Management and Risk Management arrangements. The Governing Board is responsible for approving and monitoring the Board Assurance Framework. 2.3 Strategic Objectives BAF risks have been linked to the core strategic objectives of Newham CCG, as outlined in the Newham CCG Operating Plan. These are: 1.1. To ensure community health services are responsive, located at the heart of our communities and able to meet the current and future needs of the population 3 31

32 1.2. To develop a primary care system that is modern, accessible and robust enough to care for the local population now and into the future 1.3. To ensure our population can access effective, high quality urgent and emergency care in and out of hospital 1.4. To develop a strong and sustainable acute system that places the needs of the patient at the heart of its design 1.5. To be central to a whole system approach working across traditional boundaries to effectively tackle health inequalities and make a positive impact on the health and social care economy of East London 1.6. Staff and clinical leaders are equipped with the skills and expertise to enable the delivery of the CCG s priorities and commissioning agenda 1.7. To review and improve the existing governance structures to ensure they effectively support the delivery of our corporate and strategic objectives and our statutory duties It is recognised that a number of BAF risks could be linked to more than one of the above strategic objectives. 2.4 Risk Identifiers Each BAF risk will be assigned a unique risk identifier (number) linked to the applicable strategic objective. 2.5 Newham CCG Risk Grading Matrix Risk Impact Assessing the possible impact of a risk in conjunction with the likelihood of the risk occurring is used to determine the risk rating. 4 32

33 Risk Rating Risk Category High (Risk Rating 15-25) Risk Category desription High categorisation level risks are not acceptable under any circumstances as they will (i) be highly likely to prevent the achievement of the corporate, principle and business objectives and will damage the organisation s reputation, politically and financially as well as creating a significant and unacceptable response from stakeholders, (ii) impact on individual or population health outcomes resulting in death. They require specific monitoring and appropriate action plans at Board level to ensure that their impact is mitigated at the earliest opportunity Medium (Risk Rating 8-14) Medium categorisation risks are generally not acceptable as they are likely to (i) cause much disruption and efficiency losses to the achievement of corporate, principle and business objectives, (ii) impact on individual or population health outcomes resulting in greater chances of suboptimal health outcomes. They require specific monitoring and appropriate action plans at individual directorate senior management level to ensure that their impact does not increase to a higher risk level Low (Risk Rating 1-7) Low categorisation risks are in general at an acceptable level of risk as they are (i) unlikely to cause much disruption and efficiency losses to the achievement of corporate, principle and business objectives, (ii) impact on individual or population health outcomes resulting in some chances of suboptimal health outcomes. They are unlikely to require specific application of resources and will be subject to on-going review and monitoring at a departmental / functional level 5 33

34 2.6 Risk Rating Matrix The table below can be used to help to determine an appropriate risk rating. Examples are not exhaustive and are given to aid assessment only. 6 34

35 2.7. Common abbreviations used in the BAF Below is a list of commonly used abbreviations that are found in the risk summary of the BAF. These are detailed below for ease of reference: Barts/BHT BCP CEG CCG COI CQC CQN CQRM CQUIN DES DoH ELFT EPCT EPCS FBC F&A FOI HoT HWBB IAPT Barts Health NHS Trust Business Continuity Plan Clinical ness Group (provider of primary care data quality and informatics and analytics services to the CCG and Newham GP Practices) Clinical Commissioning Group Conflict of Interest Care Quality Commission Contract Query Notice Clinical Quality Review Meeting Commissioning for Quality and Innovation Direct Enhanced Service Department of Health East London Foundation Trust (The provider of Community and Mental Health Services in Newham) Extended Primary Care Team Extended Primary Care Services Full Business Case Finance and Activity Freedom of Information Heads of Terms Health and Wellbeing Board Improving Access to Psychological Therapies 7 35

36 IC IG IM&T ITT KPI LA LAS LBN LD LIS LMC NEL(CSU) NELIE NHSE NUH OOH PDP PMC PPE QIPP RAID Integrated Care Information Governance Information Management and Technology Invitation to Tender Key Performance Indicator Local Authority London Ambulance Service London Borough of Newham Learning Disability Local Incentive Scheme Local Medical Committee North East London (Commissioning Support Unit) North and East London Information Exchange (A web based commissioning analytics tool) NHS England Newham University Hospital Out of Hours Personal Development Plan Practice Member Council Patient and Public Engagement Quality, Innovation, Productivity and Prevention (a large-scale programme developed by the Department of Health to drive forward quality improvements in NHS care, at the same time as making up to 20 billion of efficiency savings by 2014/15) Rapid Assessment, Interface and Discharge 8 36

37 RAG RAP RLH RTT SI SLA SMT SPG SPR TDA TNA ToR UCC WEL WHX Red, Amber, Green (e.g. the status of a risk or performance indicator) Remedial Action Plan Royal London Hospital Referral to Treatment Serious Incident Service Level Agreement Senior Management Team Strategic Planning Group Service Performance Review Meeting Trust Development Authority Training Needs Analysis Terms of Reference Urgent Care Centre Waltham Forest and East London (CCGs) WEL CCGs are: Newham, Tower Hamlets and Waltham Forest. *WELC CCGs also includes City and Hackney CCG. Whipps Cross Hospital 9 37

38 Risk Profile Risk ID Objective Risk Summary Risk Owner Initial Risk Rating Latest Forecast Trend End of Year Target Review Date BAF Failure to meet NHS Constitutional standards Steve Gilvin Jan-2017 BAF ; 1.5 Failure to operationalise the STP to secure a financially sustainable balanced East London Health Economy Steve Gilvin Jan-2017 BAF Failure to effectively monitor performance and activity levels of acute and non - acute providers Steve Gilvin Jan-2017 BAF Failure to effectively monitor performance and activity levels of acute providers Ian Tritschler Jan-2017 BAF Failure to effectively monitor performance and activity levels of non - acute providers Ian Tritschler Jan-2017 BAF ; 1.5 Failure to effectively monitor the quality of commissioned services for all healthcare providers Chetan Vyas Feb

39 Risk ID Objective Risk Summary Risk Owner Initial Risk Rating Latest Forecast Trend End of Year Target Review Date BAF ; 1.5 Failure to effectively monitor the quality of commissioned services for Barts Health Chetan Vyas Feb-2017 BAF ; 1.5 Failure to effectively monitor the quality of commissioned services for East London Foundation Trust Chetan Vyas Feb-2017 BAF Failure to meet the CCG s financial targets for 2016/17 and 2017/18 Chad Whitton Jan-2017 BAF Failure to effectively integrate health & social care Selina Douglas Jan-2017 BAF Failure to develop a Primary Care Strategy that is adequately resourced to service Newham Residents and secure a sustainable and viable GP Federation Selina Douglas Jan

40 Risk ID Objective Risk Summary Risk Owner Initial Risk Rating Latest Forecast Trend End of Year Target Review Date BAF Failure to develop a Primary Care Strategy that is adequately resourced to service Newham Residents and secure a sustainable and viable GP Federation - Primary Care Selina Douglas Jan-2017 BAF Failure to develop a Primary Care Strategy that is adequately resourced to service Newham Residents and secure a sustainable and viable GP Federation - GP Federation Steve Gilvin Jan-2017 BAF ; 1.4 Failure to deliver the stated TST benefits including quality and financial efficiency Steve Gilvin Jan-2017 BAF ; 1.4 Failure to deliver the stated TST benefits including quality and financial efficiency: - Sustainable Hospitals Steve Gilvin Jan-2017 BAF ; 1.4 Failure to deliver the stated TST benefits including quality and financial efficiency: - Care Closer to Home Steve Gilvin Jan

41 Risk ID Objective Risk Summary Risk Owner Initial Risk Rating Latest Forecast Trend End of Year Target Review Date BAF Failure to transform services through re- commissioning (children, adults, UCC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised. Selina Douglas Jan-2017 BAF Failure to transform services through re- commissioning (children, adults, UCC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised - children Selina Douglas Nov-2016 BAF Failure to transform services through re- commissioning (children, adults, UEC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised - adults Selina Douglas Jan-2017 BAF Failure to transform services through re- commissioning (children, adults, UCC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised - UCC Selina Douglas Jan-2017 BAF Failure to transform services through re- commissioning (children, adults, UCC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised - MSK Selina Douglas Jan

42 Risk ID Objective Risk Summary Risk Owner Initial Risk Rating Latest Forecast Trend End of Year Target Review Date BAF Failure to implement the improvements agreed in corporate governance structure Satbinder Sanghera Jan-2017 BAF Failure to equip staff, the Board and clinical leaders with the skills, knowledge and expertise to enable the delivery of the CCG s priorities and commissioning agenda Chetan Vyas Jan

43 BAF.01 Failure to meet NHS Constitutional standards Risk Owner Steve Gilvin Lead Committee Executive Committee Next Review Date Current RAG Status Red Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2017 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.01a NHS Standard Contract BAF.01b Contract Review Group (CRG) BAF.01c Urgent Care Working group BAF.01d RTT, Diagnostics and Cancer Meeting BAF.01e Performance Reports to Acute Commissioning Committee BAF.01f Performance Report to Board The NHS Standard Contract provides a number of contract clauses to facilitate the tracking of performance against NHS Constitutional Standards and incentivise delivery. This is now in the form of issuing of Contract Performance Notices (CPNs). In , CCGS are unable to to impose nationally mandated financially penalties as NHSE and NHS improvement have directed; use perforamce against standards to determine access to STF. The CRG is a contractual requirement between Commissioner and Provider General Condition 8 (GC8). This is the main contract meeting each month and is the forum for escalation of noncontract compliance, which includes a provider not delivering the NHS Constitutional requirements. Monthly meeting of Urgent Care working group to oversea the delivery of A&E standards BAF.01d RTT, Diagnostics and Cancer Monthly meeting Reports produced by NEL CSU, for the CCGs Acute Commissioning Committee, to advise group members on current provider performance against NHS Constitutional Standards. CCG Board receives a performance report which includes performance against the national standards for all the commissioned providers a. Completed and signed NHSE Assurance Contract Documentation b. SDIPs - STP trajectories - specific levels of performance, on a monthly by month basis during 2016/17, against Operational Standards in relation to provider performance against Sustainable & Transformational Fund Performance trajectories and assurance statements. c. Remedial Action Plans (RAPs) a. CRG Terms of Reference b. CRG Meeting Minutes. C. Clinical Strategy Group a. System Review Group (System Cabinet) b. Terms of Reference for site level meetings. c. Meeting Minutes of site specific meetings. d. Reporting packs produced by the Trust. e. UC working group f. A & E standards a. RTT, Diagnostics and Cancer Monthly Meeting Terms of Reference. b. RTT, Diagnostics and Cancer Monthly Meeting Minutes. c. Reporting packs produced by the Trust. a. Weekly and Monthly Performance Reports produced by NEL CSU. b. Specific deep dive analysis sub reports c. Terms of reference a. High level summary Performance Report submitted to the Board b. Additional reports providing more granular analysis, forming a sub report to 6a. c. WIP not fully effective National Standards Monthly Assurance Meeting Data Quality Concerns Agreed Data Quality Recovery Plan with trusts to improve Quality in data especially in relation to RTT monitoring at Monthly Standard meeting Oversight of estimated RTT position, due to Trust not reporting formally Fully 15 43

44 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.01g BAF.01g Clinical Strategy Group Meeting (CSG) Meeting of the Clinical Chairs and Executive Directors of Waltham Forest, East London and the City CCGs. a. Terms of Reference for the CSG. b. Meeting minutes for the CSG. c. Adhoc reports to the CSG. BAF.01h Commissioning Collaborative Committee (CCC) Monthly meeting of the Barts Health Contract lead CCGs Chief Officer, Waltham Forest, East London and the City CCGs Chief Finance Officers and Associate CCGs Chief Finance Officers. a. Terms of Reference for the CCC. b. Meeting minutes for the CCC. c. Adhoc reports to the CCC. Mitigating Action Due Date Assigned To Latest Note Status BAF.01a Review of SDIP - June 01-Jul-2016 Agreed revised plan end of June and incorporated into contract Completed BAF.01ai External Assurance - NHSE new governance 30-Sep-2016 Steve Gilvin There is a new delivery board in place. Completed BAF.01c A& E workshop - 29 June 29-Jun-2016 Held 29 June to agree a joint analysis action plan for Newham site. Agreed to do a further analysis of a wider cohorts of patients which can be seen in UCC. Agreed to identify what pathways between GP and specialist area can be prioritised for implementation, e.g. Gynae pathway. In the first instance CCG to identify a list specialty area for discussion, in addition to those pathways noted at this meeting. Summary of the meeting with the following headline actions: Barts Health to submit to CCG a proposal with regard to skill mix at UCC front door, as a pilot. Completed BAF.01ci Barts Health to submit to CCG a proposal with regard to skill mix at UCC front door, as a pilot. BAF.01cii Further deep dive into the HRG codes once primary care treatment codes have been identified. BAF.01ciii CCG to explore GP registration process BAF.01civ CCG to investigation B&D patient flows BAF.01d Trust action : Barts Health Diagnostics & Cancer BAF.01di Return to RTT reporting & review of data quality Further deep dive into the HRG codes once primary care treatment codes have been identified. CCG to explore GP registration process CCG to investigation B&D patient flows Agreed to identify what pathways between GP and specialist area can be prioritised for implementation, e.g. Gynae pathway. In the first instance CCG to identify a list specialty area for discussion, in addition to those pathways noted at this meeting. 31-Oct-2016 Ian Tritschler Superseded as the contract is up for renewal. We are currently considering a revised service model moving forward. 31-Oct-2016 Ian Tritschler This has been completed. 31-Oct-2016 Ian Tritschler This has been integrated into the STP strategy. 31-Oct-2016 Ian Tritschler This has been completed. 31-Mar-2017 Barts Health continues to meet the Cancer and Diagnostic standards for 2016/ Sep-2016 Steve Gilvin CCGs have met with Barts Health, NHSE and NHS Improvement to discuss progress. Discussions are currently ongoing regarding this. Completed Completed Completed On Track Unlikely to be Completed on Time BAF.02 Failure to operationalise the STP to secure a financially sustainable balanced East London Health Economy Risk Owner Steve Gilvin Lead Committee Executive Committee Next Review Date Current RAG Status Red Direction of Travel 16 44

45 Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2017 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.02a NEL Programme Board BAF.02b Development of STP Governance BAF.02c STP leadership workstream BAF.02d Finance workstream BAF.02e STP Executives the Programme board is responsible for the oversight of planned delivery. This is made up of CO/CE of CCGs and Providers Acceptable STP Plan to NHSE & NHS Improvement The 5 CCGs/ providers put in 35k each to support production of plan. Programme board has initiated an working group including lay members of trusts and CCGs to make recommendations on STP governance. A CE/CO is leading each of the workstreams with project management support. The Finance Workstream has been established to validate the financial model and plans to close the financial gap. This involves DoFs from trusts and CFOs from CCGs. Madeup of the work stream leads STP Plan submission MOU now drafted and being consulted on with comments due by the end of Jan. Working up further detailed plans for 17/18 for each project. Plans in place for 16/17. Agreeing Financial Plan Review progress of delivery Independent chair to facilitate discussions appointed mid May Plan agreed with NHSE and NHS Improvement Mitigating Action Due Date Assigned To Latest Note Status BAF.02a Delivery of detailed STP plan BAF.02ai Developing Operating plan for 2017/18 & 2018/19 BAF.02b Put in place the working Group 21-Oct-2016 Steve Gilvin 1st draft submitted and initial feedback from NHS England and NHS Improvement has been very positive. 24-Nov-2016 Steve Gilvin Operating plans for 2017/19 on 23/12/16. STP programme are now triangulating plans from all sectors. 30-Sep-2016 Steve Gilvin The working group is established, has met and has CCG representation. Completed Completed Completed BAF.03 Failure to effectively monitor performance and activity levels of acute and non - acute providers Risk Owner Steve Gilvin Lead Committee Executive Committee Next Review Date 01-Jan-2017 Current RAG Status Amber Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2017 Control Control Description Internal Assurance External Assurance Gaps in Control Status AC.01a Focus on Demand Management initiatives agenda for acute commissioning committee WEL Collaborative lead by CSU SLA with WEL Collaborative and CSU 17 45

46 BAF Failure to effectively monitor performance and activity levels of acute providers Risk Owner Ian Tritschler Lead Committee Executive Committee Next Review Date Current RAG Status Amber Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2017 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.03.01a Service Performance Review Meetings (SPR) BAF.03.01b Site level CQC Assurance meetings BAF.03.01c Demand management initiatives BAF.03.01d NEL CSU Acute MDT dedicated analytics support BAF.03.01e Dedicated Acute Collaborative Commissioning Team BAF.03.01f WEL CCGs Acute Commissioning Collaborative BAF.03.01g System Resilience BAF.03.01h Acute Commissioning Committee Monthly SPR meetings now attended by Trust CEO, and chaired by NHS Newham CCG Chief Officer, are held with Barts Health to ensure robust discussions around performance with assurance reports provided to CCG on areas of concern. Monthly Barts Health Site level CQC Assurance Group meeting with TDA, NHSE and CCGs Focus on demand management initiatives at cluster level to review referrals where safe alternatives exist in the community. To review and discuss with patients whether other acute providers could be used as an alternative to Barts in light of 18 week RTT issues at the Trust. NEL CSU provide a well-resourced contract management function for all acute provider contracts with dedicated analytics, finance, performance and contract functions. They provide a monthly analysis of performance, finance and activity, and undertake deep dive analysis for specific areas of concern. A dedicated Acute Collaborative commissioning team (Director of Commissioning and Senior Finance Support) works across WEL CCGs to work closely with the CSU Acute MDT. The WEL CCG Acute Commissioning Collaborative reviews Barts Health performance and activity information and agrees jointly approaches to managing performance issues A WEL-wide System Resilience Group (SRG) reviews capacity and surge requirements across the health system. Additional funding is agreed and monitored for impact for specific target areas through the SRG and Newham Urgent Care Working Group (UCWG). The Newham Acute Commissioning Committee meets monthly to review contract activity and performance for Barts Health through a set of reports provided by the NEL CSU. Monthly SPR meetings with assurance reports Assurance meeting terms of reference, minutes and action logs a. Dashboard reports to Cluster meetings. Terms of reference and minutes from meetings. Cluster plans for Example practice plan SLA with NEL CSU to provide monthly finance and activity reports. The CSU issue monthly activity query notices (AQN) to challenge changes in activity reported by the Trust. MOU across the WEL CCGs for Barts Collaborative Team. WEL CCG Acute Commissioning Collaborative meetings. Terms of Reference, Minutes and Action Logs. Newham Maternity Quality Review Meeting Terms of reference. Terms of reference and minutes of SRG and UCWG meetings. Evidence of additional investment for providers in resilience schemes. Newham Acute Commissioning Committee terms of reference, minutes and action log. Feedback from clusters required 18 46

47 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.03.01i Urgent Care Centre SPR meetings BAF.03.01j Clinical Forum meeting BAF.03.01k NUH/CCG monthly management team meeting Monthly SPR meetings for the new UCC contract held by Barts Health This Forum allows the CCG (GPs & officers) to meet NUH site leadership team and consultants to discuss and agree actions on a range of clinical and operational issues. NUH site leadership team (Managing Director and Medical Director) meet with CCG executive team to discuss progress with key operational issues and strategic programmes. Urgent Care Centre SPR meetings, ToR, minutes and action notes. Bimonthly operational meeting ToR. Minutes from Clinical Forum meetings. Action log from NUH/CCG meetings and biweekly meeting with NUH Director of Operations. Mitigating Action Due Date Assigned To Latest Note Status BAF.03.01d <Clusters to produce 16/17 demand management plans, (July 2016). Dashboards shared at cluster meetings, (Aug 2016). BAF.03.01d(ii) Activity query notices 30-Dec-2016 Neil Hamer Practices/Clusters are rapidly developing referral management processes to address demand management. These have been presented to Practice Council and other key meetings. 31-Mar-2017 On Track On Track BAF Failure to effectively monitor performance and activity levels of non - acute providers Risk Owner Ian Tritschler Lead Committee Executive Committee Next Review Date Current RAG Status Amber Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2017 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.03.02a Service Performance Review Meetings (SPR BAF.03.02b Demand management initiatives BAF.03.02c NEL CSU dedicated analytics and contract support BAF.03.02d Mental Health Commissioning Collaborative Monthly SPR meetings for all non-acute providers, key providers are ELFT mental health, ELFT Community services, St Joseph s Hospice, Richard House, Mildmay, to ensure robust discussions around performance with assurance reports provided to CCG on areas of concern. Focus on demand management initiatives at cluster level to increase referrals from acute providers into community and primary care providers where safe alternatives exist. CSU provides a dedicated analytics for community contracts and a contract management function for 111, LAS, GP OOH contracts. CSU provide a monthly analysis of performance, finance and activity, and undertake deep dive analysis for specific areas of concern. NEL CSU provide a contract management function for Mental Health for Newham, Tower Hamlets and City & Hackney CCGs. - SPR terms of reference. - Minutes and action logs of meetings. Monthly activity reports for mental health. MOU across the ELC CCGs for Mental Health Commissioning Collaborative Team

48 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.03.02e St Joseph s Hospice WEL CCG Commissioning Collaborative Quarterly SPR meeting for St Joseph s Hospice across all WEL CCGs through the Commissioning Collaborative - St Joseph s Hospice WEL CCG Commissioning Collaborative ToR. - Minutes and action logs BAF.03.02f Commissioning Committees The Newham Community, Mental Health, Integrated Care, Maternity & Children s Commissioning Committees meet monthly to review contract activity and performance for ELFT and other nonacute providers through a set of reports provided by CCG commissioning teams. - Terms of reference. - Minutes and action logs of Commissioning Committee meetings. Mitigating Action Due Date Assigned To Latest Note Status BAF.03.02a (i) Service Performanc ecsu to validate ELFT data against patient level minimum dataset, (July 16). BAF.03.02a (ii) ELFT to provide full set of new 16/17 KPIs, (Oct 16). BAF.03.02b(i) Clusters to produce 16/17 demand management plans, (July 2016) BAF.03.02b(ii) Dashboards shared at cluster meetings, (Aug 2016). BAF.03.02f Develop forward planners for each Commissioning Committee, (July 16) 31-Mar-2017 Patrick Zola Meeting took place in December to clarify previously outstanding issues on KPI reporting. Some issues still remain, primarily relating to EMIS web. 31-Mar-2017 Patrick Zola ELFT now reporting on 80% of KPIs. Some queries raised and a meeting is in place for Decmber to clarify outstanding issues. 28-Feb-2017 Neil Hamer Clusters have not yet produced demand management plans this is now being included as part of the Efficiency improvements under 10 High Impact changes as part of Making Time in General Practice. It will be a focus area within the HEE IL plan. 28-Feb-2017 Neil Hamer Dashboards were shared at cluster meetings and with the Cluster leads 31-Jul-2016 Ian Tritschler Forward planners developed, but will be revised in light of the wider committee re-structuring. On Track On Track On Track On Track Completed BAF.04 Failure to effectively monitor the quality of commissioned services for all healthcare providers Risk Owner Chetan Vyas Lead Committee Executive Committee Next Review Date 01-Feb-2017 Current RAG Status Amber Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2017 BAF Failure to effectively monitor the quality of commissioned services for Barts Health Risk Owner Chetan Vyas Lead Committee Executive Committee Next Review Date 01-Mar-2017 Current RAG Status Amber Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar

49 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.04.01a Monthly Oversight and Assurance/ Clinical Quality Review Meeting (CQRM) BAF.04.01b Monthly Quality Intelligence Report BAF.04.01c Key Performance Indicator (KPI) Review Meetings BAF.04.01d Newham site Maternity Quality and performance group Meeting BAF.04.01e Amber Alert Process BAF.04.01f Barts Health Care Quality Commission (CQC) visits BAF.04.01g Quality Assurance (QA) Visits BAF.04.01h WELC Serious Incident (SI) Panel Meeting BAF.04.01i Quality Leads Meeting BAF.04.01j Commissioning for Quality and Innovation (CQUIN) BAF.04.01k Quality Report to Board BAF.04.01l CCG Quality Committee BAF.04.01m Director of Quality, Chief Medical Director and Chief Nurse meetings BAF.04.01p Serious Incidents workshop BAF.04.01q Quality Surveillance Group BAF.06.01l Clinical Harm Review Meetings Regular meetings with Barts Health (all sites) around quality and improvement. Monthly report on quality intelligence to the CCG Quality Committee Regular meetings with Barts Health to review performance against KPIs Regualr mettings with Newham Site Maternity Team to review performance and quality Mechanism for GPs to report quality issues in relation to Barts Health. Regulator (CQC) visits to Barts Health Visits to wards by the CCG to observe first hand the quality of care being delivered to patients. Joint panel with WELC to review and approve closure of Serious Incidents. Regular meetings with WELC Quality Leads and Teams Proportion of healthcare providers' income conditional on demonstrating improvements in quality and innovation in specified areas of patient care. Regular reports to the CCG Board around performance against quality measures. CCG Quality Committee Bi-monthly meeting between WEL CCGs, Director of Quality and Barts Health Chief Medical Officer and Chief Nurse to discuss hot topics and quality issues. NHSE holding series of Serious Incident workshops with commissioners and providers to improve the Serious Incident process Attending regional quality surveillance group to share and gain intelligence regarding Barts Health quality matters with Healthwatch, local authority and CCG colleagues. Regular Meetings with Barts Health to review clinical harm of patients with long RTT and Cancer waits. Terms of Reference for Newham Oversight and Assurance Meeting. Newham Oversight and Assurance papers from meetings. Monthly Quality Intelligence Report Terms of Reference for Barts Health KPI Review Meeting. Barts Health KPI Review meeting papers. Maternity Quality and Performance Sub Group Meeting Papers. Amber Alert reporting and response forms. Amber Alert database. Quality Assurance Visit Framework. Quality Assurance Visit Reports and Action Plans. WELC SI panel Terms of Reference. WELC SI panel papers. Terms of Reference for the WELC Quality Leads Meeting. Quality Leads papers of meetings. CQUIN Reports. Quality Board Reports. Quality Committee Terms of Reference. Quality Committee papers. Performance monitoring arrangements. Agendas and minutes of Barts Health and East London Foundation Trust CQRM and SPR meetings. Monthly serious incident panel held with WELC. Quality Assurance Visits at Barts Health. Commissioning for Quality Framework. Patient stories that go to the CCG Board. Fully Fully Fully Fully Fully Fully Fully 21 49

50 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.06.01n IPIT site meetings Improvement Plan Implementation (IPIT) Team Meeting with Newham Hospital Leadership Team to monitor progress against delivery of improvement plan Mitigating Action Due Date Assigned To Latest Note Status BAF.04.01a Develop a forward plan for Monthly oversight assurance & CQRM BAF.04.01a Monthly OA/CQRM, QA Visits, WELC SI Panles and Quality Leads Meetings 30-Jun Mar-2017 Saem Ahmed CQC re-inspection on the Newham site and external clinical review also undertaken on Newham site. Completed On Track BAF Failure to effectively monitor the quality of commissioned services for East London Foundation Trust Risk Owner Chetan Vyas Lead Committee Executive Committee Next Review Date 01-Mar-2017 Current RAG Status Amber Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2017 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.04.01p Serious Incidents workshop BAF.04.02a Monthly Clinical Quality Review Meeting (CQRM) BAF.04.02b Service Performance Review Meetings (SPR) BAF.04.02c Amber Alert Process BAF.04.02d Quality Assurance (QA) Visits BAF.04.02e ELC Serious Incident (SI) Panel Meeting BAF.04.02f Quality Leads Meeting BAF.04.02g Commissioning for Quality and NHSE holding series of Serious Incident workshops with commissioners and providers to improve the Serious Incident process Regular meetings with East London Foundation Trust around quality and improvement. Regular meetings with East London Foundation Trust to review performance against KPIs Mechanism for GPs to report quality issues in relation to ELFT Visits to services by the CCG to observe first hand the quality of care being delivered to patients. Joint panel with ELC to review and approve closure of Serious Incidents. Regular meetings with WELC Quality Leads and Teams Terms of Reference for Community Health Clinical Quality Review Meeting. A Clinical Quality Review Meeting papers. Community Health Service Performance Review Meeting Terms of reference. Community Health Service Performance Review meeting papers. Amber Alert reporting and response forms Amber Alert database. Quality Assurance Visit Framework. Quality Assurance Visit Reports and Action Plans. WELC SI panel Terms of Reference. WELC SI panel paper. Terms of Reference for the WELC Quality Leads Meeting. Quality Leads papers of meetings. CQUIN reports. Agendas and minutes of East London Foundation Trust CQRM and SPR meetings. Agreed reporting through contracts via KPI and Information Schedule reporting Quality Assurance Visits at ELFT. Monthly serious incident panel held with ELC. Commissioning for Quality Framework. Fully Fully Fully 22 50

51 Innovation (CQUIN) Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.04.02h Quality Report to Board BAF.04.02i CCG Quality Committee BAF.04.02j Monthly Quality Intelligence Report BAF.04.02k Consortia Quality Role BAF.04.02l Development of PROMs Regular reports to the CCG Board around performance against quality measures. CCG Quality Committee Monthly report on quality intelligence to the CCG Quality Committee Consortia Quality Manager across City and Hackney, Tower Hamlets and Newham CCGs for a Trust wide oversight and to share best practice. CCG working with CHN ELFT to develop PROMS to demonstrate patient reported outcomes Quality Board Reports. Quality Committee Terms of Reference. Quality Committee papers. Monthly Quality Intelligence Report. Patient stories that go to the CCG Board. Fully Fully Fully Fully Mitigating Action Due Date Assigned To Latest Note Status BAF.04.02a Monthly CQRM/ELC SI panel meetings BAF.04.02d Develop a forward plan on Quality Assurance (QA) Visits 31-Mar-2017 Saem Ahmed Since April 2016/17 CQRMs and ELC SI panels have taken place. 31-Jul-2016 Saem Ahmed Forward Planner for QA visits at Community Health Services has been completed. On Track Completed BAF.05 Failure to meet the CCG s financial targets for 2016/17 and 2017/18 Risk Owner Chad Whitton Lead Committee Executive Committee Next Review Date 01-Jan-2017 Current RAG Status Red Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2017 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.05a 2016/17 Finance and Activity Plan BAF.05b 2016/17 Budget BAF.05c Monthly budget manager and budget holder meetings BAF.05d Monthly financial reporting to NHS England The CCG submitted a balanced Finance and Activity Plan for 2016/17 in line with financial requirements to NHSE on 2016/17. Budget in line with the 2016/17 Finance and Activity Plan have been signed off by all the budget holders and the Board in June implementation of strengthened financial controls approved by the June Board and the finalisation of the budget reductions agreed with Directors. Monthly meetings are held with budget managers and budget holders to ensure robust discussions and performance monitoring of potential financial risks on areas of concerns. Detailed financial performance and financial positions are reported to NHS England via monthly returns. Balanced 2016/17 Finance and Activity plan submitted to NHS England. 2016/17 budget signed off by budget holders and the Board. Notes to monthly budget managers and budget holder meetings. Monthly Financial Position Return and Non-ISFE Return to NHS England. NHSE review Monthly Financial Position Return and Non-ISFE Return to NHS England Fully 23 51

52 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.05e CCG Finance Committee BAF.05f CCG Audit Committee BAF.05g Finance report to the CCG Board The Finance Committee provide assurance and advise the CCG s Executive Committee on all matters relating to finance and make recommendations to the Executive Committee. The Audit Committee is responsible for scrutinising the CCG s financial policies and procedures, and providing to the Board with an independent and objective view of the CCG s financial systems, financial information and compliance with laws, regulations and directions governing the CCG in so far as they relate to finance. The CCG Board receive regular finance report based on the latest financial performance and budget management. Finance Committee Terms of Reference. Finance Committee Minutes of meetings and action logs. Audit Committee Terms of Reference. Audit Committee Minutes of meetings and action logs. Board finance report. Mitigating Action Due Date Assigned To Latest Note Status BAF.05c Monthly Budget holder 31-Mar-2017 Lei Wei Budget holder meetings are on - going each month with a deep dive to to validate the expenditure run-rate and the success of efficiency measures to address the financial challenges faced by the CCG. On Track BAF.06 Failure to effectively integrate health & social care Risk Owner Selina Douglas Lead Committee Executive Committee Next Review Date Current RAG Status Amber Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2017 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.06a Development of an agreed strategy for health and social care integration across CCG, LB Newham Adult Social Care and Children's Services. Describes the direction of travel for the integration of health and social care functions in line with the 2020 requirement set out in the Five Year Forward View Agreed Strategy and Implementation plan signed off by CCG and LBN. Direction of Strategy is not yet drafted BAF.06b Development of Strategy for joint commissioning of health and social care services BAF.06c Joint Chair Integrated Commissioning Committee Strategic plan for how health and social care services will be jointly commissioned over the next 5 years Governance arrangements for the cochairing of the IC committee Programme plans for Joint commissioning of children's services. Single Point of Access in adult services and future scope of adult community services procurement (Building Healthy Communities) Integrated Commissioning Committee Terms of Reference and Membership. BAF.06d Better BCF Delivery monitors progress around Terms of Reference of Better Care Fund 24 52

53 Control Control Description Internal Assurance External Assurance Gaps in Control Status Care Fund Governance & Delivery Group BCF the Better Care Fund Governance & Delivery Group. Section 75 Agreement. Submission to NHSE and quarterly assurance reports BAF.06e Health & Well Being Board Oversight group for health and social care strategy and implementation Health & Well Being Board Terms of Reference. Health and Well Being Strategy. Health and Well Being Annual Work Programme Forward Plan BAF.06f Public Health MOU Describes the range of services and products provided to the CCG via LBN s Public Health Team Public Health Memorandum of Understanding. Mitigating Action Due Date Assigned To Latest Note Status BAF.06a Decision on how an integration strategy will be developed and timeline, review of the PPL options on integration paper, (Aug 16) BAF.06d BCF Delivery Group forward plan BAF.06e Development of a Prevention Strategy, (Sept 16). Development of a revsied JSNA, (Sept 16). BAF.06f MOU to be agreed with LBN, (July 16). 15-Feb-2017 Selina Douglas The structure for collaborative commissioning has been approved at Remuneration Committee. 31-Jul-2016 Ian Tritschler CCG and LBN leads have met to draft a BCF Deliery Group forward plan which was discussed at the 8 August meeting 18-Jan-2017 Ian Tritschler A final version of the Prevention Strategy will be presented to the next Health and Wellbeing Board. 31-Jul-2016 Selina Douglas Completed On Track On Track Completed BAF.07 Failure to develop a Primary Care Strategy that is adequately resourced to service Newham Residents and secure a sustainable and viable GP Federation Risk Owner Selina Douglas Lead Committee Executive Committee Next Review Date Current RAG Status Red Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2017 BAF Failure to develop a Primary Care Strategy that is adequately resourced to service Newham Residents and secure a sustainable and viable GP Federation - Primary Care Risk Owner Selina Douglas Lead Committee Executive Committee Next Review Date 01-Mar-2017 Current RAG Status Red Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar

54 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.07.01a Deliver Initial Board Dev. sessions to create Outline for revision vision March & May 16.Strategic of Strategy Drivers reviewed at PCCC June, Draft content to July board, engagement & consultation Aug/Sep & present to Sept PCCC Board PCCC and NCCG Board. NHSE and TST, Audit, Public, BAF.07.01b utilisation and management of spend Review of contractual spend as part of monthly review of budgets, tracking of EPCS/LIS claims, ¼ly review of performance v KPI on APMS and 6m on PMS PCCC and NCCG Board and TST Board. NHSE and Public Inability to ascertain background data /info BAF.07.01c Oversight of Federation governance via CCG Regular reporting cycle to COO & CFO plus SMT by Interim CO of Federation. Papers to PCCC SMT and CCG Board. BAF.07.01d Control of pump priming funding for Federation Direct Business Case submission and application to CFO for approval DoF SMT and CCG Board Federation Board and articles Mitigating Action Due Date Assigned To Latest Note Status BAF.07.01a Outline Proposal on PC strategy June PCCC BAF.07.01b Monthly review of budget with increased access to fig. BAF.07.01c Regular (as a minimum Monthly) review by SMT 01-Dec-2016 Neil Hamer 2 Board sessions have been held on Primary Care Strategy development 31-Mar-2017 Neil Hamer There are gaps in automated information gathering. Issue still remains of insufficient data as access to Open Exeter is still outstanding. 01-Mar-2017 Neil Hamer Regular report to PCCC are done. Completed Likely to be Overdue On Track BAF Failure to develop a Primary Care Strategy that is adequately resourced to service Newham Residents and secure a sustainable and viable GP Federation - GP Federation Risk Owner Steve Gilvin Lead Committee Executive Committee Next Review Date 01-Jan-2017 Current RAG Status Red Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2017 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.07.02a GP Federation Meet Fortnighly - cluster rep Secured first contract award of Vicarage lane Practice. Overseers - CCG Chair/ CO & Programme Director Newham Health Collaboration (NHC) Capacity and Viability still uncertain BAF.07.02b Business Plan The Federation has submitted a draft business plan. Mitigating Action Due Date Assigned To Latest Note Status BAF.07.02a NHSE - Business Case to be reviewed & determined by CCG 31-Oct-2016 Approved with conditions at PCC. Completed BAF.07.02b Recruitment 31-Mar-2017 Unsuccessful in initial recruitment attempt. CCG have seconded On Track 26 54

55 Mitigating Action Due Date Assigned To Latest Note Status member of the Finance Team to help with the interim arrangements. BAF.08 Failure to deliver the stated TST benefits including quality and financial efficiency Risk Owner Steve Gilvin Lead Committee Executive Committee Next Review Date 01-Nov-2016 Current RAG Status Red Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2018 BAF Failure to deliver the stated TST benefits including quality and financial efficiency: - Sustainable Hospitals Risk Owner Steve Gilvin Lead Committee Executive Committee Next Review Date 01-Dec-2016 Current RAG Status Amber Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2018 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.08.01a Acute Care Hubs BAF.08.01b TST Programme Board BAF.08.01c Strong Sustainable Hospitals Board Trust to plan what the delivery plan will be like Prioritised this year The TST Programme Board is a meeting of clinical and managerial senior leadership of CCGs and the trust to provide oversight of the TST programme. Chaired by Barts Medical Director Pilot of ambulatory care established in November at the NUH site running 2 days a week. Meet monthly - CEO/Chairs. Meet monthly. Mitigating Action Due Date Assigned To Latest Note Status BAF.08.01a Meeting 20 June Develop a Business Case for Acute Care Hubs 31-Oct-2016 Philippa Robinson Draft reviewed and further work is being undertaken to develop the plan. On Track BAF.08.01b Ambulatory Care Pilot 31-Mar-2017 On Track BAF Failure to deliver the stated TST benefits including quality and financial efficiency: - Care Closer to Home Risk Owner Steve Gilvin Lead Committee Executive Committee Next Review Date 01-Dec-2016 Current RAG Status Red Direction of Travel 27 55

56 Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2018 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.08.02a Financial and quality benefits Programme to be evaluated and signed off by CCG Board, so that minimum standards can be set. Financial and quality benefits plan to be evaluated and signed off by CCG Board, so that minimum standards can be set, and performance monitoring put in place. Executive Committee. Procurement Committee. (i) TST Strategic steering Board (ii) NEL STP Internal assurance BAF.08.02b Introduce Business case process Internal business case process to be adhered to with agreed minimum quality and financial outcomes Mitigating Action Due Date Assigned To Latest Note Status BAF.08.02a Validate centrally developed finance and activity plan within the CCG BAF.08.02b (i) Ensure CCG delivery plan aligns with TST CCH PID's BAF.08.02b(ii) Produce timeline of anticipated business case production. 31-Mar-2017 Julie Van Bussel The CCG is currently working on the development of a strategic development plan (SDP), work is being undertaken to ensure the TST programme links in, and therefore a refresh of finance and activity is required. 31-Jul-2016 Julie Van Bussel A Prioritisation process has been developed and will be reviewed by the end of October. 31-Mar-2017 Julie Van Bussel The delivery plan has been completed and is aligned to STP/Operating Plan. On Track Completed On Track BAF.09 Failure to transform services through re- commissioning (children, adults, UCC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised. Risk Owner Selina Douglas Lead Committee Executive Committee Next Review Date 01-Dec-2016 Current RAG Status Red Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2017 BAF Failure to transform services through re- commissioning (children, adults, UCC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised - children Risk Owner Selina Douglas Lead Committee Executive Committee Next Review Date 01-Nov-2016 Current RAG Status Amber Direction of Travel 28 56

57 Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2017 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.09.01a Engage General Practice/Practice Council BAF.09.01b Children & Maternity Commissioning Committee BAF.09.01c Board Development and Board meetings BAF.09.01d Quality Committee BAF.09.01e Integrated Children's Health Board To inform General Practice on the changes taking place to Children s health services and the relationship with General Practice The main commissioning committee of the CCG for children to provide an input and to assure themselves that the transformation is consistent with the CCG vision and approach For a key transformation Programme the CCG board need to be assured that the programme is on schedule and will deliver the changes expected and required Quality Committee will need assurance that quality indicators are being adhered to and that services will be safe. The Integrated Children's Health Board is the joint management forum between LBN and the CCG and collectively own the operational transformation Practice Council presentations. Children & Maternity Commissioning Committee minutes and agendas. Community and Integrated Care Commissioning Committees minutes and papers. Quality Impact Assessment. Integrated Children's Health Board minutes & papers.. Inform and consult NHS England Agree London Borough of Newham sign off for ITT Engage Future Generations Validation process for procurement with external representatives Market bidders event Section 75 Agreement with London Borough of Newahm All procurement documentation Contract Management arrangements Mitigating Action Due Date Assigned To Latest Note Status BAF.09.01a Board Agreement - July Jul-2016 Satbinder Sanghera Completed BAF.09.01b B. Invitation to Tender Stage - July/August Aug-2016 Satbinder Sanghera ITT published in July Completed BAF.09.01c Tender Evaluation - September Sep-2016 Satbinder Sanghera The tender has been completed and we were unable to appoint. Completed BAF.09.01d Contract Award - October Oct-2016 Satbinder Sanghera Action closed as we were unable to award the contract and the tender process is now closed. Completed BAF.09.01e Contract Starts - February Feb-2017 New contract is in operation On Track BAF.09.01f BHC Procurement 31-Jan-2017 On Track BAF.09.01g Negotiations with ELFT 31-Jan-2017 On Track BAF Failure to transform services through re- commissioning (children, adults, UEC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised - adults Risk Owner Selina Douglas Lead Committee Executive Committee Next Review Date 01-Jan-2017 Current RAG Status Red Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2017 Control Control Description Internal Assurance External Assurance Gaps in Control Status 29 57

58 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.09.02a CCG and LBN Programme Board for Building Healthy Communities (BHC) Oversight and assurance group for BHC programme Programme Board minutes, decisions, risk register and issues log. NHSE assurance around process for competition BAF.09.02b CG Executive Commitee Senior oversight of the BHC programme Executive committee minutes and papers. External validation of ITT submissions and financial costing of bids from Consultancy/Audit firm BAF.09.02c Community and Integrated Care Commissioning Committees Committees to agree care models and specifications for BHC services Community and Integrated Care Commissioning Committees minutes and papers. BAF.09.02d CCG Board assurance CCG Board to authorise approval to advertise procurement, approval of award of selected bidder CCG Board or delegated subgroup to approve PQQ and ITT documentation. Mitigating Action Due Date Assigned To Latest Note Status BAF a Review of scope of programme and clinical model at Sept Board Development session 08-Feb-2017 Ian Tritschler Route to market going to Feb Board. On Track BAF.09.02b Programme plan progress, risk register and issues log reviewed at each Programme board, (June 16). SMT oversight of progress and risks, (June 16). 31-Mar-2017 Currently ongoing and subject to monthly updates and reviews. On Track BAF Failure to transform services through re- commissioning (children, adults, UCC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised - UCC Risk Owner Selina Douglas Lead Committee Executive Committee Next Review Date 01-Jan-2017 Current RAG Status Red Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2017 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.09.03a Board to approve procurement against transformational Outcomes Develop the specification/s and procurement programme with a clear set of transformational outcomes. i) UCWG, and (ii) procurement group UEC Network, NHSE U&EC programme BAF.09.03b Procurement Process Procurement programme will measure tender requirements using transformation outcomes in a quantifiable way. Mitigating Action Due Date Assigned To Latest Note Status BAF.09.03a Agree procurement approach for U&E 14-Dec-2016 Procurement approach to December Board. On Track 30 58

59 Mitigating Action Due Date Assigned To Latest Note Status BAF.09.03a Board to approve procurement against transformational Outcomes 14-Dec-2016 Satbinder Sanghera Route to market to be taken to Feb Board. On Track BAF.09.03b Agree transformation criteria with UCWG and procurement 14-Dec-2016 Scope to be presented to December Board On Track BAF.09.03b Agree transformation critieria with UCWG and procurement group arrangements by 31 August Dec-2016 Scope agreed and going to Board in December. On Track BAF Failure to transform services through re- commissioning (children, adults, UCC and MSK) and that inter dependencies with NHS 111 and other re-commissioned services are not realised - MSK Risk Owner Selina Douglas Lead Committee Executive Committee Next Review Date 01-Dec-2016 Current RAG Status Amber Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2017 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.09.04a Structured Collaboration process is approved through a series of gateways for governance, clinical model, finance & activity, and mobilisation Assurance process to award contract Acute Commissioning Committee minutes, CCG MSK Steering Group minutes. BAF.09.04b External consultancy support through STO Healthcare Additional expert consultancy support Outputs from Provider Collaboration workshops. Mitigating Action Due Date Assigned To Latest Note Status BAF.09.04a (i) Meeting with Barts Health Executive team to agree Trust's commitment to the programme, (June 16) 30-Jun-2016 Ian Tritschler Completed BAF.09.04a (ii) Finance & activity model and asumptions to be drafted by provider collaborative 28-Feb-2017 Ian Tritschler Contract signing and mobilisation by end of Feb 17. On Track BAF.10 Failure to implement the improvements agreed in corporate governance structure Risk Owner Satbinder Sanghera Lead Committee Executive Committee Next Review Date 01-Dec-2016 Current RAG Status Amber Direction of Travel 31 59

60 Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2017 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.10a CCG Constiution Working Group The working group will develop options for changes to the committee structure, constitution, role of clinical leads and future of cluster leads Constitution and committee structures approved by the Board. Consult LMC Fully BAF.10b Practice Council Practice Council will approve or not the Board s recommendations to effect and implement changes Practice Council minutes. New Terms of Reference agreed. Seek Legal Services input Fully BAF.10c Board Meetings and Board Development sessions Board and Board Development will need to consider the proposals of the Constitution Working Group and decide the recommendations to be made to Practice Council Board Development and Board meetings minutes. Inform and consult NHSE Revised clinical lead roles BAF.10d NHSE assurance NHS England through quarterly assurance meetings will need to be satisfied that all changes are consistent with national guidance on conflicts of interest and support transformation NHSE assurance meetings and Domain assessments. Review of Membership of all committees approved. Engage key partners such as LBN Fully Mitigating Action Due Date Assigned To Latest Note Status BAF.10b Consult LMC & Partners - August Mar-2017 Satbinder Sanghera Currently ongoing. Further discussions regarding clinical lead roles Likely to be Overdue BAF.10c Engage Member Practices - August Mar-2017 Satbinder Sanghera Engagement ongoing Unlikely to be Completed on Time BAF.10d (i) i. Draft Constiutional Changes - September Sep-2016 Satbinder Sanghera Linked to the standing order changes being proposed to the December Board meeting. Likely to be Overdue BAF.10d (ii) Practice Council/Board Approval - October Feb-2017 Satbinder Sanghera Proposals will be made to the December and February Board meetings. Unlikely to be Completed on Time BAF.11 Failure to equip staff, the Board and clinical leaders with the skills, knowledge and expertise to enable the delivery of the CCG s priorities and commissioning agenda Risk Owner Chetan Vyas Lead Committee Executive Committee Next Review Date Current RAG Status Amber Direction of Travel Original Risk Current Risk Target Risk Impact Likelihood Rating Impact Likelihood Rating Movement Impact Likelihood Rating Target Date Mar-2017 Control Control Description Internal Assurance External Assurance Gaps in Control Status BAF.11a Staff annual appraisals. BAF.11b Actus performance management system BAF.11c Staff Development Centre Annual review of performance against objectives. System to manage performance against objectives on a regular basis Development Centre to identify talent and opportunties for CCG staff Staff Appraisal forms. Actus Performance System Reports. Staff Development Centre Dates. Procurement of provider to deliver Staff Development Centres 32 60

61 Control Control Description Internal Assurance External Assurance Gaps in Control Status External reports for individual members of staff from the Development Centres BAF.11d Staff Conference BAF.11e Board/clinical/clust er leads development sessions BAF.11f Board Development Programme Celebration of success and future priorities with CCG staff Regular development sessions with Board/clinical/cluster leads development sessions Staff Conference on in June Board Development Minutes and papers. Development programmes for Board Specification Procurement of a provider to facilitate the programme BAF.11g Scope to be determined of review and Governance review review undertaken of clinical leadership potentially impacted by the governance review. Constitution Working Group minutes Mitigating Action Due Date Assigned To Latest Note Status BAF.11c Staff training delivery of Development Centres BAF.11ci Staff Training with launch of staff development programme BAF.11d Develop Board/ Clinical & Cluster Leads Development Schedule BAF.11di Develop Board only development programme BAF.11f Board Development Programme Session 1 12-Aug-2016 Chetan Vyas Development Centres have been delivered to all permanent CCG staff, and feedback have been provided at one-to-one's with staff. 23-Sep-2016 Chetan Vyas Staff programme launched in November May-2016 Chetan Vyas Development schedule has been developed. 30-Sep-2016 Chetan Vyas Board development programme developed and procurement completed November Jan-2017 Chetan Vyas Session 1 delivered in January Completed Completed Completed Completed Completed 33 61

62 Board 08 February 2017 Title: Quality Report Agenda item 3.2 Author: Saem Ahmed, Newham CCG, Head of Quality and Development Presented by: Dr Stuart Sutton, Newham CCG, Chair of Quality Committee Contact for further information: Chetan Vyas, Newham CCG, Director of Quality and Development, This Paper is for: Monitor Action required: The Board are asked to: NOTE the actions taken by Newham CCG or CSU on behalf of Newham CCG in relation to the Red and Amber RAG rated Quality Indicators reported on an exception basis. NOTE the assurances provided in relation to the other Quality matters reported on. 62

63 Executive summary: The January 2017 Newham CCG Quality Report provides an update against the reported Quality Indicators for the 3 Providers from which Newham CCG commissions health services in addition to providing an update on other quality related matters. Barts Health Green rated areas Amber Alerts acknowledged within target of 3 working days at 100% Zero MRSA reported 8 C.DIFF reported Safeguarding Childrens Training Level 1 above the 85% target with 92% Safeguarding Adults Level 1 above the 85% target with 89.6% VTE Assessment at 99.50% above the 95% target 22% FFT Maternity Response Rate above the target of 15% 93.40% FFT Inpatient % recommended the service 96.90% FFT A&E % recommended the service 91% FFT Maternity % recommended the service 90.70% FFT Outpatient % recommended the service Amber rated areas Safeguarding Childrens Training Level 2 performance at 84.60% slightly under the 85% target. Safeguarding Childrens Training Level 3 level 3 performance at 83.90% slightly under the 85% target. Red rated areas 12 Mixed Sex Accommodation Breaches reported, however zero on the Newham site. 65% Amber Alerts actioned within target of 10 working days, below the 100% target. FFT Inpatient Response Rate at 8.90% and A&E response rate at 2.20% below the 15% target. All Red issues are being discussed with Barts Health and assurances are sought on improvement plans and trajectories through the Newham site CQRM meetings and Trust KPI review meetings. East London Foundation Trust Mental Health Green rated areas Amber Alerts acknowledged within target of 3 working days Amber Alerts actioned within target of 10 working days Zero MRSA reported in June against a threshold of zero Zero C.DIFF reported in June against a threshold of zero Discharge notification sent to GP within 48 working hours of patient discharge is above the target of 95% with 98.30% Adult inpatient re-admissions within 28 days at 4.90% which is below the threshold of 7.5% Smoking status of patients recorded electronically above the 80% target with 99.50% Child and Adolescent Mental Health Service DNA rates (CAMHS) below the threshold of 15% with 4.90%, further information provided on the report 63

64 Zero Mixed Sex Accommodation breaches reported Amber rated areas Older Community DNA rate is below the threshold of 10% with performance at 10.30% Adult Community DNA rates above the threshold of 10% with 13.9%, further details of actions taken provided on the report Reduction of medication errors through medicine on admission to hospital is below the target of 95% with 90.70% Clinical sharing information with GP slightly under the 90% target with 89.20%, further information provided on the report. Red rated areas None reported All Amber issues are being discussed with East London Foundation Trust and assurances are sought on improvement plans and trajectories through the East London Foundation Trust Clinical Quality Review Meetings East London Foundation Trust Community Health Green rated areas Safeguarding Children compliance Level 2 at 87% above the 85% target Safeguarding Children compliance Level 3 at 99% above the 85% target No MRSA reported No c.diff cases reported VTE Assessments at 100% achieving the target 100% of Cardiac Rehab patients surveyed were satisfied with the service against a target of 85% 80% of adults in Cardiac Rehab achieving independence three months after entering care/rehab rate per 10,000 (%) against a target of 60% 100% of Children in Physiotherapy Services who have shown improvement on agreed Therapy Outcome Measures following direct intervention against a target of 80% Amber rated areas 76% of Children in Occupational Therapy Services who have shown improvement on agreed Therapy Outcome Measures following direct intervention against a target of 80% Red rated areas Safeguarding Children compliance Level 1 at 78% below the 85% target 66.70% of patients in Foot Health Service who have completed treatment (closed) were satisfied with the service against a target of 80% Other Quality Matters The Newham CQR/ Oversight and Assurance Meeting took place on 19 January 2017 and details are within the report ELFT Community Health Services CQRM took place on 1 December 2016 and details are within the report ELFT Mental Health Services CQRM took place on 8 December 2016 and details are within the report 64

65 Quality, safety and patient experience of London Ambulance Service, further details within the report Outcomes of July 2016 CQC inspections at the Royal London and Whipps Cross sites, further information within the report. Supporting papers: None How does this fit with Newham CCG Strategy: Values: Collective clinical leadership & collaborative communication Patient/Public voice throughout our decision making Transparency with our decision-making and leadership Accountability and responsibility Caring culture and behaviour Working with our partners to improve health outcomes Aims: Improving health outcomes through developing models of integrated care and focusing on prevention Reducing inequalities and improving accessibility Reducing quality variation Ensuring equity of Health and Wellbeing outcomes Where has the paper been already presented? Not presented to any meeting ahead of the CCG Board. Risk: The risks in relation to Barts Health and East London Foundation Trust are around non-delivery and these are reported on in the appended report. Newham CCG Board Assurance Framework reference BAF.06. Equality Impact: This document relates to all Newham residents in the 9 protected characteristics that are covered by the Equality Act 2010 and our Equality Duties. Stakeholder engagement: Integrated Care Impact No consultation has taken place nor is it required for this report. A number of quality indicators will have an impact on Integrated Care and the report has been shared with the programme team. Financial Implications No financial implications for this paper. For information only. 65

66 Quality Board Report January

67 Purpose The purpose of this report is to provide the CCG Board with an update on quality matters across our local Provider organisations. The report covers the following providers: o Barts Health o East London Foundation Trust (Mental Health) o East London Foundation Trust (Community Health) 67 2

68 Key Headlines Barts Health ELFT (Mental Health) ELFT (Community Health) Amber Alerts acknowledged within target of 3 working days MRSA C.DIFF Safeguarding Childrens Training Level 1 Safeguarding Adults Level 1 VTE Assessment FFT Maternity Response Rate FFT Inpatient % recommended FFT A&E % recommended FFT Maternity % recommended FFT Outpatient % recommended Safeguarding Childrens Training Level 2 Safeguarding Childrens Training Level 3 Mixed Sex Accommodation Breaches Amber Alerts actioned within target of 10 working days FFT Inpatient Response Rate FFT A&E Response Rate Amber Alerts acknowledged within target of 3 working days Amber Alerts actioned within target of 10 working days MRSA C.DIFF Reduction of medication errors through medicines on admission to hospital Discharge notification sent to GP within 48 working hours of patient discharge Smoking status of patients recorded electronically Adult inpatient re-admissions within 28 days Child and Adolescent Mental Health Service DNA rates Mixed Sex Accommodation Breaches Adult Community DNA rates Clinical sharing information with GP Older Adult Community DNA rate Safeguarding Children compliance Level 2 Safeguarding Children compliance Level 3 MRSA C.DIFF VTE Assessments audit Duty of Candour clearly presented on all responses where harm is identified % of Cardiac Rehab patients surveyed who were satisfied with the service Proportion of adults in Cardiac Rehab achieving independence three months after entering care/rehab rate per 10,000 (%) % of Children in Physiotherapy Services who have shown improvement on agreed Therapy Outcome Measures following direct intervention % of Children in Occupational Therapy Services who have shown improvement on agreed Therapy Outcome Measures following direct intervention Safeguarding Children compliance Level 1 % of patients in Foot Health Service who have completed treatment (closed) satisfied with the service 68 3

69 Quality Dashboard Some data for Barts Health is missing as the reporting timetable from Public Health England and NHS England means the data was not available at the time of authoring this report. The indicator for Mental Health where * is displayed is due to amber alerts not being reported by general practices. No data available (ND) for Patients on CPA with diabetes, CHD, COPD HTN and obesity have completed annual physical health check Barts Health Safeguarding Childrens Training Level 1 is at Trust-wide level, as site level data was not available at the time of authoring this report Indicator Target/Threshold Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov De Barts Health - Newham site Quarter 1 Quarter 2 Quarter 3 Mixed Sex Accommodation Breaches Amber Alerts acknowledged within target of 3 working days (Newham site) 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Amber Alerts actioned within target of 10 working days (Newham site) 100% 50% 82% 67% 50% 60% 80% 63% 55% 33% 76% 65% MRSA C.DIFF < Safeguarding Childrens Training Level 1 (Newham site) 85% 95% 96% 96% 99% 99% 98% 96% 96.5% 91.30% 91.90% 92.00% Safeguarding Childrens Training Level 2 (Newham site) 85% 81% 82% 81% 87% 86% 87% 88.4% 90.2% 87.60% 83.10% 84.60% Safeguarding Childrens Training Level 3 (Newham site) 85% 72.50% 76.60% 80.00% 89.80% 81.60% 84.00% 78.60% 83.8% 85.10% 82.80% 83.90% Safeguarding Adults Level 1 (Newham site) 85% 94% 97% 97% 99% 99% 98% 96% 96% 88.90% 89.50% 89.60% Safeguarding Adults Level 2 (Newham site) 85% 81.40% 81.30% 80.20% 80.80% 80.00% 80.10% 82.90% 84.00% 80.30% 72.50% 77.60% VTE Assessment (Newham site) 95% 99% 99% 99% 99% 98% 100% 100% 99.3% 99.70% 99.70% 99.50% FFT Inpatient Response Rate (Newham site) 15% 8.5% 10.0% 12.0% 14.4% 4.8% 31.8% 10.6% 12.4% 14.90% 15.70% 8.90% FFT A&E Response Rate (Newham site) 15% 0.1% 0.5% 0.5% 0.7% 0.2% 5.9% 2.1% 2.7% 1.7% 2.50% 2.20% FFT Maternity Response Rate (Newham site) 15% 16.2% 29.0% 1.7% 37.8% 31.1% 32.3% 25.6% 21.1% 16.50% 18.20% 22.00% FFT Inpatient % recommended (Newham site) 80% 98% 94% 96% 97% 100% 92.1% 93.90% 93.40% 92.80% 94.61% 93.40% FFT A&E % recommended (Newham site) 80% 100% 92% 93% 92% 100% 83.2% 96.30% 86.90% 89.90% 96.95% 96.90% FFT Maternity % recommended (Newham site) 80% 92.00% 90.50% 96.00% 94.40% 92.26% 90.30% 95.50% 93.50% 96.04% 91.00% FFT Outpatient % recommended 80% 90.00% 92.80% 96.30% 91.80% 91.90% 85.30% 84.20% 90.30% 92.00% 91.41% 90.70% Serious Incidents Reported (Newham site) No target Never Events Reported (Newham site) No target East London Foundation Trust - Mental Health Adult Community DNA rates 10% 12.6% 15.0% 14.4% 16.0% 18.8% 14.9% 16.7% 16.2% 13.9% 12.80% 11.40% Amber Alerts acknowledged within target of 3 working days 100% * * * * * * 100% 100% 100% 100% 100% Amber Alerts actioned within target of 10 working days 100% * * * * * * 100% 100% 100% 100% 100% MRSA C.DIFF Reduction of medication errors through medicines on admission to hospital 95% 98.9% 97.7% 98.0% 69.0% 96.6% 95.2% 97.30% 91.70% 90.70% 94.10% 97.30% Clinical sharing information with GP 90% 89.5% 88.0% 88.6% 85.7% 80.2% 82.4% 86.50% 86.30% 88.00% 89.50% 89.20% Discharge notification sent to GP within 48 working hours of patient discharge 95% 97.3% 95.5% 96.8% 85.8% 88.7% 97.9% 97.90% 98.90% 97.20% 98.00% 98.30% Smoking status of patients recorded electronically 80% 98.9% 97.7% 98.1% 96.0% 97.1% 98.7% 98.3% 98.30% 99.10% 99.50% 99.50% Patients on CPA with diabetes, CHD, COPD HTN and obesity have completed annual physical health check 80% 87.6% 87.9% 81.8% 81.1% 85.8% 85.8% 81.8% 81.80% 78.40% ND ND Adult inpatient re-admissions within 28 days 7.5% 6.4% 8.3% 5.8% 10.7% 6.8% 4.6% 8.70% 8.20% 3.70% 10.00% 4.90% Child and Adolescent Mental Health Service DNA rates 15% 13.5% 16.0% 16.4% 14.5% 13.9% 15.2% 18.1% 16.00% 14.20% 9.60% 6.70% Older Adult Community DNA rate 10% 7.0% 6.2% 12.6% 8.9% 10.7% 9.1% 11.5% 10.80% 9.70% 10.50% 10.30% Mixed Sex Accommodation Breaches Serious Incidents No target Never Events No target Indicator Target/Threshold Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov De East London Foundation Trust - Community Health Safeguarding Children compliance Level 1 85% 99% 99% 96% 98.1% 98.7% 100.0% 97% 49% 66% 94% 78% Safeguarding Children compliance Level 2 85% 80% 82% 81% 86.0% 88.7% 88.8% 93% 93% 91% 100% 87% Safeguarding Children compliance Level 3 85% 93% 93% 91% 90.5% 93.4% 97.0% 96% 96% 98% 90% 99% Amber Alerts acknowledged within target of 3 working days 100% 100% 100% 100% * 100.0% 100% 100% 100% 100% * * Amber Alerts actioned within target of 10 working days 100% 100% 100% 100% * 100.0% 100% 100% 100% 100% * * MRSA C.DIFF VTE Assessments audit 100% 100% 100% 100% 100.0% 100.0% 100.0% 100% 100% 100% 100% 100% Duty of Candour clearly presented on all responses where harm is identified 100% 100.0% 100% 100% 100% 100% 100% % of Cardiac Rehab patients surveyed who were satisfied with the service 85% 100.0% 100.0% 100% 100% 100% 100% 92% Proportion of adults in Cardiac Rehab achieving independence three months after entering care/rehab rate per 10,000 (%) 60% 75.0% 63% 65% 70% 48% 80% % of patients in Foot Health Service who have completed treatment (closed) satisfied with the service 80% 85.0% 100% 100% 100% 100% 66.70% % of Children in Occupational Therapy Services who have shown improvement on agreed Therapy Outcome Measures following direct intervention 80% 86.0% 100.0% 95% 95% 79% 100% 76% % of Children in Physiotherapy Services who have shown improvement on agreed Therapy Outcome Measures following direct intervention 80% 83.3% 100.0% 100% 100% 100% 100% 100% Serious Incidents 69 No target Never Events No target

70 Key Exceptions Indicator Barts Health Perform. Dec Further intelligence Actions taken by CCG Mixed Sex Accommodation Breaches Amber Alerts actioned with 10 working days Safeguarding Childrens Training Level 2 Safeguarding Childrens Training Level 3 Safeguarding Adults Level 2 FFT Inpatient and A&E Response Rate 17 Majority of these breaches occur at the Royal London site (8) and Whipps Cross site (4) no breaches from the Newham site. The Royal London site breaches come from the Adult Critical Care Unit. 65% The Trust continues to not meet the 10 working day response time, however compared to previous years the number of days of delays have reduced % Performance for the Safeguarding training has declined. This is due to while staff are being trained, further staff training expires, hence the variation of achievement over the last few months. A further break down by speciality was provided at the Barts Health KPI 83.90% review meeting. Newham site is under the 85% target. The Trust has a trajectory in place and reports progress against trajectory on a regular basis % Staff requiring training have been identified and are booked on to the relevant training sessions. Inpatient 8.90% A&E 2.20% Inpatient response rates improved in October with 15.70%, however declined in November (8.90%), A&E performance has been significantly low through the year. The main focus is around A&E targets which is seeing significantly low response rates. Action Plan in place for the Royal London site and is monitored at the Royal London site CQRM. Remedial Action Plan (RAP) is in place to improve performance, the RAP is being monitored at the Newham site CQRM. Continue to monitor progress at the Barts Health KPI review meeting. Various actions have been undertaken by the Trust to get to a sustained position, the actions promote further layer of accountability and scrutiny at a local level. Joint Health safeguarding sub-group and the CQRM seeking assurances around improving this performance Remedial Action Plan (RAP) is in place to improve performance, the RAP is being monitored at the Newham site CQRM. 70 5

71 Indicator Perform. Dec East London Foundation Trust (Mental Health) Further intelligence Actions taken by CCG Clinical sharing information with GP 89.20% The data suggests continuous improvement against the previous reporting months and slightly under the 90% target with 89.20%. The Trust anticipates that performance will continue to improve over the coming months to achieve the target. Adult Community DNA rates 13.9% The Trust had submitted an action plan which was being monitored at the Service Performance Review Meeting. Over the last 5 months performance is showing a month on month improvement. Older Adult Community DNA rate 10.30% Performance is slightly above the 10%, the Service Performance Review Meeting continues to monitor this target. East London Foundation Trust (Community Health) The CCG continues to monitor progress at the Service Performance Review Meetings. Actions and performance continue to be monitored at Service Performance Review Meetings. Actions and performance continue to be monitored at Service Performance Review Meetings. Safeguarding Children Level 1 Compliance % of patients in Foot Health Service who have completed treatment (closed) satisfied with the service % of Children in Occupational Therapy Services who have shown improvement on agreed Therapy Outcome Measures following direct intervention 78% As reported previously technical issues with OLM system impacted on performance, however the Trust expects performance to improve over the coming months. 66.7% This is the first time performance has been below target since reporting. At this stage this is not considered to be a trend. 76% The Trust is currently under the 80% target. At this stage this is not considered to be a trend or a ongoing issue. Compliance will be monitored at the CQRM. CQRM is undertaking a deep dive of Foot Health at the February Community Health CQRM. The CCG continues to monitor progress at the Clinical Quality Review and Service Performance Review Meetings. 71 6

72 Other quality matters Topic Subject Matter Summary Barts Health/ Newham site East London Foundation Trust/ Community Health East London Foundation Trust/ Mental Health London Ambulance Service (LAS) Newham Clinical Quality Review (CQR)/ Oversight and Assurance Meeting Newham Community Health Clinical Quality Review Meeting (CQRM) Newham Mental Health Service Clinical Quality Review Meeting (CQRM) Quality, safety and patient experience of London Ambulance Service The Newham CQR/ Oversight and Assurance Meeting took place on 19 January The meeting discussed the following areas; o Maternity Deep Dive o Remedial Action Plan (RAP) for FFT, Duty of Candour, Amber Alerts and Complaints. o Analysis around complaints, Datix incidents and serious incidents. The Community CQRM meeting took place on 1 December The meeting discussed the following areas; o Cardiac Rehab Service Deep Dive o Accessible Information Standard o CQC Action plans o Improvement trajectory for waiting times o Performance against quality indicators The Mental Health CQRM meeting took place on the 8 December The meeting discussed the following areas; o Quality Improvement around waiting times and DNAs. o Eating Disorder Service o CQC Action plans o Performance and assurance against quality measures. The WEL CCGs are represented by the Director of Nursing, Quality and Governance from WFCCG at the London Ambulance Service CQRM and following recent discussions at the WELC and BHR Quality Leads meeting it was agreed that that our collective concerns regarding safety, quality and patient experience were escalated to the CQRM. They have also been formally escalated to NHSE and the Care Quality Commission. 72 7

73 Topic Royal London Hospital CQC Report Subject Matter CQC reinspection Summary The CQC inspected Royal London Hospital in July The inspectors reviewed eight core services: Urgent and Emergency Care, Medicine (including older people s services), Surgery, Critical Care, Maternity and Gynaecology, End of Life Care, Services for Children and Young People and Outpatients and Diagnostics. Overall the Royal London Hospital has improved from a rating of Inadequate in 2015 to Requires Improvement in The table below shows the comparison between the 2015 and 2016 CQC report outcomes Overall Direction Safe Direction Direction Caring Direction Responsive Direction Well-led Direction Medical Care Same Same Same Same Same Better Urgent and Emergency Services Same Same Same Worse Better Same Surgery Better Better Same Worse Same Same Intensive/critical care Same Same Same Better Worse Same Maternity and Gynaecology Worse Same Same Worse Worse Worse Services for children and young people Better Better Same Same Same Better End of Life Better Same Better Better Same Better Outpatients Same Same N/A Same Same Better Whipps Cross Hospital CQC Report CQC reinspection Overall Better Better Same Worse Same Better Full report can be found here The CQC inspected Whipps Cross Hospital in July The inspectors reviewed eight core services: Urgent and Emergency Care, Medicine (including older people s services), Surgery, Critical Care, Maternity and Gynaecology, End of Life Care, Services for Children and Young People and Outpatients and Diagnostics. Overall there was improvement with no overall ratings deteriorating, Maternity and Gynaecology moved from Requires Improvemen t to Good and Children s and Young People services from Inadequate to Good. The table below shows the comparison between the 2015 and 2016 CQC report outcomes Overall Direction Safe Direction Direction Caring Direction Responsive Direction Well-led Direction Medical Care Better Better Better Better Same Better Urgent and Emergency Services Better Better Same Same Better Better Surgery Same Same Same Same Same Same Intensive/critical care Same Same Same Same Better Same Maternity and Gynaecology Better Same Same Same Better Better Services for children and young people Better Better Better Same Better Better End of Life Better Better Better Worse Same Better Outpatients Same Same N/A Better Same Same Overall Same Better Better Same Same Same Full report can be found here

74 Board 8 February 2017 Title: Finance Report Month 9 Agenda item 3.3 Author: Lei Wei, Deputy Chief Finance Officer Newham CCG Presented by: Chad Whitton, Chief Finance Officer Newham CCG Contact for further information: Chad Whitton, Chief Finance Officer Newham CCG Lei Wei, Deputy Chief Finance Officer Newham CCG This Paper is for: Decision Action required: The Board is asked to Note and approve the 2016/17 Month 9 Finance Report (Appendix 1) Note the internal budget setting process and timetable for 2017/18. Note progress in developing the 2017/18 QIPP programme. 74

75 Executive summary: The CCG received details of its allocations in December and submitted a draft final Five Year Operating Plan on 18 th May Changes to the CCG business requirements set by NHSE and the confirmation that no draw-down on the surplus would be allowed for 2016/17 has added an additional pressure of approximately 6.5 million. The Finance Team worked with budget holders to identify roll-over budgets from February To manage the additional financial pressures, the CCG is implementing an additional saving programme targeted at delivering at least 5 million further savings. The programme ensures that funding essential to deliver the key CCG objectives is made available, but this will be tightly managed and will need to be held within agreed cash envelopes. A five year QIPP Plan has also been developed. Significant locally based QIPP has been identified for 2016/17 with the bulk of savings being delivered through the Transforming Services Together (TST) programme in later years. In 2016/17 the QIPP target is 12.27million. There is no planned capital spend in 2016/17. The budget, together with the additional saving targets for 2016/17 has been signed off by senior management team and budget holders. Details on the financial plan, budgets, reserves and QIPP were agreed at the CCG Board meeting in June It is noted by the Board that there has been increasing financial challenges during the year, and to maintain the financial sustainability of the organisation, the Board approved a further set of savings measures on 9 th November. A summary of the allocations and budgets, comparatives and the performance as at Month 9 is shown in the table below: Area 2015/16 Final Outturn 2016/17 Annual Budget 2016/17 Cumulative Budget 2016/17 Cumulative Actual Cumulative Variance Projected Final Outturn '000 '000 '000 '000 '000 '000 Acute Services 228, , , ,880 (70) 237,069 Mental Health 46,110 46,442 34,844 35, ,744 Community Health 40,437 40,548 30,442 30, ,644 Other Non-Acute 47,925 37,526 27,985 27,288 (697) 36,418 Primary Care 101,285 98,264 74,024 74, ,158 Reserves 0 9, ,429 Running Cost 7,266 7,416 5,562 5, ,416 Total Spend 471, , , ,805 (2) 476,879 Total Allocation (477,852) (483,379) (355,682) (355,682) 0 (483,379) (Suplus)/Deficit (6,518) (6,500) (4,875) (4,877) (2) (6,500) At 2016/17 Month 9 the CCG total resource allocation was 483,379,000 with planned expenditure, including reserves of 476,879,000 generating a surplus of 6,500,000 (1.5%). The projected QIPP delivery is currently on track. The CCG is also contributing to a North East London (NEL) Five Year Sustainability and Transformation Plan (STP). An initial version was submitted at the end of June with an update in September and the final plan submitted on 21st October. The CCG submitted the updated 2017/19 Operating Plan Financial Template on 23rd December 2016, reflecting all the contract values agreed during the national contract 75

76 negotiation process. The Plan also aligns with the final NEL STP submission on 21st October The CCG is developing its 2017/18 QIPP programme in detail and this is described in Appendix 2. The CCG s internal budget setting for 2017/18 started from December 2016, with refreshed guidance on process and timetable being communicated to all budget holders and budget managers on 13th December. It is expected that the budget will go through a process of challenge and rigour at the CCG Senior Management level. All the budget holders and budget managers are required to present their draft budget to the CCG Senior Management Review Panel by 17th February Finance team will work closely with budget holders and budget managers and support them in preparing the presentations and resolving queries arising from the Panel review. The final draft budget will be presented to the Panel by 24th March 2017 and signed off by 31st March 2017 to get ready for the April Board approval. The Board and Executive Committee will receive updates at each meeting. It is a Board duty for the CCG to manage within the resources provided to it and achievement of our financial targets will therefore be an overriding priority. The CCG is currently reporting a balanced financial position to NHSE. The successful implementation of our QIPP and savings programmes, combined with effective management of agreed budgets will be a key component of our ability to deliver this target. Supporting papers: Appendix 1 Newham CCG Finance Report Month /17. Appendix 2 QIPP development 2017/18. How does this fit with Newham CCG Strategy: Values: Accountability and responsibility Requirement to meet target surplus Aims: Ensuring equity of Health and Wellbeing outcomes Where has the paper been already presented? The Month 9 financial position has been reviewed in detail by the Finance Committee and Executive Committee. Risk: The Financial Plan and effective Financial monitoring, reporting and control (including the QIPP programme) as identified in the Finance and Activity Plan is an essential component in identifying and managing financial risk and ensuring the CCG delivers its statutory financial requirements. The risk of failure to deliver this is identified specifically in BAF.05 Equality Impact: delivery of the financial plan will support the CCG in achieving its duty to reduce inequality of health provision and outcomes for the residents of Newham. Stakeholder engagement: This report has been subject to no specific prior consultation but reflects any comments from NHSE scrutiny and assurance processes and any comments, queries or suggestions raised by CCG members, the Board or Newham residents in relation to earlier reports. 76

77 Financial Implications The report provides a high level view of the CCG s financial performance for 2016/17 and planned spending, QIPP and other savings programmes for 2016/21 to secure financial sustainability for the next five years. 77

78 3.3 - Appendix 1 Newham CCG Board 8 February 2017 CCG 2016/17 Month 9 Outturn Month 9 Outturn At 2016/17 Month 9 the CCG total resource allocation was 483,379,000 with planned expenditure, including reserves of 476,879,000 generating a surplus of 6,500,000 (1.5%). This is summarised in the table below. Area 2015/16 Final Outturn 2016/17 Annual Budget 2016/17 Cumulative Budget 2016/17 Cumulative Actual Cumulative Variance Projected Final Outturn '000 '000 '000 '000 '000 '000 Acute Services 228, , , ,880 (70) 237,069 Mental Health 46,110 46,442 34,844 35, ,744 Community Health 40,437 40,548 30,442 30, ,644 Other Non-Acute 47,925 37,526 27,985 27,288 (697) 36,418 Primary Care 101,285 98,264 74,024 74, ,158 Reserves 0 9, ,429 Running Cost 7,266 7,416 5,562 5, ,416 Total Spend 471, , , ,805 (2) 476,879 Total Allocation (477,852) (483,379) (355,682) (355,682) 0 (483,379) (Suplus)/Deficit (6,518) (6,500) (4,875) (4,877) (2) (6,500) Acute service budget Primary care service budget Please note that for NHSE reporting purpose, the annual budget for acute services include 'acute reserves' which are the funding put aside from general reserves to specifically manage overspend on acute services. As at M9, 3,838k is committed as 'acute reserves' Please note that for NHSE reporting purpose, the annual budget for primary care include 'Primary care Reserves' which are the funding put aside from general reserves to specifically manage overspend on primary care services. As at M9, 768k is committed as 'primary care reserves' A more detailed analysis of expenditure is given in the Month 9 Activity and Finance Report provided by CSU to relevant CCG Commissioning Committees and by the CFO to the Finance Sub-Committee (26 January 2017). The Month 9 Report was also considered by the January Executive Committee. Detailed budget analysis is provided and an update on the savings programme will be tabled for discussion at each meeting. 78

79 The table below shows the financial performance of the CCG s main acute providers in Month /17. Acute over-performance 2015/16 Final Outturn 2016/17 Annual Budget 2016/17 Projected Final Outturn 2016/17 Projected Final Variance % Variance on contract % Variance on 15/16 FOT '000 '000 '000 '000 % % Barts Healthcare 176, , , % 4.4% Homerton 6,057 6,399 7,548 1, % 24.6% Guys & St Thomas 2,612 2,775 3, % 30.6% Moorfields 4,103 4,246 4, % 9.4% BHRUT 3,680 4,076 3, % 0.6% UCLH 4,008 4,700 4, % 24.1% BMI 2,576 2,492 2, % 1.6% Other 29,275 29,805 26,654 (3,151) -10.6% -9.0% Total Spend 228, , ,069 (185) -0.1% 3.8% The increase in spend on the acute sector is currently projected 3.8% higher than the 2015/16 outturn. This continued net cash growth presents a significant constraint on investments in integrated care, primary care and other CCG priorities and a challenge to CCG financial sustainability. Collaborative programme management. Since inception the CCG has participated in collaborative arrangements including WELC risk share, Acute commissioning and Transforming Services Together. These arrangements are ongoing and are now in the process of being augmented by participation as a core element of the North East London STP. The Board has at various times provided approval for participation and agreed funding through the Annual budget setting process with detailed analysis, be it of programme or contract components reviewed in relevant service committees or the Executive Committee. However, following discussion at the Audit Committee it was agreed that in the light of continuing and expanding collaborative arrangements over the next period it would be appropriate for the Board to be informed of the CCG s participation in such arrangements where there is a funding implication. Current CCG support and/or participation in arrangements in 2016/17 is summarised in the table below: 79

80 Collaborative Arrangement Type of commitment 2016/17 Commitment '000 Risk Share (NEL) NHSE require 1% uncommitted reserve holding Collaborative Commissioning Committee (CCC) WEL TST Programme NEL STP WEL TST Business Cases MH Collaborative Commissioners Acute Contracting, monitoring, reporting and performance management TST Programme Management and Service leads, CCC Management and CSU MDT. STP Programme Management to built full STP and provide STP (including financial plan to NHSE/I) Support for TST specific programmes (including IT) Joint Mental Health commissioning for ELFT Monitoring and control 4,686 Held and identified in reserves. Any proposed move will be reported to Exec Committee and Board 225,305 Summarised in Month Board Report - Detail provided to Executive Committee, Finance Committee and Acute Committee. 1,050 TST Programme Board, WEL Joint Management Team and CCC (note CCG Board and Clinical leads engaged in TST programmes) 250 STP Programme Board participation and STP reports to Board. Lead Officer CFO CO CO CO 750 TST Programme Board plus CO specific Business Case summaries to Board Members for input to budget holder (CO) 41,919 Mental Health Committee DCO QIPP In the Finance and Activity Plan the net QIPP Programme is 12,269,000, including 150,000 for Primary Care Commissioning. The delivery of QIPP savings in 2016/17 was crucial in enabling the CCG investment plans to be fully rolled out. In Month 9 the CCG reported projected achievement of 12,269,000 against the target as detailed below. Service areas Initiative Annual target m Scheme details Year to date target at M9 m Year to date at M9 m Forecast outturn at M9 m Acute services Care Closer to Home (IC/PrimCare broad schemes) 2.00 TST assumptions Care Closer to Home (specific schemes) 0.80 TST assumptions In Hospital (inc OP and Prod) 2.10 TST assumptions Urgent Care - Projected additional saving 0.73 Saving target built in the agreed contract Community Health Services Community Contract - Rapid Response 0.75 Saving target built in the agreed contract Community estates 0.30 Saving target built in the agreed contract Mental Health Services Mental Health - Triage Ward 1.45 Saving target built in the agreed contract Mental Health Contract- Raid 0.30 Saving target built in the agreed contract Other Programme Services Better Care Fund 1.11 Saving target built in the agreed contract Estate 0.80 Saving target built in the agreed contract TST PMO Programme 0.75 Saving target built in the agreed commitment Primary Care Co-Commissioning Primary Care List size 0.15 NHSE QIPP target and assumption Primary Care services Minor Ailments Transfer to NHSE 0.29 Saving agreed with NHSE Prescribing 0.75 CCG's local schemes Grand Total

81 The 2016/17 QIPP performance will be monitored regularly by the Executive Committee. Further savings amounting to 5m were identified as part of the budget setting process. The CCG is struggling to deliver these fully and while it continues to target these it was acknowledged in the October report that further savings measures were required. It was reported to the November Board the CCG faces a significant financial challenge a further savings target of 2.4m was approved. Financial controls are also being strengthened. The successful delivery of these targets will assist the CCG to deliver its business requirements and progress in achieving the targets will also be reviewed through the Executive Committee. The projected delivery of the agreed programme is as follows: Savings - Actual and Projected/Required Additional Savings Scheme (Approved Target saving December January February March Variance Notes by November Board) from target Interim/Contract staff review 500,000 Based on known 123, , , , ,000 agreements/plan Permanent staff options - recruitment 50,000 To be determined against freeze, offer part-time or unpaid leave. 5,000 10,000 15,000 20,000 0 payroll Clinical and Board sessional costs 200,000 Based on response to Chair's 28,512 28,512 28,512 28,512 85,952 letter Building Income from additional 10,000 Discussions in progress letting/charging 10,000 0 Referral Changes - TOPS - letter to GPs. 50,000 Letter to GPs - Impact to be 10,000 20,000 20,000 0 identified in February Referral Changes - Path tests 80,000 10,000 at M8 - Projection on 6,000 4,000 6,000 18,000 46,000 increased use in Q4 Referral changes - all services - CATS, PN 60,000 Letter to GPs - Scheme rollout or Clin lead review 10,000 20,000 30,000 0 wef 12th December Extract funding from TST/STP 50,000 50,000 0 To be negotiated Prescribing 300,000 Letter to practices 25th 100, , ,000 0 November. Incentive scheme scheduling 900,000 Payment confirmed but to be 900,000 0 reviewed Federation 300, ,000 To be determined in discussion Total 2,500, , , ,512 1,381, ,952 An update on the progress of key schemes including referral management will be provided to the Board. The Board should note that at this point in time all reserves are committed against anticipated required spending, including 1m identified for 2016/17 TST investments and 2m Primary Care Risk and Innovation Reserve. The CCG is currently developing the 2017/18 QIPP programme. Progress on this is described in Appendix 2. Capital There is no planned capital spending for 2016/17. 81

82 QIPP Development and finalisation 2017/18 This paper updates the NCCG Board on progress in delivering the CCG QIPP requirement for 2017/18 and beyond. Background The November Executive Committee agreed a process for identifying QIPP for the 2017/21 period. This is approximately 2.5% per annum and can be summarised as follows: The QIPP requirement for the remaining period of the Five Year Forward View is currently as follows: 2017/18-13,377, /19-12,653, /20-13,008, /21-13,493,000 Total - 52,531,000 The key components of the process are as follows: Stage 1 Existing QIPP plan validation Stage 2 Stakeholder generation Stage 3 QIPP generation against target Existing QIPP plans are refreshed, revalidated and assured through the agreed governance process Target completion end December 2016 Budget holders and other key stakeholders are requested to identify QIPP ideas using a simple template. Following review an MDT will develop selected schemes for formal validation Target completion date end January 2017 The QIPP gap balance will be allocated as a target to Budget Holders via SMT. SMT leads will work with budget holders to identify QIPP efficiencies to meet the target. Target completion date end January

83 Progress to date On 23 rd December the CCG provided details of the 17/18 and 18/19 QIPP in the Operating Plan Financial Template as indicated below: CCG Year Income/Expenditure Line QIPP Type Intervention description Recurrent Saving STP related (Y/N) STP solution NHS Newham CCG 17/18 Acute contracts -NHS (includes Ambulance services) Transformational Service Re-design and Pathway Changes Referral management for optimising care pathways 4,951 - To be confirmed TST - To be confirmed Infrastructure NHS Newham CCG 17/18 MH contracts - NHS Transformational Service Re-design and Pathway Changes Improve asset management through consolidation 3,094 - To be confirmed Infrastructure NHS Newham CCG 17/18 CH Contracts - NHS Transformational Service Re-design and Pathway Changes Improve asset management through consolidation 1,238 - Yes TST NHS Newham CCG 17/18 Other Programme Services Transformational Service Re-design and Pathway Changes Diagnostic and TST schemes roll out 1,857 - No n/a NHS Newham CCG 17/18 Community Base Services Transformational Service Re-design and Pathway Changes Optimising prescribing and other benchmarking (right care) 1,238 - To TST NHS Newham CCG 18/19 Acute contracts -NHS (includes Ambulance services) Transformational Service Re-design and Pathway Changes Referral management for optimising care pathways 5,061 be confirmed - To be confirmed Infrastructure NHS Newham CCG 18/19 MH contracts - NHS Transformational Service Re-design and Pathway Changes Improve asset management through consolidation 3,163 - To be confirmed Infrastructure NHS Newham CCG 18/19 CH Contracts - NHS Transformational Service Re-design and Pathway Changes Improve asset management through consolidation 1,265 - Yes TST NHS Newham CCG 18/19 Other Programme Services Transformational Service Re-design and Pathway Changes Diagnostic and TST schemes roll out 1,898 - No n/a NHS Newham CCG 18/19 Community Base Services Transformational Service Re-design and Pathway Changes Optimising prescribing and other benchmarking (right care) 1,265 Additional detail was provided as shown in the attachment. 25,030 List of QIPP Schemes Reducing Unnecessary Dignostics (TST) Outpatient Referral Management (ReFas) Productivity MSK OP and Diagnostics Brief explanation of Scheme Rurrent or Existing or New Non Proportion Point of Delivery Decrease in recurrent Total scheme value phased into eg OP, NEL, EL activity (pre-risk adjustment) Risk adjustment Risk Adjusted QIPP Investment to deliver QIPP* Net QIPP second half of FY 17/18 Proportion built into contracts Rag Rating Note Reduction in GP direct access New Recurrent % % 100% See business case Direct Access -7% imaging and pathology requests via educational and behavioural Green changes Reduction in OP attendances via New Recurrent 0.7 0% % 100% See business case OPFA -1% Green GP referral mgt processes BHT productivity for C2C,Fups Green etc. Existing Recurrent 0.9 0% % 100% NEL -1% Structured Collaboration with Green gain/loss risk share. New Recurrent 1.4 0% % 100% OP 0% Cardiology Rollout of 15/16 business case New Recurrent 0.3 0% % 0% Green OP n/a Mental Health QIPP Programme Service efficiency through ward Green consolidation New Recurrent 0.6 0% % 100% n/a n/a Mental Health OOS/NCA reductions Existing Recurrent % % 100% Red n/a n/a Community Contract Efficiencies and service Green reconfiguration New Recurrent 0.8 0% % 100% n/a n/a UCC/ED Reductions Re-profiling of activity through Delivery of existing UCC contract Amber triage as per UCC contract Existing Recurrent % % 100% targets ED n/a Prescribing GP Programme Roll-out Existing Recurrent 1.0 0% % 0% Green n/a n/a Prescribing Acute-based prescribing Green reduction programme Existing Recurrent 0.3 0% % 0% Part of WEL based initiatives n/a n/a CCG Premises Asset utilisation - CCG estate Green including deleg and CHN Existing Recurrent 1.0 0% % 0% ongoing n/a n/a PMO consolidation TST and CCG New Recurrent 1.5 0% % 0% Green ongoing n/a n/a Other Inc CSU SLA Existing Recurrent % % 10% Amber ongoing n/a n/a Total * Note these are the costs of investment and reprovision and not the N/R costs of project management Net QIPP RAG definitions 10.1 Green 81% 1.8 Amber 15% 0.5 Red 4%

84 The initial trawl of staff response has been returned and is currently being reviewed for further development. In total new QIPP has potentially been identified. A review of the proposals has identified a number of key areas for further action including: TST Diagnostics Cardiology Prescribing ReFas Demand Management Dermatology/Community Ophthalmic A decision matrix and a business case format have been developed and these will be tabled at the meeting. Next Steps A QIPP Group has been established (Selina, Wayne, Chad, Lei) that meets bi-weekly to oversee progress (Chetan will be brought in for prescribing). Initial options are being reviewed and best options will be followed up. Targets are being provisionally identified to ensure QIPP coverage as part of the budget setting round. This will be initially discussed with budget holders and will be applied subject to progress in identifying QIPP. A detailed analysis and review will be undertaken at the 31 st January SMT and an detailed position with progress on key targets provided to the February Executive Committee. Concerns/Risks Currently the initial ideas require significant development and this will be undertaken in targeted approach that reflects capacity and vfm. The budget round is primarily designed to ensure overall financial position is manageable rather than simply a QIPP target so a safety net not an alternative. However, the intention is to ensure that budgets are set to deliver financial sustainability regardless of whether QIPP is fully delivered. As yet there is limited focus on years beyond 17/18. This needs to be developed, particularly as a number of schemes may require a longer gestation to achieve maximum effectiveness. The CCG will continue to be required to deliver data to NHSE (eg Triangulation of expectation and QIPP risk due 27 th Jan). It will be important to ensure fully worked up schemes are synthesised with information provided to NHSE. 84

85 Newham CCG Board 08 February 2017 Title: Governing Body Structure and Constitutional Change Agenda item: 3.4 Author: M Sims Board Secretary Newham CCG Presented by: S Sanghera Director of Partnerships and Governance Newham CCG Contact for further information: S Sanghera Director of Partnerships and Governance Newham CCG, Satbinder.sanghera@newhamccg.nhs.uk; This Paper is for: Decision Monitor Discuss Information Action required: Agree the recommended constitutional changes in relation to; Rotation of Retirement for Board members Maximum Terms of Office for Board members The Constitutional position of the Lay Vice (Deputy) Chair Executive summary: Board agreed a series of changes for a revised Governing Body structure and constitutional changes at its December 2016 meeting Board was advised that the Constitution Working Group was still yet to consider some final recommendations which would need to be returned in February for decision. This report asks Board to consider those changes; o Rotation of Retirement for Board members o Maximum Terms of Office for Board members o The Constitutional position of the Lay Vice (Deputy) Chair Supporting papers: None How does this fit with Newham CCG Strategy:. Values: Collective clinical leadership. & collaborative 85 communication.

86 Patient/Public voice throughout our decision making. Transparency with our decision-making and leadership. Accountability and responsibility. Aims: Improving health outcomes through developing models of integrated care and focusing on prevention. Reducing inequalities and improving accessibility. Reducing quality variation. This report has been presented at: No previous meeting Risk: Equality Impact: BAF.10 - Failure to implement the improvements agreed in corporate governance structure The Constitution sets out the CCG s obligations in relation to equalities and diversity including compliance with the Equality Act The revised structure must incorporate the CCG s public sector equality duties three aims to be able to support the CCG s commitment to reduce health inequalities. The memberships of Committees should also reflect the CCG s long held commitment to PPE. Stakeholder engagement: Constitution Working Group (CWG) January 2017 Financial Implications: 1. Proposed changes Rotation of Retirement Board has agreed rotation of retirement for GP Members only on the Board CWG proposed to establish a 4 and 4 split of the 8 cluster seats with elections each alternate 2 years but retaining 2 year terms of office i.e. Group 1 4 retirements / elections in 2018 Group 2-4 retirements / elections in 2019 then Group 1 4 retirements / elections in 2020 Group 2-4 retirements / elections in 2021 And so forth Given there will shortly be 2 vacancy elections in Clusters South 1 and South 2 GWG proposed these two constituencies should logically be included in Group 2 i.e. no retirements until Consequently GWG needed to recommend which 2 further constituencies are included in

87 Group 2 and therefore which 4 will therefore be in Group Options considered; By area choose 2 more south constituencies or 2 more north areas for group 2, or by some other geographical logic By volunteer consult the remaining 6 GP Board members and ask if they intend to retire in 2018 and use this as the constituency template for rotation going forward in terms of the 4 and 4 split By drawing lots if none or if there are up to three volunteers for retirement in 2018 then draw lots from those who have not volunteered for however many retirements are required then use this as the constituency template for rotation going forward in terms of the 4 and 4 split CWG recommended that the six existing GP Board Members should be approached informally to determine the four constituencies that will be classified in Group 1. If no consensus can be obtained then lots should be drawn as required to determine the constituencies. This would then fix the rotation of the eight clusters in two groups that would be written into the Constitution. Maximum Terms of Office Generally it is recognised that having maximum terms of office is part of a good governance model along with rotation to ensure there is appropriate balance on a Board between continuity and change. Who would be affected - CWG proposed a maximum term of six years service for all the following Board Members; Elected GP Members Lay members Secondary Care Consultant Registered Nurse Co-opted members Elected Practice Manager Member Elected Practice Nurse Member A Six Year Term - It is proposed that this means six years not just 6 consecutive years but any 6 years i.e. a break in service followed by a return of a further 2 years is only permissible if only 4 years or less have already been served. Additionally where a board member retires from office before the end of an existing 2 year term then any return to office would require consideration of the time already served Lay members, Secondary Care Consultant and Registered Nurse appointments - It is proposed that these posts remain on 2-year terms but that the Board has the option to extend them by two lots of 2 years each two years following expiry of the original 2 years i.e. 2 original years plus maximum of further 4 years. Rotation of these appointments occurs by default given contracts are agreed and expire on different cycles Date of implementation CWG considered the relative merits or recommending any retrospective implementation date ; For without retrospective implementation the CCG Board will have permitted its members to, theoretically, remain on the Board for a period of 10 years since 2013 Against current board members have taken their posts based on the current constitutional position that there is no maximum term of office theoretically they may not have stood for appointment had this not been the case CWG recommended that implementation should be retrospective for all relevant Board members, effective from the date the CCG was formally authorised on 1 st April 2013 although the effective date for GP members would be 31 st June 2013 to synchronise with the GP election cycle. 87

88 Constitutional position of Lay Vice (Deputy) Chair The current wording of the Constitution vests the post of Lay Vice (Deputy) Chair specifically in the role of the lay member for PPE although this is not an NHSE statutory requirement and the NHSE template constitution does not stipulate this. CWG therefore recommended this should be amended to state that the role of the Deputy Lay Chair would be a Chair appointment in line with the appointments of the Joint and Joint Deputy Clinical Chairs which would be therefore logical in terms of how the CCG appoints all its deputy posts on the Board as well as being more equitable. 2. Next Steps 2.1 Consultation with Practice Council Consultation with LMC Approval of NHSE sought 88

89 Newham CCG Board 08 February 2017 Title: Conflict of Interests Policy/ Gifts, Hospitality and Anti - Fraud and Bribery Policy / Commercial Sponsorship Policy Agenda item: 3.5 Author: M Sims Board Secretary Newham CCG Presented by: S Sanghera Director or Partnerships & Governance NCCG Contact for further information: S Sanghera Director of Partnerships & Governance; Satbinder.sanghera@newhamccg.nhs.uk; This Paper is for: Decision Monitor Discuss Information Action required: Approve the Conflict of Interests Policy, Gifts, Hospitality and Anti - Fraud and Bribery Policy and Commercial Sponsorship Policy Approve Audit Committee s recommendation for failure to comply with the requirement to complete regular Declaration of Interest returns for Board members, Clinical and Cluster Leads Executive summary: Asks the Board to consider the recommendations of the Audit Committee in relation to revisions to the Conflict of Interests Policy/ Gifts, Hospitality and Anti - Fraud and Bribery Policy and a new Commercial Sponsorship Policy primarily based on guidance issued by NHSE in June Asks the Board to approve Audit Committee s recommendation for failure to comply with the requirement to complete regular Declaration of Interest returns; i.e. that where Board Members, Clinical or Cluster leads fail to complete declarations within an appropriate timescale that CCG pay should be suspended. Supporting papers: a) Appendix A - CCG Conflicts of Interest Policy b) Appendix B - Gifts, Hospitality and Anti - Fraud and Bribery Policy c) Appendix C - Commercial Sponsorship Policy How does this fit with Newham CCG. Values: 89

90 Strategy: Transparency with our decision-making and leadership. Accountability and responsibility. Aims: Reducing inequalities and improving accessibility. Reducing quality variation. This report has been presented at: Audit Committee 19/1/17 Risk: Failure of the organisation to adopt a workable and transparent model for decision making in terms of the management of conflicts gifts, hospitality and sponsorship risks commissioning decisions being made which are potentially prejudicial or corrupt or perceived as such. Equality Impact: The Constitution sets out the CCGs obligations in relation to equalities and diversity including compliance with the Equality Act Stakeholder engagement: Audit Committee 19/1/17 Financial Implications: The potential additional cost if the proposed sponsorship policy is approved is under 22,000 and as such would be affordable within the existing budget framework. The potential cost will be reviewed on a six monthly basis and any requirement for additional support be brought forward for discussion at the Executive Committee 1. Introduction and Background 1.1 New NHSE Guidance 1.2 In June 2016 NHSE updated the statutory guidance following the previous iteration in December The CCG had already revised its policy in March 2016 and the revisions proposed to the policy now reflect the requirements stipulated in the June revision. The key features of the new guidance from the previous version are; 1.3 Conflicts of Interest An extended scope of the definition of interests, in particular introducing detail on the potential conflict of secondary employment and personal interests Extending the requirement for declarations to be made by all CCG staff or office holders as well as GP Partners in Practices and the requirement to refresh them six monthly as opposed to three monthly The appointment of a Conflicts Guardian (Lay Member) The requirement for an annual internal audit of conflicts management and its review by the Audit Committee The requirement to ensure the Lay Member Chair of Audit is not also the Lay Chair of the Primary Care Commissioning Committee Online annual mandatory training for 90 all CCG staff or office holders as well as GP

91 Partners in Practices 1.4 Gifts All gifts offered to CCG staff, Board Members, Clinical Leads and Cluster Leads and to Member Practices by suppliers or contractors must be declined whatever the value and declared. Gifts from other sources should also be declined if it give rise to perceptions of bias or favouritism. Only exception is gifts less than 10 in the form of stationery, calendars, dairies, etc. All cash gifts must be declined and declared. 1.5 Hospitality Modest hospitality can be accepted as long as it is on the same basis provided by the CCG (tea, coffee, refreshments). This kind of hospitality does not need to be declared unless offered by suppliers or contractors (currently or prospectively). Hospitality that goes beyond being modest should not be accepted such as : o Value over 25 and o Offers of foreign travel and accommodation In some circumstances this could be accepted but express prior approval should be sought. However, particular caution should be exercised where hospitality is offered by suppliers or contractors (currently or prospectively). All offers should be declared and recorded. 1.6 Sponsorship A process of prior approval of acceptance of sponsorship Publication of sponsorship accepted and rejected Revisions to the Changes to the Conflict of Interests Policy/ Gifts, Hospitality and Anti - Fraud and Bribery Policy The changes made as a result of the guidance have been highlighted in these two existing policy at Appendices A and B Conflict of Interests Policy - changes highlighted in red Hospitality and Anti - Fraud and Bribery Policy - text highlighted in lime green represents an addition and text highlighted in sky blue represents a deletion. Audit Committee reviewed the policies on 19th January 2017 and, overall, felt the proposed revisions appropriately reflected the requirements stipulated in the revised guidance Escalation process - failure to comply with the requirement to complete regular Declaration of Interest returns At its meeting on 19 th January 2017, Audit Committee received a report which reviewed the CCG s compliance with its own Conflicts of interest Policy and the guidance issued in June As part of that report the Committee was asked to recommend an escalation process for Board Members, Clinical or Cluster leads who failed to complete declarations of interest updates within an appropriate timescale. The Committee noted that two clinical leads had failed to comply with a series of requests to update their conflicts of interest forms. The Committee is therefore recommending to the Board a process which would involve the suspension of pay in the event that such returns are not received in a timely manner. It is proposed that the determination of the appropriate timescale is made by the Director of Partnerships and Governance and would, of course, involve a process of evidencing officer attempts to secure the return. 91

92 Commercial Sponsorship Policy Context Newham CCG already has a sponsorship policy that relates specifically to the issue of sponsorship and medicines management. It does not, however, have a corporate sponsorship policy for matters other than medicines management. A corporate sponsorship policy was therefore presented to the Audit Committee for consideration which addressed both pharmaceutical and any other form of possible sponsorship. The Policy presented to Audit Committee Most typically the issue of sponsorship as it has existed to date for the CCG has involved requests from pharmaceutical organisations as provider organisations to be permitted an audience with primary care practitioners through the CCG meeting structure (Practice Council, Cluster Meetings, education sessions) where presentations have been made in return for the provision of refreshments The proposed policy presented to the Audit Committee had been framed in such a way as to continue to permit sponsors an audience with CCG members (remembering this includes GP Members) but placed a new significant emphasis on the requirement for the CCG to have to assure itself that no significant advantage was being conferred on the provider as a sponsor in doing so. The Audit Committee was, however, advised that it may wish to take the view that a more risk averse approach was required meaning that any form of sponsorship by providers or potential providers should not be permitted at commissioner events at all given that; Typically providers approached the CCG to offer sponsorship as opposed to the CCG offering the opportunity to allow sponsorship to all providers and hence there was not a fair and equitable system allowing similar access to all providers at events. As a matter of principle, the CCG as a commissioning body should remove itself from the risk of being perceived as conferring an advantage on an existing or potential provider The Audit Committee concluded that, subject to a review of the overall financial value of typical sponsorship for the CCG, and assuming this value was not significant, the CCG should adopt a policy which did not permit sponsorship with providers or potential providers as a matter of principle Financial Value A summary of the annual value of sponsorship that the CCG may need to pay for at events is; Practice Council - 3,300 CCG Practice Council meetings - pharmaceutical companies until recently were permitted to provide stands within the restaurant room before the meeting at these sessions in return for payment direct to the onsite catering company at NUH. This practice has been suspended and the CCG is currently paying for the catering. The CCG had no control over which companies provided sponsorship at the sessions and this was determined by BHT staff on site. Primary Care Education sessions - 15,000 Pharmaceutical companies until earlier this financial year were permitted to make presentations at these sessions in return for payment direct to the onsite catering company at NUH. This practice has been suspended and the CCG is currently paying for the catering. The decisions on which organisation can present at the meetings was taken by the CCG and recorded in the CEPN Team. Cluster meetings - 1,700 Pharmaceutical companies are permitted 92 to make presentations prior to the

93 commencement of these meetings in return for the provision of light refreshments. The decisions on which organisation can present at the meetings is taken by the CCG made is recorded in the Primary Care Team. Other events Diabetes MDT meetings - 1,500 Pharmaceutical companies are permitted to make presentations prior to the commencement of these meetings in return for the provision of light refreshments. The decisions on which organisation can present at the meetings is taken by the CCG made is recorded in the Long Term Conditions Team The GP Federation Audit Committee made the point that in fact the most appropriate forum for sponsorship would be in a provider to provider relationship between pharmaceutical companies and Newham Health Collaborative i.e. potential sponsors should be referred to NHC in terms of seeking an audience with primary care practitioners Proposed Policy Given that the opportunity cost of the value of financial value of sponsorship is relatively low the Policy being recommended to Board by Audit Committee advises that sponsorship should not be considered by the CCG as a matter of principle as a commissioning organisation. Having said this, there is risk that in adopting such a policy there may be some loss of knowledge or awareness in terms of medicines management issues to the CCG both in terms of staff and employed clinicians. Next Steps Advise staff, NHC and primary care practitioners of the CCG s policy. 93

94 CONFLICT OF INTERESTS POLICY V0.7 (December 2016) CONTENTS 1 Purpose 2 2 Scope 2 3 Policy Statement 3 4 Responsibilities 3 5 The Declaration of Interest 4 6 Register of Declarations of Interest 5 7 Declarations of Interests at meetings 5 8 Interests and gifts 5 9 Equality and Diversity Statement 6 10 Advice, Training and monitoring compliance and effectiveness of the Policy 6 Appendix 1 Appendix 2 Appendix 3 Appendix 4 Appendix 5 Conflicts of Interests Proforma Pro forma to be used when commissioning services from GP practices, including provider consortia, or organisations in which GPs have a financial interest Frequently asked questions Potential Conflicts Scenarios to consider Case Studies of conflicts 1 94

95 1. Purpose 1.1 This policy sets out how NHS Newham Clinical Commissioning Group will manage conflicts of interest arising from the operation of the group s Board, Committees, Transformation Programmes and working groups. The aim of this policy is to protect both the organisation and the individuals involved from any appearance of impropriety and demonstrate transparency to the public and other interested parties. 1.2 The Board of NHS Newham Clinical Commissioning Group have ultimate responsibility for all actions carried out by staff and committees throughout the clinical commissioning group s activities. This responsibility includes the stewardship of significant public resources and the commissioning of healthcare to the community. The board will therefore ensure the organisation inspires confidence and trust amongst its patients, staff, partners, funders and suppliers by demonstrating integrity and avoiding any potential or real situations of undue bias or influence in the decision-making of the Clinical Commissioning Group (CCG). 1.3 This conflict of interest policy respects the seven principles of public life promulgated by the Nolan Committee. The seven principles are: selflessness integrity objectivity accountability openness honesty leadership. 1.4 The CCG has a legal obligation in accordance with its constitution and terms of establishment created by the NHS Commissioning Board, and to avoid situations where there may be a potential conflict of interest. 2. Scope 2.1 This policy applies to all employees and appointed individuals who are working for NHS Newham Clinical Commissioning Group and members of the CCG Board, Committees and Transformation Programmes and any other decision making groups. 2.2 Anyone contracted to provide services or facilities directly to the Clinical Commissioning Group will be subject to the same provisions of this policy in relation to managing conflicts of interests. This requirement will be set out in the contract for their services. 2.3 The policy should be read in conjunction with the following documents, which also set out generic guidelines and responsibilities for NHS organisations and General Practitioners in relation to conflicts of interests: NHS Newham CCG Constitution Standing Orders, Reservation and Delegation of Powers and Standing Financial Instructions Code of conduct for NHS Managers

96 Appointments Commission: Code of Conduct and Code of Accountability The Healthy NHS Board: Principles for Good Governance General Medical Council: Good Medical Practice 2006 National Health Service (Procurement, Patient Choice and Competition) (No 2) Regulations 2013 National Health Service Act 2006 (as amended by the Health & Social Care Act 2012) NHSE Guidance issued in December 2014 NHSE Revised Statutory Guidance issued in June NHS Newham Clinical Commissioning Group will ensure that all employees, contractors and decision-makers are aware of the existence of this policy. The following will be undertaken to ensure awareness: introduction to the policy during local induction for new starters to the organisation, whether a Board Member, Clinical Lead, Cluster Lead or an employee annual reminder of the existence and importance of the policy via internal communication methods annual reminder to update declaration forms sent to all Board members, Clinical Leads, Cluster Leads, GP Partners and CCG staff 2.5 Staff should also refer to their respective professional codes of conduct relating to the declaration of conflicts of interest. 2.6 We collectively agree the following in relation to managing conflicts of interest when CCGs commission from member practices: If CCGs are doing business properly (needs assessments, consultation mechanisms, commissioning strategies and procurement procedures), then the rationale for what and how they are commissioning is clearer and easier to withstand scrutiny. Decisions regarding resource allocation should be evidence-based, and there should be robust mechanisms to ensure open and transparent decision making. CCGs must have robust governance plans in place to maintain confidence in the probity of their own commissioning, and maintain confidence in the integrity of clinicians. CCGs should assume that those making commissioning decisions will behave ethically, but individuals may not realise that they are conflicted, or lack awareness of rules and procedures. To mitigate against this, CCGs should ensure that formal prompts, training and checks are implemented to make sure people are complying with the rules. As a rule of thumb, if in doubt, disclose CCGs should anticipate many possible conflicts when electing/selecting individuals to commissioning roles, and where necessary provide commissioners with training to ensure individuals understand and agree in advance how different scenarios will be dealt with. It is important to be balanced and proportionate the purpose of these tools is not to constrain decision-making to be complex or slow. 3. Policy Statement 3 96

97 3.1 This policy supports a culture of openness and transparency in business transactions. All employees and appointees of NHS Newham Clinical Commissioning Group are required to: ensure that the interests of patients remain paramount at all times be impartial and honest in the conduct of their official business use public funds entrusted to them to the best advantage of the service, always ensuring value for money ensure that they do not abuse their official position for personal gain or to the benefit of their family or friends ensure that they do not seek to advantage or further, private or other interests, in the course of their official duties. 3.2 The CCG recognises that: A perception of wrongdoing, impaired judgement or undue influence can be as detrimental as any of them actually occurring: If in doubt, it is better to assume the existence of a conflict of interest and mange it appropriately rather than ignore it; For a conflict of interest to exist, financial gain is not necessary. 3.3 NHS Newham Clinical Commissioning Group will view instances where this policy is not followed as serious and may take disciplinary action against individuals as appropriate. 3.4 Appendix 3 of this policy sets out in greater detail Newham CCG s definition of interest and what to do if a conflict of interest arises for Members of the Board, clinical leaders and employees. This policy should also be read in conjunction with the Procurement Policy that sets out the CCG procurement process, register of procurement decisions and compliance with procurement law and best practice. 4. Responsibilities 4.1 It is the responsibility of all staff employed or appointed by the NHS Newham Clinical Commissioning Group and those serving in a formal capacity to ensure that they are not placed in a position which creates a potential conflict between their private interests and their CCG duties. 4.2 NHS Newham Clinical Commissioning Group needs to be aware of all situations where an individual has interests outside of his / her Contract of Employment or other involvement with the CCG, where that interest has potential to result in a conflict of interest between the individual s private interests and their CCG duties. 4.3 All decision-makers must therefore declare relevant and material interests to the NHS Newham Clinical Commissioning Group upon appointment, when a new conflict of interest arises, or upon becoming aware that the CCG has entered into or proposes entering into a contract in which they or any person connected with them has any financial interest, either direct or indirect. 5. The declaration of interests 4 97

98 5.1 All persons appointed by the CCG are required to declare any relevant and material interests, and any gifts or hospitality offered and received in connection with their role in the clinical commissioning group. 5.2 CCG has arrangements to ensure individuals declare any conflict or potential conflict in relation to a decision to be made by the group as soon as they become aware of it, and in any event within 28 days. The CCG will record the interest in the registers as soon as they become aware of it. 5.2 Interests that may impact on the work of the CCG and should be declared include (including a family member, spouse or partner): No member of the CCG s Governing body may lead or have an executive role in a provider organisation (for example, defined as a GP primary care network or federation or GP OOH Coop) or have a material interest (e.g. shareholder of more than 5% of the nominal share capital) in that provider organisation. This would not exclude their practice from joining a primary care network/federation/provider, or another member of their practice team having a leadership role within the network/federation/provider. No member of the CCG s Governing body could be an office holder of the Local Medical Committee any directorships including non-executive directorships held in private companies or public limited companies (with the exception of those of dormant companies) of companies likely to be engaged with the business of the clinical commissioning group ownership or part ownership of companies, businesses or consultancies which may seek to do business with the CCG previous or current employment or consultancy positions voluntary or remunerated positions, such as trusteeship, local authority positions, other public positions membership of professional bodies, mutual support organisations or a position of trust in a charity or voluntary organisation in the field of health and social care investments in unlisted companies, partnerships and other forms of business, major shareholdings (more than 25,000 or 1% of the nominal share capital) and beneficial interests gifts or hospitality offered to you by external bodies and whether this was declined or accepted in the last twelve months receipt of research funding / grants from the CCG or related parties interests in pooled funds that are under separate management (any relevant company included in this fund that has a potential relationship with the CCG must be declared) formal interest with a position of influence in a political party or organisation current contracts with the CCG in which the individual has a beneficial interest any other employment, business involvement or relationship or that of a spouse or partner that conflicts, or may potentially conflict with the interests of the CCG any other conflicts that are not covered by the above. 5.3 Where individuals are unsure whether a situation falling outside of the above categories may give potential for a conflict of interest they should seek advice from the Chief Officer. However, the individual is advised that if in any doubt they should declare an interest. 5 98

99 5.4 Managers of NHS Newham Clinical Commissioning Group must ensure members of staff are aware of the policy and process to be followed. 5.5 It is the responsibility of all employees and appointees to familiarise themselves with this policy and comply with the provisions set out in it. 5.6 If you are not sure what to declare, or whether/when your declaration needs to be updated, please contact the Chief Officer for guidance. 5.7 The Declaration of Interests proforma with guidance for completion is attached at Appendix Register of Declarations of Interests 6.1 NHS Newham Clinical Commissioning Group has established a Register of Declarations of Interest, which is held by the Chief Officer. The Register is available on the CCG Internet Pages and is also available for public inspection. 6.2 Declarations of interest made by CCG group members are published within the CCG s annual report. 6.3 The Register of Declarations of Interest will be reported to the CCG Audit Committee annually. 6.4 All CCG Board members, Committee members and Programme Board members, CCG Members (GP Partners) and all staff will be required to complete a Declaration of Interests proforma (Appendix 1). Where there are no interests to declare a nil return is required. The CCG will ensure that, as a matter of course, declarations of interest are made and regularly confirmed or updated. This includes the following circumstances: On appointment: Applicants for any appointment to the CCG or its governing body are asked to declare any relevant interests. When an appointment is made, a formal declaration of interest proforma is required to be made and recorded. At meetings: All attendees are asked to declare any interest they have in any agenda item before it is discussed or as soon as it becomes apparent. Even if an interest is declared in the register of interests, it should be declared in meetings where matters relating to that interest are discussed. Declarations of interests are recorded in minutes of meetings. Six Monthly: Newham CCG asks all Board Members, Clinical Leads, Clusters Leads, GP Partners and all employees to update their declaration of interest details on a six monthly basis so that their register of interests is accurate and up to date. On changing role or responsibility: Where an individual changes role or responsibility within a CCG or its governing body, any change to the individual s interests should be declared 6 99

100 On any other change of circumstances: Wherever an individual s circumstances change in a way that affects the individual s interests (e.g. where an individual takes on a new role outside the CCG or sets up a new business or relationship), a further declaration should be made to reflect the change in circumstances. This could involve a conflict of interest ceasing to exist or a new one materialising. 6.5 All individuals who have a conflict should declare this as soon as they become aware of it, and in any event not later than 28 days after becoming aware. 7. Declarations of Interests at meetings 7.1 The agenda (both public and confidential agenda) for meetings of the CCG Board and also of its committees will contain a standing item at the commencement of each meeting, requiring members to declare any interests relating specifically to the agenda items being considered. If during the course of a meeting, an interest not previously declared is identified, this shall be declared. The minutes of the meeting should detail all declarations made and any relevant responses and/or action taken. 7.2 The Chief Officer shall endeavour to ensure that reports for consideration by the Board, Committees or Transformation Programmes will identify potential conflicts of interest. 7.3 Board, Committee and Transformation Programmes members must be specific when declaring interests. They should state which agenda the potential conflict of interest relates to and the nature of that conflict. Where an interest is significant or when the individual or a connected person has a direct financial interest in a decision, the individual should not take part in the discussion or vote on the item and should consider leaving the room when the matter is discussed. The Chair of the meeting may ask that a member leaves the room if they have a significant interest or a direct financial interest in a matter under discussion. Where the Chair has made a declaration of interest they should not Chair for that particular item. 7.4 If there is any doubt as to whether an interest should be declared, a declaration should be made and / or advice sought from the Chief Officer. 7.5 All agendas of Board meetings, committee meetings and transformation programmes will include the following paragraphs under the declaration of interest item: Financial Interest If you have a direct financial interest in any matter on the agenda you must not participate in any discussion or vote on that matter. If you do so you may be committing a criminal offence, as well as a Breach of the Conflict of Interest Policy and the CCG Code of Conduct. The individual should leave the meeting (including any public seating area) during consideration of the matter. Non-financial Professional Interest The CCG Policy requires you to make a verbal declaration of the existence and nature of any Indirect Financial Interest. Any Member who does not declare these 7 100

101 interests in any matter when they apply may be in breach of the Policy and Code of Conduct. A decision in relation to that business might reasonably be regarded as affecting your well-being or financial standing, or a member of your family, or a person with whom you have a close association with to a greater extent than it would affect the majority of the GPs or other Board Members. Non-financial personal interests The CCG Policy requires you to make a verbal declaration of the existence and nature of any Indirect Financial Interest. Any Member who does not declare these interests in any matter when they apply may be in breach of the Policy and Code of Conduct. A decision in relation to that business might reasonably be regarded as affecting your well-being or financial standing, or a member of your family, or a person with whom you have a close association with to a greater extent than it would affect the majority of the GPs or other Board Members. Indirect interests The CCG Policy requires you to make a verbal declaration of the existence and nature of any Indirect Financial Interest. Any Member who does not declare these interests in any matter when they apply may be in breach of the Policy and Code of Conduct. For further advice about these matters please contact the Director of Partnerships & Governance. 8. Interests and gifts 8.1 Interests and gifts will be recorded on the register of interests and register of gifts and hospitality, which will be maintained by the Chief Officer. The register will be accessible by the public and inspection of the register of board members interests will be encouraged, as appropriate. 8.2 Board members should not use confidential information acquired in the pursuit of their role to benefit themselves or another connected person. 9. Equality and Diversity Statement 9.1 The organisation is committed to ensuring that it treats its employees fairly, equitably and reasonably and that it does not discriminate against individuals or groups on the basis of their ethnic origin, physical or mental abilities, gender, age, religious beliefs or sexual orientation. An Equality Impact Assessment has been completed for this policy. 9.2 If you have any concerns or issues with the contents of this policy or have difficulty understanding how this policy relates to you or your role, please contact in the first instance the Director of Partnerships and Governance

102 10. Advice, Training and monitoring compliance and the effectiveness of the Policy 10.1 The policy will be reviewed annually by the Audit Committee to ensure it remains fit for purpose 10.2 All those required to comply with the Conflicts of interest policy will be required to undertake mandatory conflicts management training as directed by NHSE as well as being reminded of the policy and register of interests management process at least annually 10.3 The Chair of Audit Committee will act as the appointed CCG Conflicts of Interest Guardian. The Guardian will support the Director of Partnerships and Governance in respect of providing advice on conflicts of interest cases, overall conflicts of interests management and training 10.3 The Director of Partnerships & Governance and the Conflicts Guardian will review register entries on a regular basis and take any action necessary as highlighted by the review The Audit Committee will review the Declarations of Interest Register at least annually to consider if further advice should be offered to all or individuals who are required to declare interests. The Audit Committee will also receive an annual review of conflicts management as part of the CCG s Internal Audit programme

103 Appendix 1 Conflicts of Interests Proforma Please complete the form and return to the address below: Name: Position: Please detail below any relevant and material interests as listed overleaf (further guidance is available in the Conflicts of Interest Policy) Type of Interest Details Personal interest or that of a family member, close friend or other acquaintance? Roles and responsibilities held within member practices

104 Directorships, including nonexecutive directorships, held in private companies or PLCs. Ownership or partownership of private companies, businesses or consultancies likely or possibly seeking to do business with the CCG. Shareholdings (more than 5%) of companies in the field of health and social care. Positions of authority in an organisation (e.g. charity or voluntary organisation) in the field of health and social care. Any connection with a voluntary or other organisation contracting for NHS services. Research funding / grants that may be received by the individual or any organisation they have an interest or role in. Any other role or relationship which the public could perceive would impair or otherwise influence the individual s judgement or actions in their role within the CCG

105 To the best of my knowledge and belief, the above information is complete and correct. I undertake to update as necessary the information provided and to review the accuracy of the information provided regularly and no longer than annually. I give my consent for the information to be used for the purposes described in the constitution and the Conflict of Interest Policy, and published accordingly. Signed: Date: Where interests change or new interests are identified this form must be updated and returned to the Accountable Officer. Return to: Newham CCG, Unex Tower, 4 th Floor 5 Station Street Stratford E15 1DA London Guidance Note for Completion of the declaration form This form must be completed by all CCG members on appointment and updated as interests change or new interests are identified. It should also be completed by any employees, persons serving on all committees and other decision-making groups and as soon as a potential conflict of interest is identified or if requested by the Accountable Officer as part of the annual review of interests. Relevant and material interests are defined as: any directorships including non-executive directorships held in private companies or public limited companies (with the exception of those of dormant companies) of companies likely to be engaged with the business of the clinical commissioning group ownership or part ownership of companies, businesses or consultancies which may seek to do business with the CCG previous or current employment or consultancy positions

106 voluntary or remunerated positions, such as trusteeship, local authority positions, other public positions membership of professional bodies, mutual support organisations or a position of trust in a charity or voluntary organisation in the field of health and social care investments in unlisted companies, partnerships and other forms of business, major shareholdings (more than 25,000 or 1% of the nominal share capital) and beneficial interests gifts or hospitality offered to you by external bodies and whether this was declined or accepted in the last twelve months receipt of research funding / grants from the CCG or related parties interests in pooled funds that are under separate management (any relevant company included in this fund that has a potential relationship with the CCG must be declared) formal interest with a position of influence in a political party or organisation current contracts with the CCG in which the individual has a beneficial interest any other employment, business involvement or relationship or that of a spouse or partner that conflicts, or may potentially conflict with the interests of the CCG any other conflicts that are not covered by the above. Where individuals are unsure whether a situation falling outside of the above categories may give potential for a conflict of interest they should seek advice from the Accountable Officer. Appendix 2 Proforma to be used when commissioning services from GP practices, including provider consortia, or organisations in which GPs have a financial interest. NHS Newham Clinical Commissioning Group Service: Question Comment/Evidence Questions for all three procurement routes How does the proposal deliver good or improved outcomes and value for money what are the estimated costs and estimated benefits?

107 How does it reflect the CCG s proposed commissioning priorities? How have you involved the public in the decision to commission this service? What range of health professionals have been involved in designing the proposed service? What range of potential providers have been involved in considering the proposals? How have you involved your Health and Wellbeing Board? How does the proposal support the priorities in the relevant joint health and wellbeing strategy? What are the proposals for monitoring the quality of the service? What systems will there be to monitor and publish data on referral patterns? Have all conflicts and potential conflicts of interests been appropriately declared and entered in registers which are publicly available? Why have you chosen this procurement route? What additional external involvement will there be in scrutinising the proposed decisions? How will the CCG make its final commissioning decision in ways that preserve the integrity of the decision making process? Additional question for AQP or single tender (for services where national tariffs do not apply) How have you determined a fair price for the service? Additional question for AQP only (where GP practices are likely to be qualified providers)

108 How will you ensure that patients are aware of the full range of qualified providers from whom they can choose? Additional questions for single tenders from GP providers What steps have been taken to demonstrate that there are no other providers that could deliver this service? In what ways does the proposed service go above and beyond what GP practices should be expected to provide under the GP contract? What assurances will there be that a GP practice is providing high-quality services under the GP contract before it has the opportunity to provide any new services?

109 Appendix 3 Frequency Asked Questions What is a conflict of interest? Conflicts arise when the interests of the Board, Committee or Transformation Programme members, or persons connected to them, are incompatible or in competition with the interests of the clinical commissioning group. Such situations present a risk that decisions could be made based on these external influences, rather than the best interests of the patients and public on whose behalf they are commissioning services or considering service redesigns. A conflict of interest occurs where an individual s ability to exercise judgement, or act in a role, is or could be impaired or otherwise influenced by his or her involvement in another role or relationship. The individual does not need to exploit his or her position or obtain an actual benefit, financial or otherwise, for a conflict of interest to occur. For a commissioner, a conflict of interest may therefore arise when their judgment as a commissioner could be, or be perceived to be, influenced and impaired by their own concerns and obligations as a provider. A conflict is something which compromises, or may compromise, a decision maker s professional judgement. Conflicts can be directly financial (for example, a commissioner has a financial interest in a provider), non-financial professional (for example, an advocate for a group of patients, GPSI) or non-financial personal (for example, a voluntary sector champion or provider). The most common types of conflicts of interest include: Financial interest Non-financial professional interest Non-financial personal interests Indirect interests Regulation 6 (1) prohibits the award of a contract where there is a conflict or potential conflict between the interests of those involved in commissioning the service and the interests of those providing it which affects or appears to affect the award of the contract. Financial interest This is where an individual may get direct financial benefits from the consequences of a commissioning decision. This could, for example, include being: A director, including a non-executive director, or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations

110 A shareholder (or similar ownership interests), a partner or owner of a private or not-forprofit company, business, partnership or consultancy which is doing, or which is likely, or possibly seeking to do, business with health or social care organisations. A management consultant for a provider. This could also include an individual being: In secondary employment (see below); In receipt of secondary income from a provider; In receipt of a grant from a provider; In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; and Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider). The General Medical Council s guidance is clear in that: You must be honest in financial and commercial dealings with employers, insurers and other organisations or individuals. In particular: before taking part in discussions about buying or selling goods or services, you must declare any relevant financial or commercial interest that you or your family might have in the transaction. Additionally, the General Medical Council s guidance on managing conflicts of interest states: If you have financial or commercial interests in organisations providing healthcare or in pharmaceutical or other biomedical companies, these interests must not affect the way you prescribe for, treat or refer patients. Non-financial professional interests This is where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. This may, for example, include situations where the individual is: An advocate for a particular group of patients; A GP with special interests e.g., in dermatology, acupuncture etc. A member of a particular specialist professional body (although routine GP membership of the RCGP, British Medical Association (BMA) or a medical defence organisation would not usually by itself amount to an interest which needed to be declared); An advisor for the Care Quality Commission (CQC) or the National Institute for Health and Care Excellence (NICE); A medical researcher. GPs and practice managers, who are members of the governing body or committees of the CCG, should declare details of their roles and responsibilities held within their GP practices

111 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. This could include, for example, where the individual is: A voluntary sector champion for a provider; A volunteer for a provider; A member of a voluntary sector board or has any other position of authority in or connection with a voluntary sector organisation; Suffering from a particular condition requiring individually funded treatment; A member of a lobby or pressure group with an interest in health. 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 commissioning decision (as those categories are described above) for example, a: Spouse / partner Close relative e.g., parent, grandparent, child, grandchild or sibling; Close friend; Business partner. A declaration of interest for a business partner in a GP partnership should include all relevant collective interests of the partnership, and all interests of their fellow GP partners (which could be done by cross referring to the separate declarations made by those GP partners, rather than by repeating the same information verbatim). Whether an interest held by another person gives rise to a conflict of interests will depend upon the nature of the relationship between that person and the individual, and the role of the individual within the CCG. Secondary employment CCG will take all reasonable steps to ensure that employees, committee members, contractors and others engaged under contract with them are aware of the requirement to inform the CCG if they are employed or engaged in, or wish to be employed or engage in, any employment or consultancy work in addition to their work with the CCG. The purpose of this is to ensure that the CCG is aware of any potential conflict of interest. Examples of work which might conflict with the business of the CCG, including part-time, temporary and fixed term contract work, include: Employment with another NHS body; Employment with another organisation which might be in a position to supply goods/services to the CCG; Directorship of a GP federation; and Self-employment, including private practice, in a capacity which might conflict with the work of the CCG or which might be in a position to supply goods/services to the CCG. It is a requirement that individuals obtain prior permission to engage in secondary employment, and reserve the right to refuse permission where it believes a conflict will arise which cannot be effectively managed

112 When may a conflict of interest arise? Conflicts of interest may arise where an individual s personal, or a connected person s interests and/or loyalties conflict with those of the clinical commissioning group. Such conflicts may create problems such as inhibiting free discussion which could: result in decisions or actions that are not in the interests of the clinical commissioning group and the public it was established to serve risk the impression that the clinical commissioning group has acted improperly. It is not possible, or desirable, to define all instances in which an interest may be a real or perceived conflict. It is for each individual to exercise their judgement in deciding whether to register any interests that may be construed as a conflict. Individuals can seek guidance from the Chief Officer, but may decide to declare when in doubt. The CCG policy is that to avoid any unnecessary conflict of interest, that no elected member of the CCG s governing body or elected cluster lead could lead or have an executive role in a provider organisation or have a material interest (e.g. shareholder) in that provider organisation. This would not exclude their practice from joining a primary care network/federation/provider, or another member of their practice team having a leadership role within the network/federation/provider. Conflicts that affect or appear to affect the integrity of an award Even if a conflict of interest does not actually affect the integrity of a contract award, a conflict of interest that appears to do so can damage a commissioner s reputation and public confidence in the NHS. Regulation 6 of the Procurement, Patient Choice and Competition Regulations therefore also prohibits commissioners from awarding contracts in these circumstances. As well as affecting the decision to award a contract and to which provider, a conflict of interest may affect a variety of decisions made by a commissioner during the commissioning cycle in a way that affects, or appears to affect, the integrity of a contract award decision taken at a later point in time. For example, conflicts of interest might affect the prioritisation of services to be procured, the assessment of patients needs, the decision about what services to procure, the service specification/design, the determination of qualification criteria, as well as the award decision itself. Conflicts might arise in many different situations. A conflict could arise where a CCG is deciding whether to procure particular services from GP practices in the area or from a wider pool of providers, or where it is deciding whether to commission services that would reduce demand for services provided by GP practices under the NHS General Medical Services contract. Depending on the circumstances of the case, there may be a number of different ways of managing a conflict or potential conflict of interest in order to prevent that conflict affecting or appearing to affect the integrity of the award of the contract. It will often be straightforward to exclude a conflicted individual from taking part in decisions or activities where that individual s involvement might affect or appear to affect the integrity of the award of a contract. The commissioner will need to consider whether in the

113 circumstances of the case it would be appropriate to exclude the individual from involvement in any meetings or activities in the lead up to the award of a contract in relation to which the individual is conflicted, or whether it would be appropriate for the individual concerned to attend meetings and take part in discussions, having declared an interest, but not to take part in any decision-making (not having a vote in relation to relevant decisions). It is difficult to envisage circumstances where it would be appropriate for an individual with a material conflict of interest to vote on relevant decisions. Where it is not practicable to manage a conflict by simply excluding the individual concerned from taking part in relevant decisions or activities, for example because of the number of conflicted individuals, the commissioner will need to consider alternative ways of managing the conflict. For example, depending on the circumstances of the case, it may be possible for a CCG to manage a conflict affecting a substantial proportion of its members by: involving third parties who are not conflicted in the decision-making by the CCG, such as out-of-area GPs, other clinicians with relevant experience, individuals from a Health and Wellbeing Board or independent lay persons; or inviting third parties who are not conflicted to review decisions throughout the process to provide on-going scrutiny, for example the Health and Wellbeing Board or another CCG. Whether a conflict of interests affects or appears to affect the integrity of a contract award (such that the commissioner may not award the contract) will depend on the circumstances of the case. The list of factors in the box below is not exhaustive, but covers some of the core factors that a commissioner is likely to need to consider in deciding whether it is appropriate to award a contract. Conflicts that affect or appear to affect the integrity of a contract award: Examples of factors that a commissioner is likely to need to consider in deciding whether or not it can award a contract: the nature of the individual s interest in the provision of services, including whether the interest is direct or indirect, financial or personal, and the magnitude of any interest; whether and how the interest is declared, including at what stage in the process and to whom; the extent of the individual s involvement in the procurement process, including, for example, whether the individual has had a significant influence on service design/specification, has played a key role in setting award criteria, has been involved in deliberations about which provider or providers to award the contract to and/or has voted on the decision to award the contract; and what steps have been taken to manage the actual or potential conflict (or example, via an external review of the decisions taken throughout the procurement process, including whether a conflict of a member of a CCG has been dealt with in accordance with the CCG s constitution. Why have a conflicts of interest policy for clinical commissioning group members?

114 The board, and individual directors, of an NHS entity have a legal obligation to act in the best interests of the organisation, in accordance with the organisation s governing document, and to avoid situations where there may be a potential conflict of interest. As such, there are requirements for members to register personal financial and non-financial interests which may be perceived as conflicting with that overriding duty. Benefit to clinical commissioning group: With proposed responsibility for approximately 60% of the NHS budget, clinical commissioning groups need to operate effectively and efficiently and with an appropriate level of transparency to ensure accountability. It is essential for maintaining public trust and confidence that clinical commissioning groups work within a robust ethical framework, and are seen to act in accordance with the high standards expected of healthcare professionals. Conflicts of interest may present problems in the form of: inhibiting free discussion resulting in decisions or actions that are not in the interests of the clinical commissioning group, public and patients risking the impression that the clinical commissioning group has acted improperly. Benefit to members: Decisions made under a conflict of interest may be legally challenged and could result in personal liability for the board member. There are clear benefits to be derived from establishing, and adhering to, a conflict of interest policy to protect both the organisation and the individuals involved from any appearance of impropriety. Benefit to the public: For public trust and confidence to be maintained both real and perceived conflicts need to be acknowledged and managed. Where the conflicts of interest policy requires members to withdraw from meetings, the Chief Officer should take care to ensure that edited minutes are provided to that member to ensure that any information related to the matter in question is not disclosed, and to avoid presenting any further instances of conflict, real or perceived. Any conflicts of interest policy should be accompanied by policies on receiving gifts and hospitality and anti-bribery procedures. All policies should be publicly available along with a regularly updated register of interests and gifts, offered and accepted, for board members and staff. Maintaining public trust and confidence will be essential if the public and patients are to believe that the NHS arrangements are working on their behalf. The General Medical Council s Good Medical Practice: Duties of a Doctor states that: Patients must trust doctors with their lives and health You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions. What to do if you face a conflict of interest CCG has arrangements to ensure individuals declare any conflict or potential conflict in relation to a decision to be made by the CCG as soon as they become aware of it, and in

115 any event within 28 days. The CCG will record the interest in the registers as soon as they become aware of it. All CCG members are required to declare their interests in relation to any items on the agenda at the start of each Board, Committee or Transformation Programme meeting. Where the conflict is material to the discussion that member shall withdraw from discussions pertaining to that agenda item, the conflict and the action will be recorded in the minutes of the meeting and the register of interests updated accordingly. A flowchart is attached as Appendix 4 to provide further guidance on potential conflicts and the action to take in those circumstances. It is the responsibility of the Chief Officer to monitor quorum and advise the chair accordingly to ensure it is maintained throughout the discussion and decision of the agenda item. Should the withdrawal of the conflicted director result in the loss of quorum, the item cannot be decided upon at that meeting. Where permitted under the clinical commissioning group s constitution or the conditions of its establishment, the board has the power to waive restrictions on any clinical professional board member participating in board business, where to authorise such a conflict would be in the interests of the clinical commissioning group. The application of a waiver can, therefore, be used in the following situations: the CCG member is a clinical professional providing healthcare services to the clinical commissioning group that do not exceed the average for other practices and NHS entities commissioned to provide services by the clinical commissioning group; or where the CCG member has a pecuniary interest arising out of the delivery of some professional service on behalf of the clinical commissioning group, and the conflict has been adjudged by the chair and the governance lay member not to bestow any greater pecuniary benefit to other professionals in a similar relationship with the clinical commissioning group. Where the chair and the governance lay member have approved the use of the waiver, the chair must have discussed it with the Chief Officer before the meeting. In such circumstances where the waiver is used, the board member: must disclose his/her interest as soon as practicable at the start of the meeting may participate in the discussion of the matter under consideration; but must not vote on the subject under discussion. The minutes of the meeting will formally record that the waiver has been used, and that this policy and the governing document provisions have been observed in managing that authorised conflict. Where a member has withdrawn from the meeting for a particular item, the Chief Officer will ensure that the minutes for that member do not contain such information that may compound the potential conflict, but do not unnecessarily disadvantage the member in their performance of their functions and legal responsibilities. Decisions taken where a board member has an interest In the event of the Board, Committee or Transformation Programme having to decide upon a question in which a member has an interest, all decisions will be made by vote, with a simple majority required. A quorum must be present for the discussion and decision; interested

116 parties will not be counted when deciding whether the meeting meets quorum. Interested members must not vote on matters affecting their own interests, even where the use of the waiver has been approved by the Chairman and used. All decisions under a conflict of interest will be recorded by the Chief Officer and reported in the minutes of the meeting. The report will record: the nature and extent of the conflict an outline of the discussion the actions taken to manage the conflict use of the waiver and reasons for its implementation. Where a member benefits from the decision, this will be reported in the annual report and accounts, as a matter of best practice. All payments or benefits in kind to members will be reported in the clinical commissioning group s accounts and annual report, with amounts for each board member listed for the year in question. Independent external mediation will be used where conflicts cannot be resolved through the usual procedures. Breaches of this policy Breaches of the policy may result in the member being removed from office in line with the constitution. The CCG will also report all breaches of this policy to the appropriate professional body so that the CCG is acting responsibly and in accordance with the principles of good corporate governance. Managing contracts If you have a conflict of interest, you must not be involved in procuring, tendering, managing or monitoring a contract in which you have an interest. Monitoring arrangements for such contracts will include provisions for an independent challenge of bills and invoices, and termination of the contract if the relationship is unsatisfactory

117 Appendix 4 Potential Conflicts of Interest Scenarios to consider as a CCG Commissioning Committee Member, CCG Employee, and/or CCG Board Member 117

118 Scenario Is a director of a provider arm company in the locality Has a shareholding or other beneficial interest in a provider arm company Action Required CCG Board Member OR Clinical /Cluster Lead or Employee of CCG Has a family member, spouse or partner with an interest in a provider arm company Has a beneficial interest in an organisation/company providing or bidding for services to the CCG Board Member or Clinical/Cluster Lead or Employee should be excluded from any decision making process or any discussion relating to any of the given scenarios Has a family member, spouse or partner with a beneficial interest in an organisation/company providing or bidding for services to the CCG 118

119 Scenario Conflict Level Action Required Is a director of a provider arm company HIGH Scenario not permissible Is a director or has a family member being a shareholder or having any beneficial interest in an organisation/company providing services to the CCG HIGH The individual should be excluded from any assessment or decision in relation to commissioning services CCG Governing Board Member Has a family member, spouse or partner who is a director of a provider arm company MEDIUM Assessment of conflict and appropriate management of conflict during relevant decision making process Is a shareholder in a provider arm company LOW No immediate action required. Although some management is required, e.g. assessment of bids Has a family member, spouse or partner who is a shareholder in a provider arm company LOW No immediate action required Works as an employee for a provider such as Barts or ELFT for less than 4 sessions pw 119 LOW No action required