NHS Salford Clinical Commissioning Group Governing Body Meeting Wednesday, 30 th November :00 17:00Hrs Salford Suite, St. James s House AGENDA

Transcription

1 NHS Salford Clinical Commissioning Group Governing Body Meeting Wednesday, 30 th November :00 17:00Hrs Salford Suite, St. James s House AGENDA Part I Start of NHS Salford Clinical Commissioning Group Governing Body Meeting 14:00 Public Meeting Open Agenda for Members of the Public to raise items previously mentioned to the Senior Committee Support Officer 14:10 Start of NHS Salford Clinical Commissioning Group Governing Body Meeting Item Time Description Lead 1 14:10 Apologies for absence Chair 2 14:15 Declaration of Interest in items on this Meeting s Agenda 3 14:20 Minutes of the meeting and matters arising a) 28 th September 2016 Meeting Minutes b) 28 th September 2016 Action Log c) 9th November 2016 Meeting Minutes d) Matters arising 4 14:25 Leadership Reports a) Chair (Verbal) b) Chief Accountable Officer (Paper) For Assurance/Decision 5 Strategy 14:45 a) Planning Update 2017/ /22 (Paper) Chair Chair Chair Chair Chair Chair Chief Accountable Officer Chief Accountable Officer 6 15:05 Performance a) Quality Performance (i) Quality and Safety Overview (Paper) (ii) Quality of Commissioned Services (Paper) Quality and Safety Clinical Lead 15:45 b) Organisational Performance (Paper) Chief Accountable Officer 16:05 c) Financial Performance (Paper) Chief Finance 16:25 d) Research and Innovation Strategy 6 Month Review (Paper) Chief Accountable Officer

2 For Information 7 16:40 Minutes/Reports of Partnership Boards/Sub Committees a) Commissioning Committee Report (Paper) b) The Integrated Health and Care Commissioning Joint Committee (ICJC) (Paper) c) Audit Committee Report (Paper) d) Primary Care Commissioning Committee (PCCC) 26 th September 2016 (Paper) e) Executive Team Report (Paper) f) Association of Greater Manchester CCG Summaries (Paper) g) Salford Children and Young People s Trust (Paper) Chair of the Commissioning Committee Co-Chair of the ICJC Chair of the Audit Committee Chair of the PCCC Chief Accountable Officer Chair Chair 8 16:55 Reflection a) Key Decisions b) Key Messages c) Benefits to the Population of Salford Chair Chair Chair 9 17:00 Meeting to close Date and Time of Next Meeting 25 th January 2017, 14:00-17:00Hrs Salford Suite, Salford Civic Centre, Chorley Road, Swinton, Salford, M27 5AW

3 MINUTES OF NHS SALFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING Held on 28 th September 2016 at Broughton Hub, Salford Governing Body reports and previous minutes can be found by following the link: Present: Dr Tom Tasker (TT) Dr Aisha Awan (AA) Dr Paul Bishop (PB) Dr Nick Browne (NB) Mr Steve Dixon (SD) Dr Clare Gibbons (CG) Dr Mansel Haeney (MH) Mr Anthony Hassall (AH) Mr David Herne (DH) Mrs Alison Kelly (AK) Mr Paul Newman (PN) Dr Jeremy Tankel (JT) Dr Jenny Walton (JW) Mr Brian Wroe (BW) In attendance: Mr David Dobson (DD) Mrs Hannah Dobrowolska (HD) Mrs Karen Proctor (KP) Mrs Francine Thorpe (FT) Part I Chair Neighbourhood Clinical Lead Clinical Lead for Strategic Planning and Partnerships Neighbourhood Clinical Lead Chief Finance Officer Neighbourhood Clinical Lead Governing Body Secondary Care Consultant Chief Accountable Officer Director of Public Health Governing Body Nurse Lay Member Neighbourhood Clinical Lead Neighbourhood Clinical Lead Lay Member Senior Committee Support Officer Director of Corporate Services Director of Commissioning Director of Quality and Innovation Apologies for Absence: Mrs Charlotte Ramsden (CR) Strategic Director of Adult and Children s Services Salford City Council Dr Owain Thomas (OT) Neighbourhood Clinical Lead Mr Edward Vitalis (EV) Lay Member 1. Apologies for absence 1.1 The apologies for the meeting were recorded. 2. Declarations of Interest in items 2.1 No declarations of interest were made in relation to today s agenda. 3. Minutes of the meeting and matters arising from 13 th July Minutes from 13 th July The minutes of the meeting were agreed as a true and accurate reflection. NHS Salford Clinical Commissioning Group Governing Body Meeting 28 th September 2016

4 3.2 Action Log from 13 th July FT advised that the Oaklands Hospital patient survey information is contained within Item 6A (i) the Quality and Commissioning Services Report AH advised that in addition to Item 6B regarding the CCG s Organisational Performance, he had circulated a separate document to the Governing Body on 12 th August 2016 regarding the North West Ambulance Service (NWAS) performance data. 3.3 Matters Arising TT advised that there were no matters arising from the meeting of 13 th July Leadership Report 4.1 Chair s Report TT commenced with gratitude following the retirement of his predecessor, Dr Hamish Stedman as Chair of the CCG. He referred to the strong partnership building undertaken by Dr Stedman as Chair. He advised that he wished to build upon this. TT advised that since commencing in post he has formally met individually with all the Governing Body members, as well as Clinical Leads and attended wider public engagement events. 4.2 Chief Accountable Officer s Report AH highlighted four key areas within the Chief Accountable Officer s Report. The report refers to the tremendous achievement for Salford CCG with being one of only ten CCG s in the country to be rated as Outstanding. Following the announcement he expressed gratitude to staff and the support from partners. Letters of congratulations have been received which include Jeremy Hunt Secretary of Sate for Health and Sir Howard Bernstein the Chief Executive of Manchester City Council AH referred to the 5 Year Forward View for mental health, the Chief Accountable Officer s Report details the CCG s performance in relation to the indicators which mental health services are measured upon. He highlighted that there is further work to do to improve mental health services, as detailed within this month s Organisational Performance Report. He reported on the commentary detailed within the report surrounding the CCG s integration, with the success of the Salford Locality in obtaining 18 million from the Greater Manchester Transformation Fund over the next two years. Measurements and performance indicators will need to be achieved by the Salford Locality to obtain this funding AH reflected on the CQC inspection of Pennine Acute Hospital Trust (PAHT) with North Manchester General Hospital (NMGH) being a local hospital used by many Broughton patients in particular. The inspection report revealed a number of concerns which are being monitored closely by the CCG s Executive Team in collaboration with SRFT s Executive Team who are formally supporting improvements at PAHT. The CCG is monitoring this closely due to the impact on Salford patients in particular those who access services from NMGH. NHS Salford Clinical Commissioning Group Governing Body Meeting 28 th September 2016

5 4.2.4 AH referred to the General Practice survey data which is being used to measure experience of Primary Care in Salford. He highlighted that the primary care commissioning responsibility is being considered by the CCG given the role of the CCG s Primary Care Commissioning Committee (PCCC). MH referred to the information contained within the General Practice survey data which appears to detail outliers when interpreting the results whereby some patients score practices highly for clinical care but score the same Practice poorly in relation to accessing appointments The Governing Body noted the information contained within the report. 5. Strategy 5.1 Primary Care Workforce Strategy AH commenced with an overview of the paper and expressed gratitude to the CCG s Team who led on this significant piece of work. AH and TT have undertaken visits to General Practices which has highlighted the recurring theme of pressures with obtaining, as well as maintaining, a strong workforce. AH advised that the work involved a large number of stakeholders, including the CCG s role as commissioners, with the strategy focussing on supporting primary care partners to ensure the deliverables of primary care are achieved. Reference was made to the implementation section of the strategy. Across Salford there are 46 General Practices, the strategy explores where Practices can deliver care in collaboration FT advised that the key points she wanted to highlight about the strategy were that it had taken account of national and local information and initiatives around workforce development. It was focused on the development of the whole practice workforce, not just on GPs. The approach that had been taken was a population based approach and had included public engagement in relation to their views. She also referenced the fact that it linked with other programmes of work previously endorsed by the Governing Body such as the General Practice Development Plan. Additional funding has already been made by the CCG in relation to the primary care workforce, such as the investment in a Clinical Pharmacy Team MH enquired as to whether the document was predicated upon NHS England and Health Education England promises to train and recruit additional GPs. FT advised that the national strategy around training more GPs was a long term plan and that the CCG s strategy included a range of initiatives supporting the development of the wider primary care workforce. FT also highlighted that part of the engagement work undertaken with patients specifically asked for their views on whether they would be prepared to see professionals other than GPs. AK commented that she thought the document was strong in terms of including the development of all clinicians and also working with patients as to what clinical roles are required for delivering primary care services. This also involves linking in with the University of Salford in the training of health care professionals The Governing Body ratified the Primary Care Workforce Strategy for NHS Salford CCG NHS Salford Clinical Commissioning Group Governing Body Meeting 28 th September 2016

6 5.2 North West Sector Partnership Memorandum of Agreement (MOA) SD reported on the collaborative working in the North West Sector of Greater Manchester in relation to the Healthier Together reconfiguration of hospital services. Wrightington, Wigan and Leigh NHS Foundation Trust, Salford Royal NHS Foundation Trust and Bolton Royal Foundation Trust and the three CCGs of Salford, Wigan and Bolton which form the North West Sector Partnership of Healthier Together. The work specifically relates to the Greater Manchester hospital reconfiguration for the North West Sector for Healthier Together, although has recently started to look at other hospital services that could be developed along similar single-service principles adopted by the Healthier Together work. These six organisations have been meeting each month as a North West Sector Partnership Board. This is not a decision making board, but a discussion board from which recommendations are then made to the respective organisations Governing Body or Trust Board. The MOA articulates the governance arrangements and the principles that would guide the six organisations in the partnership JW joined the meeting AH reported upon the long term sustainability of hospital services which requires further scoping of arrangements. DH relayed the importance of engaging in the Overview and Scrutiny Committees discussions regarding the challenges faced by acute services due to the sectoral discussions, not just within Salford but also for other areas across the North West Sector of Healthier Together. Salford is working closely with Salford City Council and their elected members alongside other local partners The NHS Salford Clinical Commissioning Group Governing Body agreed the Memorandum of Agreement between the organisations which has been developed jointly with the support of Salford CCG s Chair, Chief Accountable Officer and Chief Finance Officer. The Governing Body also agreed to receive regular updates on this work. 5.3 Greater Manchester Estates Memorandum of Understanding (MOU) SD reported all 37 statutory healthcare and local authority organisations in Greater Manchester are required to gain approval for this MOU from their respective Governing Body or Trust Board. He provided a brief overview in relation to estates such as the work of the Salford Estates Group (SEG) which comprises of the CCG, SRFT, Greater Manchester West Mental Health NHS Foundation Trust (GMW) and Salford City Council. The SEG also has attendance from NHS Property Services and Community Health Partnership (CHP). The main purpose of the Salford SEG is to ensure public estate is fit for purpose as well as delivering an estates strategy. The Group ensures that the highest quality estate is being used to its maximum capacity, such as the Gateway buildings, which following comprehensive reviews of utilisation of these buildings revealed occupancy was as low as 50%. The work also looks at the estates facilities across the whole of Salford to ensure that there is adequate coverage of good quality estate in all the neighbourhoods across Salford and where the estate quality is not good, then a work programme is agreed to either improve the condition of the building or agree disposal if it is not economically viable to maintain the building to quality standards. The first MOU focussed on creating a Greater Manchester Strategic Estates Group (GM SEG). Each of the ten localities in GM has a SEG and they all should report into the GM SEG. The GM SEG s membership is all ten local SEG chairs as well as other attendees from localities.. NHS Salford Clinical Commissioning Group Governing Body Meeting 28 th September 2016

7 5.3.2 The second MOU relates to the relationship between the GM SEG and the national decision making bodies for NHS capital and approvals processes. This MOU would give the GM SEG some flexibilities and freedoms to recommend business cases for capital development to national decision making bodies and, over time, it is anticipated that the GM SEG would have delegated authority from the national bodies to approve such business cases up to a certain value. This MOU would therefore help considerably in streamlining process and decision making in GM Salford CCG s Governing Body approved the Estates MOUs to enable more coordinate work on estates across GM and to enable GM to work in a more cohesive way with Central Government. 5.4 Information Governance Framework SD reported that the Governing Body s role is to ensure robust procedures are in place for the safe storage, transfer and destruction of information in-line with Information Governance (IG) Protocols and that these procedures are embedded and followed within the organisation. The Governing Body signs off the IG Framework on an annual basis. SD advised that the Governing Body receives an IG report in May each year which shows how the CCG is performing against IG standards that are contained within the annual self-assessment framework (the IG Toolkit). There are additional elements that the CCG does on IG, such as staff interviews, spot checks, office walk arounds from the IG officer and communications in the CCG s newsletter to ensure that staff awareness is raised The Governing Body reviewed and approved the Information Governance Framework. 5.5 Conflicts of Interest Policy AH reported upon the work carried out within the CCG s Corporate Directorate to ensure compliance with revised statutory guidance referred to in July s Chief Accountable Officer s Report. There has been national media attention associated with the conflict of interest processes within public sector organisations. The role of the Conflict of Interest Guardian will be discussed under item 7C of today s meeting. AH reported that the revised policy is in line with revised statutory guidance issued by NHS England. The Policy also includes the Gifts and Hospitality arrangements which had previously been covered in a separate document. There is work across Greater Manchester to share information on the creation of Conflict of Interest policies to ensure consistency, as such there may be a revision to the Policy should there be recommendations at a Greater Manchester level The Governing Body approve the revised Conflicts of Interest Policy and agreed that this policy will supersede the existing Gifts, Payments and Hospitality Policy. NHS Salford Clinical Commissioning Group Governing Body Meeting 28 th September 2016

8 6. Performance 6.1 Quality Performance Quality and Safety Overview (i) JT introduced the Quality Overview report highlighting the Joint Targeted Area Inspection that had just taken place in Salford. The focus of this inspection was children living with Domestic Abuse. Verbal feedback from the inspectors included positive comments about Salford s approach to partnership working in this area. JT highlighted the Multi-agency Risk Assessment Conferences (MARAC) as an example of this work. An overview of the Safer Salford programme which was based on the learning from Making Safety Visible was also discussed. JT outlined that the focus of this work was on handover of patients between primary and secondary care professionals. The programme also included work within care homes to improve safety, which linked to safe patient handovers between health and social care professionals. AK asked that feedback on the recent Joint Targeted Area Inspection would be included in a future report AK enquired whether when the domestic abuse pilot work (the Identification and Referral to Improve Safety IRIS Project) ended it would become business as usual. FT reported that it was agreed as a two year pilot and would be reviewed once it had been fully rolled out. She reported the IRIS Project is able to pick up concerns surrounding domestic violence at an earlier stage. A discussion took place regarding the Safer Salford work and the importance of supporting safety improvement in care homes was noted. FT provided more detail on the measurement work linked to the overall programme that was being led by HAELO. She referenced a workshop that was planned to review how we could develop system-wide measures that would enable safety improvement to be demonstrated. She reported on one of the challenges being that very few national measures exist to support this wider strategic system approach MH congratulated the CCG s Safeguarding Team, as only one standard was found by NHS England to have required attention to evidence compliance. He drew the Governing Body s attention to section 7.4 of the report in which it detailed that the revised governance arrangements will see the Primary Care Quality Report presented to the Primary Care Commissioning Committee and not the Governing Body Meeting. FT advised that this recommendation was made following discussions within the CCG in light of the delegated responsibility of primary care commissioning from NHS England The Governing Body noted the contents of the Quality and Safety Overview Report. 6.2 The Quality of Commissioned Services Report (ii) JT presented the report outlining the contents which included an update on discussions at the Quality and Outcomes Meeting with SRFT, information on the CQC reports from other providers across Greater Manchester and an update on the ongoing issues at PAHT. AH asked about the serious incidents reported at SRFT and whether there was an upward trajectory compared to previous years. FT commented that it was difficult to compare to previous years as guidance had changed and also SRFT were now providing more complex surgical services. She advised that a better indication of the safety culture within an organisation was the relationship between the numbers of low level incidents reported compared to those where harm occurs. SRFT benchmarks favourably with other providers in this respect. SD asked whether NHS Salford Clinical Commissioning Group Governing Body Meeting 28 th September 2016

9 there was any possibility of getting information on serious incidents that had occurred in other providers to Salford CCG patients. Action: FT to explore the possibility of including information on serious incidents occurring in other providers that had happened to Salford CCG patients MH commented on the assurance provided by the Mersey Internal Audit Agency (MIAA) in relation to serious incident processes at SRFT which they found to be robust and open. MH asked about the information included around diagnostics which indicated a staffing shortage of radiologists. FT reported that the presentation in relation to diagnostic services had been initiated following collation of softer intelligence about delays in reporting timescales. SRFT currently meet their Key Performance Indicators (KPI s) for access to diagnostics The Governing Body noted the content of the report. The Governing Body received assurance that relevant information is being sought and processes established to scrutinise the quality and safety of commissioned services. 6.3 Organisational Performance AH highlighted the current operational performance data as shown within the report which uses Greater Manchester and national performance measures. Appendix 2 which details the recovery plans evidences that concerns still exist with regards to the North West Ambulance Service s (NWAS) performance, however Blackpool CCG are acting on behalf of Salford CCG to address these concerns. AH advised that since the Organisational Performance Report was published, further guidance has been received from NHS England for 2016/2017 and as such a more detailed update will be provided to November s Governing Body Meeting. AH referred to Section 4 of the report which details the strategic risks facing the organisation which have been reviewed. The decision was taken to add the industrial action by Junior Doctors to the risk register. Although the CCG has noted the recent cancelling of the industrial action, as the dispute is ongoing it was felt appropriate for the strategic risk to remain AH advised that he taken over the role of Chair of the Locality Urgent Care Board as of last week. Very significant issues exist which relate to urgent care performance, not just for SRFT s Accident and Emergency Department but wider system pressures. The work of the Board also includes preparing for what could be a challenging winter period. Discussions within last week s Board meeting also discussed the mental health KPIs such as Improving Access to Psychological Therapies (IAPT). There is particular focus on IAPT targets, not just across the Salford locality but at Greater Manchester as well PB referred to Section 2.2 of the Report, highlighting Code E.B.S.04 asking about any possible harm that could have resulted for a referral to treatment exceeding 52 weeks. AH advised that this is an area which the CCG can challenge South Manchester CCG upon as the lead commissioner for UHSM. SD referred to the Making Safety Visible campaign in relation to indicators such as E.B.S.04. Action: AH to liaise with South Manchester CCG regarding code E.B.S.04 which has a Red status from the performance data collected for Quarter KP referred to Section 2.2 of the report regarding Code B.C.F.04 in which the national average for the measure for patients being able to manage their own NHS Salford Clinical Commissioning Group Governing Body Meeting 28 th September 2016

10 condition was presented in the report as 67.5%, which is incorrect, it should be 63.1% TT advised that NHS England have published 6 clinical priority areas, data is publically available on 3 of these which are dementia, learning disabilities and cancer. A discussion took place regarding how the CCG s governance arrangements will consider this information on behalf of the CCG. It was noted that further information will be provided to October s Commissioning Committee Meeting The Governing Body: Considered the CCG s latest performance position and accepted the recovery plans set out for the measures currently underperforming. Noted the progress made to date in relation to the Strategic Programme updates. Noted the updated risk position including the new Strategic Risk Register and confirmed that the current level of risk is acceptable in line with risk mitigation plans for high risks. Noted the current position in relation to provider risk ratings. The Governing Body noted the current position in relation to NHSE CCG ratings. 6.4 Financial Performance SD gave an overview on the Financial Report detailing the CCG s position at the end of month 5. He advised that the CCG was on target to meet all the financial statutory duties, however financial pressures still exist, mainly on acute hospital contract spend, the Continuing Healthcare (CHC) national negotiations and more recently on the prescribing budget. He advised that a report on the prescribing overspend will be presented to October s Commissioning Committee which gives a full breakdown of the key areas of overspend, mainly price increases in specific drugs. There are underspends on community services that partially offset the overspending areas. These underspends relate to delays in recruitment to both the District Nursing service and the community practice based Pharmacy business case. PN enquired as to whether there are delays in the recruitment process as a decision being made by the provider to deliver a cost saving. SD advised that this was not the case as the recruitment process is underway and significant additional staff have been recruited over the past 12 months. There are 7 vacancies short of a full complement within the District Nursing Service. He highlighted the work to recruit 20 additional Clinical Pharmacists, of which 6 are already in post. The recruitment process is now complete with all vacancies being filled, however personnel are not yet in post SD advised that 0.5% of the CCG s allocation was set aside at the start of the year to mitigate the risk of any in-year overspends. This amounts to circa 2m. This contingency along with the underspending areas highlighted above are sufficient to cover the overspending areas SD referred to the excess bed days section of the hospital contracts, which is showing a significant overspend this year. A review by the contracting team has looked at the number of patients at any one time who have been in a bed above 100 days. Over the past two years, there have been around five patients at any one point that fall into this category, being the most complex admissions to hospital. In more recent months, this number has been increasing to ten patients. SD advised that personnel from the Local Authority s Public Health Team, the CCG s commissioning NHS Salford Clinical Commissioning Group Governing Body Meeting 28 th September 2016

11 team and Salford Royal (SRFT) will undertake a joint audit on these patients to understand the reasons for these long lengths of stay SD advised that although the financial position is tight the CCG is on target to meet the CCG s statutory financial duties. This is in light of having an accumulated underspend which sits with NHS England at a national level. The guidelines have changed on the rules which will see a return of 2 million to the CCG from NHS England in 2017/18, whereas last year s financial planning guidance stated the CCG would receive 4 million of this underspend. In light of this, 2017/18 is likely to be another tough year in relation to finances. The five year financial plan will be brought to Governing Body in November to provide more detail on the financial outlook for the coming years PB referred to the work of the integrated care programme with specific reference to non-elective care, which is showing an overspend of 1 million. SD referred to the ambition in the locality was to reduce unplanned hospital admissions. This year s opening contract was reduced by 1,000 admissions. The reason that the CCG is overspending on unplanned admissions is not because activity has grown materially year on year but because we have not achieved our planned levels of reductions. This is being discussed at the Integrated Care Joint Committee (ICJC) as this committee is keen to ensure that the new model of care is evaluated to ensure that it is working as anticipated The Governing Body noted the content of the report, in particular the risks identified in Section 7 to the delivery of statutory financial duties. 6.5 Looked After Children (LAC) Annual Report AH introduced the paper reporting on the joint work of the CCG with SRFT and other partner agencies such as the Local Authority. There are currently 555 children from Salford who are deemed to be LAC. FT highlighted the following key points in relation to the report, that it included an overview of the work undertaken over the past 12 months, actions agreed from a previous CQC inspection had been completed and new national guidance around LAC had been incorporated into the work programmes moving forwards. There are also plans in place to move to a more outcome focussed reporting mechanism in relation to health interventions AK highlighted that whilst the report provided a good overview of the work programmes around LAC, she would have liked to see more references to the Voice of the Child. She also asked about the difference in access to health assessments for out of area LAC and what was being done to improve performance. FT advised that a small working group had been convened to review this issue and that the Designated Nurses across Greater Manchester would be taking this forwards.. A discussion took place regarding the number of LAC compared to other areas. FT advised that comparative data was provided in the Annual Safeguarding report which was presented to July s Governing Body Meeting. Action: FT to ensure that the Voice of the Child is included in the next LAC annual report The Governing Body noted the contents of the report and the progress made in support the health needs of Looked after Children in Salford. NHS Salford Clinical Commissioning Group Governing Body Meeting 28 th September 2016

12 6.6 Patient and Public Engagement Annual Report AH advised that the 2015/16 Patient and Public Engagement Annual Report demonstrates compliance with the CCG meeting one of its statutory duties. Although the document reads well as an annual report it is not able to fully reflect the true breath or vibrancy of the work undertaken by the CCGHD reported how the engagement influences decision making across the CCG and that the CCG is becoming increasing innovative in its engagement techniques BW referred to how the report is fulfilling statutory and regulatory issues; however it also captures the coproduction with new ways of working such as working collaboratively with patients. Reference was made to the use of the citizen s panel events, which in turn feed into the plans and overall work of the CCG The Governing Body noted the contents of the report. 7 Minutes / Reports of Partnership Boards / Sub-Committees 7.1 The Commissioning Committee The Governing Body noted the contents of the report, including decisions made by the Commissioning Committee in June, July and August The Integrated Adult Health and Social Care Joint Commissioning Committee (ICJC) JT referred to the work of the newly formed ICJC in which members of the CCG s Governing Body are working with elected members of Salford City Council regarding the commissioning of services from the pooled budget The Governing Body note the content of the report, including decisions made by the ICJC in July and August The Audit Committee Report JT provided an overview of the report in the absence of EV at today s meeting. SD advised that he had written to NHS Protect in relation to the CCG s annual assessment on fraud. One of the indicators is shown as red because the CCG has not used the on line fraud reporting system. This is because the CCG did not have any frauds to report. It is a nuance in the self-assessment tool that this is automatically marked red. SD requested that this indicator should be marked with not applicable or neutral. The response from NHS Protect is that this remains as red. It was noted that several other CCGs had written to NHS Protect on this issue The Governing Body noted the contents of this report and the assurances provided. The Governing Body formally ratify the Audit Chair being appointed as the CCG s Conflicts of Interest Guardian. NHS Salford Clinical Commissioning Group Governing Body Meeting 28 th September 2016

13 7.4 The Primary Care Commissioning Committee (PCCC) BW made reference to the information detailed on page 2 of the minutes, in particular the support provided by the CCG to Ellenbrook Medical Centre. BW referred to this week s PCCC Meeting which included discussions regarding the Height Medical Centre. BW commented on the likely population growth and the challenges this brings, in particular to the Ordsall Ward. The CCG is forward planning and exploring what primary care provision is required. A discussion took place regarding the sad news of Dr Rahman s sudden and unexpected death, in which the Practice Staff have continued to support the surgery during this very sad and challenging time. The Governing Body wanted to pay their respects and send best wishes to the late Dr Rahman s family and Practice Staff The Governing Body noted the contents of the minutes from the PCCC Meeting held on 11 th July The Executive Team Report The Governing Body noted the content of this report, covering Executive Team Meetings in July and August The Governing Body noted that for this period there are no decisions made by the Executive Team that require ratification by the Governing Body. 7.6 The Association of Greater Manchester CCGs Meeting Minutes TT advised that the minutes are provided to the Governing Body for completeness of the discussions and decisions made by the Association The Governing Body noted the contents of the minutes from the recent Association of Greater Manchester CCG meetings. 7.7 Salford Young People and Children s Trust Board The Governing Body noted the contents of the Salford Young People and Children s Trust Board from July Reflection 8.1 TT reflected on the Primary Care Workforce Strategy which plays a key part in the forward planning of healthcare provision in Salford. TT made reference to the importance of engagement as detailed within the Patient and Public Engagement Annual Report. 9 Meeting to Close 9.1 The meeting closed at 17:05Hrs. NHS Salford Clinical Commissioning Group Governing Body Meeting 28 th September 2016

14 Governing Body Meeting 28 th September 2016 Part 1: Action Log Ref. Subject Action Responsible Status The Quality of Commissioned Services Report Organisational Performance Report Looked After Children Annual Report FT to explore the possibility of including information on serious incidents occurring in other providers that had happened to Salford CCG patients. AH to liaise with South Manchester CCG regarding code E.B.S.04 which has a Red status from the performance data collected for Quarter 1 (RTT Performance at the University Hospital of South Manchester). FT to ensure that the Voice of the Child is included in the next LAC annual report. Francine Thorpe Anthony Hassall Francine Thorpe FT discussed this matter with the Quality Team and asked them to start collating this information for inclusion in future reports. As part of the ongoing work to look at the breaches a Trafford CCG GP (Clinical Director for Quality, Performance and Finance) is reviewing the clinical notes of every patient and making a judgement of harm. So far 158 of the 347 breaches have been reviewed. FT provided feedback to the Safeguarding Team and the LAC Team who have agreed to include this information in the next report. Page 1 of 1

15 MINUTES OF NHS SALFORD CLINICAL COMMISSIONING GROUP EMERGENCY POWERS GOVERNING BODY MEETING Held on 9 th November at St. James s House, Salford Governing Body reports and previous minutes can be found by following the link: Present: Dr Tom Tasker (TT) Mr Steve Dixon (SD) Dr Clare Gibbons (CG) Mr Anthony Hassall (AH) Dr Jenny Walton (JW) In attendance: Mr David Dobson (DD) Part I Chair Chief Finance Officer Neighbourhood Clinical Lead Chief Accountable Officer Neighbourhood Clinical Lead Senior Committee Support Officer 1. Apologies for absence 1.1 No formal apologies were recorded. 2. Declarations of Interest in items 2.1 No declarations of interest were made in relation to today s agenda. 3. Appointment of External Auditor 3.1 SD highlighted the procurement process has to be concluded, with the appointment of external auditors, by 31 st December He provided an overview of the procurement process in which six other Greater Manchester CCGs joined Salford CCG to appoint an External Auditor. The evaluation of the procurement process included representation from each CCG with the Audit Committee Chair, Mr Edward Vitalis, representing Salford CCG. In addition, Elaine Vermeulen, Deputy Chief Finance Officer of Salford CCG, was the operational lead for the procurement on behalf of all seven CCGs. The recommendation from the procurement panel is to appoint Grant Thornton UK LLP as the CCG s External Auditor. The CCG s Audit Committee reviewed the process and outcome of the procurement at the meeting on 3 rd November 2016 and supported this recommendation to Governing Body. SD concluded that the decision is required today to ensure all seven CCGs have agreed to the recommendations of the procurement within the agreed timescales. 3.2 A discussion took place as to the evaluation process in which it was recommended to approve the appointment of Grant Thornton UK LLP. The Governing Body noted that Grant Thornton is currently the CCG s External Auditor to which the CCG is satisfied with the service they provide. Confirmation was given that the contract runs for a three year period. 3.3 The Governing Body approved the appointment of Grant Thornton UK LLP as the External Auditor from 1 st April Meeting to Close 4.1 With no further business TT closed the meeting. NHS Salford Clinical Commissioning Group Emergency Powers Governing Body Meeting 9 th November 2016

16 30 November 2016 Agenda Item No 4 (b) NHS SALFORD CLINICALCOMMISSIONING GROUP GOVERNING BODY MEETING AGENDA ITEM NO 4(b) Item for Information 30 November 2016 REPORT OF: Chief Accountable Officer DATE OF PAPER: 10 November 2016 SUBJECT: Report of the Chief Accountable Officer IN CASE OF QUERY PLEASE CONTACT: STRATEGIC PRIORITIES: Jenny Noble Head of Governance and Policy Please tick w hich strategic priorities the paper relates to: Quality Community Based Care Integrated Care In Hospital Care Long Term Conditions and Mental Health Effective Organisation PURPOSE OF PAPER: This paper contains summaries of local and national policies, strategies and relevant news to ensure that the NHS Salford Clinical Commissioning Group (CCG) Governing Body remains up to date on the latest developments relevant to the organisation. Page 1 of 14

17 30 November 2016 Agenda Item No 4 (b) Further explanatory information required HOW WILL THIS BENEFIT THE HEALTH AND WELL BEING OF SALFORD RESIDENTS OR THE CLINICAL COMMISSIONING GROUP? This paper contains summaries of local and national policies, strategies and relevant news to ensure that the NHS Salford Clinical Commissioning Group (CCG) Governing Body remains up to date on the latest developments relevant to the organization to benefit the health and wellbeing of Salford residents. WHAT RISKS MAY ARISE AS A RESULT OF THIS PAPER? HOW CAN THEY BE MITIGATED? None identified. WHAT EQUALITY-RELATED RISKS MAY ARISE AS A RESULT OF THIS PAPER? HOW WILL THESE BE MITIGATED? None identified. DOES THIS PAPER HELP ADDRESS ANY EXISTING HIGH OR EXTREME RISKS FACING THE ORGANISATION? IF SO WHAT ARE THEY AND HOW DOES THIS PAPER REDUCE THEM? None identified. PLEASE DESCRIBE ANY POSSIBLE CONFLICTS OF INTEREST ASSOCIATED WITH THIS PAPER. None identified. PLEASE IDENTIFYANY CURRENT SERVICES OR ROLES THAT MAY BE AFFECTED BY ISSUES WITHIN THIS PAPER: None identified. Page 2 of 14

18 30 November 2016 Agenda Item No 4 (b) Document Development Process Yes No Public Engagement (Please detail the method i.e. survey, event, lt ti ) Clinical Engagement (Please detail the methods i.e. survey, event, Has due regard been given to Equality Analysis (EA) of any adverse impacts? (Please detail outcomes, including risks and how these will be managed. Legal Advice Sought Presented to the Commissioning Committee Not Applicable Comments and Date (i.e. presentation, verbal, actual report) Outcome Presented to the Health and Wellbeing Board Presented to the Integrated Commissioning Joint Committee Presented to any other groups or committees, including Partnership Groups (Please specify in comments) This paper was shared electronically with the Director of Corporate Services and Chief Accountable Officer on 17 November 2016 for comment. Amendments made in light of any comments received. Note: Please ensure that it is clear in the comments and date column how and when particular stake holders were involved in this work and ensure there is clarityintheoutcomecolumnshowingwhatthekeymessageordecisionwasfromthatgroupandwhetheramendmentswererequestedaboutaparticularpartofthework. Page 3 of 14

19 30 November 2016 Agenda Item No 4 (b) Report of the Chief Accountable Officer 1 Executive Summary This paper contains summaries of local and national policies, strategies and relevant news to ensure that the NHS Salford Clinical Commissioning Group (CCG) Governing Body remains up to date on the latest developments relevant to the organisation. 2 Policy and Strategy 2.1 Consultation on managing conflicts of interest In March 2016, NHS England set out plans to develop a stronger, more consistent approach to managing conflicts of interest across the health system. A task and finish group, chaired by Sir Malcolm Grant, Chair of NHS England, was established to develop a common set of principles and rules for how conflicts of interest should be managed. As part of this work, NHS England has now published draft guidance for consultation. The guidance supports a consistent and transparent approach to managing conflicts of interest and the CCG responded by the deadline on 31 October This is in addition to the revised statutory guidance on managing conflicts of interest for CCGs published recently, with which the current Conflicts of Interest Policy approved by the Governing Body at the previous meeting complies. 2.2 New procedures published for CCGs wishing to apply for constitutional change, merger or dissolution NHS England has published updated statutory guidance for CCGs considering constitutional change, merger or dissolution. This document supersedes guidance published in October It outlines the process a CCG can take to apply to NHS England to make changes to its constitution, and to dissolve or merge two or more CCGs. This guidance has been revised to provide CCGs with a set of clear criteria when considering mergers. Further information is available on the resources for CCGs section of the NHS England website and will be considered as part of the next constitution review in spring Greater Manchester Update As reported at the previous meeting, Warren Heppolette is the 4 th appointment to the new GMHSC Partnership Executive Management Team. He has been appointed as Executive Lead for Strategy and System Development and his role will be to act as the main champion for the development and implementation of the GM Strategic Plan Taking Charge, ensuring that it is achieved with on-going input from all key partners and stakeholders. The appointment of the Executive Lead for Commissioning and Population Health is expected to be confirmed shortly. Page 4 of 14

20 30 November 2016 Agenda Item No 4 (b) The Executive Team will review the programme plan at its next away-day in December Transformation Fund Update The first of GMHSC Partnership s Transformation Fund Investment Agreements was signed with Salford in the last month. Additionally, in light of the report from the independent evaluator and its review at the Transformation Fund Oversight Group, the Strategic Partnership Board Executive in September 2016 proposed a substantive investment of 23.2m into Tameside and Glossop. 2.5 Global Centre for Digital Excellence Salford Royal NHS Foundation Trust was selected as one of only twelve global centres of digital excellence, receiving funding of up to 10m and will be expected to deliver pioneering approaches to digital services and help others in the NHS learn from their experience. This will have significant benefits for the people of Salford. 2.6 Update on Pennine Acute Improvement Programme The Improvement Plan for the Pennine Acute Hospitals Trust was submitted to the Care Quality Commission on 6th October. It addresses four key services and a number of key cross-cutting themes. As part of the improvement plan, a finance package of 9.2m has been secured this year - additional money to spend on staffing and service improvements. A clinical services and estates strategy is being developed which will provide the basis for a longer term investment and improvement plan to assure sustainable services. More information is provided in the quality report. A number of key appointments have been made at PAHT to strengthen the corporate support within the Trust and to begin the development of the site-based leadership model. 2.7 Specialised Commissioning Greater Manchester took delegated responsibility for the commissioning of the basket/ tier 1 services from 1 April 2016 (i.e. those delivered at a GM level, largely for GM patients). The formal route for this delegation is via Jon Rouse, the Chief Officer for the GM Health and Social Care Partnership. In recognition of the size and scope of this agenda, it was recommended that the Association of GM CCG s Governing Group (AGG) should identify two lead CCGs for specialised services. There were a number of potential permutations in identifying these leads but it was suggested that a logical option would be to work with the two areas with the highest volume of specialised services within their local provider. For GM, these are Manchester and Salford. It was also recommended that the two lead CCGs and the Health and Social Care Partnership establish working arrangements. These arrangements will be governed by a Memorandum of Understanding, (MoU), which will clearly describe the respective roles and responsibilities of the parties.

21 30 November 2016 Agenda Item No 4 (b) 2.8 NHS Salford CCG Update Dr Owain Thomas recently stepped down as Neighbourhood Clinical Lead for Ordsall and Claremont. I would like to recognise all the hard work that Owain did for us a view that I m certain is echoed by all the members in the Governing Body. Dr David McKelvey has been appointed as his replacement for a three-year term from 1 January We also welcome Alice Lanceley to the CCG as part of the NHS Graduate Management Training Scheme, specialising in Health Informatics. 2.9 Integrated Care Highlights for the Integrated Care Programme for adults since my last report include the agreement of the Service and Finance Plan (SAFP). This five year plan outlines the model of integrated care and the commissioning intentions for the health and social care pooled budget for adult services. Phase three of the plan was endorsed by the Integrated Adult Health and Social Care Joint Committee (ICJC) on the 19 th October It was subsequently considered by the CCG Commissioning Committee on 2 nd November and is scheduled at Salford City Council Cabinet on 22 nd November. Phase three progresses phase two through inclusion of consolidated commissioning plans/workstreams, public engagement priorities and reflection of the confirmed allocation of Greater Manchester transformation funding. With regards to the latter, the ceremonial signing of the Investment Agreement for the 18.2 million transformation funding was held on 21 st October. Organisation and delivery of the plan s workstreams are through four overarching programme domains (below). Domain aligned management arrangements which engage staff and citizens in redesign are now in place, supporting the agreed governance, previously reported to Governing Body. Domains 1. Prevention, Early Intervention & Self Care 2. Care Navigation, Co-ordination and Transfers 3. Neighbourhood Community-based Care, 4. Quality & Safety plus Neighbourhood General Practice Organisation Since my last report an allocation of transformation funding to support the establishment of Salford Primary Care Together has been approved. A federated approach to delivering general practice services is an integral part of Salford s integration and neighbourhood plans, as highlighted in domain three above. Commissioning of general practice will however not form part of the pooled budget. Regular reports will now be provided to ICJC on delivery of the SAFP and performance against key measures Update on Salford s Freestanding Midwife Led Unit (FMU) As Members will be aware, Salford Royal Foundation Trust (SRFT) is undergoing major expansion plans as part of the Greater Manchester wide hospital reconfiguration plans, including those agreed in the Healthier Together programme. This includes Salford Page 6 of 14

22 30 November 2016 Agenda Item No 4 (b) Royal being a Greater Manchester stroke hyper- acute centre and a regional trauma centre, with the imminent move of high risk emergency and non-emergency surgery from other hospitals in Greater Manchester. These improvements require additional capacity on the SRFT hospital site and detailed estates plans have been developed. A consequence is that there is a need for services to vacate the space occupied by the Freestanding Midwife Led Unit (FMU) by October 2017 and antenatal/postnatal clinics on the hospital site by April The CCG and the three providers have to start planning to exit/relocate the current service provision from the hospital site as a matter of urgency. A new site has been identified to relocate the birth centre in Salford and we are now seeking expressions of interest from provider organisations to deliver services from the relocated Salford Birth Centre. With regards to the ante-natal and post-natal clinics, the intention is to identify an alternative location(s) within the community, which would be operational from April We will continue to engage with partners and members of the public and update Governing Body regularly Special Educational Needs and Disabilities (SEND) audit The Children and Families Act 2014 was implemented from September 2014 and requires a major transformation to how services to meet children and young people with special educational needs and or disabilities are delivered. This includes the need for a Designated Medical Officer / Designated Clinical Officer within each CCG to drive the changes needed within health and to ensure appropriate services are commissioned and provide strategic leadership and Governance of health services for children with special educational needs. In Salford this role is fulfilled by Dr Alison Pike, Consultant Paediatrician in Community Child Health (DMO) and Michelle Morris, Consultant Speech and Language Therapist (DCO). The DMO / DCO help ensure the CCG fulfils its statutory responsibility to children and young people with SEND. Another significant change within the Children and Families Act is the replacement of the current Statement system with new Education, Health and Care Plans (EHCP), CCGs need to ensure that there are arrangements in place for participating in the development of EHC plans by ensuring sufficient resource to carry out necessary assessments and by the provision of health advice. CCGs also need to develop a mechanism for agreeing the health provision identified. The Act also extends provision to young people aged up to 25 years, introduces a local offer where all existing provision is listed, new arrangements for young people in secure estate and the introduction of personal budgets. As part of the assurance for these new arrangements, a SEND Diagnostic Checklist for CCGs has been developed looking at leadership and governance, joint arrangements, commissioning, EHC Plans, engagement and monitoring and redress. The first review against the checklist has been completed. This has identified a number of areas that need to be resolved. Some of these are issues for the CCG to consider and some are joint issues with the Local Authority and these will be raised at the joint Children and Families Project Board. Key issues for the CCG to resolve are senior leadership for SEND within the CCG, formal recognition within a strategy, regular reporting at a senior level, the CCG approach to personal health budgets, engagement with vulnerable groups and complaints handling in relation to SEND. All areas within the audit that could not be deemed to be at full compliance will be reviewed at the joint DMO/DCO monitoring meetings, and reported back at the CYPCG. The Executive Team is also aware of the

23 30 November 2016 Agenda Item No 4 (b) details associated with the Audit and will monitor action in this area. The DMO/DCO annual report and an update on progress against the SEND Diagnostic Checklist for CCGs will be brought to Governing body at a future date Locality Plan Update Salford Health and Wellbeing Board recently considered and commented on the proposed delivery framework for the Salford Locality Plan including proposed changes to the Health and Wellbeing Board Terms of Reference and establishment of a new Locality Plan Programme Board. Following the meeting, it was agreed that the draft, revised Terms of Reference document be circulated through the governance arrangements of all Board partners for comment and approval, prior to a final version being brought to the Board for its January meeting. A copy of the Health and Wellbeing Board paper and updated Terms of Reference is provided for approval by the Governing Body. It is recommended that that approval of any further amends to these is delegated to the Chief Accountable Officer and Chair who are the proposed CCG representatives on the Health and Wellbeing Board. As highlighted in the paper, the Salford representative on the GM Transformation Portfolio Board will be our locality Senior Responsible Officer (SRO). It is proposed that this role be taken by myself and a member of the Board, supported by David Herne, Director of Public Health. We will be supported locally by lead officers from the programmes of work which are described in the Locality Implementation Plan Public Health Update by David Herne, Director of Public Health Salford City Council Fighting Flu Together in Salford Flu Champions The CCG, SCC and SRFT have been asking all frontline staff to promote the flu vaccination with a Salford wide programme called Flu Champions. We are engaging and working with a range of local community services, the local fire service, the housing work scheme, GP s, Dental Practices, Care Homes and Pharmacies to influence uptake across the community. Staff have been provided with a flu pin badge to be worn throughout the flu vaccination period, September, October and November. The objective being to prompt staff to ask eligible patients /clients if they have had the flu vaccination. This has given them the opportunity to provide accurate information and quash the myths. A crib sheet - Facts and Myths, has been provided to all staff to ensure they feel confident in giving out the correct information. Free flu vaccinations have been available in GP surgeries and most pharmacies from early October. The following groups have been invited to attend for their jab. These include: People over 65; anyone of any age who has asthma or other chest conditions, heart disease, diabetes, multiple sclerosis, kidney or liver disease or who has had a stroke; carers; pregnant women. Children aged two, three and four have received a painless nasal spray. Page 8 of 14

24 30 November 2016 Agenda Item No 4 (b) More info: Smoking prevalence in England is the lowest on record, according to Public Health England (PHE) In 2015, 16.9% of adults described themselves as smokers, compared with 19.3% in The decrease is due to the availability and use of e-cigarettes. More than a million people said they used e-cigs as they tried to quit and 700,000 used a licensed nicotine replacement product such as patches or gum. Out of the 2.5 million smokers who tried to quit, 20% were successful. According to Public Health England, this is the highest recorded successful quitting rate to date - six years ago the success rate was around one in seven. Year Smoking prevalence in England data from Integrated Household Survey Salford data from Integrated Household Survey % 26.3% % 22.9% % 24.4% % 22.3% The biggest decreases in smoking over the last four years were seen in the South West (18.7% to 15.5%), the North East (22% to 18.7%) and Yorkshire & Humber (21.9% to 18.6%). At the same time, prescriptions for nicotine replacement such as patches and gum have gone down, while sales of e-cigarettes have gone up. In 2014/15, the number of prescription items dispensed in England to help people stop smoking was 1.3 million, compared to two million 10 years ago. Health professionals say the most effective way to quit smoking remains through prescription medication and professional support from free local NHS stop smoking services. Rosanna O'Connor, director of drugs, alcohol, tobacco at Public Health England, said: "The reduction in smoking rates isn't the result of a single magic bullet but concerted policies over decades." PHE released the figures ahead of its Stoptober campaign, which aims to encourage smokers to quit smoking during October because the evidence shows that taking a complete break from cigarettes for at least 28 days greatly increases the odds of being able to quit long term E-cigarettes can help smokers to quit Electronic cigarettes could help smokers quit and do not appear to pose serious sideeffects in the short- to mid-term, say researchers.

25 30 November 2016 Agenda Item No 4 (b) The findings come from medical research group the Cochrane Collaboration, which has examined the best available evidence on the devices, together with a new study published in the British Medical Journal (BMJ). The new Cochrane Review builds on a 2014 review of the evidence on e-cigarettes, since when 11 more studies have been added. From examination of this evidence the Cochrane committee has concluded that e-cigarettes can help smokers quit and there is no evidence of serious side-effects from use over a two-year period. The review coincides with the publication in the BMJ of a study that suggests that e- cigarettes can increase success rates for smokers who are attempting to quit. The study looked at survey data from 170,490 individuals aged 16 and older in England between 2006 and 2015, 23% of whom had smoked in the past year, and 21% of whom were current smokers. The study also incorporated data on the use of NHS stop smoking services, which encompassed more than 8 million smokers. We estimate for every 10,000 people who used an e-cigarette to quit, approximately 580 would have quit who wouldn t have quit otherwise, said Robert West, co-author of the study and Professor of Health Psychology at University College, London. Overall, in 2015 the researchers estimate that e-cigarettes helped roughly 18,000 people to quit who would not have done otherwise. Deborah Arnott, Chief Executive of health charity Action on Smoking and Health, said: Taken together, the Cochrane review and BMJ article provide further reassurance that e-cigarettes are not undermining quitting. Indeed, the evidence from England, where smoking prevalence is continuing to decline, is that e-cigarette use is associated with a higher rate of successful quit attempts by smokers Sudden Infant Death Syndrome: The Guardian view on a public health triumph: the numbers say it all A news publication by the Guardian celebrates a public health triumph and highlights the latest statistics from England and Wales show there were 2,517 infant deaths in England and Wales in 2014, compared with 2,686 in 2013 and 6,037 in The infant mortality rate was 3.6 deaths per 1,000 live births, the lowest rate ever recorded in England and Wales and a decrease from 3.8 in Figure 1. Infant Mortality England and Wales trend data Page 10 of 14

26 30 November 2016 Agenda Item No 4 (b) Infant mortality rates have decreased in England and Wales since the early 1900s. More recently, over the past 30 years, the rate of decline has varied; the decrease between 1984 and 1994 was more than double the decrease recorded in each of the latter 2 decades. Since 1984, when the rate was 9.5 deaths per 1,000 live births, there has been a 62% fall in the infant mortality rate in England and Wales. The Lullaby Trust, which funded his research, estimates that since the back to sleep campaign was launched in England and Wales in 1991, as many as 20,000 babies have been saved. General improvements in healthcare and more specific improvements in midwifery and neonatal intensive care can partly explain the overall fall in mortality rates. Figure 2. Infant Mortality Salford and England trend data In response to concern about the rate of child death in Salford, a partnership group has been established to identify areas which should be addressed in order to ascertain whether current activity in Salford is appropriately targeted and proportionate. An over-arching aspect of the rates of death is the inequality and this increased risk of death is understood to involve a series of complex interactions between many factors, including genetics, the child s physical, social and economic environment and the health and care systems which surround families. The identification of modifiable risk factors is essential to driving down infant and child mortality rates. The overarching increase in risk

27 30 November 2016 Agenda Item No 4 (b) due to poverty and inequalities is an important action for Salford City Council and the Salford partnership. The partnership has created an action plan that takes the issues and sets them in the Salford context. The action plan also includes area to address a range of risk factors which lead to an increased risk of premature births. A summary of these area include: Social Insight into smoking during pregnancy Maternal obesity Standardised PSHE education in Schools Late antenatal care Infection screening Universal antenatal parenting/understanding child development and risks Unintentional injuries and fall under 4s Poverty and inequalities/the role of housing providers 3 Process 3.1 Human Resources and Organisational Development Update The information presented in this report is from the period ending 31 October This information is shared in greater detail with the Executive Team. 3.2 Headcount As of the 31 st October, Salford CCG had a head count of 171 members of staff (including all Clinical Leads and Lay Members). The total CCG headcount includes: 127 whole time equivalents (WTE) or full time equivalents (FTE); An increase of 21% in our headcount from November 2015); 30% (52) male and 70% (119) female members of staff; 100% of all employees paid at hourly rates greater than the Living Wage Rate (as defined by the Living Wage Foundation). 3.3 Employee Banding As requested by the Governing Body, the table provided in Appendix Three shows the breakdown of employees by Agenda for Change (AFC) banding and local pay scale posts (not assimilated), with variation when compared to all CCGs. As previously reported, staffing levels at Salford remains concentrated with just over one quarter of staff at AfC Band 7 at 28.7%, 13% higher in comparison to all CCGs nationally (15.7%). This data also includes posts we host, for example for the Greater Manchester Association of CCG s. A note of caution should also be applied when comparing figures with other CCG s due to the varying arrangements for commissioning support services. 3.4 Gender Profile Figures illustrate (Appendix Three) that: female staff account for 70% of the CCG workforce; Page 12 of 14

28 30 November 2016 Agenda Item No 4 (b) 44% of male staff work part-time as opposed to 39% of all female staff 3.5 Turnover The graph provided in Appendix Three shows the % turnover of Salford CCG and GM CCGs average by month for the period November 2015 October 2016 (including voluntary resignation and retirements). The data indicates that throughout the last 12 months, Salford CCG staff turnover rate remained 4% lower than the national average and other GM CCGs. We have also had a total of 36 new starters during the reported period. 3.6 Attendance This information, at the request of the Governing Body on long and short term absence rates by month, covers the period from October 2015 September For the month of September 2016 we achieved an attendance rate of 98.1%, just above our annual target rate of 97% for attendance rates. 3.7 Mandatory Training Salford CCG continues to outperform completion rates for mandatory training in comparison to the GM CCG average. Records demonstrate that Salford CCG remains above the GM CCG average for mandatory compliance for all seven modules. Our performance on completion of information governance remains at 91%, with the remaining modules at between 78% - 88%. 4 Recommendations 4.1 The NHS Salford Clinical Commissioning Group Governing Body is asked to: Note the information contained in this report; Note that Jon Rouse has delegated authority from NHSE for specialised commissioning; and Approve the updated Health and Wellbeing Board Terms of Reference and delegate any further amendments to the Chief Accountable Officer and Chair.

29 Item no. 6 Salford Health and Wellbeing Board Title of report Salford s Locality Plan and arrangements for the Health and Wellbeing Board Date 15 th November 2016 Contact Officer David Herne, Director of Public Health 1. Executive Summary Why is this report being brought to the Board? - Relevance of this report to the priorities of the Joint Health and Wellbeing Strategy, the Joint Strategic Needs Assessment or integrated working Health and Wellbeing Board s duties or responsibilities in this area Key questions for the Health and Wellbeing Board to address - what action is needed from the Board and its members? What requirement is there for internal or external communication around this issue? This report contains a description of progress with regards to the administrative and reporting arrangements which will be put in place for the Health and Social Care Locality Plan for Salford. The Board is responsible for assurance around the delivery of the Locality Plan outcomes and the Implementation Plan. Board members are asked to note and comment on the evolving administrative and reporting arrangements described in this report. The full Locality Plan is published at the dedicated web pages at the NHS Salford CCG website. 2. Introduction The purpose of this report is to allow the Board to consider and comment on the proposed delivery framework for the Salford Locality Plan including proposed changes to the Health and Wellbeing Board Terms of Reference and establishment of a new Locality Plan Programme Board. These proposals build upon the report provided to the September meeting of the Board, as well as discussions which took place at the October development session. 3. Key issues for the Board to consider GM context Board members will recall from the presentation at the October development session that details of the assurance and delivery arrangements for the GM Strategic Plan have now been circulated to localities. 1

30 These arrangements include a new Transformation Portfolio Board which reports directly in to the existing GM Strategic Partnership Executive and Strategic Partnership Board as shown in the following diagram: Bury locality plan Bolton locality plan Manchester locality plan Oldham locality plan Rochdale locality plan Salford locality plan Stockport locality plan Tameside locality plan Trafford locality plan Wigan locality plan The GM Transformation Portfolio includes representatives from all the transformation programmes in the transformation themes, cross-cutting programmes and the 10 localities: GM TRANSFORMATION PORTFOLIO BOARD Transformation Theme 1 Transformation Theme 2 Transformation Theme 3 Transformation Theme 4 Transformation Theme 5 2

31 Mental health Cancer Learning disability Children s vision and objectives of Taking Charge. In order to plan, design, implement, deliver and evaluate the impact that all of the GM transformation programmes have on the GM health and social care system (and wider public sector), it is proposed that a portfolio management function is formalised within the GM HSC Partnership Team. This function would work with and alongside leads within the localities, themes and crosscutting programmes to ensure that collective efforts deliver the The Salford representative on the GM Transformation Portfolio Board will be our locality Senior Responsible Officer (SRO). It is proposed that this role be taken by Anthony Hassall, Chief Accountable Officer of NHS Salford CCG and a member of the Board, supported by David Herne, Director of Public Health. Anthony and David will be supported locally by lead officers from the programmes of work which are described in the Locality Implementation Plan. Assurance and Delivery arrangements for Salford s Locality Plan At the October meeting, it was agreed that the Health and Wellbeing Board should be the main body responsible for Assurance, Strategy and Information around the Locality Plan having oversight of the agreed outcomes for the people of Salford, making sure that what is happening in the city is making the difference that has been described in the Locality Plan; reviewing ongoing strategic direction; and ensuring that all stakeholders in the Plan are effectively and meaningfully engaged. It was further agreed that the Locality Plan needs an infrastructure which enables linkages between strategy-making and delivery; clear responsibilities and accountabilities for delivery; and effective reporting arrangements. Delivery will be the responsibility of a number of specifically tasked committees and boards each set up to manage a particular aspect of the delivery of sections 2, 3 and 4 of the Locality Plan, and the Implementation Plan. The following diagram provides an overview of the proposed reporting arrangements for the Locality Plan: 3

32 Scrutiny Locality Leaders Group (informal) Reporting overview Salford Health and Wellbeing Board (Quarterly) Locality Plan Programme Management Board (monthly) Locality outcomes dashboard, progress summary, Implementation Plan highlight reports Locality Delivery Framework dashboard, milestone plan, progress reporting, risk registers City Council Cabinet, Voluntary Sector Leaders and other partners GM Portfolio Board KEY Prevention Better Care Enabling Group / role in development Prevention and Better Health Board (proposed) Children and Young People s Trust (Start Well) Integrated Adult Health and Care Commissioning Joint Committee (ICJC) Safer Salford Board Integrated Care Advisory Board 3x Acute Sector Programme Boards Intelligence and Performance group Communication and Engagement group Workforce Strategy Group IMT Strategy Group Group in place Locality Plan delivery Estates Strategy Group Social Value Alliance Healthwatch and user / public engagement forums (under review) Officer Reference group (proposed) Implications for Health and Wellbeing Board arrangements Arrangements for the Health and Wellbeing Board must be aligned with the governance arrangements of City Council and partners as well as meeting the requirements from GM under its MOU with government. The latter include that providers should be members of Health and Wellbeing Boards and that the terms of reference for the Board makes explicit reference to the Board s role in the governance and management of the Locality Plan. Appendix A contains a draft, revised Terms of Reference document for the Health and Wellbeing Board, which takes into account implications of the points raised previously in this report. Highlighted text indicates where changes have been made to the previous Terms of Reference which had been agreed by the Board in April Board members are asked to consider this draft and the membership proposed within, for discussion at the Board meeting. Board members will note that some representatives are not named at this stage, as nominations have not yet been sought from the member organisation. Board members will also note that the change in Chair, Deputy Chair and SRO will necessitate looking for a new slot for the Board meeting, to allow them all to attend on a regular basis. A schedule is being prepared of all meetings described in the reporting overview diagram, in order that a clear picture can be obtained of who is attending which meeting and when. Once this is completed, we will appraise Board members and propose a new time / date slot for the quarterly business meeting of the Board. Any developmental or strategy meetings will be scheduled between the business meetings as required. Proposed Programme Management Board 4

33 Arrangements for a new Locality Plan Programme Management Board (PMB) are also being developed following an evaluation of governance arrangements across GM localities and some engagement with local leads. The proposed purpose of this Board will be to oversee and coordinate the development of a delivery framework for the Locality Plan, ensure alignment upwards to GM and across the transformation work taking place in the locality. The PMB will bring together programme leads across the Locality Plan themes to oversee and drive delivery of the Locality Plan, also ensuring that the right information on outcomes is reported to the Health and Wellbeing Board. It will be responsible for overseeing the implementation, delivery, alignment and prioritisation of the Locality Plan work streams and ensuring progress is being made across all areas. There will be an opportunity for exception reporting to the Health and Wellbeing Board where issues arise. At the current time, discussion is ongoing between the lead officers for the various sections of the Locality Implementation Plan around evolving arrangements for this Board. A further paper will be brought to the Health and Wellbeing Board in due course and Board members are asked to note this work at the current time. Next steps Once Health and Wellbeing Board members are happy with the proposed revised Terms of Reference document, there are a number of steps required: Nominations will be sought from new organisational members (Salford Primary Care Together, GM H&SC Team, VOCAL H&SC voluntary, community and social enterprise sector leadership, Strategic Housing Partnership and Salford University.) The final document will need to be taken for information through the governance arrangements of the partner organisations, and in particular through the City Council s Cabinet. A revised meeting schedule will be issued The final Terms of Reference document will be brought to the January meeting of the Health and Wellbeing Board for formal adoption. 4. Recommendations for action Board members are asked to note and comment on the evolving administrative and reporting arrangements described in this report, and in particular the draft revised Terms of Reference for the Health and Wellbeing Board. 5. Contextual information CONTACT OFFICERS: Adam Hebden Head of Planning and Performance Adam.hebden@nhs.net Anne Lythgoe Manager of Policy and Partnerships Anne.Lythgoe@salford.gov.uk 5

34 BACKGROUND DOCUMENTS: The Locality Plan is published at the NHS Salford CCG website. Supporting documents attached as appendices to this report include the draft revised Terms of reference for the Health and Wellbeing Board. STRATEGIC DRIVERS AND EVIDENCE OF NEED: The Locality Plan has been developed from information available through Salford s Joint Strategic Needs Assessment and contains a summary of relevant evidence. Further information is available on request. THIS REPORT CONTENT HAS ALSO BEEN CONSIDERED BY: N/A EQUALITY IMPACT ASSESSMENT AND IMPLICATIONS: A Community Impact Assessment has been published with the Locality Plan at the CCG web pages. ASSESSMENT OF RISK: An initial Locality Plan risk register has been included within the draft implementation plan. LEGAL IMPLICATIONS: Following discussion at the Board meeting, these will be requested formally from the City Council s Assistant Director of Legal and Governance. Initial advice has been considered during the development of the attached draft Terms of Reference. FINANCIAL IMPLICATIONS: A full review of the Financial Plan was carried out at the end of March 2016, and it contained within the full Locality Plan. PROCUREMENT IMPLICATIONS: Not requested at this stage HR IMPLICATIONS: Not requested at this stage 6

35 Draft 7 th November 2016 APPENDIX A SALFORD HEALTH & WELL-BEING BOARD Terms of Reference From January 2017 Accountable to Background Statutory Responsibilities Salford City Council Cabinet and City Mayor Health and Wellbeing Boards are a key element of the Health and Social Care Act (2012) and they are a means to deliver improved strategic co-ordination across the NHS, social care, children s services and public health. The Boards must assess the needs and assets of the local population, producing a strategy that addresses these needs and builds on any assets, influences commissioning plans of organisations and promotes joint commissioning and integrated provision. In Salford, the Board will be a strong, effective partnership to improve commissioning and delivery of services through an intelligence led, and evidence based approach. There will be a clear focus on reducing health inequalities and an emphasis on prevention, early intervention and the wider determinants of health. The focus will be on continuous improvement, whole systems approaches, joint accountability, strong leadership, transparent decision-making and outcomes. Key to the role of Salford s Health and Wellbeing Board will be delivery of our Locality Plan. Salford s Locality Plan articulates our vision over the next five years for the improvement of wellbeing, health and care outcomes for residents in the city, across a timescale of short, medium and longer term impacts. The Plan sets out specific programmes and objectives which are in place to deliver against that vision, using a life course approach (Starting Well, Living Well, and Aging Well). It also reflects the need to tackle the demographic, financial and clinical challenges facing the city. The Locality Plan has been developed from and now replaces Salford s Joint Health and Wellbeing Strategy ( ). All Health and Wellbeing Boards must: Understand needs, inequalities, risks and assets locally continuous process of needs and assets assessment Determine priorities for local action focus collective efforts and resources on an agreed set of priorities and outcomes Promote integration and partnership hold organisations accountable for their contribution to outcomes in the Joint Health and Wellbeing Strategy / Locality Plan and encourage integrated commissioning and pooling of resources where applicable Further information and guidance can be found at ww.gov.uk/government/uploads/system/uploads/attachment_data/file/223842/statutory- Guidance-on-Joint-Strategic- Needs-Assessments-and-Joint- Health-and-Wellbeing-Strategies- March-2013.pdf 1

36 Draft 7 th November 2016 APPENDIX A Role and Purpose Values and Principles The Health and Wellbeing Board will be the place for joint discussion around key issues affecting the health and wellbeing of the population of Salford. It will have the following role: Assurance the Board will focus on making sure that Locality Plan outcomes and transformation objectives are being delivered for the people of Salford; Strategy it will reflect on and setting overall strategic direction, outcomes, etc and Informing the Board will ensure that information about the Locality Plan, Implementation Plan and their performance can be provided to those who need it in their work Salford s Health and Wellbeing Board will have no formal delegations, and will not make decisions about the individual budgets or resources of its partner members. Where required by Government regulation, it will endorse budgetary decisions recommended by one or more partners (such as with the Better Care Fund), but it will have no legal responsibility / accountability for these funds. The overall purpose will be: To improve health and wellbeing across the city and reduce health inequalities To create an integrated system that responds to local needs and assets, and gains public confidence To empower people to improve their own quality of life, improve the long term health of communities and promote individual responsibility and behaviour change. 1. Valuing the assets the people of Salford bring - Salford people will be at the heart of everything we do. People will be able to make informed choices about their health and wellbeing, be supported to take charge of their lives, support themselves, their friends and families and to share decisions about the services they need. 2. Supporting strong and vibrant neighbourhoods that promote health and wellbeing - we will increase individual and community resilience and enable people to maintain and improve their quality of life throughout their lives. We will deliver health, social care, children s, housing and other services which are co-produced and delivered with local people, service users and their carers to ensure that local people are not passive recipients of care but actively delivering and designing the services in the future. 3. Social Justice and tackling inequality - everyone should get a fair chance to succeed in Salford and have access to the services they need. We know that some people and families need extra help to reach their full potential, particularly when they face multiple challenges; so tackling the inequality and injustice this can lead to will underpin all that we do. 4. Health and wellbeing will be everyone s responsibility - health services alone cannot improve health and wellbeing, we will make health and wellbeing a part of everything the city does, make it everyone s job. We will ensure that there is joint accountability amongst participating partners, and that partners accept their roles and responsibilities around improving health and wellbeing. 5. Partnership and integration of provision - we will work in partnership with our local communities, the public, private and voluntary, community and faith sector organisations to improve the health and wellbeing of people in Salford. We will join up health, social care, education, children s services, housing and other local services. Where people need support from health and social 2

37 Draft 7 th November 2016 APPENDIX A Board Structure and Membership Chair Deputy Chairs Co-ordination Board Operation care services, those services will be tailored to individual needs and help people and their support networks to maintain or regain the greatest level of independence for their personal circumstances. Where possible within the confines of the Data Protection Act, we will share data and information between agencies to ensure that local people receive the services that they need in a timely manner. 6. Prevention and early intervention throughout life - we will stop problems occurring in the first place wherever we can and where they cannot be prevented we will respond efficiently to enable people to be independent again as quickly as possible. It is in everyone s best interests to tackle the root causes of ill-health, it is the only way we can make Salford s health and social care system sustainable and affordable for future generations. 7. Quality, Innovation and Evidence-based - we will ensure that the health, social care, planning, children s and housing services provided in Salford are high quality and innovative in meeting the needs of service users. We will use research expertise and national and local intelligence to ensure Salford s services are efficient, effective and meet the needs of people based on evidence of what works. Appendix 1 contains a diagram which shows the arrangements in place for Salford s Health and Wellbeing Board. This diagram shows the various Boards and groups which are in place and which contribute towards delivery of the Locality Plan. Many of these groups have their own governance arrangements and terms of reference, particularly where they take decisions or have responsibility for budgets within the health and social care system. The Health and Wellbeing Board has a direct reporting relationship in to the City Council s Cabinet, with quarterly progress updates provided. The proposed Locality Plan Programme Management Group will be a sub-group of the Board which has oversight of delivery of the many work streams in the Locality Plan, reporting back to the Board on progress and performance. In addition, there is a need for a health protection (HP) forum to review plans and issues that need escalation. This group meets on a quarterly basis and involves representatives from the City Council, Clinical Commissioning Group and Public Health England. Appendix 2 lists the membership of Salford s Health and Wellbeing Board. Selection for membership on the board has been based on the following key principles: Statutory requirement to participate Significant commissioning or delivery role in the local economy Significant capacity to impact on a key area of the Board s outcome frameworks as detailed in the Locality Plan Legitimate ability to represent a wider community of interest i.e. not self appointed Delegated authority and accountability within the organisations represented Lead Member for Health and Adults Chair of Governing Body, NHS Salford Clinical Commissioning Group Salford City Council, through Democratic Services The Health and Wellbeing Board is constituted under the provisions of section 102 of the Local Government Act 1972 (amended) and will operate accordingly under the associated legal provisions as a Committee 3

38 Draft 7 th November 2016 APPENDIX A of the Council. From April 2013 all business meetings will be held in public with fifteen minutes allocated for questions from the public at the start of the meeting. Where the Board is required to consider items of a confidential nature, the press and the public will be excluded from that part of the meeting. Members of the public will have the option to submit questions in advance and receive a response at the meeting, or address their issue to the Chair or the whole Board at the meeting. Servicing of meetings Confidentiality Board Member Roles Meetings will be publicised in advance and held in locations and at times that are accessible to the public. Planning and management of meetings will be carried out in a culturally sensitive manner An annual work plan/forward plan for the Board will be produced and published, and progress will be reviewed on an annual basis. The progress report will be available to the public. Agenda and papers will be circulated no later than five working days before the meeting. Late items will be included at the Chairs discretion. Agenda, minutes and papers will be available from the Partners IN Salford website At the commencement of all meetings members will declare any conflict of interest. Following this, the member can remain for all or part of the meeting at the chair s discretion. Meetings will be deemed quorate if at least three members are present, including one elected member and one CCG representative. If a meeting fails to achieve a quorum, it will be the Chairs discretion as to whether the meeting goes ahead, however the meeting could only make recommendations not decisions. There will be a minimum of four public business meetings a year. Development sessions will be arranged if needed, these will not be open to the public. Where decisions are required from the board, these will be reached by consensus wherever possible. Where decisions cannot be reached this way, voting will take place, and decisions will be agreed by a simple majority. Where votes are tied, the Chair will have the casting vote. Salford City Council will: Produce a schedule of meetings for the year and make these details public; Administer and maintain the work plan / forward plan of the Board; Arrange suitable venues for meetings; Prepare the agenda, collate reports and produce minutes of each Board meeting; Undertake any executive / follow up action arising from meetings. All documents will be shared and made public unless there is a specific legal or commercial reason not to do so. In such cases Members will respect confidentiality in relation to any sensitive information shared in support of the business agenda. The Chair will ensure: Meetings are conducted in a fair and transparent business-like fashion; Decisions are clear and organisations are accountable; Any actions required have a clearly identified lead person to take forward this action, and timescale. That a shared culture and language, common purpose and trust are endorsed through a collaborative leadership style. 4

39 Draft 7 th November 2016 APPENDIX A Members of the Board will ensure that: Governance and Accountability Communication, Engagement and Equality They make every effort to attend meetings. Substitutes can be sent in exceptional circumstances but they must be briefed on the agenda and be able to effectively participate in discussion on behalf of their organisation. Failure to attend three consecutive meetings will lead to a review of their membership; They are prepared for the meetings, and have read papers circulated in advance; They will represent the views of the group, organisation, and / or partnership that they speak for and they will ensure that Board business is reported back to that group, organisation / partnership as required; They will be empowered to make decisions on behalf of the group, organisation, and / or partnership that they speak for; this must also apply where substitutes are sent They will take forward any actions that they have agreed to develop, and then report back any progress to the group in the timescales agreed. They will use the available needs and assets assessments and evidence of effectiveness to develop their views, particularly with reference to the evidence within the JSNA and other strategic needs and assets assessments Members will adhere to the seven principles of public life Members endorse the collaborative model and work to ensure its achievement. The Board will be a formerly constituted committee of the council under section 102 of the Local Government Act However the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 will apply. The regulations relating to health and wellbeing boards make provision for the dis-application and modification of certain enactments relating to local authority committees appointed under section 102 of the Local Government Act 1972, insofar as they are applicable to a health and wellbeing board established under section 194 of the Health and Social Care Act The regulations mean that health and wellbeing boards are free to establish sub-committees and delegate functions to them, non-elected members of a health and wellbeing board can vote alongside nominated elected representatives and political proportionality requirements are left to local determination. The Board has published a communication and engagement plan to deliver the Locality Plan. This Plan contains details of how engagement structures will operate in Salford, to ensure that the principles for engagement are approached in a structured and co-ordinated way with the involvement of local people in monitoring and development of work programmes. There is a rich and varied engagement offer in Salford, comprised of organisation-specific engagement teams, Healthwatch Salford, Salford CVS, the Integrated Engagement Board (IEB), Voice of the Child Group, Youth Council, public engagement via elected members as well as Joint Commissioning Development Work / Patient and Public Engagement teams. Each of these strands of engagement offers a valuable contribution, and helps to build a complete picture of engagement in the City. The Community Impact Assessment carried out during the preparation of the Locality Plan is published at 5

40 Appendix 1: Health and Wellbeing Board Structure and Locality Plan reporting arrangements Scrutiny Locality Leaders Group (informal) Reporting overview Salford Health and Wellbeing Board (Quarterly) Locality Plan Programme Management Board (monthly) Locality outcomes dashboard, progress summary, Implementation Plan highlight reports Locality Delivery Framework dashboard, milestone plan, progress reporting, risk registers City Council Cabinet, Voluntary Sector Leaders and other partners GM Portfolio Board KEY Prevention Better Care Enabling Group / role in development Prevention and Better Health Board (proposed) Children and Young People s Trust (Start Well) Integrated Adult Health and Care Commissioning Joint Committee (ICJC) Safer Salford Board Integrated Care Advisory Board 3x Acute Sector Programme Boards Intelligence and Performance group Communication and Engagement group Workforce Strategy Group IMT Strategy Group Group in place Locality Plan delivery Estates Strategy Group Social Value Alliance Healthwatch and user / public engagement forums (under review) Officer Reference group (proposed) 6

41 Appendix 2: Health and Wellbeing Board Membership Role Status Name Local Authority Elected Representative (Chair) Statutory Member Lead Member for Health and Adult Services; Cllr Tracy Kelly Representative of Salford CCG Statutory Chair of Governing Body, Dr Tom Tasker (Deputy Chair) Member Director of Children s Services and Adult Statutory Charlotte Ramsden Social Care Member Director of Public Health Statutory David Herne Member Representative of Healthwatch Statutory Member CEO Health Watch Salford, Delana Lawson Additional five elected representatives from the LA Member Deputy City Mayor, Cllr Merry Deputy City Mayor, Cllr Boshell Lead Member for Children s Services, Cllr Stone (sub Cllr Walsh) Support Member for Health and Adult Services, Cllr Reynolds Opposition Member, Cllr Collinson Additional representative of Salford CCG Member Anthony Hassall Salford Primary Care Together Member Dr Paul Bishop GM Health and Social Care Partnership Member tbc Team Chamber of Commerce representative Member Chris Dabbs (Unlimited Potential) Two voluntary and community sector representatives Member Alison Page (Salford CVS) tbc (nominated by VOCAL H&SC Group) Greater Manchester Police representative Member Chief Superintendent Mary Doyle (sub Mark Kenny) Greater Manchester Fire & Rescue Service Member Carlos Meakin representative Salford Royal Foundation Trust Member David Dalton (sub Jack Sharp) Greater Manchester West Trust Member Beverley Humphrey (sub Gill Green) Salford Strategic Housing Partnership Member David Cummins Salford University Member tbc 7

42 Appendix One Headcount All the Employees of Salford CCG are paid at hourly rates greater than the current defined Living Wage Rate for areas of the UK outside of London. Age & Gender profile 28% 42% 13% 17% Full Time - Male Full Time - Female Part Time - Male Part Time - Female

43 Turnover Rates % Turnover Rates all emps excl sessional Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Turnover % Nov Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 SAL CCG all Employees SAL CCG excl sessional NHS National Average GM CCGs Average (#) Oct-16 New starters Month New Starters Nov-15 8 Dec-15 0 Jan-16 3 Feb-16 3 Mar-16 5 Apr-16 6 May-16 6 Jun-16 2 Jul-16 2 Aug-16 4 Sep-16 5 Oct-16 2 Sickness absence Month % Long Term % Short Term % Cost Oct % 1.5% 1.4% 8,683 Nov % 0.7% 1.7% 7,123 Dec % 0.9% 1.1% 6,786 Jan % 0.9% 1.8% 9,527 Feb % 1.5% 1.1% 8,200 Mar % 2.6% 1.2% 14,865 Apr % 1.9% 1.6% 11,203 May % 3.0% 2.5% 20,598 Jun % 3.5% 0.9% 17,066 Jul % 1.7% 0.6% 8,405 Aug % 1.6% 0.6% 7,927 Sep % 1.6% 0.3% 5,443 Mandatory training 0% 20% 40% 60% 80% 100% Equality and Diversity Fire Awareness Health, Safety and Security Intro to Information Governance 55% 65% 58% 82% 78% 80% 91% 89% Moving and Handling 81% 65% Safeguarding Adults Safeguarding Children 67% 67% 88% 88% 892 Salford CCG Gtr Manchester (#) Average

44 30 November 2016 Agenda Item No 5 (a) NHS SALFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING AGENDA ITEM NO 5 (a) Item for Decision/Assurance/Information 30 November 2016 REPORT OF: Chief Finance Officer DATE OF PAPER: 17 November 2016 SUBJECT: Planning Update 2017/ /22 IN CASE OF QUERY PLEASE CONTACT: STRATEGIC PRIORITIES: Quality Community Based Care Integrated Care In Hospital Care Long Term Conditions and Mental Health Effective Organisation Steve Dixon, Chief Finance Officer Please tick w hich strategic priorities the paper relates to: PURPOSE OF PAPER: The joint NHS England and NHS Improvement planning guidance published on 23 September details priorities for two year ( ) operational planning and contracting as well as providing the framework for CCGs and providers that will support delivery. The guidance brought forward the previously annual planning process by three months and additionally extends operational planning across 2 years. Salford CCG is required to submit a two year operational plan which ensures financial control totals are met, secures national planning requirements and delivery of the second and third year plans for the Salford Locality Plan and GM Sustainability and Transformation Plan. The operational plan comprises of finance, activity and contract submissions which must be made ahead of national planning timetable deadline of 23 December This paper presents the latest position as at 23 November 2016 and proposes final sign off of the CCG operational plan at the Extraordinary Governing Body meeting on 21 December This paper is presented in two parts - Part A is a financial plan update for 2017/18 to 2021/22, and Part B is a two year operational plan update for 2017/19. The financial consequences of all operational planning considerations such as the nine must dos, Mandate, GP Forward View and other cancer and mental health requirements have been reviewed and any financial consequences have been included in the CCG s financial plan. Page 1 of 21

45 30 November 2016 Agenda Item No 5 (a) Document Development Process Yes No Public Engagement (Please detail the method ie survey, event, consultation) Clinical Engagement (Please detail the method ie survey, event, consultation) Has due regard been given to Equality Analysis (EA) of any adverse impacts? (Please detail outcomes, including risks and how these will be managed) Legal Advice Sought Presented to the Programme Management Group Presented to the Health and Wellbeing Board Presented to the Integrated Commissioning Board Presented to any other groups or committees, including Partnership Groups (Please specify in comments) Not Applicable x x x x x x Comments and Date (i.e. presentation, verbal, actual report) Outcome Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work. Page 2 of 21

46 30 November 2016 Agenda Item No 5 (a) Part A - Financial Plan Update 2017/18 to 2021/22 1. Executive Summary In January 2016, the Governing Body received a report on the CCG s medium term financial planning position over the five years to 2020/21. This outlined the headline requirements from the Five Year Forward View/NHS Mandate, the local planning context and key deliverables outlined in the GM Devolution and Salford Locality Plans, and the CCG finance allocations. For the years 2016/17 to 2018/19, allocations were confirmed, and for 2019/20 to 2020/21, these were indicative. The allocations for 2017/18 have now been issued and inflation uplifts for tariff and non tariff contracts are now known. The allocation received is in line with what was expected however, there have been some amendments in the planning guidance in relation to the time period that CCGs are allowed to draw down their historic surplus. Originally Salford CCG planned to use circa 4m of its surplus next year for non recurrent transformation but the latest planning guidance limits the amount available to the CCG to circa 2m. This paper updates members on the CCG s current five year financial plan and the associated risks and issues for consideration by the Governing Body. The detailed five year plan is presented in Appendix 1. In relation to the CCG s financial plan over both the two and five year planning period, this paper gives the Governing Body assurance that: All of the national financial business rules have been met (section 3) Commitments made in previous years have been honoured and built into the plan (section 4) All of the national must dos identified in the national planning guidance have been funded (part B paper) Risks associated with delivering the financial plan have been identified and financial risks mitigated with the exception of a savings target still to be achieved of 1.5m (section 5) There are a number of items still to be resolved in order to deliver a fully balanced financial plan and this is not unusual at this stage of the year, particularly given the timescales for planning have been brought forward this year. Between now and the final sign off of the plan in December, the following items will be addressed: Contracts will be agreed and signed. The financial values within this draft financial plan are estimated values and any material changes to contract values will affect the financial plan. There is an unidentified savings target of 1.5m still to achieve. This is non recurrent and a relative small proportion of the CCG s allocation (less than 0.5%). The CCG has made two interim financial plan submissions to NHS England, with the final submission to be made on 23 December Page 3 of 21

47 30 November 2016 Agenda Item No 5 (a) 2. Introduction 2.1 In January 2016, the Governing Body received a report on the CCG s medium term financial planning position over the five years to 2020/21. This outlined: the headline requirements from the Five Year Forward View / NHS Mandate and national planning guidance the local planning context and key deliverables outlined in the GM Devolution and Salford Locality Plans CCG allocations for the next five years, of which three were confirmed and two were indicative 2.2 On 27 September 2016, NHS England published NHS Operational Planning and Contracting Guidance This document explains how the NHS operational planning and contracting processes will now change to support Sustainability and Transformation Plans (STPs) and the financial reset. It reaffirms national priorities and sets out the financial and business rules for both 2017/18 and 2018/19. The guidance requires two separate but connected plans: A five year locality plan, forming an element of the GM Sustainability and Transformation Plan (STP), place based and driving the Five Year Forward View, and; A two year operational plan for 2017/18 and 2018/19, organisation based but consistent with the STP. 2.3 The existing locality plan for Salford was developed prior to the issue of the latest planning guidance and therefore years one and two of the locality plan will no longer align exactly to the recent two year operational plan submissions. It has been agreed that the CCG, Salford City Council, Greater Manchester West NHS Foundation Trust (GMW) and Salford Royal NHS Foundation Trust (SRFT) will reconcile the finance and activity aspects of the operational and locality plans in the period January to March 2017, following contract agreements and in line with the local authority planning timescales. 3. Planning Requirements 3.1 The financial planning guidance issued by NHS England contains several key criteria which CCGs must demonstrate within their financial plans. These are commonly known as the Business Rules. The financial plan put forward to the Governing Body has met all of these business rules as summarised as follows: Planned surplus - the CCG is now required to deliver a break even position in year, and a cumulative surplus of at least 1%. For Salford CCG, the planned cumulative surplus is 2.5% at the end of 2017/18. Draw down of surplus those CCGs that have a cumulative, historic surplus above 1% can spend their surplus above 1% in future years. The amount that can be spent is capped at a national level, therefore limiting the amount that an Page 4 of 21

48 30 November 2016 Agenda Item No 5 (a) individual organisation can draw down and spend in any given year. For 2017/18, 400m has been set aside for draw down of which 200m (50%) is to support CCGs (both in-year operating deficits and draw down) with the remaining 50% as a contribution to a risk reserve. The Greater Manchester share of the available drawdown is 5.2m. Last year s planning guidance stated that CCG s should plan to draw down their surpluses between 2016/17 and 2018/19 (ie over 3 years). The 2017/18 planning guidance states that CCGs should plan to use their historic surpluses over the next four years (2017/18 to 2020/21). This has effectively extended the drawdown period by two years and reduced the non recurrent funds available to Salford CCG by 2m in each of 2017/18 and 2018/19. Use of non recurrent funds - CCGs have again been asked to ensure that 1% of their allocation is planned to be spent non recurrently, but only half of this has to be uncommitted at the start of the year, with the other half being available for immediate investment. For Salford CCG, the 0.5% uncommitted reserve is 1.9m. The other 0.5% has been committed on local non recurrent schemes. Contingency - as in previous years, the CCG is required to set aside a minimum of 0.5% of all allocations for a contingency to manage in year pressures and risks. An amount of 2.2m has been set aside recurrently. 3.2 The opening allocation for Salford CCG for 2017/18 is in line with the amount stated in last year s planning guidance. The baseline allocation has been increased to account for the impact of two national changes: Impact of new tariff pricing: The new version of national tariffs (HRG4+) has introduced a new pricing structure for national tariffs. National modelling suggests that this is cost neutral at a national level but at an individual organisation level (both CCG and provider) there are financial impacts. Salford CCG received an increase in allocation of 2.2m for the impact of the price changes although local modelling suggests the real impact is closer to 3m Impact of changing definitions of specialised services: revised definitions for specialised services and therefore what is commissioned by NHS England (NHSE), results in some services currently commissioned by CCGs transferring to NHSE and some services currently commissioned by NHSE transferring to CCGs. A national exercise was undertaken over the summer to understand the impact of these changes. Salford CCG has received an increase in allocation of 0.7m and local modelling indicates that this is cost neutral. 3.3 The provider inflation uplift is now 2.1% and efficiency requirement is 2% for 2017/18 and 2018/19, a net 0.1% uplift. Previous planning assumptions were 0.5% for both inflation and efficiency, a net nil uplift. The impact of these changes have been built into, and afforded within, the CCG s draft financial plan. Page 5 of 21

49 30 November 2016 Agenda Item No 5 (a) 4. Investments 4.1 A number of recurrent investments commenced in 2016/17, for which the full year effect is included within committed developments or budgets in 2017/18. These include the Salford Standard, Advanced Practitioner workforce development, clinical pharmacists in primary care and the Salford wide extended access scheme. 4.2 A non recurrent allocation of 0.6m was received in 2016/17 for eating disorders, and similarly 0.8m is anticipated in 2016/17 in order to compensate the CCG for the impact of NHS Property Services market rent charging policy. However, both of these have recurrent cost implications and the CCG has set aside recurrent funding from 2017/18 onwards to fund these items. 4.3 The CCG continues to invest 2m recurrently in the Innovation Fund, and this is planned to increase by 0.5m from 2018/19. The financial plan also includes 1m recurrently for investment in the voluntary sector, from 2017/18 onwards. 4.4 Non recurrent funds have been set aside for children s services joint reviews and the implementation costs of the new Freestanding Maternity Unit provider. 4.5 All of the above have been built into the CCG s financial plan, ensuring the CCG has honoured all of its previously agreed commitments. 5 Risks 5.1 The CCG has set its financial plan on anticipated contract values. These contract values assume that the ambition set aside in the Salford locality plan is delivered, including, for example, a reduction of 2,000 non elective admissions, equating to circa 2m. The opening contract plans, therefore, are lower than current activity volumes and therefore the risk of contract overspend next year is high. 5.2 In addition, there is an underlying overspend of 3m on the Adult Social Care element of the pooled budget. Again, the 2017/18 contract value for Adult Social care assumes this 3m can be saved next year. In total, the pooled budget expenditure is likely to exceed agreed contributions by 6.6m in 2017/18. As the CCG has a 70% share of the pooled budget, the financial risk for the CCG is 4.6m. As a result, the CCG has set aside a specific risk reserve of 4.6m to mitigate against these risks. 5.3 The CCG has anticipated an allocation of 0.6m from the Transformation Fund for the implementation of the extended access scheme. As this is currently only indicative and has not yet been confirmed, there is the risk that this allocation will not materialise. 5.4 In order to meet all of the business rules, honour prior year commitments and set aside a specific risk for the pooled budget, the current draft of the CCG s financial plan is not yet balanced. In order to achieve a balanced plan, the CCG has an unidentified savings target of 1.5m, of which 1m is non recurrent and 0.5m is Page 6 of 21

50 30 November 2016 Agenda Item No 5 (a) recurrent. Schemes have not yet been identified in order to achieve these savings. The CCG will need to identify appropriate areas of efficiency to meet this savings challenge. However, it should be noted that it is still early in the planning cycle and 1.5m represents less than 0.5% of the CCG s allocation and should therefore be achievable. 6 Recommendations 6.1 It is recommended that the Governing Body considers the content of this report and acknowledges the risks outlined in section 5 to delivering the planned control total of 9.7m in 2017/ The Governing Body is asked to support the further refinement and submission of the financial plan which will be submitted alongside the operational plan update to the Extraordinary Governing Body on the 21 December Steve Dixon Chief Finance Officer Page 7 of 21

51 30 November 2016 Agenda Item No 5 (a) Appendix 1 Salford CCG: 5 Year Financial Plan Most likely scenario 2016/17 - Forecast Outturn 2017/ / / / /22 Recurrent Non Non Non Non Non Non Total Recurrent Total Recurrent Total Recurrent Total Recurrent Total Recurrent Recurrent Recurrent Recurrent Recurrent Recurrent Recurrent Total Resource Limit (Programme Budget) after IAT adj 365,891 6, , , , , , , , , , , ,489 Growth 0 7,776 7,776 8,188 8,188 8,853 8,853 14,808 14,808 10,599 10,599 Post Published Allocations Jan 16 2,889 2,889 2,889 2,927 5,816 2,889 2,973 5,862 2,889 2,889 2,889 2,889 2,889 2,889 Better care fund allocation Co-Commissioning Allocation 35,143 35,143 35,143 35,143 37,401 37,401 38,765 38,765 40,156 40,156 41,958 41,958 Co-Commissioning Growth 0 2,258 2,258 1,364 1,364 1,391 1,391 1,802 1,802 1,904 1,904 Running Cost Allowance 5,520 5,520 5,534 5,534 5,547 5,547 5,559 5,559 5,570 5,570 5,570 5,570 Previous Years' underspend returned 15,578 15,578 11,602 11,602 9,657 9,657 7,712 7,712 5,955 5,955 4,169 4,169 In Year under spend (control (11,602) (11,602) (9,657) (9,657) (7,712) (7,712) (5,955) (5,955) (4,169) (4,169) (4,275) (4,275) Non-recurrent Funds 0 Total Resources Available 409,443 10, , ,491 4, , ,056 4, , ,285 1, , ,906 1, , ,409 (106) 471,303 Acute contracts -NHS (includes Ambulance services) 183, , ,536 3, , ,620 3, , , , , , , ,647 Acute contracts - Other providers (non-nhs, incl. VS) 11,326 (67) 11,260 11, ,231 11, ,246 11,246 11,246 11,303 11,303 11,416 11,416 Acute - Other 1, ,379 1, ,122 1, ,048 1,040 1,040 1,045 1,045 1,055 1,055 Acute - Exclusions / cost per case 20 (36) (16) Acute - Non Contract Activity (NCAs) 3, ,109 3,113 (24) 3,089 3,132 (25) 3,107 3,107 3,107 3,138 3,138 3,185 3,185 Acute - Pass-through Payments Inflation 0 0 1,002 1,002 2,033 2,033 2,073 2,073 Growth Impact of PbR 0 0 1,011 1,011 1,031 1,031 1,052 1,052 Sub Total Acute Services 198, , ,793 3, , ,908 3, , , , , , , ,412 MH contracts - NHS 34, ,326 34, ,263 34, ,298 34,298 34,298 34,812 34,812 35,508 35,508 MH contracts - Other providers (non-nhs, incl. VS) 2, ,882 2, ,899 2, ,928 2,928 2,928 2,972 2,972 3,032 3,032 MH - Other 3, ,439 3, ,375 3, ,465 3,465 3,465 3,517 3,517 3,587 3,587 MH - Exclusions / cost per case MH - NCAs 392 (0) MH - Pass-through payments Inflation Growth Impact of PbR Sub Total Mental Health Services 40, ,162 40, ,835 40, ,989 41, ,604 42, ,436 43, ,285 Community Health Contracts - NHS 35, ,755 36, ,729 36, ,766 36,766 36,766 36,950 36,950 37,319 37,319 Community Health Contracts - Other providers (non-nhs, incl. VS) 3, ,659 3, ,536 3, ,358 3,358 3,358 3,375 3,375 3,409 3,409 Community Health - Other Community Health - Exclusions / cost per case Community Health - NCAs Community Health - Pass-through payments Inflation Growth Sub Total Community Services 38, ,415 40, ,266 40, ,124 40, ,325 40, ,728 41, ,135 Continuing Care Services (All Care Groups) 5, ,923 5, ,977 6, ,155 6,155 6,155 6,340 6,340 6,530 6,530 Local Authority / Joint Services Free Nursing Care 2, ,647 2, ,727 2, ,809 2,809 2,809 2,893 2,893 2,980 2,980 Inflation Growth Sub Total Continuing Care Services 8, ,791 8, ,858 9, ,118 9, ,387 9, ,666 9, ,953 Page 8 of 21

52 30 November 2016 Agenda Item No 5 (a) Appendix 1 Salford CCG: 5 Year Financial Plan Most likely scenario 2016/17 - Forecast Outturn 2017/ / / / /22 Recurrent Non Non Non Non Non Non Total Recurrent Total Recurrent Total Recurrent Total Recurrent Total Recurrent Recurrent Recurrent Recurrent Recurrent Recurrent Recurrent Total Prescribing 41,748 (429) 41,319 42, ,353 43, ,213 43,213 43,213 44,510 44,510 45,845 45,845 Enhanced services 6,467 (42) 6,425 7,388 (918) 6,471 7, ,388 7,388 7,388 7,531 7,531 7,674 7,674 Out of Hours 1, ,667 1, ,669 1, ,671 1,671 1,671 1,703 1,703 1,735 1,735 Practice Transformation Support Other 175 1,531 1, Inflation ,013 1,013 Growth Sub Total Primary Care Services 50,057 1,060 51,117 51,589 (792) 50,797 52, ,453 53, ,928 55, ,442 57, ,000 General Practice - GMS 14, ,970 15, ,377 15, ,681 15,681 15,681 15,983 15,983 16,287 16,287 General Practice - PMS 6, ,844 6, ,893 7, ,029 7,029 7,029 7,165 7,165 7,301 7,301 Other List-Based Services (APMS incl.) 1, ,728 1, ,762 1, ,797 1,797 1,797 1,831 1,831 1,866 1,866 Premises Cost Reimbursement 4,345 (117) 4,227 4, ,479 4, ,568 4,568 4,568 4,656 4,656 4,745 4,745 Primary Care NHS Property Services Costs - GP Other Premises Cost Enhanced Services 1, ,838 1, ,897 1, ,935 1,935 1,935 1,972 1,972 2,009 2,009 QOF 3,149 (8) 3,141 3, ,225 3, ,257 3,257 3,257 3,320 3,320 3,383 3,383 Other GP Services 2, ,340 2, ,363 2, ,410 2,410 2,410 2,456 2,456 2,503 2,503 1% Non Recurrent - uncommitted funds delegated Inflation Growth Sub Total Co-Commissioning Services 35,230 (58) 35,172 35, ,997 36, ,676 37, ,385 38, ,095 38, ,820 GP IT Costs 1, ,524 1, ,233 1, ,233 1,245 1,245 1,257 1,257 1,270 1,270 NHS Property Services re-charge (excluding running cost) 1,227 (712) 515 1, ,239 1, ,239 1,251 1,251 1,264 1,264 1,277 1,277 LD Pooled Budget Integrated Care Pooled Budget 23,585 (741) 22,845 25, ,459 28, ,263 28,263 28,263 28,263 28,263 28,263 28,263 Non Running Costs 2,657 (561) 2,097 2, ,964 2, ,964 2,994 2,994 3,024 3,024 3,054 3,054 1% Non-recurrent Funds 0 4,013 4, ,883 1, ,924 1,924 2,184 2,184 2,267 2,267 2,329 2,329 Contingency (0.5%) 2, ,112 2, ,170 2, ,208 2,250 2,250 2,324 2,324 2,378 2,378 Committed Developments 3,872 1,579 5,451 8,724 (37) 8,687 11,535 1,310 12,845 11,535 11,535 16,765 16,765 27,386 27,386 TOTAL Other 34,550 4,814 39,364 41,835 1,845 43,680 47,488 3,234 50,722 47,584 2,184 49,767 52,944 2,267 55,210 63,673 2,329 66,003 32,273 5,052 37,325 CCG Pay costs 3,734 (429) 3,305 4, ,065 4, ,075 4,084 4,084 4,092 4,092 4,092 4,092 CSU Re-charge NHS Property Services re-charge / CHP Charges Running Costs - Other Non-pay 1, ,833 1, ,158 1, ,161 1,163 1,163 1,166 1,166 1,166 1,166 TOTAL Running Costs 5, ,520 5, ,534 5, ,547 5, ,559 5, ,570 5, ,570 Proposed Future Investments: Mainstream successful pilots/innovation FYE 7 Day Acute Services Reserve , , GM Risk Share 0.3% ,310 1, ,360 1, ,398 1,398 Review of Maternity Pathway - MLU Mental Health PbR (500) 0 (500) QIPP Pooled Budgets (2,722) 2,722 0 (1,038) (178) (1,216) (2,003) 0 (2,003) (2,010) 0 (2,010) (3,908) 0 (3,908) (3,908) 0 (3,908) Other investments QIPP Savings Unidentified ,231 (1,987) 3,244 8,121 (1,841) 6,280 3,970 (3,833) 137 Sub Total Proposed Future Investments (2,722) 2,722 0 (1,038) (178) (1,216) (2,003) 0 (2,003) 3,220 (427) 2,794 6,713 (481) 6, (2,435) (1,873) TOTAL EXPENDITURE 409,443 10, , ,491 4, , ,299 6, , ,285 1, , ,906 1, , ,409 (106) 471,303 SURPLUS/ (SHORTFALL)- additional to Control Total ,757 (1,757) Page 9 of 21

53 30 November 2016 Agenda Item No 5 (a) Part B - CCG Operational Plan update Executive Summary Following the publication of planning guidance for , this paper summarises Salford CCG s position against the national planning requirements along with a latest position update on activity and contracting. 2 Introduction and Background 2.1 In addition to delivering Salford and Greater Manchester priorities the two year operational planning will ensure that national must dos, NHS mandate, cancer, mental health and GP forward view requirements are secured. 2.2 The appendix accompanying this report summarises Salford CCG s stocktake against the national must dos. Similar stocktakes are being progressed to cover the additional national planning requirements involving clinical leads and relevant organisations across the Salford Health and Social Care system. The final stocktakes will be submitted to the Extraordinary Governing Body on the 21 December alongside the financial plan to provide assurance that the national requirements will be met. 2.3 Salford CCG is required to submit updates to NHS England on activity forecasts for the next two years and update on the progress of contract negotiations ahead of the final sign off by 23 December This paper also includes a brief progress update on activity and contracting (as at 23 November 2016). 3 Planning update Planning requirements including the Better Care Fund 3.1 A full draft assessment of the national planning requirements with clinical leads and the wider health and social care system is underway and so far suggests these will be met through a mixture of the existing and planned services, commissioning intentions for and work already underway as part of the transformation programmes to deliver the Salford Locality Plan. It is anticipated that the requirements will be met within the existing financial plan and previously outlined investment plan within Part A. 3.2 Further work is ongoing to understand gaps and risks of any assumptions and these will be outlined along with any mitigation in the final update to the Extraordinary Governing Body 23 December Appendix A summarises the CCG s position with respect to the national Must Dos. 3.3 The Government s Better Care Fund Policy Framework is due for publication in the next couple of weeks. This year there will be the opportunity for a limited number of areas to apply for Graduation from the BCF fund, this would mean those areas that graduate will no longer be required to submit BCF plans and quarterly returns. There Page 10 of 21

54 30 November 2016 Agenda Item No 5 (a) are likely to be 6-10 places who must demonstrate that they are making clear progress towards full integration of Health and Social Care. These places can be a single Health and Wellbeing Board area or more than one; for example, a devolution deal area. 3.5 GM will be applying as a whole via submission of an Expression of Interest early December, but this must be accompanied by the initial narrative plan submission for the 2017/19 Better Care Fund. Salford will continue to progress its plan pending further guidance. GM has noted there is a risk that the deterioration in Delayed Transfers of Care (DTOC) could hinder progress with graduation. Activity update 3.6 In line with the national expectations the CCG will set plans for the constitution measures, Referral to Treatment (RTT), Diagnostics and Cancer based on forecast outturn for 2016/17. A population growth for 2017/18 has been applied but it is assumed this will be deflected and the CCG will show a 0% growth in 2017/18 and 2018/ The hospital activity will be based on what has previously been agreed through the Locality Plan and the Salford Investment Agreement in the Integrated Care System. Planned growth is zero in future years and there is a reduction on outturn of 2000 spells for non-elective admissions and a reduction on outturn of 4000 attendances for A&E. The plans will be applying a population growth however this will be matched with the same percentage deflections. 3.8 The mental health leads will set measures in relation to Improving Access to Psychological Therapies (IAPT), dementia and Children and Young Peoples Mental Health and agreeing the activity plans for the next two financial years. 3.9 To ensure the CCG meets the additional standards set within the guidance, work is being undertaken with the relevant leads to address the new measures including e- referrals, personal health budgets, wheelchair assessments and extended GP access. Contract update 3.10 As per the guidance, financial offers for contracts over 5m have been issued by the CCG. The national process to monitor progress towards signed contracts has begun. The CCG is the lead commissioner for Salford Royal Foundation Trust and Oaklands. All schedules for inclusion in the contract are deemed to be in hand, and none are identified currently as a risk to contract sign off by 23 December The CCG s main associate contracts are with Central Manchester Foundation Trust, Bolton Foundation Trust and Pennine Acute NHS Trust and we are not aware of any issues from the lead commissioners that will prevent sign off by the above due date. Page 11 of 21

55 30 November 2016 Agenda Item No 5 (a) 4 Recommendations 4.1 The Governing Body is requested to: i. Note the work ongoing to complete stocktakes against the national planning guidance requirements. ii. Note the latest update as at 23 November 2016 on activity and contracting and support the further refinement of activity and contract plans ahead of the sign off deadline on 23 December Appendices Appendix A - Stocktake - National must dos Page 12 of 21

56 30 November 2016 Agenda Item No 5 (a) Appendix A: Salford CCG DRAFT Stocktake against the 9 NHS Must Dos National Must Dos 1. STPs Lead Work ongoing / plans in place Gaps Questions for GM Implement agreed STP milestones, so that you are on track for full achievement by 2020/21. Achieve agreed trajectories against the STP core metrics set for Chris Tyson / Adam Hebden STP and Locality Plan milestones to deliver the NHS Five Year Forw ard View and local priorities to achieve financial, clinical sustainability and improve health and w ellbeing outcomes are in place and approved by the Salford Health and Wellbeing Board. None identified. Confirm the STP core metrics. The STP core metrics are anticipated to be the measures contained w ithin this document (national must dos, mandate, new measures for Mental health, cancer, primary care and the improvement and assessment framework). Further commentary follow s below on Salford CCG s position w ith regard the trajectories for the core metrics. 2. Finance Lead Work ongoing / plans in place Gaps Questions for GM Deliver individual CCG and NHS provider organisational control totals, and achieve local system financial control totals. At national level, the provider sector needs to be in financial balance in each of 2017/18 and 2018/19. At national level the CCG sector needs to be in financial balance in each of 2017/18 and 2018/19. Thanos Polyzois CCG control total first submission made to NHSE on 1 st Nov The CCG is w orking collaboratively w ith the main acute provider so that organisational and local system financial control totals are achieved. None identified. None. Page 13 of 21

57 30 November 2016 Agenda Item No 5 (a) Implement local STP plans and achieve local targets to moderate demand grow th and increase provider efficiencies. Demand reduction measures include: implementing RightCare; elective care redesign; urgent and emergency care reform; supporting self care and prevention; progressing population-health new care models such as multispecialty community providers (MCPs) and primary and acute care systems (PACS); medicines optimisation; and improving the management of continuing healthcare processes. Provider efficiency measures include: implementing pathology service and back office rationalisation; implementing procurement, hospital pharmacy and estates transformation plans; improving rostering systems and job planning to reduce use of agency staff and increase clinical productivity; implementing the Getting It Right First Time programme; and implementing new models of acute service collaboration and more integrated primary and community services. For info GM STP and Salford Locality Plan in place to achieve transformation of health and social care system and deliver financial, clinical sustainability and improved health and w ellbeing outcomes. Further details can be found w ithin the Salford Locality Plan: None identified. None. 3. Primary Care Lead Work ongoing / plans in place Gaps Questions for GM Ensure the sustainability of general practice in your area by implementing the General Practice Forw ard View, including the plans for Practice Transformational Support, and the ten high impact changes. Ensure local investment meets or exceeds minimum required levels. Tackle w orkforce and workload issues, including interim milestones that contribute tow ards increasing the number of doctors working in general practice by 5,000 in 2020, co-funding an extra 1,500 pharmacists to w ork in general practice by 2020, the expansion of Improving Access to Psychological Therapies (IAPT) in general practice w ith 3,000 more therapists in primary care, and investment in training practice staff and stimulating the use of online consultation systems. By no later than March 2019, extend and improve access in line w ith requirements for new national funding. Anna Ganotis (See separate GPFV stocktake) All requirements are met or in plan. Further details can be found w ithin the separate GP Forw ard View stocktake. None Identified. None. Page 14 of 21

58 30 November 2016 Agenda Item No 5 (a) Support general practice at scale, the expansion of MCPs or PACS, and enable and fund primary care to play its part in fully implementing the forthcoming framework for improving health in care homes. 4. Urgent and Emergency Care Lead Work ongoing / plans in place Gaps Questions for GM Deliver the four hour A&E standard, and standards for ambulance response times including through implementing the five elements of the A&E Improvement Plan. By November 2017, meet the four priority standards for seven-day hospital services for all urgent netw ork specialist services. Implement the Urgent and Emergency Care Review, ensuring a 24/7 integrated care service for physical and mental health is implemented by March 2020 in each STP footprint, including a clinical hub that supports NHS 111, 999 and out-of-hours calls. Deliver a reduction in the proportion of ambulance 999 calls that result in avoidable transportation to an A&E department. Initiate cross-system approach to prepare for forthcoming w aiting time standard for urgent care for those in a mental health crisis. Tori Bell Over the medium and longer term pressure on A & E services will be addressed through the Locality Plan transformation w orkstreams including the integrated and community based care programmes. Short to medium term actions are contained w ithin the Salford A & E Improvement Plan (Attached). AE Improvement Plan 5 Actions.docx SRFT are actively w orking on implementing 7 day services and are significantly above the national and northw est mean for priority standards below : Standard 2 first consultant review and documented evidence that patients (carers/family) have been made aware of their diagnosis, management plan and prognosis within 48 hours of admission Standard 5 access to diagnostics within 1 hour for critical care needs Standard 8 ongoing review at least once every 24 hours Greater assurance and timescales are required from NWAS / Blackpool CCG RE Ambulance response time plans. Psychiatric liaison is currently adults only, plans are in place to make all age. There continues to be significant pressure across GM on the A & E 4 hour standard no areas are meeting the standard in quarter Salford Royal Foundation Trust represents approximately 75% of Salford population A & E attendance so underperformance of other trusts will also affect Salford patients. Confirm GM approach to securing NWAS response times in liaison w ith Blackpool CCG (lead commissioner for NWAS). Page 15 of 21

59 30 November 2016 Agenda Item No 5 (a) Psychiatric liaison currently w orks 24/7 and is located w ithin the A&E department. The service only sees patients aged 18+ at present but plans are in place to make it all age. NWAS are currently developing plans for clinical hubs to support 111 / 999. An Alternative to Treatment service is also in place. NWAS are increasing the number of See and Treat and Hear and Treat cases which will reduce transportation. NWAS are also increasing the number of calls w here an ambulance is only dispatched once the disposition of the patient has been assessed There is currently a KPI across all of GM stating that all mental health providers will see 75% of crisis referrals within 1 hour and 95% w ithin 2 hours. This is being tracked monthly and on target. 5. Referral to treatment times and elective care Lead Work ongoing / plans in place Gaps Questions for GM Deliver the NHS Constitution standard that more than 92% of patients on non-emergency pathways wait no more than 18 w eeks from referral to treatment (RTT). Deliver patient choice of first outpatient appointment, and achieve 100% of use of e-referrals by no later than April 2018 in line w ith the 2017/18 CQUIN and payment changes from October Streamline elective care pathw ays, including through outpatient redesign and avoiding unnecessary follow-ups. Implement the national maternity services review, Better Births, through local maternity systems. Tori Bell The 92% Referral to treatment (RTT) target has been met each month in the financial year 16/17 April to August. Usage of e-referrals for the CCG is currently 92% and this is part of the quality premium for 16/17. The cause for non e-referral will be assessed to close the remaining gap. The scheduled and cancer care segment of the urgent and emergency care delivery board w ill discuss streamlining elective care pathw ays in None identified. None. Page 16 of 21

60 30 November 2016 Agenda Item No 5 (a) areas w here RTT performance is an issue. A proposed pilot for Personal Maternity Care Budgets (PMCBs) w ill be initiated in December. The pilot w ill inform the w ider roll out of PMCBs both locally and nationally. A Prior Information notice has been published to 'soft test' the market for a suitable provider to deliver services from a potential new FMU. This w ork is still in the early stage but w ill inform the Pioneer on the status of the current market in terms of midw ife-led care. 6. Cancer Lead Work ongoing / plans in place Gaps Questions for GM Working through Cancer Alliances and the National Cancer Vanguard, implement the cancer taskforce report. Deliver the NHS Constitution 62 day cancer standard, including by securing adequate diagnostic capacity, and the other NHS Constitution cancer standards. Make progress in improving one-year survival rates by delivering a year-on-year improvement in the proportion of cancers diagnosed at stage one and stage tw o; and reducing the proportion of cancers diagnosed follow ing an emergency admission. Ensure stratified follow up pathways for breast cancer patients are rolled out and prepare to roll out for other cancer types. Ensure all elements of the Recovery Package are commissioned, including ensuring that: o all patients have a holistic needs assessment and care plan at the point of diagnosis; o a treatment summary is sent to the patient s GP at the end of treatment; and o a cancer care review is completed by the GP w ithin six months of a cancer diagnosis. Annette Donegani The CCG is committed to influencing and implementing the policies of the national cancer vanguard. This programme endeavours to improve patient care through streamlining the commissioning and provision of cancer services and implementing consistent pathways across GM w orking at scope and scale to reduce variation and improve outcomes. CCGs are w orking closely with the Cancer Vanguard to ensure holistic needs assessment and cancer care review s are offered to all patients. We are not commissioning extra diagnostic capacity at the moment but w atching activity closely and will review in future if monitoring show s this needs to be considered. Cancer survival has been improving year on year since 1997 and the gap Complete the clinical priorities review and Right Care w here to look analysis. An action plan w ill include any improvements to cancer screening, targeted campaigns and achieving earlier identification of cancer. The Locality Plan Prevention programme w ill also incorporate early life interventions for preventable cancer. None. Page 17 of 21

61 30 November 2016 Agenda Item No 5 (a) betw een Salford and the rest of England has narrow ed over that period. 1 year survival is felt to be a measure of diagnosis at an early stage as patients w ho die shortly after diagnosis usually have advanced disease. The CCG Commissioning Committee and Cancer Clinical lead are w orking together with the public health team to review short and longer term plans to detect cancer earlier. CCG Cancer Clinical Lead is leading on the national cancer vanguard prostate after care project within GM. Salford CCG fully supports the w ork being undertaken by the vanguard w ith respect to all three tumour groups. The cancer care reviews are part of QOF and should be done w ithin 6 months of diagnosis. Cancer care review s are to be included in the Salford Standard as part of a patient s holistic care review from next year. We have provided training for practice nurses to enable them to do this and have provided on line advice for HCPs on how to complete them. In terms of the stratified follow up patterns of care colorectal have already been implemented in Salford and w ork on the other tw o is underway at a GM level. 7. Mental health Lead Work ongoing / plans in place Gaps Questions for GM Deliver in full the implementation plan for the Mental Health Five Judd Skelton A new IAPT Shared Point of Access None identified. Out of Area Placements Year Forw ard View for all ages, including: (SPA) model has been funded and (OAPs): Elimination w ill Page 18 of 21

62 30 November 2016 Agenda Item No 5 (a) Additional psychological therapies so that at least 19% of people w ith anxiety and depression access treatment, w ith the majority of the increase from the baseline of 15% to be integrated w ith primary care; More high-quality mental health services for children and young people, so that at least 32% of children w ith a diagnosable condition are able to access evidence-based services by April 2019, including all areas being part of Children and Young People Improving Access to Psychological Therapies (CYP IAPT) by 2018; Expand capacity so that more than 53% of people experiencing a first episode of psychosis begin treatment w ith a NICErecommended package of care w ithin two weeks of referral; Increase access to individual placement support for people w ith severe mental illness in secondary care services by 25% by April 2019 against 2017/18 baseline; Commission community eating disorder (CED) teams so that 95% of children and young people receive treatment w ithin four weeks of referral for routine cases; and one w eek for urgent cases; and Reduce suicide rates by 10% against the 2016/17 baseline Ensure delivery of the mental health access and quality standards including 24/7 access to community crisis resolution teams and home treatment teams and mental health liaison services in acute hospitals Increase baseline spend on mental health to deliver the Mental Health Investment Standard. Maintain a dementia diagnosis rate of at least tw o thirds of estimated local prevalence, and have due regard to the forthcoming implemented in 2016/17. We are already delivering to the stretch target of 19% access. All NHS providers in GM are now part of the NW CYP IAPT Learning Collaborative. Work has been undertaken across the CAMHS Transformation Plan and 0-25 Integration programme to better understand need, to review services and to develop improved pathw ays and services for CYP. This w ill be reflected in the refreshed Transformation Plan. This has been addressed via EiP business case which funded the required additional capacity and w e are meeting target. We are commissioning a CEDS from Central Manchester NHS Foundation Trust (CMFT) w ith Manchester CCGs. The contract w ill commence in January 2017 w ith a service from April 2017 to deliver the referral targets. Suicide prevention strategy in development and to be launched by Jan Home based treatment team (crisis response) has been in place for 2 years. Further information can been found in Annex 8. Mental health Investment Standard (previously the parity of esteem). Salford has increased MH baseline depend upon the definition of OAPs. In Salford, OAPs have been an area of significant focus and are now very infrequent. We alw ays admit to a bed as close to home district as possible and keep admission as short as possible before repatriation to Salford NHS bed (generally only a couple of days). It is crucial to retain this strategy as a contingency for when bed crises occur, so there is no plan in place to eliminate these type of acute admissions. Page 19 of 21

63 30 November 2016 Agenda Item No 5 (a) NHS implementation guidance on dementia focusing on postdiagnostic care and support. spend for example through the additional significant recent investments in IAPT and EiP Services. Salford dementia diagnosis rates remain significantly higher than the national target at around 90%. Further information on the dementia care and support can be found in Annex 8. Salford has been closely monitoring non specialist acute out of area placements (OAPs) since our redesign of the Acute Care Pathw ay two years ago. As a result, acute OAPs have been very infrequent and rarely Eliminate out of area placements for non-specialist acute care by 2020/21. exceed 72 hours. Current year to date (as at September = 6 OAPs w ith only 1 exceeding 72hrs). Salford has continued to commission local rehabilitation facilities i.e. Copeland Ward w hich opened in 2013 and saw 9 people repatriated back to Salford from costly out of area placements. 8. People with learning disabilities Lead Work ongoing / plans in place Gaps Questions for GM Deliver Transforming Care Partnership plans w ith local government partners, enhancing community provision for people w ith learning disabilities and/or autism. Reduce inpatient bed capacity by March 2019 to in CCGcommissioned beds per million population, and in NHS England-commissioned beds per million population. Improve access to healthcare for people with learning disability so that by 2020, 75% of people on a GP register are receiving an annual health check. Reduce premature mortality by improving access to health services, education and training of staff, and by making necessary reasonable adjustments for people w ith a learning disability and/or autism. Kerry Thornley Work is ongoing and Salford is actively involved in the GM Transforming Care meetings as w ell as leading on tw o w ork streams. Salford is on track to achieve its contribution to the overall GM target for inpatient beds. The Salford Standard addresses primary care issues as w ell as other w ork with Salford Royal, and a specific optometrist service. The w ork referenced above contributes to reducing premature Autism: The access / health check requirement for people w ith Autism needs to be implemented in the near future. Capacity may be required to provide more training re: Reasonable adjustments for both LD and Autism. This w ill be picked up through annual business planning. None. Page 20 of 21

64 30 November 2016 Agenda Item No 5 (a) deaths and is supported by initiative such as the Big Health Day focussing on Cancer to drive up cancer screening, and a GM steering group to start looking at review ing LD deaths. 9. Improving quality in organisations Lead Work ongoing / plans in place Gaps Questions for GM All organisations should implement plans to improve quality of care, particularly for organisations in special measures. Draw ing on the National Quality Board s resources, measure and improve efficient use of staffing resources to ensure safe, sustainable and productive services. Participate in the annual publication of findings from review s of deaths, to include the annual publication of avoidable death rates, and actions they have taken to reduce deaths related to problems in healthcare. Rachel Farn / Sue Harris SCCG 3 year Quality and Safety strategy expires in 2017, the current strategy is being review ed against the outcomes and a revised strategy will be developed to align w ith the Safer Salford programme for the next 3 years. Safe staffing and resilience updates have been introduced at the quality and outcomes meeting w ith the main providers to drive improvements. Annual publication of mortality and learnings are included w ith provider quality accounts and assured at various points by the commissioner. None Identified. None. Page 21 of 21

65 30 November 2016 Agenda Item No 6 (a) (i) NHS SALFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING AGENDA ITEM NO 6 (a) (i) Item for Assurance/Information 30 November 2016 REPORT OF: Clinical Lead for Quality and Safety DATE OF PAPER: 8 November 2016 SUBJECT: Quality and Safety Overview IN CASE OF QUERY PLEASE CONTACT: Francine Thorpe Director of Quality and Innovation STRATEGIC PRIORITIES: Quality Please tick w hich strategic priorities the paper relates to: Community Based Care Integrated Care In Hospital Care Long Term Conditions and Mental Health Effective Organisation PURPOSE OF PAPER: This paper provides an overview on some key aspects of quality and safety for NHS Salford Clinical Commissioning Group (CCG). An update on safeguarding is included along with feedback from the Joint Targeted Area Inspection conducted during September. A high level overview of progress in the implementation of our Safer Salford programme is provided, along with information on the outcome of a medicines safety initiative within 8 GP practices across the city. Page 1 of 8

66 30 November 2016 Agenda Item No 6 (a) (i) Further explanatory information required HOW WILL THIS BENEFIT THE HEALTH AND WELL BEING OF SALFORD RESIDENTS OR THE CLINICAL COMMISSIONING GROUP? By consistently raising the quality of care residents of Salford receive from services commissioned on their behalf. WHAT RISKS M AY ARISE AS A RESULT OF THIS PAPER? HOW CAN THEY BE MITIGATED? None WHAT EQUALITY-RELATED RISKS M AY ARISE AS A RESULT OF THIS PAPER? HOW WILL THESE BE MITIGATED? None DOES THIS PAPER HELP ADDRESS ANY EXISTING HIGH OR EXTREME RISKS FACING THE ORGANISATION? IF SO WHAT ARE THEY AND HOW DOES THIS PAPER REDUCE THEM? No PLEASE DESCRIBE ANY POSSIBLE CONFLICTS OF INTEREST ASSOCIATED WITH THIS PAPER. None PLEASE IDENTIFY ANY CURRENT SERVICES OR ROLES THAT MAY BE AFFECTED BY ISSUES WITHIN THIS PAPER: Quality by its very nature is everyone s business therefore it will impact across all areas of care planning and delivery. Footnote: Members of NHS Salf ord Clinical Commissioning Group Governing Body w ill read all papers thoroughly. Once papers are distributed no amendments are possible. Page 2 of 8

67 30 November 2016 Agenda Item No 6 (a) (i) Document Development Process Yes No Public Engagement (Please detail the method ie survey, event, consultation) Clinical Engagement (Please detail the method ie survey, event, consultation) Has due regard been given to Equality Analysis (EA) of any adverse impacts? (Please detail outcomes, including risks and how these will be managed) Legal Advice Sought Presented to the Programme Management Group Presented to the Health and Wellbeing Board Presented to the Integrated Commissioning Board Presented to any other groups or committees, including Partnership Groups y y y n n n n Not Applicable Comments and Date (i.e. presentation, verbal, actual report) Public were invited to comment on Quality and Safety Strategy during development. Quality & Safety Commissioning Committee October 2016 Quality and Safety Commissioning Committee October 2016 Outcome Informed content for inclusion Informed content for inclusion y Executive Team Minor amendments made (Please specify in comments) Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work. Page 3 of 8

68 30 November 2016 Agenda Item No 6 (a) (i) 1 Executive Summary A Whole Systems Approach to Quality This paper provides an overview on several issues related to the quality and safety of patient care. An update is included on key issues relating to safeguarding along with information on the feedback from the Joint Targeted Area Inspection conducted in Salford during September. Information is provided on how the CCG is progressing with the development and implementation of the Safer Salford work-streams in relation to the themes that were highlighted during the Making Safety Visible programme. Since this programme NHS Salford CCG has had a consistent and sustained approach to improving the safety of medicines: an update is included on Practices Improving the Safety of Medicines (PrISMS). 2 Introduction and Background 2.1 This overview paper outlines high level issues relating to quality and safety including an update on safeguarding children, young people and adults. A focus on the current work in supporting GP practices in the area of domestic violence and abuse is outlined to link with the theme of the Joint Targeted Area Inspection. 2.2 A Joint Targeted Area Inspection (JTAI) was conducted in Salford during September and included the Care Quality Commission (CQC), the Office for Standards in Education (Ofsted), Her Majesty s Inspectorate of Constabulary (HMIC) and Her Majesty s Inspectorate of Probation (HMIP). The focus of the inspection related to children living with domestic abuse. Detailed feedback was provided at the end of the week that the inspectors were on site; a formal letter outlining areas of good practice and areas for development has subsequently been received and is attached as Appendix 1. A co-ordinated multi-agency approach to improvement is being adopted and will be overseen by Salford s Community Safety Partnership. 2.3 The work programme related to Safer Salford and is being overseen by a multiagency programme board to ensure the delivery of actions against key objectives that have now been agreed. An overview on progress under each of the workstreams is outlined. 2.4 One of the key areas of focus relates to improving medication safety and an improvement project that included 8 GP practices has been underway for the past 12 months. A summit meeting was held in October to report on progress made and achievements relating to this work, an overview of these is included. 3 Safeguarding Update 3.1 The Safeguarding update report presented to the Quality and Safety Commissioning Committee in October identified the following key points: Page 4 of 8

69 30 November 2016 Agenda Item No 6 (a) (i) 3.2 Serious Case Reviews, Serious Adult Reviews and Domestic Homicide Reviews Serious Case Review (SCR) Child R - This case is in respect of a child with complex health needs who was admitted to hospital in October The police investigation is now complete. The SCR final report will be presented to the SSCB in December 2016 with publication planned for January Adult Domestic Homicide Review (DHR) - This case is in respect of an 86 year old lady who was admitted to hospital in a severely neglected state. Criminal charges in respect of this case have now been dropped. The DHR process will continue in view of identified lessons learned around self-neglect for all agencies involved. Serious Adult Review (SAR) - This case is in respect of a woman with a severe Learning Disability, admitted to hospital where it is understood she later died due to complications relating to a severely obstructed bowel. The Safeguarding Adult Board Panel confirmed this case met the SAR criteria for a statutory adult review this month. 3.3 Domestic Violence and Abuse (DVA) The current status of DVA in Salford continues to demand a significant investment of resources from multiagency services; remains a major public health issue and presents a continuing challenge to Primary Care. The number of Domestic Violence Notifications where children are present within the home rose from 1540 (January to September 2015) to 1732 (January - September 2016) a 12.5% increase. These notifications are sent to the relevant GP practice for information by the CCG Safeguarding team. This informs the Practice of potential health implications, risks and safeguarding implications; assisting GP s in the appropriate management of individuals and families. 6% of these incidents are high risk and referred to Multi-Agency Risk Assessment Conference (MARAC). GP engagement in the MARAC process requires provision of reports in a timely way; performance continues to be tracked by the safeguarding team and is currently at 92%. GP s continue to be supported in training and education in relation to all aspects of safeguarding including domestic abuse through the GP Safeguarding leads forum which continues to be very well attended. The Identification and Referral to improve Safety (IRIS) Project which involves General Practices and the third sector (Salford Women s Aid) working in partnership to improve the health care response in relation to domestic violence and abuse, continues to progress. Twelve GP Practices are engaging in the pilot and are currently in the process of completing training. These programmes of work were noted as exemplary practice within the JTAI and included in their feedback. Page 5 of 8

70 30 November 2016 Agenda Item No 6 (a) (i) 4 Joint Targeted Area Inspection (JTAI) 4.1 The JTAI that was undertaken in Salford during September provided a level of scrutiny on the multi-agency arrangements for: The response to all forms of child abuse, neglect and exploitation at the point of identification. The quality and impact of assessment, planning and decision making in response to notification and referrals. The protection of children and young people at risk of specific types of harm. The leadership and management of this work. The effectiveness of the Local Safeguarding Children s Board (LSCB) in relation to this work. 4.2 The specific type of harm that the inspectors focused on for the Salford inspection was children living with domestic abuse. 4.3 The overall feedback from the inspection was very positive. There was evidence of strong, committed multi-agency partnership working in Salford and there was a culture of continuous improvement to safeguard children living with domestic abuse. The Community Safety Partnership (CSP) supported by the Salford Safeguarding Children Board (SSCB) was found to rigorously promote, coordinate and prioritise partnership work around domestic abuse. 4.4 Clear commitment of resources from all agencies and effective joint working was highlighted within the Bridge. Effective commissioning of services for victims was noted along with the innovative work in the Young Person s Domestic Abuse Meeting. 4.5 The complex health landscape in Salford was acknowledged in relation to the range of commissioned services and providers. However the work of health within Salford was highlighted as very positive. Particular examples of good practice for health were identified as; The good communication and joint working between the Health Visiting and Midwifery services with complex families and cases of domestic abuse The good liaison between Adult Mental Health Services and Drug and Alcohol Services with Children s Social Care and other health partners The work with Primary Care regarding safeguarding and domestic abuse. 4.6 Areas for improvement were identified as: More effective performance monitoring processes. The measurement of the impact of work with children living with domestic abuse Health input into the work of the Bridge to be strengthened Further work around risk assessment with victims of domestic abuse 4.7 The Local Authority will now coordinate a written statement of proposed actions in response to the findings. This will be a multiagency response setting out the actions for the partnership and individual agencies. The Designated Nurse Safeguarding Page 6 of 8

71 30 November 2016 Agenda Item No 6 (a) (i) Children and LAC will coordinate the health action plan. The Local Authority will submit the formal statement of actions to the inspectors by the 31 January Safer Salford 5.1 Progress continues to be made in the implementation of the economy-wide safety improvement plan. Key updates since the last Governing Body meeting are outlined below: 5.2 Leadership A local programme based on the original Making Safety Visible sessions held for Governing Body and Board members has been developed. Thirty senior leaders from across the health and care sector in Salford have signed up to the programme. The first session was held in October and attendees evaluated it positively. 5.3 Care Homes An expert panel has been convened and met at the end of September. Twelve care homes have signed up to the improvement collaborative and the first event is scheduled for January. 5.4 Communication A Safer Salford website has been developed for staff across the health and social care system. This will be a repository for resources related to the safety framework and also include information and progress against each of the workstreams. An engagement workshop is planned for the Citizen s panel event in November, to inform members of the public about the Safer Salford programme and to seek their views on what safety in terms of health and care services means to them. 6 Practices Improving the Safety of Medicines (PrISMS) 6.1 The Summit event for the eight practices involved in this programme was held in October. All practices that had taken part were able to demonstrate measurable improvements in the areas that they had chosen to focus on. This included better management of people that were on high risk medicines in terms of drug interactions as well as more timely reconciliation of medicines following changes that may have been made after a hospital admission. 6.2 All practices were also able to describe how the quality improvement methodology that had been utilised as part of this programme had benefited other aspects of their work. Examples were cited of improvements in productivity, the introduction of more reliable systems and workforce changes that had improved practice efficiency. 6.3 The outcome of this improvement work is scheduled to be shared at the Members Event in November which will include a workshop to determine how the learning can be scaled up and spread to other practices across the city. Page 7 of 8

72 30 November 2016 Agenda Item No 6 (a) (i) 7 Summary 7.1 The information highlighted within this report provides assurance of our continued commitment to safeguarding children and vulnerable adults; a priority area within our Quality and Safety Strategy. 7.2 The JTAI has provided a level of external scrutiny of our multiagency safeguarding arrangements in Salford. The positive findings provide a good level of assurance to Governing Body in relation to the support provided to some of the most vulnerable people within our city. However we are not complacent and the areas for development are an opportunity for improvements to be made in this important area. 7.3 Demonstrable improvements have been made in relation to medication safety within the 8 practices that participated in the PrISMS project. This programme has enabled capability building in terms of quality improvement methodology and has contributed to safer, more efficient and reliable care delivery. These are core aspirations outlined within our Quality and Safety Strategy. 8 Recommendations 8.1 The NHS Salford Clinical Commissioning Group Governing Body is asked to: Note the contents of the report. Jeremy Tankel Clinical Lead for Quality & Safety Page 8 of 8

73 30 th November 2016 Agenda Item No 6 (a) (ii) NHS SALFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING AGENDA ITEM NO 6 (a) (ii) Item for Decision/Assurance/Information 30 th November 2016 REPORT OF: Clinical Lead for Quality & Safety DATE OF PAPER: 21 st November 2016 SUBJECT: Quality of Commissioned Services IN CASE OF QUERY PLEASE CONTACT: STRATEGIC PRIORITIES: Quality Francine Thorpe Director of Quality & Innovation Please tick w hich strategic priorities the paper relates to: Community Based Care Integrated Care In Hospital Care Long Term Conditions and Mental Health Effective Organisation PURPOSE OF PAPER: This paper provides information and analysis on key aspects of the quality and safety of services commissioned by NHS Salford Clinical Commissioning Group (CCG). The following three areas: Patient safety Patient experience Clinical effectiveness Remain the main focus of data scrutinised in the preparation of this report. Page 1 of 10

74 30 th November 2016 Agenda Item No 6 (a) (ii) Further explanatory information required HOW WILL THIS BENEFIT THE HEALTH AND WELL BEING OF SALFORD RESIDENTS OR THE CLINICAL COMMISSIONING GROUP? By consistently raising the quality of care residents of Salford receive from services commissioned on their behalf. WHAT RISKS MAY ARISE AS A RESULT OF THIS PAPER? HOW CAN THEY BE MITIGATED? None WHAT EQUALITY-RELATED RISKS MAY ARISE AS A RESULT OF THIS PAPER? HOW WILL THESE BE MITIGATED? None DOES THIS PAPER HELP ADDRESS ANY EXISTING HIGH OR EXTREME RISKS FACING THE ORGANISATION? IF SO WHAT ARE THEY AND HOW DOES THIS PAPER REDUCE THEM? No PLEASE DESCRIBE ANY POSSIBLE CONFLICTS OF INTEREST ASSOCIATED WITH THIS PAPER. None PLEASE IDENTIFY ANY CURRENT SERVICES OR ROLES THAT MAY BE AFFECTED BY ISSUES WITHIN THIS PAPER: Quality by its very nature is everyone s business therefore it will impact across all areas of care planning and delivery Footnote: Members of NHS Salf ord Clinical Commissioning Group Governing Body w ill read all papers thoroughly. Once papers are distributed no amendments are possible. Page 2 of 10

75 30 th November 2016 Agenda Item No 6 (a) (ii) Document Development Public Engagement (Please detail the method ie. survey, event, consultation) Clinical Engagement Process Yes No (Please detail the method ie survey, event, consultation) Has due regard been given to Equality Analysis (EA) of any adverse impacts? (Please detail outcomes, including risks and how these will be managed) Legal Advice Sought Presented to the Programme Management Group y y n n Not Applicable Comments and Date (i.e. presentation, verbal, actual report) Clinical Lead for Quality and Safety Reports discussed at Quality & Safety Commissioning Committee in October 2016 Outcome Informed content for inclusion Informed content for inclusion Presented to the Health and Wellbeing Board Presented to the Integrated Commissioning Board Presented to any other groups or committees, including Partnership Groups n n y Executive Team Minor amendments made (Please specify in comments) Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work. y:\corporate services\governance & policy\ccg board meetings & prime committees\governing body - formal\2016\#11 november 2016\reports received\part 1\6a ii i commissioned servicesnov16.doc Page 3 of 10

76 30 th November 2016 Agenda Item No 6 (a) (ii) 1 Executive Summary Quality of Commissioned Services This paper provides an overview on a number of issues that are used to measure the quality and safety of patient care within the services commissioned by NHS Salford CCG. Issues that have been discussed at the regular quality meetings with providers are outlined to highlight the level of challenge and scrutiny that occurs through these discussions. An update on Serious Incidents reported at Salford Royal NHS Foundation Trust (SRFT) and Greater Manchester West Mental Health NHS Foundation Trust (GMW) is included along with information on how any themes or trends are being identified and associated actions taken. Key issues discussed with other local providers are also outlined along with information on how any concerns are being addressed. 2 Introduction and Background 2.1 This paper provides some detail in the analysis of quality information about Salford Royal Foundation Trust (SRFT) as our main secondary care provider and Greater Manchester West Mental Health Foundation Trust (GMW) as our main provider of mental health services. Information is included about issues that have been discussed with these providers at the regular quality meetings along with quality and safety information gained from other sources. 2.2 An update is provided on progress made in reviewing investigations of Serious Incidents (SI s), including any themes identified. 2.3 Information is also included in relation to other local providers sourced from direct discussions as well as the Greater Manchester Quality Surveillance Group. 3 Salford Royal NHS Foundation Trust (SRFT ) Update 3.1 Hot Topic Discussions The following areas have discussed at the Quality and Outcomes meetings in September and October: 3.2 Intermediate Care The Senior Manager Intermediate Care (IMC) Service and the Clinical Lead attended the meeting to provide an overview of the service. There are three IMC bedded units: The Limes 28 beds (residential care); Heartley Green 29 beds (nursing and residential care); Barton Brook 18 beds (nursing and residential care) All units have input from SRFT therapy staff, community geriatricians and all patients are registered with Salford Care Homes Practice. The Limes and Heartley Green have an Advanced Nurse Practitioner (ANP) attached to the units

77 30 th November 2016 Agenda Item No 6 (a) (ii) The service has participated in a recent national audit. The results will be utilised to benchmark against other IMC services and identify areas for improvement. A number of areas of good practice were discussed which assist the provision of safe services to patients, these included: Comprehensive Geriatric Assessment process and weekly multi-disciplinary team meetings ensuring each patient has a thorough assessment and active care plan The Electronic Patient Record is now used in all units which has improved communication and handover An Advanced Nurse Practitioner deployed at the Limes to improved clinical leadership The service faces a number of challenges which they are addressing, for example: Increasing dependency of patients Pharmacy service at Heartley Green there are plans to address this Transfer and handover of patients from hospital Delays due to care availability in the community - Home Safe model has been introduced to reduce the bed base, ease flow through the system and reduce the number of patients requiring IMC. Commissioners noted that the themes identified relating to challenges are around communication, medicines safety and handoffs which are the same themes in the Safer Salford Work programme. The presentation and subsequent discussions provided a high level of assurance of the safety and quality of services provided. The challenges faced by the service and subsequent actions are monitored at the IMC service performance meeting. 3.3 Staffing / Resilience The Deputy Director of Nursing provided information on current staffing and the challenges faced by the trust to recruit to posts. The recruitment of nursing staff is a national problem and SRFT are facing similar difficulties. He outlined how the Trust is trying to maintain the agreed staffing levels on each ward and the strategies in place to attract and retain staff. The use of the trend care system that matches patient dependency to staffing requirements in real time is helping to facilitate this. Commissioners specifically asked whether there were ongoing difficulties in recruiting to community nursing posts as this had been an issue for some time. We were advised that this situation had improved and that the main areas of concern related to the wards. The Deputy Director of Nursing has met individually with all ward managers and community team leads to listen to their concerns and ideas for making improvement. He outlined the approach taken to managing sickness absence and staff support which appeared to be robust. Plans to improve retention by offering an internal transfer scheme to keep staff within the organisation were outlined. This has resulted in an improved retention rate. It was

78 30 th November 2016 Agenda Item No 6 (a) (ii) noted that one of the current issues is that private healthcare organisations are offering opportunities for Advanced Nurse Practitioners, two bands higher than the standard NHS rate; this has meant staff are leaving the organisation for a higher paid job. It was confirmed that SRFT s Board of Directors is sighted on these issues and the level of importance that is attached to resolving them. 3.4 Patient Responsiveness report This report is scheduled every six months and the one received in November was very comprehensive, providing an excellent overview of how the organisation is responding to feedback from patients. There were some good examples of actions taken and learning as a result of complaints which provided a high level of assurance that patient feedback was being acted upon. 3.5 Serious Incidents (SI s) All incidents from 15/16 are now closed. The table below shows the numbers of serious incidents reported by SRFT from April 1 st 2016 to 31 st October Number of SI s reported 35 Number of Never Events 3 Number Closed 10 Number Aw aiting Action 1 (review ed and further assurance requested) Number ongoing (not yet due 24 or not yet review ed) Number Overdue 0 In the last update there were two never events reported, both relating to surgery. One of these is closed. Since the last Governing Body paper a further never event has been reported, this relates to wrong site surgery.

79 30 th November 2016 Agenda Item No 6 (a) (ii) The table below shows the themes of these incidents. Abuse/alleged abuse of adult patient by staff 1 Accident e.g. collision/scald (not slip/trip/fall) meeting SI criteria 1 Diagnostic incident including delay 5 HCAI/Infection control incident meeting SI criteria 1 Operation/treatment given w ithout valid consent 1 Pending Review 2 Pressure ulcer meeting SI criteria grade 3 2 Pressure ulcer meeting SI criteria - grade 4 2 Slips/trips/falls meeting SI criteria 14 Surgical/invasive procedure incident meeting SI criteria 2 Treatment delay meeting SI Criteria 3 Unauthorised Absence 1 The following are the themes that have been identified, along with actions being taken by the Trust to address the issues. Falls: The Trust continues to review all falls at the Falls Collaborative meeting, the Lead Nurse for Quality Assurance and Improvement at NHS Salford CCG regularly attends this meeting. Falls prevention strategies are ongoing and regularly audited, a number of incident investigations relating to falls with harm have been reviewed by the CCG s incident closure panel. They indicate that falls risk assessments and relevant intervention have been completed however patients have capacity and have chosen to mobilise independently resulting in a fall. Improvement work continues to try and address this issue. Consent: Thematic analysis by NHS Salford CCG has indicated an emerging theme recently noted around consent. This is related to the consent procedure not being followed appropriately, in most cases this factor has been incidental and not necessarily related to the root cause of incidents, we have raised this with SRFT and await their response. 4 Greater Manchester West NHS Health Foundation Trust (GMW) Update 4.1 Prescott House Community Mental Health Team Quality Visit Commissioners undertook a quality visit to Prescott House in September; this provided the opportunity to talk to a range of mental health staff including social workers, psychiatrists, psychologists, occupational therapists, nurses and administrative staff. They identified a range of issues including the following: Inefficiencies relating to 7-day working Problems with the clinical information system and the negative impact on day to day working practice Cumbersome nature of the commissioning panel process Increased acuity of patients being referred for support

80 30 th November 2016 Agenda Item No 6 (a) (ii) Accessing acute admission beds Increased demand relating to mental health act assessments Mental Health Commissioners are having continued dialogue with GMW to explore these issues further and how they might be resolved. 4.2 Service Review of Copeland Ward Rehabilitation Service GMW recently presented a formal service review of Copeland Ward Rehabilitation Service which was positive. Follow up work is being undertaken to strengthen the medical involvement in service access. 4.4 Serious Incidents (SI s) All incidents reported in 15/16 have now been reviewed and closed. The table below shows the numbers of Serious Incidents reported by GMW from April 1 st 2016 to 31 st October Number of SI s reported 20 Number of Never Events 0 Number Closed 8 Number Aw aiting Action (review ed and further 1 assurance requested) Number ongoing (not yet due or not yet 11 review ed) Number Overdue 0 NB the incident shown relate only to incidents in Salford services as the serious incident processes for Bolton and Trafford have now been handed over to Bolton CCG. The table below shows the themes of these incidents. Allegation of abuse of adult 8 inpatient Accident 1 Apparent, actual, suspected selfharm / suicide 5 Disruptive, Aggressive or violent 1 behaviours Falls 4 Sub-optimal care of the 1 deteriorating patient The following are the themes that have been identified, along with actions being taken by the Trust to address the issues. There has been an increase in the numbers of allegation of abuse in comparison to 2015/2016 where only 2 were reported. This raised some concerns for commissioners, however discussions with the CCG Adult Safeguarding team has indicated that a significant amount of training has been completed with GMW staff which is likely to have resulted in an increased awareness of reporting allegations of this nature. Further work is ongoing with the Trust to establish whether there are any other contributory factors.

81 30 th November 2016 Agenda Item No 6 (a) (ii) 5 Other Local Providers 5.1 Oakland s Hospital The CQC undertook an inspection visit to Oakland s Hospital on the 6 th October The report is not due to be published until early Representatives from the CCG have been in regular dialogue with the organisation and the CQC in relation to the inspection. 5.2 Pennine Acute Hospitals Trust (PAHT) The leadership team at PAHT continues to work closely and positively with its four local commissioners, local councils and NHS provider colleagues. The Pennine Improvement Board also includes regional partner agencies across Greater Manchester and is focused on strengthening medical and nurse staffing, improving models of care and supporting staff on the frontline. A robust and comprehensive improvement action plan is in place in response to both the CQC report and SRFT s own diagnostic review and assessment. The plan sets out the immediate improvement actions that are being undertaken over the next 9-12 months to stabilise services and to create the right conditions upon which the Trust can continue to improve. The CQC s 77 Must Dos and 144 Should Dos in its report have been mapped to the themes and deliverables contained within the plan. The impact of the actions on patient care, outcomes and staff will be monitored and assessed through measurement dashboards. All actions in the Improvement Plan are integrated into these six main improvement themes: Improving Fragile Services: stabilising staffing across Urgent Care at NMGH, Maternity Care, Paediatric, Critical Care; new models of care where needed Improving Quality; Improving Safety, Effectiveness, Patient Experience; largescale improvement learning collaboratives focusing on key clinical areas and patient care Improving Risk & Governance: implementation of new risk and governance arrangements to protect patients; review of all safeguarding systems and processes Improving Operations & Performance: focus on improving data quality, patient flow systems, pathway management, models of care Improving Workforce and Safe Staffing: focus on safe staffing levels. Greater emphasis on staff engagement, recruitment and retention Improving Leadership & Strategic Relations: clinical leadership development and strengthening local hospital operational management with triumvirate structure for each site with lead doctor, nurse, manager underpinned by a governance accountability framework. The Improvement Board has established a mechanism to regularly brief key stakeholders; NHS Salford CCG will continue to receive updates through this process.

82 30 th November 2016 Agenda Item No 6 (a) (ii) 6 Summary 6.1 A range of issues in relation to the quality of care provided have been highlighted within this paper. Information from a number of sources is being triangulated to provide a more rounded view of the quality and safety of local providers. 6.2 Themes and trends that are emerging through the triangulation of data are being highlighted to providers so that challenge and scrutiny is evident within our quality and safety discussions. It is expected that this will lead to improvements in the quality and safety of services provided to our population. 7 Recommendations 7.1 NHS Salford Clinical Commissioning Group Governing Body is asked to: Note the contents of this report Receive assurance that relevant information is being sought and processes established to scrutinise the quality and safety of our commissioned services. Jeremy Tankel Clinical Lead Quality & Safety

83 28 October 2016 Charlotte Ramsden, Strategic Director for Children s and Adults Services, Salford local authority Anthony Hassall, Executive lead of the Clinical Commissioning Group with responsibility for children living with domestic abuse Tony Lloyd, Police and Crime Commissioner Ian Hopkins, Chief Constable of Greater Manchester police force Mary Doyle, Territorial Commander Salford Division Katy Davidson, Manager, Salford Youth Offending Team Stuart Tasker, CEO, Community Rehabilitation Company Manjit Seale, CEO, National Probation Service Sandie Hayes, Assistant Director, CAFCASS Simon Westwood, Chair of Salford LSCB Dear local partnership Joint targeted area inspection of the multi-agency response to abuse and neglect in Salford Between 12 and 16 September 2016, Ofsted, the Care Quality Commission (CQC), HMI Constabulary (HMIC) and HMI Probation (HMI Probation) undertook a joint inspection of the multi-agency response to abuse and neglect in Salford. 1 This inspection included a deep dive focus on the response to children living with domestic abuse. This letter to all the service leaders in the area outlines our findings about the effectiveness of partnership working and of the work of individual agencies in Salford. The inspectorates recognise the complexities for agencies in intervening in families where there is more than one victim and where, as a consequence, risk assessment and decision making have a number of complexities and challenges, not least that the impact on the child is sometimes not immediately apparent. A multiagency inspection of this area of practice is more likely to highlight some of the significant challenges to partnerships in improving practice. We anticipate that each of these joint targeted area inspections (JTAIs) will identify learning for all agencies and will contribute to the debate about what good practice looks like in relation to children living with domestic abuse. In a significant proportion of cases seen by inspectors, there were risk factors in addition to domestic abuse, which reflects the complexity of the work. 1 This joint inspection was conducted under section 20 of the Children Act

84 A strong, committed multi-agency partnership in Salford prioritises children living with domestic abuse and promotes a culture of continuous improvement. There is a good understanding of the prevalence of domestic abuse in Salford and this informs strategic thinking. The partnership has a very positive approach to developing initiatives locally to maximise their benefit to children and families within Salford. The Community Safety Partnership (CSP) supported by the Salford Safeguarding Children Board (SSCB) rigorously promotes, coordinates and prioritises the work of all statutory partners around domestic abuse. Improvements to training and learning opportunities are evident, but these have not yet had the intended impact. There remain inconsistencies in decision making and practice by staff across the partnership when working with children living with domestic abuse. In all agencies we found that staff are not consistently confident or sufficiently skilled and knowledgeable in this challenging area of practice. The partnership is committed to evaluating the quality of multi-agency work, but the performance monitoring arrangements are not yet sufficiently robust and therefore the partnership is not able to understand fully the quality of frontline practice. This leads to a gap between strategic intent and the quality of frontline practice in some critical areas. Effective responses were seen through the use of early help interventions to meet the needs of some children and their families. Some excellent work was seen in gathering the views of children and young people in children s social care and in early help services. However, deficits in practice were seen in children in need and child protection cases. A lack of effective information sharing and comprehensive assessment of risk meant that the day-to-day experience of the child was not consistently understood by professionals in all cases. Key Strengths Leaders and managers have a good understanding of the nature and extent of domestic abuse in their area, and this informs the development of strategic thinking and planning. It also underpins the Salford commitment to agencies working together to respond to families at an early stage. The partnership has a clear vision and adapts initiatives to maximise their effectiveness within Salford. The partnership has invested significantly in early help. Children living with domestic abuse are a priority for the CSP and SSCB and the work includes a key focus on prevention. For example, the Real Love Rocks and Black eyes and cottage pies theatre productions have been delivered across all schools. These initiatives are supporting children to better understand healthy relationships. The SSCB drives improved multi-agency working. For example, the board identified a gap in sharing domestic abuse notifications with schools, and this led 2

85 to the SSCB initiating, and supporting, a pilot project to share domestic abuse notifications so that all schools now receive this information. The SSCB has also promoted a greater understanding of the Multi-agency Risk Assessment Conference (MARAC) process across the partnership. A particular strength across all agencies is the commitment of resources to tackle this issue and a clear determination to remove barriers to effective joint working. For example, the investment in the Bridge : a single point of contact for referrals to early help by children s social care, health services, the youth offending service, the police, the national probation service (NPS) and the community rehabilitation company (CRC). Innovative approaches such as the young people s domestic abuse meeting, which is a multi-agency meeting for those who have been physically abusive to family members or peers, demonstrate strong partnership working. These meetings enable young people to access appropriate help and support to reduce the risk of their becoming perpetrators of domestic abuse in the future. This work could be strengthened with an assessment of siblings needs, given the risks presented by these young people. The development of young people s domestic violence adviser role has enabled a more effective response to young people who harm. The youth offending service works well with children and young people who are both perpetrators and victims of domestic abuse. Their delivery of the Step Up programme, which educates young people in helping others, demonstrates an effective approach. One young person who attended this programme stated that the youth offending service listened to me and took account of my hobbies and what I wanted to achieve and I am now a much calmer person. The prioritisation of domestic abuse and safeguarding by the Clinical Commissioning Group, combined with the commitment of local GPs, has led to increased GP awareness of children living with domestic abuse. Additional training for GPs on domestic abuse was well attended and positively evaluated. As a result, GPs are making more appropriate referrals to the Bridge and increasingly effective contributions to child protection conferences. This is in addition to the Identification and Referral to Improve Safety (IRIS) project in 12 of Salford s practices. IRIS is a GP-based domestic abuse project which focuses on the health indicators of domestic abuse and incorporates a training support and referral programme that includes an enhanced pathway to domestic abuse services. GPs contribute routinely to initial health assessments, including information on children s emotional health and well-being when a child becomes looked after, thus enabling a better of understanding of their needs. Timely and effective information sharing between midwives and health visitors supports effective assessment of the child s risk and needs and the appropriate application of thresholds. 3

86 Good awareness of diversity issues was seen in the majority of cases. Good multiagency work with a specific community was seen, and this enabled effective engagement with children and their families. Children s social care routinely make concerted efforts to engage children. Direct work to gather children s views using tools such as viewpoint and three houses was used effectively to understand children s views and much of this work is sensitive and of high quality. It was evident in some cases that there was an appropriate change of focus in planning as a direct result of children sharing their experiences. Effective commissioning has led to the development of some good and effective services for victims, such as Salford independent domestic abuse support service, which provides specialised support and independent advocacy for victims of domestic violence as well as for the women s refuge. Housing workers have been trained as independent domestic violence advisers and have been involved in a pilot project with Greater Manchester Police s Strive initiative, where police and housing workers engage with first time victims. These practitioners make followup visits with police community support officers to first-time victims when police notifications have not reached a level of concern to be referred to children s social care. A pilot project to do preventative work with 4-11 year old girls in schools is also taking place. There are a number of preventative services, such as a group for young fathers. Another example of a good service, holding families, is a substance misuse service which intervenes effectively when children are living with domestic abuse. One child stated after the family had received the service, Now they [my parents] have stopped arguing and my mum understands how I felt. However, there are insufficient programmes for those perpetrators of domestic violence who are not subject to a court order. There is still work to do to improve the evaluation of the impact of commissioned services. The Bridge serves as an effective single point of contact for referrals into early help and children s social care. Daily meetings and good joint working result in effective information sharing that supports the identification and management of risks of harm to children and young people. For example, the police regularly share domestic abuse notifications with children s social care, health visitors, GPs and midwifery services. Thresholds are understood and well managed. Timely strategy discussions take place, but their impact is reduced as not all health partners are fully included. The weekly MARAC is chaired effectively and is well attended by partner agencies and there is a good focus on the needs of children living with domestic abuse, which leads to appropriate referrals to services. The multi-agency public protection arrangements identify effectively and manage the risk of harm to domestic abuse victims, including children. 4

87 Strong partnership arrangements are evident between the Bridge and youth offending and probation services. There are good examples of this when court reports are required, with the Bridge working in partnership to ensure that bail conditions of perpetrators are appropriate and focused on the protection of victims. Child protection enquiries are completed in a timely way, with good management oversight that is clear and decisive, resulting in the development of plans informed by detailed family assessments. Appropriate interim safeguarding measures are included in the majority of child protection enquires, and these support timely action to keep children safe. The police have invested in the training of staff to improve responses to domestic abuse incidents. A particular focus has been on training the neighbourhood patrol officers and neighbourhood beat officers. However, while there was evidence of an improving awareness of the responsibilities of officers when attending domestic abuse incidents, this has not yet led to consistent improvements in practice or the quality of the information recorded. Offenders known to the CRC who are also perpetrators of domestic abuse can access a number of interventions through CRC and these are delivered quickly. Good practice was seen the provision of the Improving Relationship Supporting Change programme available to people who did not have convictions for domestic abuse. A pilot programme has just been developed concerning domestic abuse in same sex relationships, which is good practice. Case study: highly effective practice The Bridge is effective in enabling children and families to access help at an early stage through a wide range of good early intervention services. Effective information sharing was evident in early help and is improving further with the development of the 0 25 pilot for early help in the West locality, which is supporting the co-location of adult and children s services. Practitioners assess effectively the needs of children and families to ensure appropriate interventions. Direct work tools are used well to gather the wishes and feelings of children. The ethos of early intervention and prevention is family led, which enables the family to engage in services and supports better outcomes for children. The recent adoption of a family assessment form is supporting a more holistic assessment of the family s needs and quicker responses. The 0 4 domestic abuse pathway enables the children centre staff to offer services to families at an early stage to reduce the escalation of needs. The outreach team is a strength. 5

88 Practitioners in the outreach team support couples with healthy relationship work when domestic violence has been identified. High quality wishes and feelings work is undertaken with children. Areas for improvement A multi-agency internal audit was coordinated by children s social care on behalf of the SSCB on children living with domestic abuse, and this identified a number of the same themes identified by this inspection. The key agencies have a good understanding of the work that they need to do locally to improve the response to children living with domestic abuse. Findings have been integrated into the children s domestic abuse action plan. The findings from the audit which was signed off by sub groups in June 2016 had not been sufficiently disseminated to practitioners across the partnership, and this undermined its effectiveness. The CSP has not effectively developed the performance monitoring and evaluation in this area of practice. The CSP and SSCB recognise that performance monitoring is focused too much on process and needs to develop to focus more explicitly on the impact of services to children and their families. The CSP has yet to develop clear success criteria to measure the impact of the work that is undertaken in relation to children living with domestic abuse. In most cases, individual agencies are responding to children living with domestic abuse and their families. Lack of effective performance monitoring and evaluation in relation to children living with domestic abuse from a multi-agency perspective does not enable the CSP to understand fully the day-to-day experiences of children living with domestic abuse or the effectiveness of the response from each of the agencies both individually and collectively. This inhibits the CSP in taking effective action to improve practice and services. The understanding of leaders and managers about the quality of decision making at the Bridge is not sufficiently robust. Although some good information sharing was seen at the Bridge and in early help across all agencies, it is too variable at different stages of the child s journey through services. The lack of consistently effective and timely multi-agency information sharing means that assessment of risk is not always based on full information. There are missed opportunities to identify emerging and escalating risks at an earlier stage. In some cases, information indicating escalating risk was known to one or more agencies and was not shared. In other cases, detailed information was shared but did not include key partner agencies, such as adult mental health, so full consideration of risk did not take place. Inspectors found a positive think family approach within health, with a clear focus on children and the risks that adults may pose to them. However, health services teams do not consistently have full information on the risk to children and families. Adult mental health services are not consistently being made aware of when there are safeguarding concerns. The inspectorates saw examples of 6

89 health records that did not indicate that children were living in households where domestic abuse occurs. Information is not consistently shared with the accident and emergency department. The adult substance misuse service is not consistently aware of the most up-to-date concerns in relation to children and families. A range of multi-agency SSCB training and workshops have taken place to develop further the skills and knowledge of frontline professionals, including in the voluntary sector, so that they are able to engage with communities to provide support and reduce risk. The impact of this has been variable for staff from different agencies and has not always enabled professionals to be confident and sufficiently skilled in working in this area of practice. However, health professionals stated that they value this training, particularly for the opportunities to network and develop their understanding of other professionals roles and responsibilities. Agencies do not consistently identify all risks for children living with domestic abuse, nor do they fully assess the impact of domestic abuse on children and young people and their families. As a result, their work with families is not always fully effective. A common feature of cases was that when the victim was no longer in a relationship with the perpetrator, this was seen as a protective factor. Professionals did not always recognise that the abuse does not end when people stop living together and may in fact escalate. This means that risk is not always fully assessed. Children s social care and the police sometimes make overly optimistic assessments about the capacity for change within relationships, leading to delays in cases being escalated when risk was clearly increasing. Some cases also showed an unrealistic view of the capacity of victims and perpetrators to comply with written agreements. Examples were seen of victims inappropriately being expected to police perpetrators contact with their children. Over-optimism also sometimes resulted in plans being continued to be followed when they had been shown previously to be ineffective at reducing risk. Responses to serious incidents of domestic abuse by children s social care and the police frequently result in perpetrators being asked to leave the family home. There is limited evidence of work taking place with perpetrators to help them understand the impact of the abuse on their children or safety planning to ensure children s safety. Agencies involved in the assessment of victims remaining in abusive relationships failed in some cases to give sufficient consideration to the possibility that the victims may be experiencing coercive control. In some cases, contact arrangements were insufficiently focused on the needs of the child and the risk to children living with domestic abuse. 7

90 In some cases, there was insufficient focus by agencies on the risk to children of domestic abuse as these considerations were at times overtaken by other risks arising from the complex needs of the families. Examples were seen in cases of the voices and lived experiences of children being less of a focus than the adults in the management of cases by health services and police. The police have developed an assessment process to ensure that the decision making of officers is in line with the training that they have received. While this is positive, inspectors found that there remain inconsistencies in practice. In some cases, significant deficits were seen in the quality of decision making at the police frontline, and further work is required by senior leaders to understand the quality of decision making. Incidents are often dealt with in isolation, with limited consideration given to any previous history of abuse or the wider risks and vulnerability posed to victims. In a number of the cases reviewed, this resulted in a failure to recognise the cumulative or escalating impact of repeated incidents of domestic abuse, leading to an incomplete assessment of risk and a lack of appropriate further action. Domestic abuse officers within the public protection investigation unit triage all domestic abuse cases except those completed by accredited officers. The detective sergeant further checks all standard risk cases that have an associated crime file attached to them, thus giving an element of quality assurance. There is, however, no routine dip sampling of all other standard risk cases. Inspectors found examples of standard risk cases that have not been referred to children s social care even when the agreed criteria had been met. Delays in the arrest of alleged perpetrators by the police were identified in some cases. Health practitioners are underutilised in the Bridge. They are not routinely involved in daily decision making and sharing of information, and in many cases are unaware when a referral is received even though health services are involved with the family. Health services provide information on request. However, there is not a proactive or consistent approach to sharing health information. In some cases sampled, the lack of health involvement meant that the risk assessment was not sufficiently comprehensive, leading to missed opportunities for earlier help. Adult mental health practitioners do not consistently ask about domestic abuse. In adult mental health, and maternity, services, the DASH risk assessment is underutilised and does not support the identification of harm relating to domestic abuse when this is known. Safeguarding supervision in adult mental and midwifery services is underdeveloped and current systems do not support the process of reflection and 8

91 challenge. There is limited senior operational oversight of safeguarding cases and therefore risk is not always shared and the workforce is not fully supported to deal with the complexity of the work in Salford to fully understand and meet the needs of families. Salford Royal Foundation Trust has a robust supervision policy. However, there are inconsistencies in its implementation due to staff shortages. There is no system in place to monitor the referrals made by CRC or NPS to the Bridge. Staff from the NPS were not aware of how to save a copy of referral, and this has an impact on effective performance monitoring of the quality of the referral, understanding of thresholds and the effectiveness of the response to safeguard children living with domestic abuse. There is a lack of knowledge by health services children s social care and the police about the role of both the CRC and NPS, and how these organisations are critical for assessing and managing the risks of the perpetrator, and most importantly in addressing violence in relationships. At practice level, the support these agencies can offer to safeguard children from domestic abuse is not fully utilised, including their ability to use licence conditions and recall perpetrators to prison. Information is not always shared with prisons about the risk an adult poses to children. In two of the three cases sampled, there was insufficient focus by CAFCASS on the voice and day-to-day experiences of children as the management of these cases were too focused on the adult. Case study: areas for improvement Information sharing is not consistently robust across the partnership and information is not always used effectively to inform the assessment of risk and therefore the response to domestic abuse. In one case, there were six domestic abuse incidents that the police responded to which were recorded as standard risk and not shared with children s social care, even though there were significant concerns about a young child living with domestic abuse. The lack of child-centred practice led to the child being recorded as being seen and spoken to on only one occasion and a record which simply said that the child had not witnessed the incident. In another case example, it is clear that current interventions and plans were not being effective in improving the child s situation. The plans had been in place for a considerable period of time but had not considered or been informed by all the available information, leading to a cycle of repeated failed interventions which meant that opportunities to change plans based on a comprehensive assessment of need and risk were 9

92 missed. This was not recognised until the partnership undertook an audit of the case as part of the inspection. In this case, the perpetrator and victim were tasked with taking action, which was not realistically achievable. A written agreement was in place and although the parent did not attend meetings, their compliance was assumed, which demonstrated an overly optimistic approach in this case. The police took appropriate action in each individual incident. However, there was a lack of recognition that restrictive orders were not being effective. Next steps The local authority should coordinate the preparation of a written statement of proposed action responding to the findings outlined in this letter. This should be a multi-agency response involving Cafcass, NPS, the CRC, Clinical Commissioning Group and health providers in Salford and Greater Manchester Police. The response should set out the actions for the partnership and, where appropriate, individual agencies. 2 The local authority should send the written statement of action to protectionofchildren@ofsted.gov.uk by 31 January This statement will inform the lines of enquiry at any future joint or single agency activity by the inspectorates. Yours sincerely Ofsted National Director Eleanor Schooling HMI Constabulary Wendy Williams Her Majesty s Inspector of Constabulary Care Quality Commission Ursula Gallagher Deputy Chief Inspector HMI Probation Chief Inspector 2 The Children Act 2004 (Joint Area Reviews) Regulations enable Ofsted s chief inspector to determine which agency should make the written statement and which other agencies should cooperate in its writing. 10

93 30 November 2016 Agenda Item No 6 (b) NHS SALFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING AGENDA ITEM NO 6 (b) Item for Assurance/Information 30 November 2016 REPORT OF: Chief Accountable Officer DATE OF PAPER: 04 November 2016 SUBJECT: Organisational Planning, Performance and Risk IN CASE OF QUERY PLEASE CONTACT: STRATEGIC PRIORITIES: Quality Community Based Care Integrated Care In Hospital Care Long Term Conditions and Mental Health Effective Organisation Emma Reid (Planning and Performance Manager) Please tick w hich strategic priorities the paper relates to: PURPOSE OF PAPER: This report presents Salford CCG s latest position in relation to; CCG performance by programme, Progress against the Operational Plan, Strategic Risks, Single Oversight Framework for NHS Providers, Performance and Delivery Board feedback. Page 1 of 10

94 30 November 2016 Agenda Item No 6 (b) Further explanatory information required HOW WILL THIS BENEFIT THE HEALTH AND WELL BEING OF SALFORD RESIDENTS OR THE CLINICAL COMMISSIONING GROUP? WHAT RISKS M AY ARISE AS A RESULT OF THIS PAPER? HOW CAN THEY BE MITIGATED? This report provides a high level summary of Salford CCG s latest position in relation to current performance; the Operational Plan; and strategic risk. Further detail has been provided in relevant appendices (referenced in this report) for areas of high risk and underperformance. None. WHAT EQUALITY-RELATED RISKS MAY ARISE AS A RESULT OF THIS PAPER? HOW WILL THESE BE MITIGATED? None. DOES THIS PAPER HELP ADDRESS ANY EXISTING HIGH RISKS FACING THE ORGANISATION? IF SO WHAT ARE THEY AND HOW DOES THIS PAPER REDUCE THEM? Areas of high risk and underperformance have been summarised within this report. Detailed performance recovery plans and risk mitigation plans are included in appendices as appropriate. PLEASE DESCRIBE ANY POSSIBLE CONFLICTS OF INTEREST ASSOCIATED WITH THIS PAPER. None. PLEASE IDENTIFY ANY CURRENT SERVICES OR ROLES THAT MAY BE AFFECTED BY ISSUES WITHIN THIS PAPER: Any issues are described within the paper. Footnote: Members of NHS Salf ord Clinical Commissioning Group Governing Body w ill read all papers thoroughly. Once papers are distributed no amendments are possible. Page 2 of 10

95 30 November 2016 Agenda Item No 6 (b) Process Yes No Public Engagement (Please detail the method ie survey, event, consultation) Clinical Engagement (Please detail the method ie survey, event, consultation) Has due regard been given to Equality Analysis (EA) of any adverse impacts? (Please detail outcomes, including risks and how these will be managed) Legal Advice Sought Presented to the Programme Management Group Presented to the Health and Wellbeing Board Presented to the Integrated Commissioning Board Presented to any other groups or committees, including Partnership Groups Document Development Not Applicable Comments and Date (i.e. presentation, verbal, actual report) This report will be used to provide the Salford Health and Wellbeing Board with a progress update on the Better Care theme of the Salford Locality Plan Reviewed by the Executive Team 16 November 2016 Outcome (Please specify in comments) Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work. Page 3 of 10

96 30 November 2016 Agenda Item No 6 (b) Organisational Planning, Performance and Risk Report 1 Executive Summary This report presents Salford CCG s latest position in relation to; CCG performance by programme, Progress against the Operational Plan, Strategic Risks, Single Oversight Framework for NHS Providers. 2 Performance Update 2.1 The position reported is based on latest published data at the time of reporting. The full CCG Operational Plan Balanced Scorecard is included in Appendix Current areas of underperformance are listed below. For all performance exceptions detailed recovery plans can be found within Appendix 2. For reference a summary of performance indicator definitions can be found within Appendix Performance Indicators are currently at Red Status, 14 were previously reported to Governing Body in September. Code BCF.04 BCF.05 E.B.04 E.B.05 E.B.05 E.B.07 E.B.12 E.B.15.i E.B.15.i E.B.15.i Short Name Patients feel supported to manage long term conditions Non-elective admissions (general & acute) Diagnostic Test Waiting Times A&E Waiting Time - Seen within 4 hours (CCG) A&E Waiting Time - Seen within 4 hours (SRFT) Cancer Patients - 2 Week Waits (Breast Sy mptoms) Cancer Waits - 62 Days (Urgent GP Ref erral) Cat A (Red 1) 8 Minute Response Cat A (Red 2) 8 Minute Response Cat A 19 Minute Transportation Response Time Latest Value 66.8% 8,427 1% 90.1% 90.1% 92.8% 77.7% Latest Data Q1 2016/17 Q1 2016/17 September 2016 August 2016 August 2016 Q2 2016/17 Q2 2016/ % September % September 2016 September 89% 2016 Jul 2016 Aug 2016 Sep 2016 Q2 2016/17 Oct /17 Value Value Value Value Value Value Target 66.8% 67.5% 7, % 0.9% 1% 1% 1.2% 1% 83.4% 90.1% 89.4% 95% 81.8% 90.1% 89.7% 95% 92.4% 93.5% 92.7% 92.8% 92.9% 93% 80.5% 76.5% 75.8% 77.7% 81.7% 85% 70.5% 72.6% 69.5% 70.9% 72.7% 75% 62.7% 65.3% 61.8% 63.2% 65% 75% 89.8% 91.1% 89% 90% 90.8% 95% E.A.S.02 IAPT Recovery Rate (CCG) - PUBLISHED 42.4% June % 50% E.D.3 Satisf action with Accessing Primary Care 72.9% Q1 2016/ % 73.2%

97 30 November 2016 Agenda Item No 6 (b) The following performance indicator is currently on track (Green) but is off track (red) in terms of year to date performance due to underperformance throughout Quarter 1 (see Appendix 1). Code E.B.14 Short Name Cancer Waits - 62 Days (Decision to Upgrade) Latest Value 86.8% Latest Data Q2 2016/17 Jul 2016 Aug 2016 Sep 2016 Q2 2016/17 Oct /17 Value Value Value Value Value Value Target 85.7% 85.7% 88.9% 86.8% 81% 85% In addition to those listed above, the following performance indicators have already failed for this financial year (zero tolerance indicators). Code E.B.S.04 E.B.S.01 Short Name RTT: Incomplete Pathways (>52 weeks) Mixed Sex Accommodation Breaches (CCG) Latest Value 3 5 Latest Data August 2016 September 2016 Jul 2016 Aug 2016 Sep 2016 Q2 2016/17 Oct /17 Value Value Value Value Value Value Target E.A.S.04 HCAI Measure MRSA (CCG) / Planning Update 3.1 NHS Salford CCG s Operational Plan for 2016/17 was approved by the Governing Body on 23 rd March 2016 and the detailed activities which provide the basis of that plan are monitored and managed using Covalent. 3.2 Programme update reports including progress to date, current issues and priorities for the next period can be found within Appendix 4. Assurance and Planning 3.3 Governing Body members will recall NHS England introduced a new Improvement and Assessment Framework (IAF) for CCGs from 2016/17 onwards. The new framework replaces the previous CCG assurance arrangements and CCG performance dashboard and has been designed to support Sustainability and Transformation Plans to deliver the aims of the Five Year Forward View: Improving the health and wellbeing of the whole population Better quality for all patients through care redesign, and; Better value for taxpayers in a financially sustainable system. 3.4 The NHS can only deliver the Forward View through placed based partnerships spanning across NHS commissioners, local government, providers, patients communities, the voluntary and independent sectors. Recognising this, the new framework provides a whole health and social care system assurance focus beyond individual organisational boundaries. 5

98 30 November 2016 Agenda Item No 6 (b) 3.5 Whilst not comprehensive, the IAF indicators have been selected as a reasonable balance of the drivers for better health and care and NHS England will from time to time amend the indicators to ensure focus on the biggest priorities. By way of example, during 2017/18 NHSE anticipate further indicators will be added to measure patient safety in primary care and patient and public engagement. 3.6 The framework is constructed in four domains: Better Health: This section looks at how the CCG and partners are contributing towards improving the health and wellbeing of its population, and bending the demand curve; Better Care: This principally focuses on care redesign, performance of constitutional standards, and outcomes, including in important clinical areas; Sustainability: This section looks at how the CCG is remaining in financial balance, and working collaboratively to secure good value for patients through working together to deliver new models of care and deliver the supporting enablers including local digital road maps and strategic estates planning; Leadership: This domain assesses the effectiveness of the working relationships in the local system as well as the CCGs quality of leadership, the quality of its plans and the governance arrangements which the CCG has in place to ensure it acts with probity, for example in managing conflicts of interest. 3.7 Work is underway to incorporate the appropriate measures from the IAF within the Salford Locality performance framework which will serve to measure the success of the Locality Plan through the Health and Wellbeing Board and supporting governance and reporting groups. 3.8 The initial IAF contains 60 indicators across 29 areas. NHSE are still developing the definitions and data collection arrangements for some of these but the initial focus is on 6 clinical priority areas which incorporate 19 of the indicators. 3.9 Across Salford a stocktake has been completed against the 6 clinical priority areas, compiling information from clinical, public health and commissioning leads across the CCG and Council Where available benchmarking / comparison data was included for GM and England to help identify areas where Salford may be able to learn from the approaches of others and to also better understand its relative performance. Leads have used this information to consider the potential impact of work ongoing, in plan or still required to further improve outcomes and performance in each of the clinical areas In addition to this work around the 6 Clinical Priority areas, a stocktake has been completed to indicate Salford s current position against the remaining areas of the IAF including the National must dos, mandate and other Annexes. 6

99 30 November 2016 Agenda Item No 6 (b) 3.12 Both pieces of work are being reviewed and compared against the commissioning intentions to identify any gaps and the final outcome will inform the framework for the CCG s business planning process for Strategic Risk Update 4.1 New Risks Since the last report 3 new risks have been identified for approval to be included on the Strategic Risk Register. New risks and existing risks assessed as high risk are summarised in Appendix 5. The new risks in this period relate to: SRR.14 Failure to provide quality assurance for services where Salford CCG is not the lead commissioner SRR.12 Co-commissioners and Specialist Commissioner decisions leading to unforeseen impacts upon SCCG SRR.13 Failure to commission high quality, resilient and sustainable services for the population of Salford 4.2 Existing Risks The matrices below show the change in risk distribution on Salford CCG's Strategic Risk Register. September 2016 November There are currently 14 live risks on the SRR, each with supporting mitigation plans. Details of the CCG s high risks including mitigation plans can be found in Appendix 5. 5 Single Oversight Framework for NHS Providers 5.1 Governing Body members will recall that from 1 April 2016, Monitor became part of NHS Improvement (NHSI). NHS Improvement s new Single Oversight Framework (SOF) applies from 1 October 2016, replacing the Monitor 'Risk Assessment Framework' and the NHS Trust Development Authority 'Accountability Framework'. 7

100 28 September 2016 Insert Agenda Item No 5.2 The new Framework is designed to help NHS providers attain, and maintain, Care Quality Commission ratings of Good or Outstanding. The Framework doesn't give a performance assessment in its own right. 5.3 How it works The Framework will help to identify NHS providers' potential support needs across five themes: quality of care finance and use of resources operational performance strategic change leadership and improvement capability 5.4 Under the SOF, NHSI will segment providers based on the level of support each provider needs. 5.5 What the segments mean NHSI will segment trusts according to the level of support each trust needs across the five themes of quality of care, finance and use of resources, operational performance, strategic change and leadership and improvement capability. Each trust is segmented into one of the following four categories: Se gment Description 1 Providers with maximum autonomy: no potential support needs identified. Lowest level of oversight; segmentation decisions taken quarterly in the absence of any significant deterioration in performance. 2 Providers offered targeted support: there are concerns in relation to one or more of the themes. We've identified targeted support that the provider can access to address these concerns, but which they are not obliged to take up. For some providers in segment 2, more evidence may need to be gathered to identify appropriate support. 3 Providers receiving mandated support for significant concerns: there is actual or suspected breach of licence, and a Regional Support Group has agreed to seek formal undertakings from the provider or the Provider Regulation Committee has agreed to impose regulatory requirements. 4 Providers in special measures: there is actual or suspected breach of licence with very serious and/or complex issues. The Provider Regulation Committee has agreed it meets the criteria to go into special measures. Page 8 of 10

101 28 September 2016 Insert Agenda Item No 5.6 NHSI has now carried out a shadow (or indicative) segmentation of the sector ahead of the first formal segmentation expected later in November This shadow segmentation is based on performance data and other information gathered before the SOF came into place on 1 October Some of the data that will help inform future decisions was not available at the time of preparing the shadow segmentation. 5.7 Below is a summary of the shadow segmentation results applicable to Greater Manchester Provider Trusts. This information will be reported to Governing Body as part of this report in place of the former NHS Trust Risk Ratings. Further information relating to the SOF can be found at: hed_30_september_2016.pdf Trust Type Region Segment The Christie NHS Foundation Trust Specialist North 1 Bolton NHS Foundation Trust Acute North 2 Bridgewater Community Healthcare NHS Foundation Trust Community North 2 Central Manchester University Hospitals NHS Foundation Trust Acute North 2 Greater Manchester West Mental Health NHS Foundation Trust Mental Health North 2 Pennine Care NHS Foundation Trust Mental Health North 2 Salford Royal NHS Foundation Trust Acute North 2 Wrightington, Wigan and Leigh NHS Foundation Trust Acute North 2 Manchester Mental Health and Social Care Trust Mental Health North 3 Pennine Acute Hospitals NHS Trust Acute North 3 Stockport NHS Foundation Trust Acute North 3 Tameside Hospital NHS Foundation Trust Acute North 3 University Hospital Of South Manchester NHS Foundation Trust Acute North The shadow segmentations reflected above are not dissimilar to the former TDA / Monitor risk ratings and is in line with the level of risk previously reported to the Governing Body. 6 Performance & Delivery Board Feedback 6.1 As part of the GMHSC governance structure, the Performance and Delivery Board meets on a monthly basis to review delivery across health and social care, including but not limited to NHS constitutional mandate standards and performance against the CCG Improvement and Assurance Framework metrics. The emphasis of the meetings is to evaluate performance and delivery at a GM level, as well as highlighting localities where particular delivery challenges are apparent, and to agree further actions. 6.2 The latest update can be found at Appendix 6. This updates summarises the GM position in relation to: Transforming Care Children s Dental Surgery Referral to Treatment Mental Health Urgent Care Delayed transfers of care (DTOC) Page 9 of 10

102 28 September 2016 Insert Agenda Item No 6.3 GMHSC undertake deep dives at each meeting; having covered maternity and children in the last two months, they will be examining RTT in December and directly commissioned public health services in January. 7 Recommendations 7.1 The NHS Salford Clinical Commissioning Governing Body is asked to: Consider the CCG s latest performance position and accept the recovery plans set out for the measures currently underperforming; Note the progress made to date in relation to the Strategic Programme updates; Note the updated risk position, approve the 3 new risks for inclusion on the Strategic Risk Register and confirm that the current level of risk is acceptable in line with risk mitigation plans for high risks; Note the current position in relation to the SOF shadow segmentation results and consider how NHS Salford CCG might want to use this information going forward. Note the update in relation to Performance and Delivery Board feedback. Anthony Hassall Chief Accountable Officer APPENDICES: Appendix 1 CCG Operational Plan Balanced Scorecard Appendix 2 Detailed recovery plans for current performance exceptions Appendix 3 Summary of performance indicator definitions Appendix 4 Strategic Programme updates Appendix 5 Strategic Risk Summary New and Risks only Appendix 6 - Performance & Delivery Board Feedback Page 10 of 10

103 Salford CCG Balanced Scorecard 2016/17 Generated on: 11 November 2016 Quality Programme Code Short Name Ap r 2016 May 2016 Jun 2016 Q1 2016/17 Jul 2016 Aug 2016 Sep 2016 Q2 2016/17 Oct 2016 Nov 2016 Dec 2016 Q3 2016/17 Jan 2017 Feb 2017 Mar 2017 Q4 2016/ /17 Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Target E.B.S.01 Mixed Sex Accommodation Breaches (CCG) E.B.S.01 Mixed Sex Accommodation Breaches (SRFT) E.A.S.04 HCAI Measure MRSA (CCG) E.A.S.04 HCAI Measure MRSA (SRFT) E.A.S.05 HCAI Measure CDIFF (CCG) E.A.S.05 HCAI Measure CDIFF (SRFT) E.A.05 Patient experience of hospital care 127 E.D.1 Satisf action with the Quality of Consultation at a GP Practice E.D.2 Satisf action with the Overall Care received at the surgery 85.3% 85.3% 84.4% E.D.3 Satisf action with Accessing Primary Care 72.9% 72.9% 73.2% QP.01a Antibiotics prescribed in primary care QP.01b Proportion of broad spectrum antibiotics prescribed in primary care Community Based Care Programme Code E.A.07 Short Name Composite indicator comprised of i) GP Services ii) GP Out of Hours Serv ices Ap r 2016 May 2016 Jun 2016 Q1 2016/17 Jul 2016 Aug 2016 Sep 2016 Q2 2016/17 Oct 2016 Nov 2016 Dec 2016 Q3 2016/17 Jan 2017 Feb 2017 Mar 2017 Q4 2016/ /17 Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Target 4.87 Integrated Care Programme Code Short Name Ap r 2016 May 2016 Jun 2016 Q1 2016/17 Jul 2016 Aug 2016 Sep 2016 Q2 2016/17 Oct 2016 Nov 2016 Dec 2016 Q3 2016/17 Jan 2017 Feb 2017 Mar 2017 Q4 2016/ /17 Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Target E.A.02 Health related QoL for people with LTC (CCG) 69 1

104 Code Short Name Ap r 2016 May 2016 Jun 2016 Q1 2016/17 Jul 2016 Aug 2016 Sep 2016 Q2 2016/17 Oct 2016 Nov 2016 Dec 2016 Q3 2016/17 Jan 2017 Feb 2017 Mar 2017 Q4 2016/ /17 Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Target E.A.04 Emergency Admissions for acute conditions (CCG) ,937 E.A.04 Emergency Admissions for children with LRTI (CCG) E.A.04 E.A.04 E.A.S.03 Unplanned Hospitalisation for chronic ambulatory care sensitive conditions (CCG) Unplanned Hospitalisation for asthma, diabetes and epilepsy in under 19s (CCG) Proportion of older people 65 and over still at home 91 days af ter discharge into rehabilitation , E.J.01 Delay ed transfers of care E.J.02 Long term support needs of older people (aged 65 and over) met by admissions to residential and nursing care homes BCF.04 Patients feel supported to manage long term conditions 66.8% 66.8% 67.5% BCF.05 Non-elective admissions (general & acute) 8,427 7,862 E.F.15 Population v accination coverage - Flu (aged 65+) 85% In Hospital Care Programme 78% Code Short Name Ap r 2016 May 2016 Jun 2016 Q1 2016/17 Jul 2016 Aug 2016 Sep 2016 Q2 2016/17 Oct 2016 Nov 2016 Dec 2016 Q3 2016/17 Jan 2017 Feb 2017 Mar 2017 Q4 2016/ /17 Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Target E.B.03 RTT: Incomplete pathways (<18 weeks) 94.6% 94.5% 94.2% 94.4% 93.8% 93.6% 93.3% 93.6% 94% 92% E.B.S.04 RTT: Incomplete Pathways (>52 weeks) E.B.04 Diagnostic Test Waiting Times 1.8% 1.2% 1.1% 1.4% 1.2% 0.9% 1% 1% 1.2% 1% E.B.05 A&E Waiting Time - Seen within 4 hours (CCG) 91.2% 89.7% 92.7% 91.2% 83.4% 90.1% 89.4% 95% E.B.05 A&E Waiting Time - Seen within 4 hours (SRFT) 92.7% 90.2% 94% 92.2% 81.8% 90.1% 89.7% 95% E.B.S.05 Trolley Waits in A&E (>12 Hours) (SRFT) E.B.S.02 Cancelled Operations (SRFT) E.B.S.06 Urgent Operations Cancelled for a Second Time (SRFT) E.B.06 Cancer Patients - 2 Week Waits (Urgent GP Referral) 94.8% 96.2% 96.5% 95.9% 94.5% 91.9% 96.8% 94.4% 95.2% 93% E.B.07 Cancer Patients - 2 Week Waits (Breast Symptoms) 90.9% 97.7% 90.3% 93% 92.4% 93.5% 92.7% 92.8% 92.9% 93% E.B.08 Cancer Waits - 31 Days (All Cancers) 98.2% 96.5% 99% 98% 100% 96.4% 96.6% 97.8% 97.9% 96% E.B.09 Cancer Waits - 31 Days (Surgery) 100% 100% 100% 100% 100% 96.2% 100% 98.5% 99.1% 94% E.B.10 Cancer Waits - 31 Days (Drugs) 100% 100% 100% 100% 100% 100% 100% 100% 100% 98% E.B.11 Cancer Waits - 31 Days (Radiotherapy) 100% 100% 100% 100% 100% 100% 100% 100% 100% 94% 2

105 Code Short Name Ap r 2016 May 2016 Jun 2016 Q1 2016/17 Jul 2016 Aug 2016 Sep 2016 Q2 2016/17 Oct 2016 Nov 2016 Dec 2016 Q3 2016/17 Jan 2017 Feb 2017 Mar 2017 Q4 2016/ /17 Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Target E.B.12 Cancer Waits - 62 Days (Urgent GP Referral) 84.7% 86.2% 84.3% 85% 80.5% 76.5% 75.8% 77.7% 81.7% 85% E.B.13 Cancer Waits - 62 Days (Screening Service) 85.7% 100% 88.9% 88.9% 100% 100% 100% 100% 95% 90% E.B.14 Cancer Waits - 62 Days (Decision to Upgrade) 88.9% 64.3% 71.4% 76.1% 85.7% 85.7% 88.9% 86.8% 81% 85% E.B.15.i Cat A (Red 1) 8 Minute Response 76.5% 74.3% 73.1% 74.6% 70.5% 72.6% 69.5% 70.9% 72.7% 75% E.B.15.i Cat A (Red 2) 8 Minute Response 67.5% 66.3% 66.2% 66.7% 62.7% 65.3% 61.8% 63.2% 65% 75% E.B.15.i Cat A 19 Minute Transportation Response Time 92% 91.5% 91.5% 91.7% 89.8% 91.1% 89% 90% 90.8% 95% E.B.S.07 Ambulance Handover Time (over 30mins) E.B.S.07 Ambulance Handover Time (over 1 hour) E.B.S.08 Crew Clear Delay s (over 30 hour) E.B.S.08 Crew Clear Delay s (over 60mins) E.C.01 E.C.02 E.C.03 Number of general and acute elective ordinary admission first f inished consultant episodes Number of general and acute daycase first finished consultant episodes Total number of general and acute first finished consultant episodes , ,288 2,567 2,314 2,442 2,517 7,273 2,372 2,464 2,504 7,340 14,613 2,713 2,850 2,989 8,552 2,862 2,873 2,893 8,628 17,180 E.C.04 Non-elective first finished consultant episodes 2,532 2,740 2,495 7,767 2,570 2,548 2,522 7,640 15,407 E.C.05 All f irst outpatient attendances (consultant-led) 6,636 7,210 7,438 21,284 6,667 6,769 7,225 20,661 41,945 E.C.06 All subsequent outpatient attendances (consultant-led) 72,564 72,564 E.C.07 Attendances at Ty pe 1 A&E departments (SRFT) 7,997 9,015 8,413 25,425 8,814 8,149 8,252 25,215 50,640 E.C.08 Attendances at all A&E departments (SRFT) 7,997 9,015 8,413 25,425 8,814 8,149 8,252 25,215 50,640 E.C.09 GP Written Referrals 4,993 4,946 5,357 15,296 5,040 4,920 5,115 15,075 30,371 E.C.10 Other ref errals for first outpatient appointment 4,620 4,905 3,904 13,429 3,942 3,907 4,162 12,011 25,440 E.C.11 Total Ref errals 9,613 9,851 9,261 28,725 8,982 8,827 9,277 27,086 55,811 E.C.12 First outpatient attendances following GP Referrals 3,511 3,838 4,163 11,512 3,718 3,807 3,972 11,497 23,009 Long Term Conditions/Mental Health Programme Code Short Name Ap r 2016 May 2016 Jun 2016 Q1 2016/17 Jul 2016 Aug 2016 Sep 2016 Q2 2016/17 Oct 2016 Nov 2016 Dec 2016 Q3 2016/17 Jan 2017 Feb 2017 Mar 2017 Q4 2016/ /17 Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Target E.A.01 PYLL f rom causes amendable to healthcare (CCG) 2703 E.A.S.01 Dementia (aged 65 and over) 88.9% 89% 90.5% 90.1% 89.7% 88.9% 88.9% 87.5% 3

106 Code Short Name Ap r 2016 May 2016 Jun 2016 Q1 2016/17 Jul 2016 Aug 2016 Sep 2016 Q2 2016/17 Oct 2016 Nov 2016 Dec 2016 Q3 2016/17 Jan 2017 Feb 2017 Mar 2017 Q4 2016/ /17 Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Value Target E.B.S.03 Care Programme Approach (CCG) 100% 100% 95% E.A.03 IAPT Roll-Out (CCG) - PUBLISHED 1.91% 2.01% 2.42% 15% E.A.S.02 IAPT Recovery Rate (CCG) - PUBLISHED 42.4% 40% 42.4% 42.4% 50% E.H.1_A1 E.H.2_A2 E.H.04 IAPT Waiting Times - 6 Week Wait Ended Referrals (CCG) - PUBLISHED IAPT Waiting Times - 18 Week Wait Ended Referrals (CCG) - PUBLISHED People experiencing a first EIP treated within two weeks of ref erral 76.8% 76.1% 78.1% 78.1% 75% 95.7% 94.4% 95.9% 95.9% 95% 85.7% 100% 84.6% 87.5% 77.8% 87.3% 4

107 Appendix 2 Recovery Plans - Current Red Status BCF.04 Patients feel supported to manage long term conditions Patients feel supported to manage long term conditions. Target: 67.5% Latest update provided: 21-Nov-2016 Feedback from the Commissioning Committee 14 th September was that the GP Survey data for BCF 04 was unreliable and not a good indicator of performance and/or patient satisfaction i.e. a very small number of patients can impact on overall performance. To provide assurance to the CCG, the Business Intelligence (BI) Team have reviewed CCG Outcome Indicator Set (Indicator 2.2): Proportion of people who are feeling supported to manage their condition, which is calculated differently to the measure within the BCF. This indicator looks at a combination of the following three questions asked: 1. Do you have a long standing health condition? 2. Which, if any, of the following medical conditions do you have? [List of medical conditions] 3. In the last 6 months, have you had enough support from local services or organisations to help you to manage your long-term health condition(s)? Based on this calculation, the figures for Salford CCG are as follows Reporting Period Breakd own ONS code Level Level description Indicator Value National July 2015 to March 2016 July 2014 to March 2015 Source: NHS Digital CCG CCG E G NHS Salford CCG E G NHS Salford CCG The yearly data provides assurance that Salford CCG is still above the National average for the last two years and an improvement can be seen for the CCG compared to the previous year. 1

108 Appendix 2 Actions being taken: Ongoing discussions with BI team to identify the most accurate performance data. Current Outcome: Expected Outcome: Timescale for Recovery: Lead Manager: Failed (currently Red) Expected to achieve target The yearly data provides assurance that Salford CCG is still above the National average for the last two years and an improvement can be seen for the CCG compared to the previous year. Robin Gene 2

109 Appendix 2 BCF.05 Non-elective admissions (general & acute) Total number of non-elective admissions in to hospital (general & acute), all age Target: 7,849 Latest update provided: 21 Nov 2016 The Salford CCG BI and Contracts team have undertaken further analysis of the non-elective (NEL) activity in Q1. Analysis shows that the same trends have been identified in two data sources used for activity and contract monitoring SLAM (contract activity data) and SUS (Hospital Activity Dataset) within the non-elective inpatient data. Year to Date (YTD) there is an over performance related to the reduction in plan for 2016/17 that was agreed by Salford Together to allow funds to be invested in community services (reduction of 1000 non-elective admissions in 2016/17 was agreed). However, the anticipated reductions are not yet being seen in NEL activity. Actions being taken: The BI and Contracts team are producing quarterly reports for the Service and Finance Group to monitor the hospital activity throughout 2016/17. The ambition to reduce NEL admissions will be delivered through the integrated care programme and ongoing development of the Salford Together transformation programmes. There has been a delay to the development and delivery of the full range of transformation programmes due to the transitioning of funding arrangements from the National Vanguard funding to GM transformation fund. Salford Together has established a strategy group to prioritise the work plan which will significantly contribute to reducing NEL activity by investing in additional District Nurses and Multi-disciplinary Teams (MDTs). Current Outcome: Failed (currently Red) Expected Outcome: Expected to achieve target Timescale for Recovery: 2016/17 Lead Manager: Victoria Bell 3

110 Appendix 2 E.B.04 Diagnostic Test Waiting Times Percentage of patients waiting six weeks or more for a diagnostic test. Target: 1% Latest update provided: 21-Nov-2016 Performance deteriorated slightly in September, rising to 1.0% for the CCG Population against the <1% target compared with 0.9% position in August. SRFT met the 1% diagnostic target for September and poor performance in month related mainly to breaches at other Trusts; Central Manchester NHS Foundation Trust (CMFT), 3% and Pennine Acute NHS Foundation Trust performance 5.42%. Care UK also had 5 breaches in the ENT pathway in September. Actions being taken: CMFT have had a significant gap in diagnostic capacity since in August 2015 and have had staffing issues affecting their diagnostic scope capacity in particular. CMFT initially provided a trajectory of improvement that identified no >6 week waiters by the end of March 2016; however, as part of the detailed work CMFT were doing to clear the backlog in diagnostic scopes they identified a number of patients on the planned list who had gone beyond their indicative month of planned treatment. These patients (in line with national guidance) were moved from the planned list to the active list in March which has put further pressure on achievement of the diagnostic standard. The Trust secured some additional capacity from the private sector to manage these patients in a timely manner; Manchester CCG continue to work with CMFT on this issue. The original plan was to manage these patients through quarter 1 of 2016/17 but breaches have continued into Q2. However, improvements in performance have been seen since May with reduced breaches (from ~ 12% to 3%) contributing to an improving position for the CCG population. Concerns about diagnostic performance at CMFT have been escalated via the CCG Executive Team directly with the Trust. The five Care UK breaches in the ENT pathway in September have been escalated with the provider via the contracts meeting in October. In addition to this Salford CCG is considering imposing contract penalties for underperformance. Current Outcome: Failed (currently Red) Expected Outcome: Expected to achieve target Timescale for Recovery: October 2016 Lead Manager: Victoria Bell 4

111 Appendix 2 E.B.05 A&E Waiting Time - Seen within 4 hours (CCG) Percentage of A&E attendances where the patient spent 4 hours or less in A&E from arrival to transfer, admission or discharge. CCG figure based on weighting. Target: 95% Latest update provided: 21-Nov-2016 Please see update on performance against the A&E standard at Salford Royal Foundation Trust (SRFT) for information. Approximately 75% of Salford CCG population A&E attendances are at SRFT so performance against the standard for the Salford CCG population is largely driven by performance at SRFT. None of the Trusts across GM achieved the 95% A&E standard in quarter 1 16/17; and have continued to struggle in Q2 with some achieving above 85% and therefore performance affects the Salford CCG population. Note: Latest invalidated data from the GM Gold report suggests a Year to Date position of 89.10% as at 17 th November However, this data is invalidated and subject to daily variation. Actions being taken: Salford CCG is a member of the Greater Manchester Urgent and Emergency Care Network (GMUECN) which is developing overarching delivery plans for the implementation of the Urgent and Emergency Care Review. Under oversight of the network a GM Urgent and Emergency Care Taskforce led by a team of four senior leaders from secondary & primary care, Council and CCG is being established which will be responsible for comprehensively understanding the urgent and emergency care challenges for Greater Manchester and for delivery of the following; Assurance when something is supposed to be happening as outlined in the GM UECN Plan Implementation when something good isn t happening everywhere Facilitating solutions & action identifying innovative solutions to common problems In response to the National A&E Improvement Plan for 16/17 System Resilience Groups have been asked to re-form into A&E Delivery Boards (or Urgent and Emergency Care Delivery Boards) with Executive level membership and to have a focus solely on urgent and emergency care and initially on recovering the A&E 4 hour target. The Taskforce will collaborate with these Delivery Boards across Greater Manchester to deliver improvements in access, outcomes and experience throughout the urgent and emergency care pathway. Current Outcome: Failed (currently Red) Expected Outcome: Expected to fail target Timescale for Recovery: March 2017 Lead Manager: Victoria Bell 5

112 Appendix 2 E.B.05 A&E Waiting Time - Seen within 4 hours (SRFT) Percentage of A&E attendances where the patient spent 4 hours or less in A&E from arrival to transfer, admission or discharge. (Data for SRFT Only) Target: 95% Latest update provided: 13-Oct-2016 Performance against the 4 hour 95% standard for A&E at SRFT improved in August but remained below the target, being 90.1% in Month. The majority of the 4 hour breaches in A&E at SRFT continue to relate to waits for bed capacity for admissions; escalation bed capacity has continued to remain open at SRFT to try and manage demand. Actions being taken: In response to the National A&E Improvement Plan for 16/17, the System Resilience Group in Salford was re-formed into a Salford Urgent and Emergency Care Delivery Board in September 2016 with Executive Level membership from system partners. It is through this Urgent & Emergency Care Delivery Board that the Salford system will work to deliver achievement of the A&E Sustainability and Transformation projections at Salford Royal for 2016/17; which has performance against the A&E standard improving each quarter and recovering to 95% in March 2017.The Delivery Board will also oversee the five mandated national improvement initiatives that are outlined in the national plan relating to NHS 111, ambulances, streaming of patients at A&E to primary and ambulatory care, improved patient flow and discharge processes. Weekly System teleconference calls (CCG, SRFT, SCC) continue to monitor system pressures and identify tactical actions required to support resilience. Breaches continue to relate mainly to waits for bed capacity for those patients being admitted; all escalation bed capacity remains open at SRFT to try and manage this demand. Current Outcome: Failed (currently Red) Expected Outcome: Expected to fail target Timescale for Recovery: March 2017 Lead Manager: Victoria Bell 6

113 Appendix 2 E.B.07 Cancer Patients - 2 Week Waits (Breast Symptoms) Percentage of patients, referred urgently with breast symptoms (where cancer was not initially suspected) by a GP, who waited less than two weeks for first outpatient appointment. Target: 93% Latest update provided: 14- Nov September 2016 performance for breast symptomatic 2WW is 92.7% against the 93% target; year to date (Q1+Q2) performance is at 92.9%. During September 110 referrals were received of which 102 were seen within the 2 week target; 7 of the 8 breaches were SRFT and 1 Bolton FT and all breaches were due to patients cancelling their original appointment (which was within target) and re-booking at a more convenient time for them which was outside of the 2 week target. This indicator is monitored closely by the Urgent and Emergency Care Delivery Board and SRFT assure the CCG that this target will be met going forward. Actions being taken: The Breast Service, commissioned by Salford CCG and provided by SRFT, has experienced a number of workforce challenges affecting service resilience and sustainability. This coupled with increasing patient demand has placed the service under great pressure which has required immediate action to ensure the continuation of high standards of care and adherence to national cancer waiting time standards. Following a tender process the Salford Breast Service has been subcontracted by SRFT for an interim period of 12 months to University Hospital of South Manchester NHS Foundation Trust (UHSM). The new SRFT Breast Service at UHSM commenced on the 4th April 2016 and to-date there have been no reports of any problems being encountered by patients or clinicians, however the situation will continue to be monitored closely. A robust monitoring system is in place to ensure patients receive effective management and treatment and cancer wait times are maintained. The priority is to deliver a safe and sustainable interim solution to the challenges faced by the SRFT service. This sub-contracting arrangement is for 12 months only, SRFT and Salford CCG will progress a longer term service solution in line with the development of the proposals for a wider reconfiguration of Breast Services both within the Northwest sector and across Greater Manchester as a whole Current Outcome: Expected Outcome: Timescale for Recovery: Lead Manager: Failed (currently Red) Expected to achieve target Expected to achieve target for 2016/17 - July performance is 0.6% short of the 93% target and shows good progress in meeting this standard in the 4 months since the service was sub-contracted from SRFT to UHSM Annette Donegani 7

114 Appendix 2 E.B.12 Cancer Waits - 62 Days (Urgent GP Referral) Percentage of patients who waited a maximum two months (62 Days) from urgent GP referral to first definitive treatment for cancer. Target: 85% Latest update provided: 21-Nov-2016 September 2016 performance for 62-day maximum waiting time from urgent referral to treatment for all cancers is at 75.8% against the national 85% target this CWT has fallen for four months in succession. During September a total of 33 patients were referred with 25 being seen within target (to reach target 3 more patients needed to be treated within the 62 day timescale). Of the 8 breaches 3 were for lung; 3 for Urology; 1 for LGI and 1 for UGI. Reasons for breaches included one elective and two out-patient capacity issues, patient being unfit for surgery, three late referrals to the Christie; one due to further diagnostics needed and the remainder, reasons unknown; there was also one late referral to UHSM due to complexity of the diagnostics needed. Length of waiting time to be treated ranged from 75 to 134 days. Q2 performance is at 77.7% and year to date 81.7% - both failing target, however monitoring closely via CCG presence on SRFT Cancer Governance Board and Urgent and Emergency Care (UEC) meetings. Year-end performance is expected to be on track to meet the national target. CCG raised the issue of the breach reason late referral to the Christie reason unknown with SRFT at the UEC Board meeting on the 29th October analysis of this performance shows that up to August 2016 there were a total of 37 breaches, of which 12 were for late referral from SRFT to The Christie. SRFT are to investigate and report back to the UEC meeting in November. In addition the CCG have requested and received anonymised timelines for the late referral to Christie breaches which will be reviewed by Dr Elliot, CCG Clinical Lead for Cancer. Actions being taken: The CCG raised the issues of late referral to the Christie with SRFT at the Urgent and Emergency Care Board meeting on the 29th October analysis of this year performance shows that up to August 2016 there were a total of 37 breaches for this target of which 12 were for late referral from SRFT to The Christie. SRFT are investigating and will report back to the next Urgent and Emergency Care Delivery Board meeting. In addition to the above the CCG has received anonymised timelines for the late referral to Christie breaches which will be reviewed by Dr Elliot, CCG Clinical Lead for Cancer. A paper detailing his findings will be reported back to the Urgent and Emergency Care delivery Board in due course. 8

115 Appendix 2 Current Outcome: Failed (currently Red) Expected Outcome: Expected to achieve target Timescale for Recovery: Quarter Lead Manager: Annette Donegani 9

116 Appendix 2 E.B.15.i Cat A (Red 1) 8 Minute Response The percentage of Category A Red 1 incidents, which resulted in an emergency response, where the first ambulance service-dispatched emergency responder arrived at the scene of the incident. NOTE: Red 1 are the most time critical and cover cardiac arrest patients who are not breathing and do not have a pulse, along with other severe conditions. Target: 75% Latest update provided: 21-Nov-2016 Ambulance performance against the CAT A 8 minute response (Red 1) deteriorated further below the 75% standard in September for the NWAS footprint (69.49%). The position was better for the Greater Manchester population (72.55%) but was still below the 75% standard. NWAS performance is managed by Blackpool CCG through formal monthly contract meetings. In addition, there are monthly Greater Manchester Ambulance Commissioning Group meetings which brings together GM CCG representatives and a designated Blackpool CCG rep for GM; providing an opportunity to view performance at a GM level, challenge the provider and to seek assurance. For 2016/17 NWAS submitted an improvement trajectory to the Department of Health in order to access the National Sustainability and Transformation Fund. If they achieve the trajectory they will receive approximately 1.8 million for 2016/17. The NWAS improvement trajectory targets all 3 response times standards being achieved from quarter 2 onwards; however, this was based on modelling which assumed average ambulance turnaround times of 27 minutes. With the North-West average handover turnaround time being approximately 32 minutes alongside growth seen in all incidents in quarter /17 (approx. 8% versus last year) it is highly likely this improvement trajectory won t be fully achieved, despite seeing some improvement. In addition NWAS have had significant workforce issues; they currently have 103 vacancies within GM and Blackpool CCG are overseeing NWAS' recruitment plan which will see NWAS fully established in GM by December Actions being taken: To address ambulance turnaround times (given the negative impact on vehicle availability to respond to incidents) each System Resilience Group in GM has been asked to sign up to a concordat and to deliver 4 specific actions. Salford has completed and submitted the concordat and is working closely with NWAS to improve performance. In October NWAS attended an informal Commissioning Committee meeting to present an update on the national and local picture. NWAS highlighted intended improvements for local see and treat calls to bring Salford in line with the 10

117 Appendix 2 GM position. This will be done by ensuring all staff are aware of and are utilising the ATT (alternative to transfer) service. Current Outcome: Failed (currently Red) Expected Outcome: Expected to fail target Timescale for Recovery: Nov 16 Lead Manager: Victoria Bell E.B.15.i Cat A (Red 2) 8 Minute Response The percentage of Category A Red 2 incidents, which resulted in an emergency response, where the first ambulance service-dispatched emergency responder arrived at the scene of the incident. NOTE: Red 2 are serious but less immediately time critical and cover conditions such as stroke and fits. Target: 75% Latest update provided: 03-Nov-2016 Ambulance performance against the CAT A 8 minute (Red 2) response declined in September and remained well below the 75% standard for the NWAS footprint. This is associated with an 10.5% increase against plan in Red 2 call activity in GM. Increased activity and increased handover times at some GM Trust A&E departments continue to negatively impact on vehicle availability on the road Actions being taken: See previous recovery plan Current Outcome: Failed (currently Red) Expected Outcome: Expected to fail target Timescale for Recovery: Nov 2016 Lead Manager: Victoria Bell 11

118 Appendix 2 E.B.15.i Cat A 19 Minute Transportation Response Time The percentage of Category A incidents with ambulance response arriving at the scene of the incident within 19 minutes. Target: 95% Latest update provided: 03-Nov-2016 Ambulance performance against the CAT A 19 minute response worsened in September and remained below the 95% standard for the NWAS footprint. This is associated with a 9.1% increase against plan in September for all Red activity across Greater Manchester. Increased activity and increased handover times at some GM Trust A&E departments continue to negatively impact on vehicle availability on the road Actions being taken: See previous recovery plan. Current Outcome: Failed (currently Red) Expected Outcome: Expected to fail target Timescale for Recovery: Oct 2016 Lead Manager: Victoria Bell 12

119 Appendix 2 E.A.S.02 IAPT Recovery Rate (CCG) - PUBLISHED Measures the proportion of people who complete treatment who are moving to recovery. Target: 50% Latest update provided: 27-Sep-2016 (No further data / update since last reported) Latest local data (49.2%) shows just a 0.8% underperformance in regard to recovery rate. Commissioners have recently discussed this with NHS England. Our e-therapy provider showed a rare drop in recovery rate (44%) in September, which we expect to see corrected in October. We expect to hit 50% recovery target in October. Actions being taken: Shared point of access (SPA) innovation pilot covering half of the city. This is a big shift in patient management in that virtually all patients requiring psychological therapy will go to step 2 (Low intensity intervention) as first step and they will only access step 3 if they are deemed to require that more intensive treatment. Since Step 2 has always had better recovery rates than step 3, this expansion of step 2 involvement will increase the overall aggregate recovery rate that we report as a CCG. A business case for city-wide roll out of this model is being presented to PMG in November The interim evaluation (based on data from year 1 of the pilot) shows that in the pilot area (compared to non-pilot area), more people are entering treatment, waiting times from referral to treatment are considerably shorter across the IAPT pathway, and recovery rates are as much as 11% higher. The business case was approved by the CCG in November 2015; but the city-wide SPA model was only fully operational from April 1st It then needed a 6 month period to fully embed and see improved outcomes filtering through in the overall performance data. The Step 2 service (Six Degrees Social Enterprise) and Step 3 service (GMW Primary Care Psychology) are working collaboratively to improve the pathway (tightening up the step-up criteria). This is with the aim of getting patients who are assessed as needing step 3 (High intensity intervention) treatment stepped up much more quickly (before they actually enter treatment at step 2), thereby increasing chances of improvement. Patients who drop out of treatment between step 2 and step 3 have negatively impacted on recovery rates and this work to create a smoother pathway has potential to also reduce these drop-outs. The sharing of hard recovery data is now a common feature of clinical supervision within services. This brings it to the forefront of the therapist s everyday clinical practice and encourages them to examine closely the strategies they have used in therapy with patients that have recovered, versus those that haven t recovered. Both commissioners and service providers recognise the limitations of recovery rate as a suitable measure of effectiveness. A much more suitable measure is reliable clinical improvement (where a patient s PHQ9 and/or GAD7 score has reduced by a significant number of points following treatment). Whilst (for now) recovery rate remains the principal national effectiveness measure within IAPT, commissioners have agreed that reliable improvement will now become a part of regular service reporting. This is so that we have an additional effectiveness measure from Q4 onwards. All of the above improvement measures collectively should enable Salford to consistently achieve the 50%+ recovery rate. The signs early from the IAPT SPA pilot were most encouraging, but we are recognising that we aren t there yet 13

120 Appendix 2 and only full SPA implementation combined with the other actions above would get us to where we need to be. This has prompted a revised target date for achievement, which is now amended to end of Q2 2016/17. Current Outcome: Failed (currently Red) Expected Outcome: Expected to fail target Timescale for Recovery: End of Q Lead Manager: Tony Marlow 14

121 Appendix 2 E.D.3 Satisfaction with Accessing Primary Care Satisfaction with accessing Primary Care based on GP survey Target: 73.2% Latest update provided: 06-Sep-2016 (No further data since last reported) The July 2016 results have been published and analysed and show a further increase in trend: Current target 73.2% Salford 72.9% Actions being taken: The Quality Scheme 2015/16 introduced a new Patient Experience component which asked practices to develop an action plan which concentrated on poor ratings in their last GP survey, and this included Access to Primary Care. The Salford Standard (Domain 9) Safety & Patient Experience has required practices to continue to develop their improvement plans in these areas The Primary Care Quality Group was satisfied with the results at this stage. Current Outcome: Failed (currently Red) Expected Outcome: Expected to fail target Timescale for Recovery: July 2016 Lead Manager: Ingrid O'Neill 15

122 Appendix 2 Recovery Plans measures off track YTD (but on track in the recent reporting period) E.B.14 Cancer Waits - 62 Days (Decision to Upgrade) Percentage of patients receiving first definitive treatment for cancer within 62-days of a consultant decision to upgrade their priority status. Target: 85% Latest update provided: 22-Aug-2016 (Performance currently on track) Performance has improved since May and June and is on track for quarter 2. Actions being taken: Monitor through cancer meetings. Performance on track and may recover to achieve over the year. Current Outcome: Failed YTD (currently Green) Expected Outcome: Monitored for info Timescale for Recovery: Q4 2016/17 Lead Manager: Annette Donegani 16

123 Appendix 2 Recovery Plans - Zero Tolerance measures E.B.S.04 RTT: Incomplete Pathways (>52 weeks) The number of incomplete patients yet to start a consultant-led treatment, who are waiting more than 52 weeks since referral. Target: 0 Latest update provided: 14-Oct-2016 August reported 52 week breaches were all at University Hospital South Manchester NHS Foundation Trust (UHSM) and involved a plastic surgery patient, a gynaecology patient and one patient classed as other. There were no further 52 week breaches of Salford CCG patients at SRFT in August. Actions being taken: The breaches reported in August were Plastic Surgery, Gynaecology and other at UHSM. UHSM has now completed initial validation of open pathways weeks. New 18 week waits (dropping in from 17 weeks) in this cohort are validated on a weekly basis as part of business as usual. GPs for patients whose pathways have been closed during validation have been written to with a list of their patients and details of who to contact if they believe any of their patients still require further investigations and / or treatment. The Trust has now completed all validation open pathways in the new data script. The Trust will use the new data script to report RTT performance for the first time in September From Monday 18th July, the performance and information team spent a week working directly with front line staff to ensure that RTT data quality is right first time. This structured approach to business processes will complement the formal RTT training programmes that have been developed, providing opportunities for rapid feedback and additional learning. Although currently focused on completing validation, this right first time approach will be in place from the end of August Dr Mark Jarvis (Trafford CCG) carried out a clinical review for harm on a further 30 pathways on 24th June Dr Jarvis concluded that there had been no harm* to patients as a result of pathway delays, but did identify a theme regarding patients being referred for investigation and not subsequently tracked in the system. This will be addressed by the improved systems and processes that the Trust has now put in place to manage RTT pathways. A total of 158 pathways have now been clinically reviewed by Dr Mark Jarvis and this process will continue for the remaining pathways identified through the validation process. Dates for Dr Jarvis to carry out clinical review have been scheduled in October, November and December

124 Appendix 2 Now that validation has been completed, the new Patient Tracking List (PTL) has been issued to the directorates to enable them to complete demand and capacity modelling using the Intensive Support Team (IST) flow model. This work, including speciality level recovery trajectories will be presented to the Chief Operating Officer during the first week in October, with a revised trajectory of improvement developed and agreed by mid-october. A bespoke RTT e-learning package tailored to different professional groups (e.g. consultants, nurses, secretaries) is currently in development. The Trust expects performance against the RTT Incomplete Standard to deteriorate once reporting against the new data script commences (August data, reported in September 2016). An RTT Incomplete recovery trajectory has been included in the contract for 2016/17. This trajectory is based on indicative performance from the new RTT data script and takes into account the on-going validation of the new RTT data into Q2 2016/17. Delivery against this trajectory will see the Trust achieving RTT incomplete performance by March Current Outcome: Expected Outcome: Timescale for Recovery: Lead Manager: Failed (currently Red) Failed for year (zero tolerance) Not applicable Victoria Bell * The national definition of harm can be found in detail in the NHS England Serious Incident Guidance 15/16 edition (which can be found here: To summarise there are three levels of harm identified: Permanent harm / Death Prolonged pain (when the error has caused severe pain for 12 weeks or more) Psychological / Social Harm (when the error has caused a significant change in the patients working, living arrangements or mental health) 18

125 Appendix 2 E.B.S.01 Mixed Sex Accommodation Breaches (CCG) Number of mixed sex accommodation breaches Target: 0 Latest update provided: 21-Nov-2016 There were 5 MSA breaches in September for Salford CCG. These took place at Royal Bolton NHS FT. Actions being taken: Salford CCG have discussed the breaches with Bolton Commissioners who are equally concerned and have raised the breaches with Bolton Foundation Trust in the Quality and Performance meeting in November. BFT have provided a review of each breach that has occurred at the trust since Feb. The majority of breaches are as a result of patient flow and bed pressure. The limiting factor for BFT is the layout and lack of single rooms in the High dependence Unit at the RBH. There is an Estates solution to this which requires capital funding. This issue has been discussed with Chief Office Greater Manchester H & S Care Partnership and the Chief operating officer at BFT has shown him the unit. A review is being undertaken to determine if there are any capital funds at a Greater Manchester level to resolve this problem. The analysis also demonstrates that the lack of tracheostomy and respiratory trained staff is an issue. There are two separate actions in relation to these issues. The first relates to tracheostomy training. The ITU/HDU staff are currently delivering a training schedule which will result in the surgical wards having a trained tracheostomy nurse on each shift. The Division of Acute Adult Care have employed Practice Educators, one of whom is an experienced respiratory nurse and wards D3 and D4 now have enhanced training available. The recruitment of experienced respiratory staff has been a challenge for the organisation. An Enhanced Respiratory Care Operational Policy has been developed which will support the decision making for patients on to the Respiratory wards. In addition there are monthly recruitment events planned for Respiratory Services. The issue of Mixed Sex Breaches is discussed at the bed meetings and will continue to be considered in the decision making for bed allocation. This is highlighted to Board monthly. BCCG receive all RCA s for breaches and all patients affected are surveyed and there has been no evidence of adverse dignity and privacy issues. SCCG continue to communicate with BCCG when Salford patients are affected. 19

126 Appendix 2 Current Outcome: Expected Outcome: Timescale for Recovery: Lead Manager: Failed (currently Red) Failed for year (zero tolerance) Not applicable. Rachel Farn 20

127 Appendix 2 E.A.S.04 HCAI Measure MRSA (CCG) Healthcare acquired infection (HCAI) Measure (MRSA) Target: 0 Latest update provided: 27-Oct-2016 Full Root Cause Analysis (RCA) was undertaken by the Salford City Council Team in conjunction with SRFT on both cases. No lapses in care were identified. Both patients were elderly with underlying comorbidities. Actions being taken: SRFT Oral Care Policy and Oral Health Tool was shared with the care home. The Care home agreed to review own oral health policy and implement daily documentation of oral care provided to residents. Salford City Council public health will ensure joint working across the health economy in relation to ongoing projects concerned with good oral health for dependant adults. Current Outcome: Expected Outcome: Timescale for Recovery: Lead Manager: Failed YTD (currently Green) Failed for year (zero tolerance) Failed for this financial year (zero tolerance). Sue Harris 21

128 Appendix 3 - Performance Indicator Definitions Generated on: 04 November 2016 CCG Code Everyone Counts Code CDIFF.01.CCG E.A.S.05 HCAI Measure CDIFF (CCG) CDIFF.01.SRFT E.A.S.05 HCAI Measure CDIFF (SRFT) EXP.HOS.01.CCG E.A.05 Indicator Short Name Description Data Period Guidance and Other Notes 4. Increasing the number of people having a positive experience of hospital care GP.01 E.D.1 Satisfaction with the Quality of Consultation at a GP Practice GP.02 E.D.2 Satisfaction with the Overall Care received at the surgery Healthcare acquired infection (HCAI) measure (clostridium difficile infections) Healthcare acquired infection (HCAI) measure (clostridium difficile infections) Patient experience of hospital care Satisfaction with the Quality of Consultation at a GP Practice based on GP survey Satisfaction with the the Overall Care received at the surgery based on GP survey Months Months Years Quarters Quarters E.D.1 GP Survey Adds together % for GP.01a.Survey and GP.01b.Survey and GP.01c.Survey and GP.01d.Survey and GP.01e.Survey The measure is the number of patients answering very good or good to the question; overall, how would you describe your experience of making an appointment? Supporting questions include: GP.03 E.D.3 Satisfaction with Accessing Primary Care Satisfaction with accessing Primary Care based on GP survey Quarters Ease of getting through to someone at GP surgery on the phone (% Easy total) Frequency of seeing preferred GP (% See their preferred GP always, al most always or a lot of the time (total)) Able to get an appointment to see or speak to someone (% Yes total) Conv enience of appointment (% Convenience total) Overall experience of making an appointment (% good total) Impression of w aiting time at surgery (% Don't normally have to wait too long) Satisfaction w ith opening hours (% Satisfied (total)) 1

129 CCG Code Everyone Counts Code Indicator Short Name Description Data Period Guidance and Other Notes MRSA.01.CCG E.A.S.04 HCAI Measure MRSA (CCG) MRSA.01.SRFT E.A.S.04 HCAI Measure MRSA (SRFT) Healthcare acquired infection (HCAI) Measure (MRSA) Healthcare acquired infection (HCAI) Measure (MRSA) MSA.01.CCG E.B.S.01 Mixed Sex Accommodation Breaches (CCG) Number of mixed sex accommodation breaches Months MSA.01.SRFT E.B.S.01 Mixed Sex Accommodation Breaches (CCG) QP.01a QP.01b EXP.01 QP.01a QP.01b E.A.07 BCF.01 E.J.02 Better Care Fund BCF.02 E.A.S.03 Better Care Fund BCF.03a BCF.04 BCF.05 EA.01.CCG EA.02.CCG E.J.01 BCF.04 BCF.05 E.A.04 E.A Increasing the no of people having a positive experience of care outside hospital, in general practice and the community 3. Reducing the amount of time people spend avoidably in hospital through better and more integrated care in the community 3. Reducing the amount of time people spend avoidably in hospital through better and more integrated care in the community Number of mixed sex accommodation breaches at SRFT Improving antibiotic prescribing in primary care Part a) Reduction in the number of antibiotics prescribed in primary care Improving antibiotic prescribing in primary care Part b) Reduction in the proportion of broad spectrum antibiotics prescribed in primary care Reduce the number of people reporting very bad primary care (GP and out of hours). Average number of negative responses per 100 patients. Long term support needs of older people (aged 65 and over) met by admissions to residential and nursing care homes, per 100,000 population Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services Delayed transfers of care (delayed days) from hospital per 100,000 population (aged 18+). Patients feel supported to manage long term conditions. Total number of non-elective admissions in to hospital (general & acute), all age Emergency Admissions for acute conditions Emergency Admissions for children with Lower Respiratory Tract Infections Years Months Months Months Months Years Months Months Quarters Quarters Quarters Months Months Is GP surgery currently open at times that are convenient (% Yes total) 2

130 CCG Code QoL.LTC.01.CCG UNP.HOS.01.CCG UNP.HOS.02.CCG VAC.01 Everyone Counts Code E.A.02 E.A.04 E.A.04 E.F.15 Indicator Short Name Description Data Period Guidance and Other Notes 2. Improving health related quality of life of people with one or more LTC including mental health 3. Reducing the amount of time people spend avoidably in hospital through better and more integrated care in the community 3. Reducing the amount of time people spend avoidably in hospital through better and more integrated care in the community A&E.03.CCG E.B.05 A&E Waiting Time - Seen within 4 hours (CCG) A&E.03c.SRFT.b E.B.05 A&E Waiting Time - Seen within 4 hours (SRFT) A&E.06.CCG E.B.S.05 Trolley Waits in A&E (>12 Hours) (SRFT) AMB.01.CCG E.B.15.i Cat A (Red 1) 8 Minute Response (NWAS) AMB.02.CCG E.B.15.i Cat A (Red 2) 8 Minute Response (NWAS) AMB.03.CCG E.B.15.i Cat A 19 Minute Transportation Response Time (NWAS) Health related quality of life for people with long term conditions Unplanned Hospitalisation for chronic ambulatory care sensitive conditions Unplanned Hospitalisation for asthma, diabetes and epilepsy in under 19s Seasonal Flu Vaccine Uptake for GP registered patients aged 65 and over Percentage of A&E attendances where the patient spent 4 hours or less in A&E from arrival to transfer, admission or discharge. CCG figure based on weighting. Percentage of A&E attendances where the patient spent 4 hours or less in A&E from arrival to transfer, admission or discharge. (Data for SRFT Only) Number of patients spending more than 12 hours from decision to admit to admission. (SRFT data) The percentage of Category A Red 1 incidents, which resulted in an emergency response, where the first ambulance service-dispatched emergency responder arrived at the scene of the incident. NOTE: Red 1 are the most time critical and cover cardiac arrest patients who are not breathing and do not have a pulse, along with other severe conditions. The percentage of Category A Red 2 incidents, which resulted in an emergency response, where the first ambulance service-dispatched emergency responder arrived at the scene of the incident. NOTE: Red 2 are serious but less immediately time critical and cover conditions such as stroke and fits. The percentage of Category A incidents with ambulance response arriving at the scene of the incident within 19 minutes. AMB.04a.CCG E.B.S.07 Ambulance Handover Time (>30mins) The number of ambulance handover delays of Months Years Months Years Months Months Months Months Months Months 3

131 CCG Code Everyone Counts Code AMB.04b.CCG E.B.S.07 Ambulance Handover Time (>60mins) Indicator Short Name Description Data Period Guidance and Other Notes over 30 minutes. The number of ambulance handover delays of over 1 hour. AMB.05a.CCG E.B.S.08 Crew Clear (>30mins) The number of crew clear delays of over 30 mins Months AMB.05b.CCG E.B.S.08 Crew Clear (>30mins) ATT.01 ATT.02 ATT.03 E.C.01 E.C.02 E.C.03 Number of general and acute elective ordinary admission first finished consultant episodes Number of general and acute daycase first finished consultant episodes Total number of general and acute first finished consultant episodes ATT.04 E.C.04 Non-elective first finished consultant episodes ATT.05 E.C.05 All first outpatient attendances (consultant-led) ATT.06 E.C.06 All subsequent outpatient attendances (consultant-led) ATT.07 E.C.07 Attendances at Type 1 A&E departments (SRFT) ATT.08 E.C.08 Attendances at all A&E departments (SRFT) The number of crew clear delays of over 60 minutes. The number of ordinary elective admissions made to general & acute specialties in a given month. An ordinary admission is a hospital admission requiring an overnight stay. The number of day case admission made to general & acute specialties in a given month. A day case admission is where a patient is admitted to hospital but an overnight stay is not required. The number of elective ordinary admissions and elective day case admissions to general & acute specialties in a given month. An ordinary admission is a hospital admission requiring an overnight stay. A day case admission is where a patient is admitted to hospital but an overnight stay is not required. The number of non-elective admissions to general & acute specialties in a given month. A nonelective admission is an emergency admission, where the admission is unpredictable and at short notice because of clinical need. The number of first outpatient attendances in general & acute specialties where the patient was seen by a consultant (or a doctor acting for the consultant). The number of attendances is for all sources of referral and is not restricted to just those as a result of a GP referral. The number of consultant-led subsequent attendance appointments, in all specialties. The number of attendances at Type 1 A&E departments (SRFT). The total number of attendances at all A&E departments (SRFT). Months Months Months Months Months Months Months Quarters Months Months 4

132 CCG Code Everyone Counts Code ATT.09 E.C.09 GP Written Referrals ATT.10 E.C.10 Other referrals for first outpatient appointment ATT.11 E.C.11 Total Referrals ATT.12 E.C.12 First outpatient attendances following GP Referrals CAN.01.CCG E.B.06 Cancer Patients - 2 Week Waits (Urgent GP Referral) CAN.02.CCG E.B.07 Cancer Patients - 2 Week Waits (Breast Symptoms) CAN.03.CCG E.B.08 Cancer Waits - 31 Days (All Cancers) CAN.04.CCG E.B.09 Cancer Waits - 31 Days (Surgery) CAN.05.CCG E.B.10 Cancer Waits - 31 Days (Drugs) CAN.06.CCG E.B.11 Cancer Waits - 31 Days (Radiotherapy) CAN.07.CCG E.B.12 Cancer Waits - 62 Days (Urgent GP Referral) CAN.08.CCG E.B.13 Cancer Waits - 62 Days (Screening Service) Indicator Short Name Description Data Period Guidance and Other Notes The number of referrals made by GPs to hospital consultants for a first outpatient appointment in general & acute specialties. The number of other (non-gp) referrals to hospital consultants for a first outpatient appointment in general & acute specialties. The number of referrals made by GPs and other (non-gp) to hospital consultants for a first outpatient appointment in general & acute specialties. The number of first outpatient attendances (consultant-led) following a GP referral in general & acute specialties Percentage of patients, referred urgently with suspected cancer by a GP, who waited less than two weeks for first outpatient appointment. Percentage of patients, referred urgently with breast symptoms (where cancer was not initially suspected) by a GP, who waited less than two weeks for fi rst outpatient appointment. Percentage of patients who waited less than one month (31 days) from diagnosis to first definitive treatment for all cancers. Percentage of patients who waited less than one month (31 days) for subsequent treatment where the treatment is surgery. Percentage of patients who waited less than one month (31 days) for subsequent treatment where the treatment is an anti-cancer drug routine. Percentage of patients who waited less than one month (31 days) for subsequent treatment where the treatment is a course of radiotherapy. Percentage of patients who waited a maximum two months (62 Days) from urgent GP referral to first definitive treatment for cancer. Percentage of patients who waited a maximum two months (62 Days) from referral from an NHS Screening Service to first definitive treatment for Months Months Months Months Quarters Quarters Quarters Quarters Quarters Quarters Quarters Quarters 5

133 CCG Code Everyone Counts Code CAN.09.CCG E.B.14 Cancer Waits - 62 Days (Decision to Upgrade) DIAG.01.CCG E.B.04 Diagnostic Test Waiting Times OPS.01.CCG E.B.S.02 Cancelled Operations (SRFT) OPS.02.CCG E.B.S.06 Urgent Operations Cancelled for a Second Time (SRFT) RTT.03.CCG E.B.03 RTT: Incomplete pathways (<18 weeks) RTT.04.CCG E.B.S.04 RTT: Incomplete Pathways (>52 weeks) CPA.01.CCG E.B.S.03 Care Programme Approach DEM.03.CCG E.A.S.01 Dementia (aged 65 and over) EIP.01 IAPT.01b.CCG E.H.04 E.A.03 Indicator Short Name Description Data Period Guidance and Other Notes 2. Improving health related quality of life of people with one or more LTC including mental health all cancers. Percentage of patients receiving first definitive treatment for cancer within 62-days of a consultant decision to upgrade their priority status. Percentage of patients waiting six weeks or more for a diagnostic test. Number of patients not treated within 28 days of last minute elective cancellation The number of urgent operations that are cancelled by the trust for non-clinical reasons which have already been previously cancelled once for non-clinical reasons. Percentage of patients yet to start a consultantled treatment who are waiting less than 18 weeks since referral. The number of incomplete patients yet to start a consultant-led treatment, who are waiting more than 52 weeks since referral. The percentage of people under adult mental illness specialties on CPA who were followed up within 7 days of discharge from psychiatric inpatient care during the period. Estimated diagnosis rate for people with Dementia (aged 65 and over) Percentage of people experiencing a first episode of psychosis (EIP) treated with a NICE approved care package within two weeks of referral Measures the proportion of people that enter treatment against the level of need in the general population (the level of prevalence addressed or 'captured' by referral routes) Quarters Months Quarters Months Months Months Quarters Years Months Months This is an aim to minimise target. We are looking to see <1% of patients waiting six weeks or more for a diagnostic test. No target currently set, however it is not in the patient's interest to have their operation cancelled. The IAPT roll-out measure target is to achieve a minimum of 15% by the end of the year. Quarterly targets set to 3.75% and monthly monitoring targets at 1.25%. NHS Digital (formerly known as HSCIC) publishes data every month but there is a 3 month time lag. IAPT.02b.CCG E.A.S.02 IAPT Recovery Rate - PUBLISHED Measures the proportion of people who complete Months NHS Digital (formerly known as HSCIC) 6

134 CCG Code IAPT.03b.CCG IAPT.04b.CCG PYLL.01.CCG Everyone Counts Code E.H.1_A1 E.H.2_A2 E.A.01 Indicator Short Name Description Data Period Guidance and Other Notes 2. Improving health related quality of life of people with one or more LTC including mental health 2. Improving health related quality of life of people with one or more LTC including mental health 1. Securing additional years of life for people with treatable mental and physical health conditions treatment who are moving to recovery. The proportion of people that wait 6 weeks or less from referral to entering a course of IAPT treatment against the number of people who finish a course of treatment in the reporting period. The proportion of people that wait 18 weeks or less from referral to entering a course of IAPT treatment against the number of people who finish a course of treatment in the reporting period. Potential years of life lost (PYLL) from causes amendable to healthcare Months Months Years publishes data every month but there is a 3 month time lag. NHS Digital (formerly known as HSCIC) publishes data every month but there is a 3 month time lag. NHS Digital (formerly known as HSCIC) publishes data every month but there is a 3 month time lag. 7

135 Appendix 4 - Strategic Programme Updates Generated on: 07 November 2016 Quality Executive, Clinical and Lay Member Leads: Francine Thorpe Report of: Date: Aim: Francine Thorpe 04-Nov-2016 Alison Kelly; Jeremy Tankel Engage with our members, population and providers to minimise variations in quality and secure continuous improvement Achievements so far The Safer Salford work programmes continue to progress according to agreed timescales. Key areas of progress since last update are: Care Homes Collaborative has commenced Leadership programme started, good level of engagement across all partners PrISMS summit held in October, improvements demonstrated in all participating practices Measurement workshop held Survey of clinician views re: handover completed and presented to CSB Quality Strategy Implementation Group reviewed progress against key milestones and signed off action plans for 2016/17. Proposals being developed for refreshed strategy Alignment of Safer Salford work programme with locality plan measures completed along with better alignment with transformation programme for the ICO. Current Issues Slow progress with safer handover work, need to ensure good clinical representation at CSB and champions to move this forwards Measures remain difficult to define seek support from BI to make further progress and link into transformation themes Collation and co-ordination of medication safety work across partner agencies required to drive forwards in a more cohesive way Limited progress in developing an integrated approach to quality assurance in conjunction with SCC Priorities for next period Secure draft measures Improve buy in from CSB representatives Define scale up and spread of the PrISMS work Review how the Safer Salford programme can support Right Care challenges 1

136 Community Based Care Executive, Clinical and Lay Member Leads: Report of: Date: Aim: Karen Proctor 23-Oct-2016 Achievements so far Karen Proctor Paul Bishop; Brian Wroe Support and invest in primary and community based care services to increase integration and the provision outside hospitals Primary Care Workforce Strategy The Primary Care Workforce Development Strategy was approved by the Governing Body in September. The CCG is currently in discussion with Salford Primary Care Together regarding an implementation plan for this strategy. 35 practices have completed their return on the Health Education North West (HENW) GP Workforce Data tool, which collates the GP workforce and establishes the workforce baseline data. The next NHS England workforce report is due in October 2016 and the CCG is exploring how HEE data aligns with NHS England data to enable the CCG to have assurance around the quality of primary care workforce data. Primary care staffing model - 4 practices in Little Hulton are currently supporting the testing of this approach. The pilot phase is now complete and initial evaluation has been completed. This demonstrated that the tool has been received favourably by practices, but that further time is needed to fully understand the application. A further longitudinal evaluation will therefore be undertaken to assess what staffing changes have been considered as a result of this tool. We are currently engaging with practices via neighbourhood meetings to plan the roll out of the staffing model across Salford. The aim is to start this in November A training needs analysis based on the Salford Standards has been sent out for all practices. Training now being developed with clinical leads. An education coordination function is being commissioned from Greater Manchester Shared Services (GMSS). Recruited to Advanced Nurse Practitioner posts who are currently going through training. The CCG is working collaboratively with the lead provider and the University of Salford to plan a year 1 evaluation of the Advanced Practitioner programme. The CCG has commissioned CLAHRC to undertake a longitudinal evaluation of new roles and new ways of working within primary care. This will encompass a number of initiatives including clinical pharmacists, advanced practitioners and physician associates. All practices in Salford have been offered, through the apprenticeship framework the opportunity to take on an apprentice within primary care. 3 practices in Walkden are developing an innovation proposal to test the role of paramedics in primary care as part of an acute home visiting service. District Nursing recruitment challenges are almost overcome, with only 5 vacancies. There has been improved recruitment due to bespoke recruitment events. Practice Pharmacy service mobilisation commenced in March Recruitment process is currently being undertaken. 2

137 Salford Standard The Salford Standard launched in April practices submitted implementation plans; all 46 practice implementation plans have now been approved. Some minor amendments to the standards were approved in July The GP Dashboard which provided a snapshot of performance went out to practices on 15th August Practices have submitted evidence for the Q1 and Q2 Key Performance Indicators by 30th September Extended access to General Practice Business case for Salford Wide Extended Access approved by Primary Care Commissioning Committee. Meeting held with GMSS Market Management to explore procurement options; a pilot approach to Salford wide extended access was recommended and approved at Commissioned Services Quality Group. Meeting held with Collaboration for Leadership in Applied Health Research and Care (CLAHRC) regarding Evaluation of the Extended Access initiative. Monitoring process for Extended Access Pilot schemes established. Integration of General Practice The CCG GP Provider Team has been established to support practices to deliver federated collaborative working at Neighbourhood Level and to support delivery of the Salford Standard. Member Practices have been consulted in June and July on the formation and development of Salford Primary Care Together. A shadow Board for Salford Primary Care Together commenced from 19th July. An organisational Business Plan has been developed. Neighbourhood Provider Boards are established in shadow form; the CCG GP Provider Team has taken on responsibility for these groups from July. The Executive Group for Salford Primary Care Together has established linking with Salford Royal Foundation Trust s Integrated Care Organisation Leads to develop joint working arrangements. The Business Case for Salford Primary Care Together was considered and approved by the Integrated Care Advisory Board at the end of September. Salford Primary Care Together was officially operational from 1st October Quality Improvement in General Practice Productive General Practice rolled out across practices. PrISMS Programme currently being delivered. Delegated Primary Care Commissioning From April 2016 the CCG received delegated responsibility for commissioning general practice. Primary Care Commissioning Committee is operational. Staffing model is established and new team is in place. 3

138 Community Based Care Strategy Comprehensive set of delivery objectives have been agreed and are in progress. General Practice Delivery Plan implemented. Community Service Reviews The recommendations of the Care Homes Medical Practice review were approved by the Primary Care Commissioning Committee in July The Strategic Outline Case for the Ordsall population growth was presented at the September 2016 Primary Care Commissioning Committee. An update on the recommissioning of The Heights Medical Practice was presented at the September 2016 Primary Care Commissioning Committee. Local Commissioned Services for Community Pharmacies Local Pharmaceutical Committee (LPC) has attended and presented to the Community Based Care Commissioning Group and NHS England have provided an update. Current Issues Primary Care Workforce Strategy 11 practices have not submitted their baseline data through the HENW GP Workforce Data tool Recruitment to education coordinator role is delaying development of education programme to support the Salford Standard Salford Standard Work is ongoing to resolve an identified issue regarding the schedule of payments to practices Integration of General Practice Need to identify provider leaders for the Neighbourhood Provider Boards Community Based Care Strategy Work suspended on the strategy document due to team restructure and vacancies in the CCG Service Improvement Team and the scope of the strategy to be agreed. Local Commissioned Services for Community Pharmacies No proposals have yet been received from the LPC Priorities for period Primary Care Workforce Strategy A paper will be presented to the Community Based Care Commissioning Group to 4

139 outline the current position regarding workforce data to identify options for supporting practices to complete workforce data via the HEE GP tool. Evaluate the Advanced Nurse Practitioner Programme. Salford Standard The GP Dashboard of Q2 performance will be finalised by the end of October Practices will then have two weeks to challenge any of their performance. Practices will be paid for their Q1 and Q2 performance mid-november An in-year review of the Salford Standard is currently underway and the outcomes will be presented to the November Primary Care Commissioning Committee. Recommendations for changes and additions to the 2017/18 KPIs will also be presented in November 2016, alongside the proposal for the 50% contract sign up and payment process for 2017/18. Extended access to General Practice Ongoing monitoring of current Extended Access pilot schemes. Commence procurement of a provider for the Salford Wide Extended Access service Community Based Care Strategy Draft production of the Community Based Care Strategy. Evaluate progress of implementing General Practice Delivery Plan. Community Service Reviews Clinical Assessment and Treatment Services (CATS) procurement post implementation review to be completed once services mobilised at Pendleton Gateway. APMS contract for the Care Homes Medical Practice to be updated in line with the recommendations of the review. Completion of review and update of Podiatry Service Specification. 5

140 Integrated Care Executive, Clinical and Lay Member Leads: Report of: Date: Aim: Jennifer McGovern; Karen Proctor 23-Oct-2016 Jennifer McGovern; Karen Proctor Paul Bishop; Paul Newman Support people in retaining their independence and quality of life through integrated health and social care services with partners Achievements so far CCG and Council pooled budget for adult services established from April Salford Integrated Care Organisation (ICO) went live on 1 July New ICO contracting governance operating. Commissioning and partnership governance now operating. Domain operational forums established to engage staff in service redesign. Greater Manchester Transformation Funding Investment Agreement signed in September. Milestone / measurement plan to be agreed by end of November Service & Financial Plan (Phase 3) for the adults pooled budget completed in October Three streams of integrated care service redesign aligned in Service and Financial Plan (Older People, Commissioner-led reviews/projects and the Primary & Acute Care System (PACS) Programme). Dashboard (version 1) to monitor outcomes of Integrated Care System in place. Citizen engagement around health and social care priorities completed in July and August. Joint workshop held in September for the Kings Fund project on Exploring Joint/Integrated commissioning arrangements between Salford City Council and Clinical Commissioning Group. Further workshops planned for next quarter. CCG GP Provider Team established. Establishment of Salford Primary Care Together approved.. 100% of GP practices signed a pledge to work collaboratively with each other and with the ICO. Project to incorporate mental health and social care data into the Salford Integrated Care Record progressing as planned. Current Issues Adult s pooled budget currently forecasting to overspend. The development of a CCG policy and approach to the extension of Personalised Health Budget delayed due to staff vacancies. Priorities for next period Phase 3 Service & Financial Plan monitoring. Development and implementation of domain work plans. Investment Agreement measurement plan. Continue working with the ICO on service transformation plans. Continue with Organisational Development for members of the Integrated Commissioning Joint Committee. Progress the Exploring Joint Integrated Commissioning project. Salford Primary Care Together (SPCT) senior appointments/recruitment and establishment of governance structure. 6

141 In Hospital Care Executive, Clinical and Lay Member Leads: Steve Dixon Paul Bishop; Mansel Haeney Report of: Date: Aim: Steve Dixon 11-Nov-2016 Support secondary care reconfiguration through Healthier Together and maintain a focus on the delivery of NHS constitutional standards Summary of achievements so far: Governance arrangements- established NW Sector CCG meeting and sub groups to drive through commissioning agenda. This is in addition to the NW Sector Board (commissioners and providers) Definition on clinical model for high risk general surgery has been clarified and agreed Baseline audit of workforce been completed Baseline audit against all of the HT clinical standards been completed Priorities agreed by HoCs in the NW sector for those services that need to be reviewed and redesigned (beyond the scope of Healthier Together). Initial scoping work undertaken to prioritise list of specialties into high/low priority for review- work being coordinated by external/independent consultancy. NW Sector programme lead (vacancy) has now been appointed. Interim arrangements for Breast Surgery now in place- successful transfer from Salford Royal Foundation Trust (SRFT) to University Hospitals South Manchester Foundation Trust (UHSM) Current issues: Clarification of the paediatric high risk surgery required for the NW sector. The HT standards stated that paediatric high risk surgery should be co-located with the high risk adult surgery. For the NW sector, the high risk adult surgery site is Salford Royal, who do not undertake paediatric inpatients. Bolton FT and WWL FT designing single service offer for the NW Sector to be discussed at NW Sector HT meeting in November/December. GM side issues/barriers that could delay implementation in the NW sector, namely Radiology (lack of capacity for 24/7 scans and reporting), Workforce and lack of capital funding. All 3 of these issues being taken forward through the GM H&SC governance arrangements. Clarification required from the 3 NW Sector providers around future governance arrangements for single service ways of working- for example change in organisation form or partnership arrangements underpinned with signed agreements? Any joint appointments around senior medical or managerial posts across the sector? Providers to respond in September Priorities for next period: Implications of workforce audit- understand the gap in the workforce to deliver the standards for the NW sector Paediatric surgery solution for the NW sector- work with GM team- expected resolution December 2016 Modelling of activity in NW sector now that clinical definition agreed- build this into NW Sector business case to show full financial impact alongside quality benefitsdeadline for initial submission into GM team is December 2016 Business case required in the NW sector for the capital requirements- November

142 Long Term Conditions Executive, Clinical and Lay Member Leads: Karen Proctor Jeremy Tankel; Brian Wroe Report of: Date: Aim: Karen Proctor 23-Oct-2016 Achieve a more personalised and patient centred approach to caring for people with long term conditions Achievements so far A Business Case for a Children and Families Bereavement Facilitator has been agreed with substantive funding. The post-holder will develop training programmes and offer support to people who come in to contact with bereaved children and families, to ensure that they recognise the emotional and practical support needs of children and their families experiencing grief. A project will commence shortly that will provide choice for patients who take warfarin, to use a Self-Testing machine rather than attend for regular blood tests. The new service will be evaluated after 12 months. Collaboration continues with SRFT to develop a strong economic case for the Integrated Cardiovascular Disease (CVD) Business Case. A clinical engagement group will meet in early November to agree the pathway that will test out a new way of working between hospital cardiology (heart care) consultants and GPs. The neighbourhood to test out the new model is yet to be decided. Review of the Long Term Conditions (LTCs) domain of the Salford Standard 16/17 has been completed and recommendations for 17/18 have been made. The National Diabetes Prevention Programme is on track to meet requirements and will exceed the target for referrals into the programme. Service user feedback for the exercise programme has been very positive. Current Issues None. Priorities for next period Agree timetable for Integrated CVD to test out a new model of care. Complete review of the Chronic Airways Support Team (CAST). Completion and sign off of Service Specifications for the Community Diabetes Team and for Care Call (telephone and advice service). Confirm date for commencement of INR (international normalized ratio)self-testing pilot. An INR test provides the evidence of how fast the blood clots in patients receiving oral anticoagulant medication such as warfarin. Care Home End of Life Care Facilitator project has evaluated well and will be recommended for substantive funding. Review capacity and demand for Care Call (telephone and advice service) and the NDH (non-diabetes hyper glycaemia also known as pre-diabetes) exercise programme.. 8

143 Mental Health Executive, Clinical and Lay Member Leads: Report of: Jennifer McGovern; Judd Skelton Date: 10 November 2016 Aim: Jennifer McGovern; Judd Skelton Edward Vitalis; Jenny Walton To ensure that all residents of Salford will have access to high quality compassionate world class mental health services Achievements so far Now consistently meeting IAPT waiting time targets across all services, with GMW step 3 service having reduced its waiting list backlog and achieved remarkable improvement in RTT performance. Also delivering impressive access rate, way beyond the required national stretch target of 19% The excellent performance in Dementia Diagnosis (90%) and Care Planning Review (85%) is as a result of both the investment ( 1.5m) made by the CCG in Salford's Memory Clinic in 2014 and the ongoing quality assurance of the performance of Greater Manchester West in delivering to the requirements of the service specification. The level of dementia diagnosis in Salford is a direct consequence of the performance of GPs in successfully identifying, screening and referring patients to the Memory Clinic - the importance of the GP system in the diagnosis pathway is paramount. Community Engagement and Recovery Team re-modelling to embed the service within the Community Mental Health Teams Salford highlighted as good practice example regarding Early Intervention in Psychosis by NHS Clinical commissioners Current issues Just 0.8% short of IAPT recovery rate 50% target at end of Q2, but remain optimistic that this will improve across quarter 3 to consistently hit the required 50%. A disappointing result of the adult Autism/ADHD diagnostic service tender. Only 1 bidder submitted and this was failed at QQ stage. Commissioners will now reexamine options. Long-standing spot purchase providers remain active and delivering a good service Clarity regarding the implications and expectations of local Criminal Justice Liaison & Diversion (CJL&D) provision in light of the NHSE GM contract award for CJL&D and Health Custody to 5 Boroughs Clarity regarding NHSE assurance assessments regarding Out of Area Placements Priorities for next period Continue to monitor the IAPT recovery rate performance Revisit strategy for provision of local, compliant autism and ADHD services for adults Undertake further work regarding Perinatal Mental Health across GM Conclude mental health contract negotiations and CQUINs both locally and GM wide 9

144 Effective Organisation Executive, Clinical and Lay Member Leads: Hannah Dobrowolska Report of: Date: Aim: Hannah Dobrowolska 20-Oct-2016 Tom Tasker; Edward Vitalis Develop our systems, processes and people to deliver high quality, value for money services Achievements so far Annual accounts complete and assured by external audit Annual governance statement complete, including Head of Internal Audit Opinion providing significant Assurance on the CCG s systems of internal control Annual report complete and AGM held Annual financial plan assured by NHS England as level 1a, which is the best level of assurance (assured and meets the business rules - Low/medium risk) Contract agreed for the Adult Social Care component of the ICO which includes full contract schedules and service specifications All contracts for 2016/17 agreed and signed in line with national timescales Integrated Commissioning Joint Committee (ICJC) established and associated organisational development commenced Primary Care Commissioning Committee established Communications, Engagement and Social Marketing Strategy produced and approved, 6 month update presented to the Executive Team Risk Strategy reviewed and amendments approved Emergency Planning Core Standard self-assessment complete and on call Policy approved Governance Review presented to Governing Body Finance reporting for pooled budget developed Kings Fund led sessions to explore opportunities for greater joint working across the CCG and Salford City Council commenced Admin review complete CCG staff survey launched Updated Conflict of Interest Policy approved in line with new guidance, quarter 2 assurance submitted and implementation commenced Current issues 10

145 Clarification on the approvals process for Estates/capital business cases required particularly in relation to the interface with GM H&SC partnership and national NHS England processes Priorities for next period Implement admin review Complete accommodation work Complete of Business Intelligence Strategy Finalise estates business case for Little Hulton development Planning for 2016/17 to continue following recent guidance which brings forward timescales in comparison to previous years Undertake Equality and Diversity Scheme (version 2) (ESD2) public grading event Agree and sign NHS contracts for 2017/18 by 23/12/16 Update CCG s 5 year financial plan Information Governance Toolkit evidence collection 11

146 Appendix 5 - Strategic Risk Register - New and High Risks New risks identified since last report SRR.14 Failure to provide quality assurance for services where Salford CCG is not the lead commissioner There is a risk that patients are not getting consistent, high quality care across the Salford population. Salford CCG is unable to gain sufficient assurance for the quality of services w here w e are not the lead commissioner. Existing Controls Assurances Gaps Risk Profile Current Risk DoT Target Risk Latest Position CCG has regular dialogue with quality teams within lead commissioning organisations, greater Manchester quality board meets bi-monthly and is a f orum to raise significant concerns. CCG receives reports from lead commissioners as required and f eeds in to appropriate governance routes. No single quality assurance process has been agreed and communicated across all commissioners. SRR.12 Co-commissioners and Specialist Commissioner decisions I 4 Score I 4 Score L 4 16 L 3 12 Risk Owner Risk Sponsor Governance Group Last Reviewed: Francine Thorpe Jeremy Tankel Gov erning Body 11-Oct-2016 Decisions made by Co-commissioners and Specialist Commissioners may lead to unintended / unforeseen impacts w hich affect Salford CCG's ability to deliver its ow n priorities. Existing Controls Assurances Gaps Risk Profile Current Risk DoT Target Risk Latest Position Salf ord CCG is a member of multiple local and GM Networks where potential commissioning decisions are discussed. The Traf ford New Health Deal is being monitored closely by the Urgent and Emergency Care Delivery Board (formerly SRG) that meets monthly. Trafford CCG is represented on this group. Sir Dav id Dalton has written to Trafford CCG seeking assurance that 'that whilst rightly providing an appropriate model for Trafford residents, and supporting North Manchester, this decision will not inadv ertently destabilise the emergency care system elsewhere in Greater Manchester.' Uncertain on how this decision will impact patient flow to SRFT and other areas across the GM system. I 3 Score I 3 Score This risk has been added as a result of the 'New Health Deal for Trafford' which could result in increases in the flow of emergency patients from Trafford to SRFT. During the previous phase of L 3 9 L 2 6 Traf f ord's new health deal, SRFT received a significant increase in flow of emergency patients from Traf f ord and considerably higher than the expected number. Risk Owner Risk Sponsor Governance Group Last Reviewed: Victoria Bell; Anthony Hassall Tom Tasker Gov erning Body 03-Oct-2016 SRR.13 Failure to commission high quality, resilient and sustainable services for the population of Salford Failure to commission high quality, resilient and sustainable services for the population of Salford Existing Controls Assurances Risk Profile Current Risk DoT Target Risk Latest Position Robust quality assurance processes with our main providers. Ongoing workstreams with partners around quality improvement. We hav e external assurance from the CQC that our main provider is rated Outstanding. Our mental health provider is rated as good by the CQC. I 4 Score I Score L 2 8 L Risk Owner Risk Sponsor Francine Thorpe Jeremy Tankel 1

147 Appendix 5 - Strategic Risk Register - New and High Risks Gaps Elements of service provision that the CCG is not always well sited on where there are no national indicators/targets. Governance Group Last Reviewed: Gov erning Body 11-Oct-2016 High Risks SRR.05 Failure to deliver SRFT organisational, Salford Together and Locality Plan objectives whilst leadership team supports PAHT If the Salford Royal NHS Foundation Trust (SRFT) leadership team are supporting the Pennine Acute Hospital NHS Trust (PAHT) Leadership Team they might be less able to deliver fully against the SRFT organisational, Salford Together and Locality Plan objectives. Existing Controls Assurances Gaps Risk Profile Current Risk DoT Target Risk Latest Position This matter is a standing item in the Governing Body s meetings (part 2) and the CCG is kept appraised of the position through regular communication with SRFT. The CCG has reviewed SRFT s Board paper demonstrating how Risk Owner SRFT plan to mitigate the potential risks and has received additional inf ormation in terms of how these risks will be managed. NHS Salf ord CCG's Chief Accountable Officer is meeting the Chief Risk Sponsor Of f icer at SRFT on a monthly basis to review and discuss this risk. None identif ied. I 4 Score I 4 Score Risk rev iewed by Anthony Hassall. No change to risk scores or risk profile. L 4 16 L 3 12 Governance Group Anthony Hassall Tom Tasker Gov erning Body Last Reviewed: 07-Nov SRR.09 Failure to achieve national performance targets against constitutional standards If pressures in the health and social care system are not effectively monitored and managed then w e may fail to achieve national performance targets. This may result in patient harm, negative media attention (reputational damage), reduced patient confidence and could cause further pressures in the w ider health system. Existing Controls Assurances Gaps Risk Profile Current Risk DoT Target Risk Latest Position Monthly breach reports. Systems Resilience Group, Contract Management Group, Quality and Outcomes Group in place. Perf ormance is also managed locally by providers. Regular discussion at CCG Executive Team meetings, with formal reporting to Gov erning Body. Organisational Performance Report and Risk reports presented to ev ery Governing Body meeting. None identif ied. I 4 Score I 2 Score No change since last assessment. L 4 16 L 2 4 Risk Owner Risk Sponsor Governance Group Last Reviewed: Hannah Dobrowolska Anthony Hassall Gov erning Body 20-Oct

148 Ref: JR/js Date 14 th November 2016 Greater Manchester Health & Social Care Partnership 4th Floor 3 Piccadilly Place London Road Manchester M1 3BN Telephone No: address: jonrouse@nhs.net CCG AOs and Chief Officers LA CEOs and DASS Provider Chief Executives and Directors of Operations Dear Colleagues Performance & Delivery Board Feedback As part of the GMHSC governance structure, the Performance and Delivery Board meets on a monthly basis to review delivery across health and social care, including but not limited to NHS constitutional mandate standards and performance against the CCG Improvement and Assurance Framework metrics. The emphasis of the meetings is to evaluate performance and delivery at a GM level, as well as highlighting localities where particular delivery challenges are apparent, and to agree further actions. To try to avoid multiple communications throughout the month I agreed that I would provide a summary of key issues discussed at the Board as outlined below, which you may wish to discuss within your own organisations and your own collective governance meetings. Transforming Care There is a national focus on Learning Disability patients in secure and non-secure settings and the lack of traction in the system to get many of the individuals back into community settings and also avoid unnecessary admissions and long stays. The Partnership s Nursing Directorate is currently working with CCGs to go through individual patient level data for CCGs to develop timely discharge plans and actions to achieve this. The LD fast track board is being refocussed to ensure the plan adequately reflects the needs of the system at the same time as all localities need to focus on securing performance against at least their planned trajectories for end of March Children s Dental Surgery Following commitment from the Provider Federation Board, working with dental commissioners, the collaborative working has managed to establish clarity on current consolidated lists and waiting across Greater Manchester. Supportive approaches across providers have managed to regain capacity lost earlier in the year.

149 However, achievement to date appears to have managed only to stem inflation of the lists as they stand. Further identified capacity may be able to reduce the backlog of long waiting patients over time, but at best taking 40 weeks which is still too long. I know we are all agreed that this position of continued excessive waits for vulnerable children requiring these services is unacceptable. The Board agreed to pursue further options (perhaps requiring a further five additional sessions as week) to reduce the time required to deal with the excessive waits to around 20 weeks, considering any possible safe option to achieve this. This work shall continue to be overseen through the established fortnightly conference calls. Referral To Treatment The aggregated GM RTT position has deteriorated since April 2016, from a position of 93.2% to 91.8% (provisional September data) which shows GM failing the standard. As delivery of RTT was one of the areas where GM was achieving the standard, it is essential that we return to a sustainable position of delivery. Some of you have already submitted recovery trajectories in response to our recent letter; we will be carrying out some further analysis to identify specific specialities and the aggregate trajectory. In particular we are concerned about the build-up of waiting lists which may indicate further pressures on future performance. The Board has asked Nicky O Connor, the Partnership s Chief Operating Officer, to co-ordinate further work to understand and address our position. Mental Health GM is achieving the IAPT Access Rate in aggregate despite some concerning performances in a number of individual localities; I am pleased to report achievement of the 6 week waiting time in aggregate for the first time since the introduction of the standard, whilst delivery of the 18 week waiting time is variable. However, the IAPT Recovery Rate is well below standard and shows a deteriorating position in recent months. As such, we are commissioning an independent review in Greater Manchester from the Centre for Mental Health to give the partnership organisations a better understanding of where we are, the reasons for under performance, the adequacy of the improvement plans in place and our prospects of meeting national and GM requirements. I attach a copy of the complete specification for your information. Urgent Care A&E Delivery Boards and Urgent Care Leads have been requested to update their initial baseline assessments related to their local A&E Improvement Plan delivery: colleagues were requested to provide those updates back by the 15th November for the next UEC Task Force meeting Integrated Urgent Care is deliverable across the whole of GM by March 2017 the UECN has been asked to oversee progress and agree common delivery dates for GM. Colleagues will have received a template in October to complete and return; that enables the GMHSCP to update the SoS Delivery Office as part of the

150 Transformation Area work. Please ensure that updates are provided within the timelines requested so we can all help each other to deliver on the shared agenda. The upcoming 2nd UEC Workshop on the 23rd November at GMP Force HQ is focussing on discharge and DTOC. Invites have been sent and colleagues are encouraged to ensure they have good cross-organisational attendance on the day to take part on the day: book via DTOC There is a national drive to improve the position of the NHS as we move into the winter period; steady increases in discharge delays have seen pressures increasing on available bed stock across the country. The DH SoS is keenly aware and focussed on this agenda and we in GM need to help maintain the North aggregate level to 3% by March In order to deliver our contribution, each local system will be required to develop a trajectory to help GM drive down to an aggregate figure of 3.3% within the same timeline. I ask for your commitment and support in delivery of this improvement; my colleagues will be making further contact via you re A&E Delivery Boards to agree suitably challenging trajectories with each health economy as part of the process of releasing the additional winter funding. We are also recruiting to an interim post of Discharge and DTOC Lead to work within the UEC Team and help drive this agenda forward, linking in with subject matter experts and operational colleagues to maximise our collective effectiveness. I hope this read-out is helpful. Please do also let me know if there are specific areas that you would like the Board to examine. We undertake deep dives at each meeting; having covered maternity and children in the last two months, we will be examining RTT in December and directly commissioned public health services in January, but are very open to specific requests for review. Yours sincerely Jon Rouse Chief Officer GM Health & Social Care Partnership

151 Centre for Mental Health Draft Scope of Work Summary: Greater Manchester Health & Social Care Partnership is seeking to secure a partner to undertake a forensic review of GM s mental health performance deficits. That review seeks to inform GM s actions to support recovery and improvement across the range of key performance indicators for mental health service access and quality. In doing so it should identify the specific drivers behind any performance deficits and use a comprehensive understanding of national and international best practice to ensure any resulting actions are evidence led and proven. The review should incorporate a clear analysis based on GM s approach to mental health service commissioning and provision. The findings should be explicit in any implications for models of commissioning and provision which GM should be recommended to consider. Scope: All age mental health across all GM districts. Implications for locality and Pan-GM working across health, social care and preventative approaches. Detail of Review/ Deep Dive: 1) Areas of under delivery against national standards including: IAPT access, waiting time standards and recovery standards Early Intervention in Psychosis delivery against waiting time standard and review of data quality (including discrepancies between Mental Health Services Dataset and Unify Submissions) Forensic analysis of the drivers behind current under delivery of performance to include: Demand and Capacity Review of services Levels of Commissioning Population and Local Needs (e.g. age, employment status etc) Prevalence (if so which cohorts or groups does specific support need to be provided to) Service level provision and accessibility (opening times, location etc) Equity of Service Provision across GM (GM approach that still meets local need) Appropriateness of referrals Experience of people using services Data Quality/ Robustness of Reporting 1

152 Smooth transition of provision of services with the acquisition of Manchester Mental Health and Social Care Trust. DNA rates and benchmarking Performance Reporting Arrangements and Governance Arrangements Leadership and Accountability Arrangements Current spend, application, activity and apply any relevant national comparisons Referral Data Activity planned vs actual Number of sessions per clinic Distribution of activity and acuity Mental Health Spend per head and Benchmarking Information Economy of Scale 2) Preparedness for delivery of: Dementia Access & Waiting Time Standards Children and Young People Community Eating Disorder Access and Waiting Time Standard 3) Current Commissioning of Mental Health Provision across GM including: Crisis Care provision and Health Based Places of Safety Liaison Mental Health Provision Perinatal Services Tier 4 Services for Children and Young People Specialist Services e.g. Eating Disorders Out of Area Treatments Reporting The sponsor for the review is Warren Heppolette, Executive Lead Strategy & Performance. The review partner should engage with the GM Mental Health Implementation Executive through its Independent Chair, Steven Michael. The review must be undertaken at pace and is expected to report by the end of December

153 30 November 2016 Agenda Item No 6 (c) NHS SALFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING AGENDA ITEM NO 6 (c) Item for Decision/Assurance/Information 30 November 2016 REPORT OF: Chief Finance Officer DATE OF PAPER: 9 November 2016 SUBJECT: Finance Report - Month 7 IN CASE OF QUERY PLEASE CONTACT: STRATEGIC PRIORITIES: Elaine Vermeulen, Deputy Chief Finance Officer Please tick w hich strategic priorities the paper relates to: Quality Community Based Care Integrated Care In Hospital Care Long Term Conditions and Mental Health Effective Organisation PURPOSE OF PAPER: This paper provides information on the month 7 financial position and forecast outturn for 2016/17 based on available information at the end of October Page 1 of 18

154 30 November 2016 Agenda Item No 6 (c) Document Development Process Yes No Public Engagement (Please detail the method ie survey, event, consultation) Clinical Engagement (Please detail the method ie survey, event, consultation) Has due regard been given to Equality Analysis (EA) of any adverse impacts? (Please detail outcomes, including risks and how these will be managed) Legal Advice Sought Presented to the Programme Management Group Presented to the Health and Wellbeing Board Presented to the Integrated Commissioning Board Presented to any other groups or committees, including Partnership Groups (Please specify in comments) Not Applicable x x x x x x Comments and Date (i.e. presentation, verbal, actual report) Outcome Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work. Page 2 of 18

155 30 November 2016 Agenda Item No 6 (c) Finance Report - Month 7 1. Executive Summary This paper provides an update on the financial position of NHS Salford Clinical Commissioning Group (CCG) at the end of October There are forecast overspends on acute hospital contracts and prescribing amounting to 2.7m and 0.7m respectively. These overspends are being managed through underspends on community services and using the 0.5% contingency reserve that was set aside at the beginning of the year as part of the CCG s financial plan. The CCG is currently forecasting that it will achieve the planned surplus of 11.6m, however, the flexibility in managing the financial position is now limited given the contingency has been fully utilised. Planned commitments held within reserves are reviewed on a monthly basis, and at present there is only 0.8m remaining as uncommitted to cover any future increases in forecast overspends. The CCG is on target to achieve its other statutory financial duties with regards to cash management, the Better Payment Practice Code and spending within its running cost allocation, as highlighted in Section 2 of this report. 2. Summary Financial Performance 2.1 The four financial statutory duties are: Revenue - delivery of the CCG s planned surplus. Cash management - The CCG has been allocated a maximum cash draw down limit of 413.6m. Current guidance requires the cash balance at the end of the month to be less than 1.25% of the cash draw down for that month ( 0.3m at month 7). Better Payment Practice Code (BPPC) - 95% of invoices paid within the agreed terms or within 30 days if there are no specified terms. Running costs - manage within the CCG s running cost allocation. The table below provides the current performance against these statutory duties. Statutory Duty Commentary Year to Date Rating Revenue - delivery of the CCG s planned surplus Based on the financial information received to the end of October 2016, the CCG is forecasting that a surplus of 11.6m will be delivered. Forecast Year End rating Page 3 of 18

156 30 November 2016 Agenda Item No 6 (c) Cash - less than 1.25% of the monthly drawdown The cash balance at the end of Month 7 was 0.077m, within the 0.36m allowance. Better Payment Practice Code (BPPC) - 95% of invoices paid within the agreed terms or within 30 days if there are no specified terms Managing within the Running Cost Allocation NHS 100% by invoice value and 99.9% by invoice number. Non NHS 99.6% by value and 98.9% by number. Overall 99.9% by value and 99.2% by number. The running cost allocation for the CCG is 5.5m and the year end position is breakeven. 2.2 In the above table, the direction of the arrows indicates whether the position is improving, deteriorating or unchanged compared to the previous reported position. The CCG is currently achieving all of its statutory duties. 2.3 The latest guidance requires the cash balance at the end of the month to be less than 360k. The balance at the end of August was 77k, and therefore the CCG s cash balance was within this allowance. 2.4 The Better Payment Practice Code (BPPC) performance target is being met as at the end of August. Full details of the performance to date can be seen in Appendix The two tables below are provided to give members assurance that payments to creditors and recoveries from debtors are being made in a timely manner. They show details of the amounts outstanding by creditors and due from debtors, and the aged percentage of the totals. It should be noted that most contract payments are routinely made on the 15 of each month and therefore do not appear in the tables below which is why the month end creditor balances are relatively low value. Creditors as at October 2016 Value '000 % of Total Creditors Current % 1-30 days -65 0% Days 2 0% Days 3 0% 91+ Days -3 0% Totals 22, % Page 4 of 18

157 30 November 2016 Agenda Item No 6 (c) Debtors as at October 2016 Value '000 % of Total Debtors Current 6, % 1-30 days - 0% Days - 2 0% Totals 6, % 3. Year to Date Financial Position 3.1 The overall CCG allocation for 2016/17 is 431.2m. This consists of a programme allocation of 374.4m, the return of the surplus of 15.5m from last year, a running cost allocation of 5.5m and the transfer of Co-Commissioning funds to the CCG of 35.7m. At the start of the year, the CCG agreed a planned underspend against its allocation of 11.6m and is on track to achieve this planned surplus overall, although the pooled budgets are forecast to overspend by 2.1m, and non pooled budgets to underspend by 2.1m. This underspend of 11.6m for 2016/17 will be returned to the CCG in future years for business planning and investment priorities. 3.2 The table below provides detail of expenditure against the allocations. The adjustments in the table reflect timing issues, to adjust for items known after the financial ledger was closed at month end and therefore ensuring the Governing Body report reflects the most up to date information. Pooled Budget Forecast Outturn Variance Non Pooled Budget Forecast Outturn Variance Overall CCG budget Forecast Outturn Adj Revised Forecast Variance Variance Prior Month Comparison Last reported variance Movement from last report % Programme Acute 94,226 96,014 1, , ,869 ( 339) 220, ,882 1,797 2, % 2,149 ( 347) Community Health Services 28,343 27,773 ( 570) 8,635 7,990 ( 645) 36,978 35,763 0 ( 1,215) -3.3% ( 1,211) 4 Continuing Care 6,957 7, ,415 1,311 ( 104) 8,372 8, % Mental Health 36,168 36, ,111 5, ,279 41, % 533 ( 61) Other ( 1) 7,178 7, ,388 7, % 28 0 Primary Care 1,667 1, ,003 45, ,670 46, % ( 28) ( 49) Committed Developments ,558 11,353 ( 1,955) 12,558 11,353 ( 1,797) ( 3,002) -23.9% ( 3,017) ( 15) Prescribing ,864 41, ,864 41, % 653 ( 67) Total Commissioning Budgets 167, ,628 2, , ,665 (2,056) 414, , Planned Surplus ,602 11, ,602 11, Total Programme Allocation 167, ,628 2, , ,267 (2,056) 425, , Total Running Cost Allocation ,520 5, ,520 5, Total CCG Allocation 167, ,628 2, , ,787 (2,056) 431, , Whilst the CCG is on track to deliver its planned underspend, there are some budget areas that are showing material variances. These are explained in more detail in Section Programme Expenditure - Variance Analysis 4.1 Acute Services: Acute contracts are forecast to overspend by 0.7m overall, within non-pooled budgets. The table in Appendix 1 provides an analysis of the main secondary care providers. Page 5 of 18

158 30 November 2016 Agenda Item No 6 (c) 4.2 Salford Royal Foundation Trust (SRFT): The CCG s contract with Salford Royal Foundation Trust is forecasting a 1.5m overspend for 2016/17 which is in line with the last report to Governing Body. The main driver for this overspend relates to Non Elective admissions which are forecast to overspend by 2.7m. It should be noted that this year s plan was reduced by over 1m as investment was made in out of hospital services (intermediate care, social care and district nursing services) in order to reduce unplanned admissions to hospital. The impact of the investment in the community based care services is being reviewed through the Integrated Care Joint Committee (ICJC) as part of the pooled budget arrangements between the CCG and Salford City Council for adult services. Non elective excess bed days are forecasting to overspend by 0.8m with activity being around 40% above planned levels. This relates to the discharge of high cost patients and continues to be monitored through the contract meetings with SRFT. For planned care activity at SRFT, the current forecast is 0.8m below plan mainly in Trauma and Orthopaedics. However, most of this activity has now migrated to the Oaklands Hospital hence the over performance in that contract. Overall, across all providers, planned care activity is in line with plan, suggesting that the CCG commissioned sufficient levels of activity within its contracts, however, patients are flowing to different hospital providers than originally planned. A detailed breakdown of each contract by point of delivery is supplied in Appendix 1 of this report. 4.3 Other Providers The main areas of over and under spends at the other acute providers are: Oaklands forecast overspend is 1.8m against the contract, however this overspend in the main has been offset by planned care underspend in other contracts. Pennine Acute Hospitals NHS Trust is forecasting to underspend by 0.7m. This is a continued trend from 2015/16 whereby activity is shifting to Oaklands and SRFT. Care UK is underperforming against the contract by 0.5m and continues to be monitored. Care UK have given notice on this contract and the activity for 2017/18 will flow to SRFT and Oaklands. 4.4 Pooled Budget for Adult Services The Pooled budget for adult services is forecast to overspend by 2m which is in line with the last report to Governing Body. The position for the pooled budget is reviewed in detail at the Integrated Care Joint Committee (ICJC) as part of the pooled budget arrangements between the CCG and Salford City Council for adult services. 4.5 Other Programme Areas Community Health Services is forecast to underspend by 1.2m by the end of 2016/17. This is primarily made up of 0.5m underspend on the Clinical Pharmacists investment and 0.3m in relation to District Nursing. Both of these areas relate to approved business cases to increase the numbers of staff, however, there have been delays in recruitment. The CCG is awaiting a detailed plan from SRFT on future Page 6 of 18

159 30 November 2016 Agenda Item No 6 (c) recruitment. The balance of the underspend is made up of Urology CATS 0.1m, Anticoagulation 0.1m and other various services 0.2m. The CCG receives detailed prescribing forecast information and this is showing a forecast over spend of 0.7m by the end of 2016/17 which is in line with the last report to Governing Body. Initial investigation as to the causes of this overspend has revealed substantial price increases for some generic drugs mainly affecting the elderly population and this has resulted in a significant overspend on the Care Homes Practice prescribing budget. In addition there is increasing use of the newer more expensive direct oral anticoagulants in accordance with NICE guidance. The CCG s Head of Medicines Optimisation has undertaken a detailed review and this was presented to the CCG s Commissioning Committee in October Continuing Healthcare expenditure is forecast to overspend by 0.4m which is a reduction in forecast of 0.5m since the last report to Governing Body. The overspend position is due to a national negotiation on the fees payable to nursing and care homes for the nursing (health) component of a patient s/client s stay, known as Funded Nursing Care (FNC). The weekly fees have been increased from 112 to 156, back dated to 1 April 2016, resulting in an annual increase in costs of 1.2m for Salford. These overspends have been offset by the reduction of placements based on an updated placement list provided by the Continuing Healthcare team. Mental Health is forecasting to overspend by 0.6m by the end of 2016/17 which relates to specific, high cost, individual packages of care along with an increase in the number of placements. 5 Committed Developments - Reserves 5.1 At the start of the year the annual budget for Committed Developments was 5.9m. Since then, some amounts have been transferred out of reserves to cover budget setting adjustments and amendments to final contract values, and anticipated allocations have been received. 5.2 The current level of monies in committed developments at the end of October is 12.6m. The table below shows a high level analysis of the committed developments that have not yet been spent and it should be noted that there is only 0.8m of under committed reserves. More detail is provided in Appendix 2. Revised Planned Commitments 000 Business Planning Rules 7,476 Committed Expenditure 5,345 Anticipated allocations -1,070 CURRENT COMMITTED DEVELOPMENTS 11,751 Undercommitted reserves 807 TOTAL 12,558 Page 7 of 18

160 30 November 2016 Agenda Item No 6 (c) 6 Running Cost - Variance Analysis 6.1 The year to date variance in the table shows an underspend of 6k on running costs. The year-end forecast is to breakeven. The CCG is confident it will achieve its statutory duty on running costs. Period April - October 2016 Annual 2016/17 Prior Month Comparison Last reported Movement from Budget Forecast Outturn Variance variance last report Budget YTD Actual YTD Variance YTD Running Costs Pay 2,330 2,259 (71) 3,986 3,948 (38) 59 (97) Non Pay 1,132 1, ,888 2, Income (208) (248) (41) (354) (620) (266) (140) (127) Total Running Costs 3,254 3,189 (66) 5,520 5,520 (0) (0) (0) 7 Risks 7.1 The planned surplus for 2016/17 for the CCG is 11.6m. CCG planned surplus CCG potential risks CCG mitigations CCG Risk adjusted Surplus 11.6m ( 4.59m) 4.59m 11.6m The risk adjusted forecast surplus indicates how likely the CCG is to achieve the planned surplus. It assesses the CCG s exposure to potential risks and its capacity to mitigate them from its own resources. The above table shows that the mitigations equal the potential risks, therefore giving some added assurance that the CCG will deliver its planned surplus. 7.2 The risks that have been identified which could prevent the CCG achieving its financial duties are summarised in the table below. An estimation of the potential size of the financial risk is given (where possible) and either actions or additional financial resource has been identified to mitigate the risks. Page 8 of 18

161 30 November 2016 Agenda Item No 6 (c) Over spend on Acute Contracts Potential Size of Risk The total value of the acute contracts is 182m. Therefore if the contracts over spend by 1% there will be a financial pressure of 1.8m, although at month 7 we are forecasting this as at 2.7m. Mitigating actions and/or source of additional financial resource Contract performance is reviewed monthly through the Service and Finance Group. There are also monthly meetings with SRFT to review the performance of the contract. Whilst the forecast overspend on acute contracts is 2.7m which is high value the risk rating has been reduced to amber because our contingency will cover the majority of this. Current Risk rating Medium Prescribing over or under spend The forecast shows an overspend of 0.7m, which has recently emerged. Monitoring of prescribing spend and investigation of underlying issues. However pricing issues may not be amenable to intervention by the CCG. High Locally Commissio ned Services - Salford Standard There is a risk that the uptake of the performance element of the Salford Standard will be better than forecast in this first year of implementation. Currently there is sufficient funding to cover average achievement of 45%, but if achievement averages 75% then the overspend will be 0.5m Timely performance monitoring of key performance indicators. Medium Operation of the integrated care pooled funds The CCG s forecast position assumes that the full impact of any overperformance on the pooled budget is managed within the CCG s overall position. It is possible that there could be underlying under or over performance issues which may not be reported until later in the year. Where it is not possible to bring expenditure back in line with budget, deferral or acceleration of the investment plans may be required in order to manage the overall position. A financial risk and benefit sharing agreement has been agreed with partners. Medium Page 9 of 18

162 30 November 2016 Agenda Item No 6 (c) 8 Recommendations 8.1 The Governing Body is asked to note the contents of this report, in particular the risks identified in section 7 to the delivery of statutory financial duties. Steve Dixon Chief Finance Officer Page 10 of 18

163 30 November 2016 Agenda Item No 6 (c) Appendix 1a: Breakdown of Acute Contract Performance by Point of Delivery Reported Contract Position to Month 06 Annual Reported Month 04 Finance Forecast Activity Budget Actual Adjustment Variance Budget Forecast Adjustment Variance Variance Movement Point of Delivery Plan Actual Variance % 000s 000s 000s 000s % s 000 % 000s 000s A&E 52,692 53, % 7,116 7, % 14,324 14, % 108 ( 101) All other (PbR excluded, non activity services) 16,756 17,235 ( 459) 20 0% 33,437 33,556 ( 131) ( 12) (0%) 354 ( 366) Elective: inpatients and day cases 16,191 16,110 (81) (0%) 17,824 17, % 35,571 35, % 456 ( 268) Non-elective admissions 20,668 21, % 31,778 32, % 63,774 65, ,021 3% 1, Outpatients 127, ,396 (1,416) (1%) 16,130 15,805 1 ( 324) (2%) 32,146 31,660 ( 22) ( 508) (2%) ( 80) ( 428) Excess bed days 6,880 9,800 2,920 42% 1,533 2, % 3,062 4, % TOTAL ACTIVITY BASED SECONDARY CARE CONTRACTS ,137 92,615 ( 312) 1,166 1% 182, ,126 ( 153) 2,660 1% 2,693 ( 33) Total Other Acute ,532 6, % 11,343 11, % ( 546) 975 TOTAL ACUTE ,669 99,383 ( 312) 1,166 1% 193, ,898 ( 153) 3,089 2% 2, Page 11 of 18

164 30 November 2016 Agenda Item No 6 (c) Page 12 of 18

165 30 November 2016 Agenda Item No 6 (c) Appendix 1b: Breakdown of Contract Performance Month 06 Adjusted Month 06 Annual Reported Month 04 Budget Actual Variance Adjustment Revised Variance Budget Forecast Adjustment Revised Variance Variance Movement Provider 000s 000s 000s 000s 000s % 000s 000s 000s 000s % 000s 000s SALFORD ROYAL NHS FOUNDATION TRUST 56,352 57, ( 117) 818 1% 113, ,549 ( 29) 1,494 1% 1,559 ( 65) CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 15,331 15,086 ( 245) 221 ( 24) (0%) 30,433 30,679 ( 132) 114 0% 448 ( 334) BOLTON NHS FOUNDATION TRUST 7,772 7, ( 372) ( 338) (4%) 15,499 15,498 0 ( 1) (0%) ( 1) 0 PENNINE ACUTE HOSPITALS NHS TRUST 3,494 3,111 ( 384) ( 37) ( 421) (12%) 6,932 6,265 0 ( 667) (10%) ( 710) 43 UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FOUNDATION TRUST 1,637 1, ( 7) % 3,298 3, % WRIGHTINGTON WIGAN ANDLEIGH FOUNTATION TRUST 909 1, % 1,840 1, % 139 ( 21) WARRINGTON AND HALTON HOSPITALS NHS FOUNDATION TRUST % 1,445 1, % ( 30) 77 STOCKPORT NHS FOUNDATION TRUST % % ( 37) 57 OAKLANDS 3,603 4,658 1, ,055 29% 7,206 9, ,841 26% 1,909 ( 69) Care UK ( 230) 0 ( 230) (58%) ( 461) (58%) ( 444) ( 16) Spa Medica % 1,114 1, % Spire ( 40) 0 ( 40) (35%) ( 54) (24%) ( 144) 90 Lancashire Teaching FT ( 64) 0 ( 64) (47%) ( 121) (45%) ( 96) ( 26) TOTAL ACTIVITY BASED SECONDARY CARE CONTRACTS 91,137 92,615 1,478 ( 312) 1,166 1% 182, ,126 ( 153) 2,660 (76%) 2,693 ( 33) Non Contract Activity 1,419 1, % 2,539 2, % Ambulance Services 5,113 5, % 8,804 8, % ( 31) 42 SUB TOTAL: Other Acute 6,532 6, % 11,343 11, % GRAND TOTAL: ACUTE 97,669 99,383 1,714 ( 312) 1,166 1% 193, ,898 ( 153) 3,089 2% 3, Page 13 of 18

166 30 November 2016 Agenda Item No 6 (c) Appendix 1c: Detailed breakdown of activity based acute contracts Reported Contract Position to Month 6 Forecast as Reported at Annual Finance Month 4 Activity Budget Actual Variance Adjustment Revised Variance Budget Forecast Adjustment Variance Variance Movement Point of Delivery (POD) Annual Plan Actual Variance % 000s 000s 000s 000s 000s % 000s 000s 000s 000s % 000s 000s A&E 75,824 37,604 38, % 5,493 5, % 11,087 11, % 126 ( 85) All other (PbR excluded, non activity services) 11,867 11,562 ( 305) ( 117) ( 422) (4%) 23,807 23,005 ( 7) ( 809) (3%) ( 825) 16 Elective: inpatients and day cases 19,613 9,855 9,582 (273) (3%) 9,897 9,423 ( 474) 0 ( 474) (5%) 19,713 18,878 0 ( 835) (4%) ( 658) ( 177) Non-elective admissions 22,609 11,196 12,330 1,134 10% 18,129 19,618 1, ,489 8% 36,596 39, ,785 8% 2, Outpatients 148,170 74,414 71,822 (2,592) (3%) 9,811 9,487 ( 324) 0 ( 324) (3%) 19,515 19,017 ( 22) ( 520) (3%) ( 194) ( 326) Excess bed days 10,695 5,354 7,775 2,421 45% 1,155 1, % 2,308 3, % SALFORD ROYAL NHS FOUNDATION TRUST Total ,352 57, ( 117) 818 1% 113, ,549 ( 29) 1,494 1% 1,559 ( 65) A&E 11,557 5,802 6, % % 1,212 1, % 26 0 All other (PbR excluded, non activity services) 2,805 3, % 5,442 6,379 ( 132) % Elective: inpatients and day cases 3,878 1,935 1,925 (10) (1%) 2,024 2,007 ( 17) 2 ( 15) (1%) 4,053 4,005 0 ( 48) (1%) 172 ( 220) Non-elective admissions 8,404 4,208 4,020 (188) (4%) 6,715 6,330 ( 385) 218 ( 167) (2%) 13,356 13,210 0 ( 146) (1%) ( 117) ( 29) Outpatients 39,807 19,913 18,048 (1,865) (9%) 3,021 2,661 ( 360) 0 ( 360) (12%) 6,051 5,431 0 ( 620) (10%) ( 486) ( 134) Excess bed days 1, % % % CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST Total ,331 15,086 ( 245) 221 ( 24) 0% 30,433 30,679 ( 132) 114 0% 448 ( 334) A&E 10,500 5,265 5,239 (26) (0%) ( 24) 0 ( 24) (4%) 1,177 1,128 0 ( 49) (4%) ( 35) ( 14) All other (PbR excluded, non activity services) 1,091 1, ( 342) 37 3% 2,180 2, % 490 ( 438) Elective: inpatients and day cases 2,559 1,284 1,238 (46) (4%) 1,086 1,037 ( 49) 0 ( 49) (5%) 2,164 2,065 0 ( 99) (5%) ( 109) 10 Non-elective admissions 6,142 3,080 2,924 (156) (5%) 3,842 3,525 ( 317) ( 31) ( 348) (9%) 7,660 7, % ( 470) 477 Outpatients 23,467 11,780 12, % 1,013 1, % 2,019 2, % 162 ( 27) Excess bed days 1, (96) (14%) ( 22) 0 ( 22) (15%) ( 47) (16%) ( 39) ( 8) BOLTON NHS FOUNDATION TRUST Total ,772 7, ( 372) ( 338) -4% 15,499 15,498 0 ( 1) 0% ( 1) 0 A&E 6,182 3,100 2,914 (186) (6%) ( 16) 0 ( 16) (5%) ( 31) (5%) ( 25) ( 6) All other (PbR excluded, non activity services) ( 154) 0 ( 154) (31%) ( 207) (21%) ( 196) ( 11) Elective: inpatients and day cases (11) (3%) ( 19) 0 ( 19) (5%) ( 38) (5%) ( 48) 10 Non-elective admissions 2,915 1,478 1,307 (171) (12%) 1,822 1,564 ( 258) ( 37) ( 295) (16%) 3,598 3,129 0 ( 469) (13%) ( 468) ( 1) Outpatients 7,407 3,718 3, % % % ( 12) 16 Excess bed days % % % PENNINE ACUTE HOSPITALS NHS TRUST Total ,494 3,111 ( 384) ( 37) ( 421) -12% 6,932 6,265 0 ( 667) -10% ( 710) 43 Page 14 of 18

167 30 November 2016 Agenda Item No 6 (c) Reported Contract Position to Month 6 Forecast as Reported at Annual Finance Month 4 Activity Budget Actual Variance Adjustment Revised Variance Budget Forecast Adjustment Variance Variance Movement Point of Delivery (POD) Annual Plan Actual Variance % 000s 000s 000s 000s 000s % 000s 000s 000s 000s % 000s 000s A&E % % % 14 2 All other (PbR excluded, non activity services) % % 28 7 Elective: inpatients and day cases % % 1,248 1, % ( 67) 102 Non-elective admissions (25) (9%) ( 37) ( 7) ( 44) (8%) 1,143 1,022 0 ( 121) (11%) ( 130) 9 Outpatients 6,591 3,328 4,369 1,041 31% % % Excess bed days (12) (9%) ( 2) 0 ( 2) (8%) ( 5) (8%) ( 40) 35 UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FOUNDATION TRUST Total ,637 1, ( 7) % 3,298 3, % A&E (14) (13%) ( 0) 0 ( 0) (1%) % 2 ( 2) All other (PbR excluded, non activity services) % % 65 7 Elective: inpatients and day cases % % % 91 ( 59) Non-elective admissions % % ( 12) (3%) ( 30) 18 Outpatients 1, , % % % 14 9 Excess bed days % % % ( 3) 6 WRIGHTINGTON WIGAN AND LEIGH NHS FOUNDATION TRUST Total , % 1,840 1, % 139 ( 21) A&E % % % 3 1 All other (PbR excluded, non activity services) % % Elective: inpatients and day cases (33) (30%) ( 24) 0 ( 24) (29%) ( 43) (26%) ( 46) 3 Non-elective admissions % % % ( 16) 41 Outpatients 1, (17) (2%) % % 3 2 Excess bed days % % % 12 ( 3) WARRINGTON AND HALTON HOSPITALS NHS FOUNDATION TRUST Total % 1,445 1, % ( 30) 77 A&E % % % ( 3) 5 All other (PbR excluded, non activity services) % % Elective: inpatients and day cases (0) (3%) % ( 5) (13%) ( 10) 5 Non-elective admissions % ( 8) 0 ( 8) (16%) ( 11) (12%) ( 31) 20 Outpatients (10) (5%) % ( 1) (2%) ( 5) 4 Excess bed days % % % 0 0 STOCKPORT NHS FOUNDATION TRUST Total % % ( 37) 57 Page 15 of 18

168 30 November 2016 Agenda Item No 6 (c) Reported Contract Position to Month 6 Forecast as Reported at Annual Finance Month 4 Activity Budget Actual Variance Adjustment Revised Variance Budget Forecast Adjustment Variance Variance Movement Point of Delivery (POD) Annual Plan Actual Variance % 000s 000s 000s 000s 000s % 000s 000s 000s 000s % 000s 000s A&E % % % 0 0 All other (PbR excluded, non activity services) ( 19) 0 ( 19) (14%) ( 45) 0% ( 43) ( 2) Elective: inpatients and day cases 2,355 1,178 1, % 2,683 3, % 5,366 6, ,252 23% 1,301 ( 49) Non-elective admissions % % % 0 0 Outpatients 16,417 8,209 11,340 3,131 38% 787 1, % 1,574 2, % 651 ( 18) Excess bed days % % % 0 0 OAKLANDS ,603 4,658 1, ,055 29% 7,206 9, ,841 26% 1,909 ( 69) Outpatients 5,642 2, (1,856) (66%) ( 230) 0 ( 230) (58%) ( 461) (58%) ( 444) ( 16) Care UK ( 230) 0 ( 230) -58% ( 461) -58% ( 444) ( 16) All other (PbR excluded, non activity services) % % % 31 ( 17) Elective: inpatients and day cases 1, % % % Outpatients 2,274 1,137 1,080 (57) (5%) ( 3) 0 ( 3) (2%) ( 5) (2%) ( 6) 1 Spa Medica % 1,114 1, % All other (PbR excluded, non activity services) % 3 2 ( 1) 0 ( 1) -33% ( 2) (33%) ( 3) 2 Elective: inpatients and day cases (21) (42%) ( 37) 0 ( 37) -42% ( 50) (28%) ( 132) 82 Outpatients (40) (16%) ( 1) 0 ( 1) -7% ( 3) (7%) ( 9) 7 Spire Healthcare ( 40) 0 ( 40) -35% ( 54) -24% ( 144) 90 All other (PbR excluded, non activity services) (17) (59%) 13 4 ( 9) 0 ( 9) -68% ( 10) (37%) ( 12) 2 Elective: inpatients and day cases (97) (80%) ( 40) 0 ( 40) -62% ( 78) (61%) ( 68) ( 10) A&E % 8 8 ( 1) 0 ( 1) -8% ( 1) (8%) 0 ( 2) Non-elective admissions % ( 17) 0 ( 17) -49% ( 37) (51%) ( 23) ( 14) Outpatients % % % 6 ( 2) Excess bed days % % ( 0) LANCASHIRE TEACHING HOSPITALS NHS FOUNDATION TRUST ( 64) 0 ( 64) -47% ( 121) -45% ( 96) ( 26) A&E 105,880 52,692 53, % 7,116 7, % 14,324 14, % 108 ( 101) All other (PbR excluded, non activity services) 16,756 17, ( 459) 20 0% 33,437 33,556 ( 131) ( 12) (0%) 354 ( 366) Elective: inpatients and day cases 32,287 16,191 16,110 (81) (0%) 17,824 17, % 35,571 35, % 456 ( 268) Non-elective admissions 41,497 20,668 21, % 31,778 32, % 63,774 65, ,021 3% 1, Outpatients 254, , ,396 (1,416) (1%) 16,130 15,805 ( 325) 1 ( 324) (2%) 32,146 31,660 ( 22) ( 508) (2%) ( 80) ( 428) Excess bed days 13,742 6,880 9,800 2,920 42% 1,533 2, % 3,062 4, % TOTAL ACTIVITY BASED SECONDARY CARE CONTRACTS ,137 92,615 1,478 ( 312) 1,166 1% 182, ,126 ( 153) 2,660 1% 2,693 ( 33) Page 16 of 18

169 30 November 2016 Agenda Item No 6 (c) Appendix 2: Detail of Committed Developments as at end of October 2016 Revised Planned Commitments 000 Business Planning Rules Recurrent 1% for mandated non recurrent reserve 4,014 Financial Planning guidance - 0.5% contingency 2,112 Additional contingency required to cover acute contracts over performance 890 Greater Manchester risk share 460 7,476 Committed Expenditure Innovation fund 1,027 Winter Planning 118 Children's Services Joint Reviews 150 GP extended opening 300 CAMHS Transformation 479 Transformation Fund 3,284 Other -13 5,345 Anticipated allocations -1,070 CURRENT COMMITTED DEVELOPMENTS 11,751 Undercommitted reserves 807 TOTAL 12,558 Page 17 of 18

170 30 November 2016 Agenda Item No 6 (c) Appendix 3: Detail of Better payment practice code performance Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Cumulative NHS Volume % % % % 99.60% % % 99.94% Value % % % % % % % % Non NHS Volume 99.73% % 99.63% 98.63% 98.96% 98.07% 97.34% 98.96% Value 99.96% % 99.43% 99.96% 98.52% 99.79% 99.22% 99.58% Total Volume 99.80% % 99.73% 99.05% 99.13% 98.62% 98.21% 99.24% Value 99.99% % 99.87% 99.99% 99.70% 99.97% 99.86% 99.91% Page 18 of 18

171 30 th November 2016 Agenda Item No 6 (d) NHS SALFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING AGENDA ITEM NO 6 (d) Item for Information 30 November 2016 REPORT OF: Kirstine Farrer Head of Innovation and Research DATE OF PAPER: 30 November 2016 SUBJECT: Innovation and Research Strategy IN CASE OF QUERY PLEASE CONTACT: STRATEGIC PRIORITIES: Quality Community Based Care Integrated Care In Hospital Care Long Term Conditions and Mental Health Effective Organisation Kirstine Farrer Head of Innovation and Research Please tick w hich strategic priorities the paper relates to: PURPOSE OF PAPER This paper provides a 6 month progress report on the implementation of the research and innovation strategy

172 30 th November 2016 Agenda Item No 6 (d) Further explanatory information required HOW WILL THIS BENEFIT THE HEALTH AND WELL BEING OF SALFORD RESIDENTS OR THE CLINICAL COMMISSIONING GROUP? By providing a framework to use innovation and research to help inform the commissioning decisions and therefore the health and wellbeing of the Salford population. WHAT M AY ARISE AS A RESULT OF THIS PAPER? HOW CAN THEY BE MITIGATED? None WHAT EQUALITY-RELATED RISKS MAY ARISE AS A RESULT OF THIS PAPER? HOW WILL THESE BE MITIGATED? None DOES THIS PAPER HELP ADDRESS ANY EXISTING HIGH OR EXTREME RISKS FACING THE ORGANISATION? IF SO WHAT ARE THEY AND HOW DOES THIS PAPER REDUCE THEM? No PLEASE DESCRIBE ANY POSSIBLE CONFLICTS OF INTEREST ASSOCIATED WITH THIS PAPER. None PLEASE IDENTIFY ANY CURRENT SERVICES OR ROLES THAT M AY BE AFFECTED BY ISSUES WITHIN THIS PAPER: Footnote: Innovation is a core value for NHS Salford Commissioning Group therefore it will impact across all areas of care planning and delivery. Every CCG has a statutory duty to engage in research. Members of NHS Salf ord Clinical Commissioning Group Governing Body w ill read all papers thoroughly. Once papers are distributed no amendments are possible.

173 30 th November 2016 Agenda Item No 6 (d) Document Development Public Engagement Process Yes No (Please detail the method ie survey, event, consultation) Clinical Engagement (Please detail the method ie survey, event, consultation) Has due regard been given to Equality Analysis (EA) of any adverse impacts? (Please detail outcomes, including risks and how these will be managed) Legal Advice Sought Presented to the Clinical Commissioning Group Presented to the Health and Wellbeing Board Presented to the Integrated Commissioning Board Presented to any other groups or committees, including Partnership Groups (Please specify in comments) x x x Not Applicable x x x Comments and Date (i.e. presentation, verbal, actual report) Yes Governing Body Outcome Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work. Page 3 of 7

174 30 th November 2016 Agenda Item No 6 (d) 1 Executive Summary Research and Innovation Strategy This paper outlines the progress of the implementation of the Innovation and Research Strategy for Overall good progress has been made to date with the 2016/17 agreed milestones. The milestones are divided into two areas: a series of overarching actions for internal CCG use along with agreed milestones for external research and innovation organisations. Specific actions related to each organisation are outlined in the strategy. 2 Introduction and Background 2.1 The Innovation and Research Strategy was approved at Governing Body in May The strategy outlines a 3 year ambition with agreed milestones for 2016/17; progress against the agreed milestones is outlined. The Innovation and Research Oversight Group continues to meet monthly to oversee the 2016/17 action plan, regular updates are provided to Commissioning Committee on a bimonthly basis. 3 Implementation of the Research and Innovation Strategy 3.1 The strategy has six main objectives: To identify and prioritise local commissioning health services research topics and coordinate this work with Health Innovation Manchester, Manchester Academic Health Science Centre (MAHSC), NWeH, Manchester Academic Health Science Network (MAHSN), Manchester Clinical Research Network (CRN), Haelo, Collaboration for Leadership in Applied Health Research and Care (CLAHRC), NIHR, industry and other stakeholders. To develop the evidence base in relation to models of commissioning to ensure the approach to commissioning services is based on best evidence and effectiveness. To increase research capabilities amongst NHS Salford CCG staff to use research and quality improvement methods to utilise the outcomes of research, thereby increasing the quality of care and treatment commissioned. To ensure the inclusion of patients in setting priorities for research and participation in the design, delivery, and dissemination of research. To promote the ideal that every patient coming into the NHS is offered an opportunity to take part in research. To increase the availability of information on current and completed research and outcomes to the public.

175 30 th November 2016 Agenda Item No 6 (d) 4 Achievement of the 2016/17 Milestones to date 4.1 The following research milestones have been achieved: Appointment of an individual at board level with a responsibility for research The Chief Accountable Officer leads on research and innovation. Ensure engagement with all external research and innovation organisations to share the strategy The Head of Innovation and Research and the Director of Quality and Innovation have both ensured all partner and commissioned research and innovation organisations have received a copy of the strategy. This has been received positively by all stakeholders and other Greater Manchester CCG s have requested a copy of the strategy. Annual Research prioritisation exercise completed at the NHS Salford CCG members event and engagement with clinical leads. The priorities were diabetes, cardiovascular disease, and mental health. Promote best practice in the handling, use and sharing data by providers when commissioning services and developing innovation bids a robust system is in place to ensure all governance arrangements are in place regarding patient/resident data. All innovation bids are screened to identify the need for a personal impact assessment. CLAHRC have also run two evaluation workshops for successful innovation bids in October 2016 which included data handling. Develop a process to ensure Excess Treatment Costs are managed within 60 days of submission all requests for Excess Treatment Costs are screened by the following individuals: The Head of innovation and research: The Lead GP for innovation and research: The Head of medicines optimisation; The Head of service improvement; and the Director of Quality and Innovation. Ensure a robust process for cascading research findings in partnership with the CRN, Salford R+D and Salford CCG communications team this is work in progress as there are a couple of areas to address; how to engage the general public in Salford to engage with research and receive the research findings (Salford Citizen Project and Friends of MAHSC) and then the need for a more robust conduit from academia into CCG regarding new research findings which may influence commissioned pathway

176 30 th November 2016 Agenda Item No 6 (d) 4.2 The following innovation milestones have been achieved: Commission evaluations as part of the innovation process Centre of Local Economic Strategies (CLES) and the Centre for Leadership and Applied Health Research and Care (CLAHRC) have both been commissioned to conduct evaluations in 2016/17. CLES have completed their evaluation of the 1M innovation fund (third sector and schools). This evaluation included a positive review of the tripartite approach to innovation between Salford CVS, NHS Salford CCG and Salford City Council. the launch event was held in September CLAHRC are conducting a qualitative research project to explore the impact of various initiatives on general practices in Salford designed to relieve pressure on practices e.g. workforce development and practice pharmacists. Promoting workforce education and training in innovation, research and using quality improvement methods to build on and develop the processes and structures for routinely accessing relevant evidence including research evidence appraisals, service evaluation and grey literature to inform service redesign and commissioning policy. Haelo have completed the breakthrough series on medication safety with 8 practices in Salford. Shaping Health International has delivered the productive general practice programme for 24 practices. A CCG team completed the Haelo improvement science for academics course in 2016, their project focused on improving access in primary care in Pendleton. Another CCG team have commenced the Haelo Improvement Science for Leaders programme flu fighting Broughton Believers. Haelo continue to be the lead innovation organisation to deliver the Safer Salford strategy across the City. TRUSTECH and the innovation team have completed the call for digital and technology innovations, 124 applications were submitted, 22 shortlisted and invited to a marketplace event before the final stage a Dragons Den panel gave the final 6 an opportunity to pitch their project. The panel consisted of consisted of TRUSTECH members, AHSN member and core CCG executive team members as well as coopted strategy group members. Details of the successful bids are outlined in appendix 1, the bids are: Guardian Angel Project Salford Active Walk Salford CTZN App

177 30 th November 2016 Agenda Item No 6 (d) Improving Pharmacy Communications The successful bids will be announced in early December Recommendations 5.1 NHS Salford Clinical Commissioning Group Governing Body is asked to: Note the progress to date on the implementation of the Research and Innovation Strategy. Kirstine Farrer Head of Innovation and Research

178 Appendix 1 1 Executive Summary Digital & Tech Innovation Fund Decisions The purpose of this paper is to update the group on the Digital and Tech Innovation Fund Dragon s Den event & outcome, and to seek discussion and approval regarding which bids should be awarded innovation funding. 2 Introduction and Background 2.1 The final stage of the Digital & Tech Innovation Fund process (Dragon s Den) event was held on 31st October The event was organised in collaboration with Trustech and gave the final 6 applicants the opportunity to pitch their project to a CCG panel of Dragons consisting of core members and co-opted strategy group members. 2.2 The session consisted of a 10 minute pitch by each applicant, followed by 25 minutes of questions from the panel members. The panel comprised core dragons and co-opted dragons representing potential sponsoring groups. 2.3 The final six applications were presented at the event. 3 Dragon s Den summary 3.1 In summary the panel agreed the following: Guardian Angel Project- supported by Engagement & Experience, fits with strategic priorities (ageing well and falls prevention) links to Locality theme Age Well and contributes to the transformation programme around older people and the metrics linked to reducing NEL's and A&E attendances. Technology is sufficiently developed for project to begin immediately. The project is a collaboration with Salix homes, which have up to 200 potential participants, with further contacts through the work with the Humphrey Booth Housing Charity. The applicants understood the target audience, and have already considered alternative funding streams to be explored at the end of the innovation funding. There is a proportion of the budget allocated for engagement. In terms of social value it will look at social engagement with Alzheimer s Society, dementia cafes and Age UK. Applicants are confident that ROI will be demonstrated by a reduction in admissions. The applicants are also applying for various grants and funding streams, and exploring opportunities through the Medical Council & Innovate UK. They are undertaking a pilot with MRC to look at 10 frail people using Kinect. The panel recommended the project for funding. Philips Home Monitoring- the panel had reservations that the project was very similar to CareCall which is currently being commissioned, and therefore did not recommend for innovation funding. Closercare- the focus was narrow (COPD & HF), heavily dependent upon CCG/clinical input to identify patients and onward clinical referral pathway had not been identified. The project was not recommended for innovation funding. Salford Active Walk- supporting group LTC, links to locality theme Live Well, contributes to improving population health and should impact our aspirations around better management and delaying the onset of long term conditions. Although dependent upon a smartphone the applicants have explored alternative delivery methods. Low income patients can be identified Page 1 of 2

179 Appendix 1 through local knowledge, post code areas and linking into local community champions. Social Value through engagement with 3 rd sector bodies are exactly the groups who can be helpful in knowing the local population and in recruiting patients. Points earned can also be donated back to community projects. Patient data is maintained through a secure encrypted server. This is agreed with the patient at sign up and no data is shared with outside agencies. The panel felt that this could be scaled and recommended the project for innovation funding, with reserve to enable the project to explore more local incentives scheme. Salford CTZN App- supporting group Children & Young People, links to the locality theme Start Well and should impact on improving the mental wellbeing of young people, therefore fits with our agenda around mental health. Panel assured that safeguarding policies in place, applicants already engaged with schools and the project fits closely with Children & Young People strategic priorities. Social Value- Eejay asked what the rationale was behind starting the program with year 9 students, and Gary Lovatt replied saying that year 9 has been identified as a pivotal year when behavioural patterns change due to the variety of pressures the students face. Students work through the tools to help them at this difficult time which could then be applied in other aspects of their lives. The project was recommended for innovation funding. Improving Pharmacy Communications- supporting group Medicines strategy group & links to the Medication Safety and handover themes that are core components of our Safer Salford work stream. This is one of the enablers outlined in the locality plan. The East Lancs scheme shows 60 hospital admissions saved over a 6-month period. The panel had reservations around the 30k evaluation costs and recommended alternative evaluation is explored by the applicants. Concerns over patient confidentiality and issues that some patients may not want the full discharge summary sharing with the pharmacy were responded to by assurance that each patient will be consented to confirm they agree how much information they agree to sharing. The project excluding evaluation costs was recommended for innovation funding. 5 Recommendations 5.1 The NHS Salford Clinical Commissioning Group Exec Team is asked to approve the four applications for innovation funding: Guardian Angel Project Salford Active Walk Salford CTZN app Improving Pharmacy Communications A financial summary for the above bids are recommended for approval. Tina Dixon Senior Manager Innovation & Improvement Page 2 of 2

180 Date of Meeting 30 th November 2016 Agenda Item No 7 (a) NHS SALFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING AGENDA ITEM NO 7 (a) Item for Information 30 th November 2016 REPORT OF: Chair of the Commissioning Committee DATE OF PAPER: 14 th November 2016 SUBJECT: Commissioning Committee Report IN CASE OF QUERY PLEASE CONTACT: STRATEGIC PRIORITIES: Quality Community Based Care Integrated Care In Hospital Care Long Term Conditions and Mental Health Karen Proctor Director of Commissioning Please tick w hich strategic priorities the paper relates to: Effective Organisation PURPOSE OF PAPER: This is a report from the Salford Clinical Commissioning Group s Commissioning Committee, which is a formal Committee reporting to the CCG s Governing Body. The Committee was previously referred to as the Programme Management Group (PMG). The report s purpose is to provide assurance relating to commissioning programmes, outlining key decisions made by the Committee and seeks, as appropriate, ratification of commissioning decisions. The NHS Salford Clinical Commissioning Group Board is asked to: - note the content of the report, including decisions made by the Commissioning Committee in September, October and November 2016.

181 Date of Meeting 30 th November 2016 Agenda Item No 7 (a) Further explanatory information required HOW WILL THIS BENEFIT THE HEALTH AND WELL BEING OF SALFORD RESIDENTS OR THE CLINICAL COMMISSIONING GROUP? The Commissioning Committee oversees the organisation s commissioning activities aimed at delivering the organisation s strategic priorities. WHAT RISKS M AY ARISE AS A RESULT OF THIS PAPER? HOW CAN THEY BE MITIGATED? N/A WHAT EQUALITY-RELATED RISKS MAY ARISE AS A RESULT OF THIS PAPER? HOW WILL THESE BE MITIGATED? N/A DOES THIS PAPER HELP ADDRESS ANY EXISTING HIGH OR EXTREME RISKS FACING THE ORGANISATION? IF SO WHAT ARE THEY AND HOW DOES THIS PAPER REDUCE THEM? N/A PLEASE DESCRIBE ANY POSSIBLE CONFLICTS OF INTEREST ASSOCIATED WITH THIS PAPER. Conflicts of interest are inherent for the Commissioning Committee as clinical members are also providers of services. Items with particular material conflicts of interest are highlighted in the report. PLEASE IDENTIFY ANY CURRENT SERVICES OR ROLES THAT MAY BE AFFECTED BY ISSUES WITHIN THIS PAPER: N/A Footnote: Members of NHS Salford Clinical Commissioning Group Governing Body w ill read all papers thoroughly. Once papers are distributed no amendments are possible.

182 Date of Meeting 30 th November 2016 Agenda Item No 7 (a) Process Yes No Public Engagement (Please detail the method i.e. survey, event, consultation) Clinical Engagement (Please detail the methods i.e. survey, event, consultation) Has due regard been given to Equality Analysis (EA) of any adverse impacts? (Please detail outcomes, including risks and how these will be managed. managed) Document Development Not Applicable Comments and Date (i.e. presentation, verbal, actual report) Commissioning programmes include public engagement as appropriate Clinical chair of the Commissioning Committee presents the report. The Committee includes all Governing Body clinicians. Commissioning programmes undertake EIAs as appropriate Outcome Legal Advice Sought Presented to the Commissioning N/A Committee Presented to the Health and Wellbeing Board Presented to the Integrated Commissioning Joint Committee Presented to any other groups or committees, including Partnership Groups (Please specify in comments) Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work. Page 3 of 9

183 Date of Meeting 30 th November 2016 Agenda Item No 7 (a) 1 Executive Summary Commissioning Committee Report This report summarises the Commissioning Committee s business during September, October and November The report includes the following business, with further details in the next sections. Strategic planning and commissioning decisions: Received a report on the Children and Young Peoples Strategy Review covering 0-25 year olds in Salford. Considered a report detailing the NHS Operational Planning and Contract Requirements for Noted a report on Social Value across Salford. Received an update on Urgent, Scheduled and Cancer Performance and Work Programmes. Considered an update report provided by the Economic Use of Resource (EUR) Team. Noted a report on the Community Based Care Group.* Considered a report detailing the 6 Clinical Priority Areas for the CCG. Received a report on the Children and Young Peoples Commissioning Group (CYPCG) regarding commissioning arrangements. Noted with an update on the Breast Service. Agreed recommendations from the Children s and Young Peoples Commissioning Group (CYPCG) regarding medicines management. Received a report regarding Long Term Conditions. Quality & Safety: Received a quality report in relation to St Anne s Hospice. Agreed a report on the signing off of Quarter 1 Commissioning for Quality and Innovation (CQUIN) payments. Considered a report detailing the lessons to be learnt from incidents which have taken place within services commissioned by the CCG. Noted an update on Safeguarding arrangements across the city. Received a report on quality assurance of providers. Received a verbal report on the Greater Manchester Quality Surveillance Group (GMQSG). Received a report on Safer Salford. Finance and Contracting: Received a report on Primary Care Prescribing Budget Performance and Pressures.* Partnership Reports: Endorsed a report on the Economic Value of investments for Salford Community and Voluntary Services. Received a copy of the Service and Financial Plan (SAFP) Phase 3 document. Page 4 of 9

184 Date of Meeting 30 th November 2016 Agenda Item No 7 (a) Received a verbal update on the work being undertaken by the Integrated Adult Health and Social Care Commissioning Joint Committee (ICJC). Sub-group updates: Received a report detailing the proposed changes to the Primary Care Quality Group (PCQG).* The Commissioning Committee received a copy of the minutes from the Clinical Standards Board held on 4 th August The Governing Body is asked to note the content of this report, including decisions made by the Commissioning Committee in September, October and November in * As a GP-led organisation, conflicts of interest are not entirely avoidable. To help manage such conflicts openly, items marked with an asterisk indicate where there have been commissioning decisions or significant discussions that represent a conflict of interest between the commissioning and provider roles of clinical members of the Commissioning Committee. The Commissioning Committee manages all conflicts of interests in line with the CCG s Conflict of Interest Policy. 2 Introduction and Background 2.1 The Commissioning Committee is a formal reporting Committee of the Clinical Commissioning Group (CCG) Governing Body, to which it is accountable. 2.2 This report summarises the Committee s business during September, October and November 2016, which involved four meetings. Its purpose is to provide assurance relating to the CCG s commissioning programmes, outlining key decisions made and seeking, if appropriate, ratification of commissioning decisions. 2.3 This report covers the Committee s business under the following headings: Strategic planning and commissioning decisions; Quality & safety; Finance and contracting; Partnership reports; and Sub group updates. 3 Strategic Planning and Commissioning Decisions 3.1 The Commissioning Committee received a report on the Children and Young Peoples Strategy. The scope of the work includes the 0-25 strategy such as the CAMHS review, including the Albion Pilot around aspirations for young people. Oversight for the work was carried out by the Local Authority and the wider Public Health Team. The report refers to the achievable and long term aims that are being explored such as the pilot projects which are underway, as well as the attainment and achievement of school children in particular at the end of Key Stage 2. A report was received regarding the work of the Children s and Young Peoples Commissioning Group (CYPCG) in which it was approved for the Medicines Page 5 of 9

185 Date of Meeting 30 th November 2016 Agenda Item No 7 (a) Management Team to explore the various options in relation to the provision and supply of Healthy Start Vitamins. 3.2 The Commissioning Committee received a report which detailed the requirements of the NHS Operational Planning and Contracting Guidance , noting the arrangements in place to develop the CCG s pooled budget, contracts, operational plans and supporting business plans. 3.3 The Commissioning Committee considered a report on Social Value and noted the progress made during against the CCG s Sustainable Development Plan and Social Value Pledge. The Commissioning Committee noted the Salford Social Alliance joint framework for Social Value for The Commissioning Committee considered and endorsed the CCG s Social Value pledge and 10% BETTER commitments for The Commissioning Committee received a report on Urgent, Scheduled, Cancer Performance and Work Programmes. Information was provided on the work of Salford Royal NHS Foundation Trust (SRFT) as taking the lead in relation to trauma, stroke and high risk surgery across the North West Sector of Healthier Together. Accident and Emergency activity figures were considered in light of the standalone assessment area also located at SRFT. Information was provided as to the funding which has been made available for the Salford locality for winter pressures. The cancer targets were discussed and comparisons were made available as to the national benchmarking data. 3.5 A paper was provided to the Commissioning Committee regarding the Economic Use of Resource (EUR) Team for consideration of changes to the policies and procedures for service provision. The IVF Policy has been reworded to make it clearer for applicants to understand their eligibility for funding. The Commissioning Committee approved the following EUR Policy recommendations: Trophic Electrical Stimulation (TES) for Facial Palsy Functional Electrical Stimulation (FES) for Foot Drop Ultrasound and Pulsed Electromagnetic Systems (PES) for bone healing Facet Joint Injections for neck and back pain Radiofrequency Denervation for neck and back pain 3.6 A report was received regarding the work of the Community Based Care Group. The report referred to the implementation of the Salford Standard and the expectation placed on primary care providers to achieve particular domains within the Standard. The Commissioning Committee accepted that some changes will be considered and implemented prior to 1 st April It was noted that the CCG are investing the highest proportion of funding in primary care than any other CCG in Greater Manchester. The Commissioning Committee are exploring the community service requirements in line with the locality plan as well as a potential gap analysis approach to see what services are required within Salford due to changes to the current commissioning arrangements with providers. Page 6 of 9

186 Date of Meeting 30 th November 2016 Agenda Item No 7 (a) 3.7 The Commissioning Committee considered a report on the 6 Clinical Priority Areas for the CCG. The Commissioning Committee recommended building on the work of Making Safety Visible in addition to targeting key groups of the population. Collaborative working is to commence with the work led by Public Health at the Local Authority which links into Salford s Locality Plan. A further recommendation included a deep dive such as exploring patients notes to establish any trends or patterns that exist. The Commissioning Committee considered the stocktake and in particular commented on the gaps and opportunities to improve outcomes and performance for Cancer and Maternity. 3.8 A verbal update was provided to the Commissioning Committee as to the current subcontracting arrangements in place for the Breast Service between SRFT and the University Hospital of South Manchester (UHSM). 3.9 The Commissioning Committee received a report regarding the work of the Long Term Conditions Group. The report detailed changes to the anti-coagulant services as well as the NHS England Assurance Data which CCGs are required to submit. The report also highlighted the work of the Better Care Fund to support the programmes of the Long Term Conditions Group. 4 Quality and Safety 4.1 The Commissioning Committee received a quality report in relation to St. Anne s Hospice. The Committee agreed that St. Anne s Hospice performance and quality information should be reviewed by the Service and Financial Group moving forward, which will be in line with other small contracts. 4.2 A report was received to the Commissioning Committee on the signing off of Quarter 1 Commissioning for Quality and Innovation (CQUIN) payments. The report considered the CQUINs for SRFT, Greater Manchester West Mental Health NHS Foundation (GMW) and Oaklands Hospital. The Commissioning Committee signed off the Quarter 1 CQUIN report and noted the proposed changes to CQUIN s for 2017/ The Commissioning Committee considered a report detailing the lessons to be learnt from incidents which have taken place within services commissioned by the CCG. It was noted as to the effectiveness of Quality Walk Arounds which are conducted by the CCG and are seen to demonstrate good practice. The Commissioning Committee noted the assurance that a review of incidents is actively used to drive improvement in commissioned services. 4.4 A report was received regarding the safeguarding arrangements across the City. The Commissioning Committee discussed as to how it planned to replace the GP Safeguarding Lead for Children as it is mandatory requirement for the CCG to have someone in post. 4.5 The Commissioning Committee received a report on the quality assurance of providers. The paper was received in light of the Care Quality Commission (CQC) Page 7 of 9

187 Date of Meeting 30 th November 2016 Agenda Item No 7 (a) Inspection of Pennine Acute Hospital Trust (PAHT). This was particularly relevant for patients from the Higher Broughton area of Salford who access services out of North Manchester General Hospital (NMGH) which is part of PAHT. 4.6 A verbal update was received by the Commissioning Committee regarding the Greater Manchester Quality Surveillance Group (GMQSG). The report contained an update on the proposed changes to the GMQSG s governance arrangements. 4.7 The Commissioning Committee received a progress report on the Safer Salford Programme. The report detailed the work taking place between the CCG and partner organisations including SRFT and General Practices. 5 Finance and Contracting 5.1 The Commissioning Committee receives regular CCG finance reports and reports from the Commissioned Services Quality Group. 5.2 The Commissioning Committee received a report on Primary Care Prescribing Budget Performance and Pressures. The CCG agreed to work closely with colleagues at NHS England for advice and support on this matter. 6 Partnership Reports 6.1 The Commissioning Committee received a report on the Economic Value of investments into Salford Community and Voluntary Sector. It was noted that the reported estimated that for every 1 of investment, there was the equivalent of 7.04 in social value. A summary report was issued by the Communications Team at the launch event on 17 th October. The Commissioning Committee had agreed a further 3 million of funding, starting from April The Commissioning Committee received a copy of the Service and Financial Plan (SAFP) Phase 3 document which was also approved by the Integrated Adult Health and Social Care Commissioning Joint Committee (ICJC), including the Local Authority. The document referred to the implementation of the plan that includes maintaining the existing Older Peoples integrated care work. 6.3 A verbal update was provided to the Commissioning Committee as to the work undertaken thus far by the Integrated Adult Health and Social Care Commissioning Joint Committee (ICJC). The verbal update also included the work of the Advisory Board as well as the support currently being provided by the Kings Fund across both the CCG and Local Authority. Page 8 of 9

188 Date of Meeting 30 th November 2016 Agenda Item No 7 (a) 7 Sub-group Updates 7.1 The Commissioning Committee received a report which provided an overview of the proposed changes to the Primary Care Quality Group (PCQG) which will now become a sub-group of the Primary Care Commissioning Committee (PCCC). A review of the PCQG s Terms of Reference (TOR) was agreed, with the aim of this review to make the functioning of the group as effective as possible and to ensure clear separation between the PCQG and the Primary Care Operational Group. The proposed changes to the PCQG have already been approved at the PCCC. 7.2 The Commissioning Committee received a copy of the minutes from the Clinical Standards Board (CSB) which was held on 4 th August The remit and expectations of the CSB were discussed and noted. 8 Recommendations 8.1 The NHS Salford Clinical Commissioning Group Governing Body Board is asked to note the content of the report, including decisions made by the Commissioning Committee in September, October and November Dr Jeremy Tankel Chair of the Commissioning Committee Salford Clinical Commissioning Group Page 9 of 9

189 Date of Meeting 30 th November 2016 Agenda Item No 7 (b) NHS SALFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING AGENDA ITEM NO 7 (b) Item for Information 30 November 2016 REPORT OF: Co-Chair of the Integrated Adult Health and Social Care Commissioning Joint Committee (ICJC) DATE OF PAPER: 16 th November 2016 SUBJECT: IN CASE OF QUERY PLEASE CONTACT: STRATEGIC PRIORITIES: Quality Community Based Care Integrated Care Integrated Adult Health and Social Care Commissioning Joint Committee (ICJC) Report Karen Proctor Director of Commissioning Please tick w hich strategic priorities the paper relates to: In Hospital Care Long Term Conditions and Mental Health Effective Organisation PURPOSE OF PAPER: This is a report from the Integrated Adult Health and Social Care Commissioning Joint Committee (ICJC), which is a formal Joint Committee of the CCG s Governing Body and Salford City Council. The report s purpose is to provide assurance relating to the Committee s responsibility for the Service and Financial Plan for Adults and Older People s Services. The Committee has responsibility for all matters relating to the Adult Health and Social Care Pooled Budget as set out in the Section 75 formal partnership agreement between commissioners of both Salford CCG and Salford City Council. The NHS Salford Clinical Commissioning Group Board is asked to: - note the content of the report, including decisions made by the Integrated Adult Health and Social Care Commissioning Joint Committee in September and October 2016.

190 Date of Meeting 30 th November 2016 Agenda Item No 7 (b) Further explanatory information required HOW WILL THIS BENEFIT THE HEALTH AND WELL BEING OF SALFORD RESIDENTS OR THE CLINICAL COMMISSIONING GROUP? The ICJC oversees commissioning activities aimed at delivering both organisations strategic priorities in relation to the services included in the pooled budget for adult health and care services. WHAT RISKS M AY ARISE AS A RESULT OF THIS PAPER? HOW CAN THEY BE MITIGATED? N/A WHAT EQUALITY-RELATED RISKS MAY ARISE AS A RESULT OF THIS PAPER? HOW WILL THESE BE MITIGATED? N/A DOES THIS PAPER HELP ADDRESS ANY EXISTING HIGH OR EXTREME RISKS FACING THE ORGANISATION? IF SO WHAT ARE THEY AND HOW DOES THIS PAPER REDUCE THEM? N/A PLEASE DESCRIBE ANY POSSIBLE CONFLICTS OF INTEREST ASSOCIATED WITH THIS PAPER. Conflicts of interest are inherent for the ICJC as clinical members are also providers of services. Items with particular material conflicts of interest are highlighted in the report. PLEASE IDENTIFY ANY CURRENT SERVICES OR ROLES THAT MAY BE AFFECTED BY ISSUES WITHIN THIS PAPER: N/A Footnote: Members of NHS Salf ord Clinical Commissioning Group Governing Body w ill read all papers thoroughly. Once papers are distributed no amendments are possible.

191 Date of Meeting 30 th November 2016 Agenda Item No 7 (b) Process Yes No Public Engagement (Please detail the method i.e. survey, event, consultation) Clinical Engagement (Please detail the methods i.e. survey, event, consultation) Has due regard been given to Equality Analysis (EA) of any adverse impacts? (Please detail outcomes, including risks and how these will be managed. managed) Document Development Not Applicable Comments and Date (i.e. presentation, verbal, actual report) Commissioning programmes include public engagement as appropriate Clinical chair of the Commissioning Committee presents the report. The Committee includes Governing Body clinicians. Commissioning programmes undertake EIAs as appropriate Outcome Legal Advice Sought Presented to the Commissioning N/A Committee Presented to the Health and Wellbeing Board Presented to the Integrated Commissioning Joint Committee Presented to any other groups or committees, including Partnership Groups (Please specify in comments) Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work. Page 3 of 6

192 Date of Meeting 30 th November 2016 Agenda Item No 7 (b) Integrated Adult Health and Social Care Commissioning Joint Committee (ICJC) Report 1 Executive Summary This report summarises the ICJC s business during September and October The report includes the following business, with further details in the next sections. Strategic planning and commissioning decisions: Received a presentation and report on the work of the Salford Mental Health Services. A report was received regarding the Service and Financial Plan (SAFP) Phase 3. Quality & Safety: Received a copy of the Quality and Outcome Group Meeting minutes and a report which detailed the Key Performance Indicators (KPIs) as well as other significant national performance measures. Finance and Contracting: Received a Finance Report on the pooled budget arrangements. Noted a copy of the Integrated Care Organisation (ICO) Dashboard. Partnership Reports: Received a report on the Greater Manchester Transformation Fund. A copy of the minutes from the Integrated Care Advisory Board (ICAB) of 27 th September 2016.* The Governing Body is asked to note the content of this report, including decisions made by the ICJC in September and October * As a GP-led organisation, conflicts of interest are not entirely avoidable. To help manage such conflicts openly, items marked with an asterisk indicate where there have been ICJC decisions or significant discussions that represent a conflict of interest between the commissioning and provider roles of clinical members of the ICJC. The ICJC manages all conflicts of interests in line with the Conflict of Interest Policies of Salford CCG and Salford City Council. 2 Introduction and Background 2.1 The ICJC is a formal Joint Committee of the Clinical Commissioning Group (CCG) and Salford City Council. This report summarises the Committee s business during September and October 2016, which involved two meetings. Its purpose is to provide Page 4 of 6

193 Date of Meeting 30 th November 2016 Agenda Item No 7 (b) assurance relating to the Service and Financial Plan for Adults and Older People s Services. The Committee has responsibility for all matters relating to the Adult Health and Social Care Pooled Budget as set out in the Section 75 formal partnership agreement between commissioners of both Salford CCG and Salford City Council. 2.2 This report covers the Committee s business under the following headings: Strategic planning and commissioning decisions; Quality & safety; Finance and contracting; and Partnership reports 3 Strategic Planning and Commissioning Decisions 3.1 The ICJC received a presentation and report on the Salford Mental Health Services. The presentation explained the collaborative work taking place across Greater Manchester which had commenced prior to the announcement of the devolved health and social care budget for the region. The joint working covers both CCGs and Local Authorities across Greater Manchester with 32 key areas of work including suicide prevention. 3.2 The presentation also included an overview of how mental health services impact on the 5 Year Forward View for Mental Health and the General Practice Forward View. The commissioning arrangements currently in place with Greater Manchester West Mental Health NHS Foundation Trust (GMW) were also highlighted, such as significant areas of performance such as the Improving Access to Psychological Therapies (IAPT) which has seen joint working with Greater Manchester Police (GMP). A pilot has been developed whereby a Registered Mental Health Nurse will be based within the Police Service. Further work is being explored such as deflecting calls from the North West Ambulance Service (NWAS) as well as Accident and Emergency presentation and admissions to Salford Royal NHS Foundation Trust (SRFT). Work is under way with the intention of the Integrated Mental Health Team to develop service specifications to align with service delivery for the 2017/18 contracts for mental health services across Salford. 3.3 The ICJC were updated on the Salford Integrated Care Programme for Adults Service and Financial Plan (2016/ /21) Phase 3, which included the proposed list of domains and workstreams for the plan. The ICJC were provided with the next steps to deliver and report on the plan. This Programme also forms part of Salford Locality Plan. 4 Quality and Safety 4.1 The ICJC received a copy of the Quality and Outcome Group Minutes as well as a report which detailed the Key Performance Indicators (KPIs) as well as other significant national measures including Accident and Emergency (A&E) targets. Specific performance data for Salford Royal NHS Foundation Trust (SRFT) was Page 5 of 6

194 Date of Meeting 30 th November 2016 Agenda Item No 7 (b) provided such as the number of cancelled appointments including the reason for them being cancelled. 4.2 The ICJC received a copy of the quality visits schedule planned over the coming months. Elected Members have been invited to join the CCG as part of the quality visits to services which are within the remit of the Integrated Care Organisation (ICO). 5 Finance and Contracting 5.1 The ICJC received a finance report to update on the current budgetary pressures associated with the pooled budget arrangements. The anticipated overspends have also taken into account the scheduled contingency which operates within the pooled budget arrangements. 5.2 A paper provided to the ICJC delivered an overview of the performance information collated following input from the three Business Intelligence Teams across the partner organisations of Salford CCG, Salford City Council and SRFT who were asked to prepare their information for inclusion into the dashboard. All of the indicators used within the report come from routine data collections for each of the partner organisations. 6 Partnership Reports 6.1 The ICJC received a report on the Greater Manchester Transformation Fund which included an update on the work of the Advisory Board s remit and governance arrangements of the 18.2 million from the Greater Manchester Health and Social Care Partnership. The ICJC noted the particular risks which have been identified within the pooled budget arrangements. 6.2 A copy of the minutes from the inaugural meeting of the Integrated Care Advisory Board (ICAB) were provided to the ICJC. The Terms of Reference (TOR) have been agreed which sets out the responsibility of the ICAB. Also, the importance of General Practice provider membership on the ICAB was noted. The terminology used for the TOR is to be amended to reflect agreed changes to the membership representation from SRFT. 7 Recommendations 7.1 The NHS Salford Clinical Commissioning Group Governing Body Board is asked to: - note the content of the report, including decisions made by the ICJC in September and October Dr Jeremy Tankel Co-Chair of Integrated Adult Health and Social Care Joint Committee Salford Clinical Commissioning Group Page 6 of 6

195 30 November 2016 Agenda Item No 7 (c) NHS SALFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING AGENDA ITEM NO 7 (c) Item for Information 30 November 2016 REPORT OF: Chair of CCG Audit Committee DATE OF PAPER: 14 th November SUBJECT: CCG Audit Committee Update IN CASE OF QUERY PLEASE CONTACT: STRATEGIC PRIORITIES: Quality Ms Elaine Vermeulen, Deputy Chief Finance Officer Please tick w hich strategic priorities the paper relates to: Community Based Care Integrated Care In Hospital Care Long Term Conditions and Mental Health Effective Organisation PURPOSE OF PAPER: This paper updates the NHS Salford Clinical Commissioning Group Governing Body Board on decisions and risks identified at the last Audit Committee meeting held on 3 rd November (Please see further explanatory requirements overleaf)

196 30 November 2016 Agenda Item No 7 (c) Further explanatory information required HOW WILL THIS BENEFIT THE HEALTH AND WELL BEING OF SALFORD RESIDENTS OR THE CLINICAL COMMISSIONING GROUP? Provides assurance that controls are effective. WHAT RISKS M AY ARISE AS A RESULT OF THIS PAPER? HOW CAN THEY BE MITIGATED? None. WHAT EQUALITY-RELATED RISKS MAY ARISE AS A RESULT OF THIS PAPER? HOW WILL THESE BE MITIGATED? None. DOES THIS PAPER HELP ADDRESS ANY EXISTING HIGH OR EXTREME RISKS FACING THE ORGANISATION? IF SO WHAT ARE THEY AND HOW DOES THIS PAPER REDUCE THEM? Summarises the work of the Audit Committee around controls assurance. PLEASE DESCRIBE ANY POSSIBLE CONFLICTS OF INTEREST ASSOCIATED WITH THIS PAPER. None. PLEASE IDENTIFY ANY CURRENT SERVICES OR ROLES THAT MAY BE AFFECTED BY ISSUES WITHIN THIS PAPER: None. Footnote: Members of NHS Salf ord Clinical Commissioning Group Governing Body w ill read all papers thoroughly. Once papers are distributed no amendments are possible.

197 30 November 2016 Agenda Item No 7 (c) Document Development Process Yes No Not Applicable Comments and Date (i.e. presentation, verbal, actual report) Outcome Public Engagement (Please detail the method ie survey, event, consultation) X Clinical Engagement (Please detail the method ie survey, event, consultation) Has due regard been given to Equality Analysis (EA) of any adverse impacts? (Please detail outcomes, including risks and how these will be managed) Legal Advice Sought Presented to the Commissioning Committee. Presented to the Health and Wellbeing Board Presented to the Integrated Commissioning Board Presented to any other groups or committees, including Partnership Groups (Please specify in comments) X X X X X X This report is a summary of the meeting of the CCG Audit Committee. Minutes of the previous meeting were approved by the CCG Audit Committee. Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work.

198 30 November 2016 Agenda Item No 7 (c) 1 Executive Summary Audit Committee Update This report details the main issues arising from the CCG Audit Committee Meeting held on 3 rd November The Governing Body is asked to note the contents of this report and the assurances provided. The Governing Body is asked to note the recommendation which was made to the Governing Body, and subsequently approved at the Emergency Powers Governing Body Meeting on 9 th November 2016, in which the CCG ratified the appointment of Grant Thornton UK LLP as the CCG s External Auditor from 1 st April Audit Committee Minutes 2.1 The minutes of the meeting held on 1 st September 2016 were approved. 3 Matters Arising 3.1 The log of outstanding matters arising was reviewed and progress noted. 4 Reports Presented to the CCG Audit Committee 4.1 Cyber Security 4.2 The Head of Information Management and Technology provided a report which detailed the CCG s governance arrangements, in addition to the support and advice taken from NHS Digital s Cyber Security Lead. Reference was made to the National Caldicott Guardian and the update provided in July The Audit Committee noted the assurance detailed in the report which provides assurance to the Governing Body. The Audit Committee noted the actions in place to monitor and maintain cyber security and receive 6 monthly reports on actions listed in the summary table to ensure progress is being made. 4.3 Conflict of Interest Guardian 4.4 The Head of Governance and Policy reported that approval was given by the Governing Body in September 2016 as to EV s appointment as the CCG s Conflict of Interest Guardian. She added that a national consultation is under way which the CCG has responded to. The CCG completed the selfcertification submission in relation to Conflicts of Interest in October The online national conflict of interest training has now been delayed until 2017/18.

199 30 November 2016 Agenda Item No 7 (c) 4.5 External Audit Update 4.6 The Audit Director from Grant Thornton reported that it was fairly early in the 2016/17 Cycle, and an Audit Plan will be presented in February External Audit Procurement 4.8 Representatives from Grant Thornton were asked to leave the room and were not present during this item of the agenda. The Deputy Chief Finance Officer advised as to the recommendation which was reached following the procurement exercise on behalf of the seven Greater Manchester CCGs who took part. The Audit Committee Chair had supported the process as a member of the panel. The Audit Panel concluded that Grant Thornton UK LLP should be appointed, with the Audit Committee Chair providing an overview of the process and how the decision and recommendation had been reached. The Audit Committee recommended the appointment of Grant Thornton UK LLP as external auditors from 1 st April 2017 to the Governing Body for approval. A subsequent meeting of the Governing Body was held on 9 th November 2016 under Emergency Powers in which the approval was given to appoint Grant Thornton as the CCG s External Auditor from 1 st April Internal Audit 4.10 The Audit Manager from Mersey Internal Audit referred to the Progress Report and the Salford Standard review which is with the CCG s Management Team for finalising. The revised Conflict of Interest (COI) process is being embedded, with an update on this area of work due in February 2017 following the new NHS England guidance Review of Progress of Audit Committee Recommendations Report 4.12 The Deputy Chief Finance Officer reported on the revised format which details those actions which were closed within the last period. The Audit Committee agreed to close the recommended actions, which left six recommendations open. A further progress report on these areas will be provided to the Audit Committee in February Presentation of the Gifts and Hospitality Register 4.14 The Head of Governance and Policy advised that the process has been updated since the last register in September This is the final format of this nature as any new Gifts and Hospitality will now come under the revised Conflicts of Interest Policy which was approved by the Governing Body in September She advised that the register only applies to those who have direct interaction with the CCG such as an employee or a Committee Member. The Audit Committee noted the register of all entries of Gifts and Hospitality reported to the Senior Committee Support Officer.

200 30 November 2016 Agenda Item No 7 (c) 4.15 Approval of Amendments to the Scheme of Reservation and Delegation 4.16 The Deputy Chief Finance Officer advised that there have been no changes made to the Scheme of Reservation and Delegation since the Audit Committee meeting on 1 st September Recommendations 5.1 The NHS Salford Clinical Commissioning Group Governing Body is asked to note the contents of this report and the assurances provided. 5.2 The CCG s Governing Body is asked to note the recommendation which was made to the Governing Body, and subsequently approved at the Emergency Powers Governing Body Meeting on 9 th November 2016, in which the CCG ratified the appointment of Grant Thornton UK LLP as the CCG s External Auditor from 1 st April Mr Edward Vitalis Chair of the Audit Committee

201 Minutes of NHS Salford Clinical Commissioning Group Primary Care Commissioning Committee (PCCC) 26 th September 2016, 10:30-12:00Hrs in the Salford Suite, St James s House, Salford Present: Mr Brian Wroe (BW) Mr Steve Dixon (SD) Mrs Karen Proctor (KP) Mr Anthony Hassall (AH) Mrs Delana Lawson (DL) Dr Jenny Walton (JW) Sara Roscoe (SR) In Attendance: Mr Harry Golby (HG) Mrs Anna Ganotis (AG) Mr David Dobson (DD) Mrs Sam Glynn-Atkins (SGA) Emma Reid (ER) Lauren Smith (LS) Part I Chair, Lay Member for Engagement, Salford CCG Chief Finance Officer, Salford CCG Director of Commissioning, Salford CCG Chief Accountable Officer, Salford CCG Chief Officer, Healthwatch Salford GP Neighbourhood Lead, Salford CCG Head of Primary Care Transformation, NHS England Head of Service Improvement, Salford CCG Head of Service Improvement, Salford CCG Senior Committee Support Officer, Salford CCG Service Improvement Manager, Salford CCG Planning and Performance Manager, Salford CCG Senior Service Improvement Officer, Salford CCG Apologies: Mr Paul Newman (PN) Miss Siobhan Farmer (SF) Mrs Francine Thorpe (FT) Lay Member, Salford CCG Consultant in Public Health (representative for the Health and Wellbeing Board), attending on behalf of Mr David Herne Salford City Council Director of Quality and Innovation, Salford CCG 1. Welcome and Introductions 1.1 BW introduced the remit of the Primary Care Commissioning Committee followed by introductions by members of the Committee. 2. Declarations of Interest 2.1 No formal declarations of interest were made. 3. Minutes of the last Meeting and Action Log of 11 th July The minutes were agreed as a true and accurate reflection of the meeting. 3.2 HG advised that recruitment is still taking place to the new Clinical Pharmacist Team. However, Jason Farrow from the CCG s Medicines Optimisation Team is carrying out one session a week at Ellenbrook Medical Centre until the mobilisation of the new Clinical Pharmacy Team is complete. Therefore this action is now closed. Primary Care Joint Commissioning Meeting 26 th September 2016 Part 1 Page 1 of 9

202 3.3 SD advised that Action No. 4 is now complete as detailed within his update provided on the Action Log. 4. Matters Arising 4.1 AH provided an update in relation to Section 9.2 that the new Refuah development will accommodate Dr Levenson s Practice from early October 2016, with Dr Davis Practice and Newbury Green Medical Practice already based within the Centre. 5. Community Based Care 5.1 Salford Medical Practice HG expressed the CCG s condolences of the sad news of Dr Rahman s sudden death in August BW expressed the Committee s gratitude to all the staff affected. HG advised that the paper is for a decision which is based upon specific guidance from NHS England. HG reported that an interim Alternative Provider Medical Services (APMS) contract has been put in place with Dr Salim (Salford Medical Centre 1). The contract will remain in place until 30 th November 2016 to provide care to the patients of the late Dr Rahman. HG reported that there are three options available to the CCG, with one being procurement of a new contract for the patient list, whereas the remaining two options relate to list dispersal. HG emphasised the importance of patient choice through this process. The recommendation of the paper is for managed list dispersal BW highlighted the importance of patient choice as to the provider of their primary medical care through the process. HG advised that letters were sent out to the patients concerned who were given the right to express their views. DL referred to the letters that were sent to patients in which only five responses were received. She enquired as to whether the practice Patient Participation Group (PPG) had been involved? HG advised that the CCG wrote to the PPG Chair. He then referred to the letters which were sent to patients and advised that the first letter provided an overview. The second letter invited patients to contact the CCG. This was felt appropriate due to the volume of calls which the practice had received following the initial letter to patients DL enquired how patient opinion had been considered in the options appraisal. DL offered the assistance of Healthwatch to help out in the future for any correspondence such as letters to ensure the wording used by the CCG is clear to patients. She emphasised the importance of different ways to engage with patients other than by letter. HG provided an overview in relation to safe service and making considerations clear as detailed in the first and fourth criteria of the options appraisal. DL suggested that in future the CCG should consider having specific scoring criteria on the options appraisal which takes into consideration the views of patients. Primary Care Joint Commissioning Meeting 26 th September 2016 Part 1 Page 2 of 9

203 5.1.4 JW expressed concerns over the GMS contract regulations which stipulate that the contract is ceased seven days after the death of a single handed contractor and the challenges facing practices in similar situations. She suggested that this case should be shared with other practices from a lessons learnt perspective. AH advised that the challenges facing the contract has resulted in difficulties which the CCG tried as best as possible to deal with, based upon the constraints and guidance from NHS England. He reported on the ways to support other single handed general practices in Salford, in which support is to be provided by the CCG with Salford and Trafford Local Medical Committee (LMC) jointly. He added that key lessons for both the CCG and NHS England following these extremely difficult circumstances will also be considered. BW requested the CCG completes a lessons learnt review, with particular focus on the seven day termination. Action: KP and colleagues will complete a lessons learnt review in relation to the termination of primary medical care contracts KP enquired as to whether the three prescribed options were contractually the only available. HG advised that this was correct, with the CCG having no discretion on this. SR confirmed this was the case as detailed within the GMS contract. AH enquired as to what action would be taken by the CCG in the event of the decision being for a managed list dispersal. HG advised that the first method of communication would be by letter, but the CCG would also take up the offer and use the support of Healthwatch. AG highlighted that patients who have a high level of need may require additional support with registering with a new GP practice. HG highlighted the high number of ghost patients, who appear to have been historically registered at the practice, but their whereabouts, are currently unknown. AG advised that Trafford CCG recently undertook a managed list dispersal and that Salford CCG would use lessons learnt following this process ER referred to Section of the report in which four patients wanted an option which wasn t available as part of the decision making process. BW enquired as to whether the patients who responded would be contacted following the conclusion of the decision making process? HG advised that this may not be possible if returning details were not collected for each telephone call. SD enquired as to how the CCG obtains assurance that affected patients have been supported, in particular those most vulnerable. HG advised that the intention is for a cut-off point after a certain period, e.g. 12 months. He advised that consideration needs to be made for the implications associated with the prospective receiving general practices. HG advised that updates following this decision will be given via the Primary Care Operations Group The Primary Care Commissioning Committee noted the contents of the paper and approved the recommendation to implement Option 3 Managed List Dispersal, in line with the outcome of the options appraisal. Primary Care Joint Commissioning Meeting 26 th September 2016 Part 1 Page 3 of 9

204 5.2 The Height General Practice Procurement Briefing Paper AG advised of the decision made in July 2015 to re-procure APMS contract at the Height General Practice. She reported that the work was placed on hold due to insufficient capacity within the Commissioning Directorate of the CCG, however, managerial capacity has now been identified and a project team is now in place. The current APMS contract is due to expire at the end of March AG advised that the recommendation of the paper is to ask permission for a twelve month extension, subject to agreement with the current service provider. Section 3 of the report was highlighting as to the commissioning considerations of this proposal. AH enquired as to whether there are any current quality concerns with this practice? AG advised that none had been highlighted. AH also enquired as to whether there was a reason why the CCG wouldn t consider a 6 month extension. It was explained that the project group had felt that a 6 month extension would mean a tight timeframe for procurement; whereas 12 months would allow more leeway. AH requested that a risk assessment should be made by the project team as to the most appropriate course of action SD advised that there was no mention of finance in the paper. If the contract was to be under a GMS contract, on which nearly all Salford GP surgeries are under, the cost of the service would be approximately 200,000 cheaper. JW enquired as to what the contract constitutes to warrant the additional expense. SD advised that this is simply the core contract value based on the numbers of patients listed at the practice. KP advised of her recollection from July 2015 of which one option was for allowing the Committee to consider allowing the contract to run out and then carry out a managed list dispersal for the practice. HG advised of the challenges that this option would present, such as the list size of the Height General Practice is twice the size of Dr Rahman s, also with fewer practices within the local community SD highlighted that the PCCC is considering three decisions papers, of which a similar set of circumstances is being considered. SD added that there is a need for a clear set of principles, such as sufficient workforce in General Practice and resources for future items. JW believed that the use of principles would allow for consistency in the decision making process A discussion took place as to considering the paper s recommendations. AH said that he felt unable to reaffirm the July 2015 decision to re-procure without understanding the pros and cons of the different options available to the CCG. It was agreed that a supplementary paper would be circulated to voting members of the Committee to allow for a decision to be made The Primary Care Commissioning Committee noted the contents of the paper and agreed to make a decision outside of the meeting as to whether to progress with the July 2015 decision to procure. The Primary Care Commissioning Committee noted the planned commissioning approach. Primary Care Joint Commissioning Meeting 26 th September 2016 Part 1 Page 4 of 9

205 5.3 Expanding Capacity AG provided an overview of the paper which included the population prediction and trends expected within the Ordsall Ward, as well as the potential commissioning options available to the PCCC. She advised that there is sufficient capacity in the north of the Ward, however Ordsall Health Surgery which primarily services the south of the ward do not have additional capacity to absorb the new residents moving in to the area. AG reported that the outcome of the options appraisal was a recommendation to expand the capacity at Ordsall Health Surgery by utilising community service rooms within the same building AG reported that a response had been received from Ordsall Health Surgery who had fed back that there was a risk that if community services were to be moved out of the building and not re-provided locally, then vulnerable patients may be disadvantaged. The practice also noted that the speed with which community services could be moved out of the current health centre should not be underestimated and that the branch surgery option may open up the possibility for more creative working. AG highlighted that it was important to note that there was only a ten point difference between a branch surgery option and the option to expand the Ordsall Health Surgery. The plan is to review impact of the population growth in two years time to assess whether the expansion option provides enough additional capacity. This will also be important given that the demographic increases are expected to be residents who are young and transient and may not even register at a local GP practice AH queried whether there was any existing primary care provision on Salford Quays. AG confirmed that there is currently no primary care provision on the Quays area of the Ordsall Ward SD stated that there was some confusion mixing up estates and workforce capacity. He said that whilst it was determined that there was the capacity of physical estates in the north of the Ordsall ward, there was a risk that there may not necessarily be the staffing and workforce capacity. SD referred to the example provided by Trinity Medical Practice who referred to the need to recruit one whole time equivalent general practitioner in order to take on two thousand additional patients. AH advised that the strategy on primary care workforce is being presented to this Wednesday s CCG Governing Body Meeting DL advised that she was pleased to see the Patient Participation Group involvement in the process. However, DL believed it would have been beneficial to list the feedback in the appendices. AH stated that the concerns related to the relocation of the community services and the implications attached to this need to be established. SD advised that Lance Burn Medical Practice is the nearest health centre within half a mile of the Ordsall Ward which could be considered for housing SRFT s community services as they have additional estates capacity. It was agreed that there should be a caveat that the recommended option should only be progressed if there was assurance that the community services could be re-housed locally. BW Primary Care Joint Commissioning Meeting 26 th September 2016 Part 1 Page 5 of 9

206 requested an update at the January 2017 meeting. AH commended the outstanding quality of the three Community Based Care papers. Action: SD to formally update on the Estates Extended Capacity at the PCCC Meeting in January The Primary Care Commissioning Committee agreed to Option 2 to Expand Current Local Provision (with the expectation that it will provide at least a 5 10 year solution) and passed to the Salford Strategic Estates Group for implementation, with the caveat that only if the community services can be rehoused locally. The Primary Care Commissioning Committee agreed to the scale and impact of population growth in Ordsall is reviewed in two years time and the need for a branch surgery is re-considered at that point. 6 Primary Care Commissioning Committee Functions 6.1 Primary Care Commissioning Committee Workplan AG presented the Primary Care Commissioning Workplan with an overview of the calendar of business over the coming months. KP advised that there will be a need to cross reference the new national planning guidance into the workplan. 6.2 Primary Care Commissioning Committee Risk Register AG advised that a Risk Register Workshop was held in conjunction with ER. ER advised that the risk report provided is not a bespoke risk register for Primary Care Commissioning; she explained that risks contained within the report were actually being managed and monitored through other programme risk registers but have been categorised as the PCCC risks allow generation of this report for the purpose of oversight and scrutiny by this group. It was noted that Risk Number PR.IC.02 requires update as reference is made to Salix Healthcare. Action: ER to update the CCG s Risk Register in relation to Salix Healthcare A discussion took place as to how the risk reports should be presented to the meeting. It was agreed that red risks and those that have increased should come to each meeting. The full risk register would then be presented twice a year The Primary Care Commissioning Committee reviewed the draft Risk Register and provided suggestions for amendments and additions. The Primary Care Commissioning Committee considered the frequency of which they would wish to receive the risk register for oversight and scrutiny at committee meetings. Primary Care Joint Commissioning Meeting 26 th September 2016 Part 1 Page 6 of 9

207 6.3 Primary Care Quality KP provided an overview of the Primary Care Report in the absence of FT. KP reported on the proposed changes to the CCG s reporting mechanisms which would be in shadow form if agreed, then formally operational from November 2016 when the CCG s constitution is reviewed. This would involve the reporting of the Primary Care Quality Group moving from the Commissioning Committee to the Primary Care Commissioning Committee. SD queried why the governance chart in Appendix 1 included Salford Primary Care Together. KP agreed that this would be updated. She also advised that this item would also be discussed within the CCG s Commissioning Committee to obtain their support for the proposal. AG queried the frequency of reports from the Primary Care Quality Group. It was agreed that update reports would come to each Primary Care Commissioning Committee The Primary Care Commissioning Committee noted the contents of this paper and supported the recommendations made in relation to Section 6 which refer to the changes to the terms of reference and the change to move the Primary Care Quality Group to become accountable to the Primary Care Commissioning Committee. 6.4 Primary Care Commissioning Committee Training AG advised that she had been made aware of some training available for Primary Care Commissioning Committees and an example agenda was attached to the meeting papers. She explained that the training would consist of a three hour training session. KP advised that she was aware of the success of the service provider, but pointed out that the proposed training doesn t focus on the strategic areas in relation to population and commissioner decision making. AH believed that the training would be valuable to carry out, but requesting that the invitation is extended to Governing Body Members as well to support their understanding of the CCG s responsibilities for the commissioning of primary care services. 7 Performance 7.1 Primary Care Finance Report SD advised that the Primary Care Finance Report is to the month ending August He gave an overview of the content of the report SD reported that the core GMS and PMS contracts are on trajectory with a forecast of a breakeven position. He added that additional funding from NHS England has been secured to bridge the risk in year. The risks specifically relate to the primary care delegated functions. The challenges of invoicing for services with NHS tenants year on year is showing a difference. SD emphasised that this is a national issue, whereby not only Salford CCG Primary Care Service providers are affected. Primary Care Joint Commissioning Meeting 26 th September 2016 Part 1 Page 7 of 9

208 7.1.3 SD reported upon the locally commissioned services such as the Salford Standard. He advised that the CCG recognised early that not all practices would achieve all the Salford Standard Key Performance Indicators (KPIs). SD advised that an estimated 50% achievement is expected by general practices against the Salford Standard KPIs. However, if over 50% then there will be financial implications to the primary care budget. SD emphasised that the CCG can only accommodate 50-60% achievement within the current financial envelope and anticipated trajectories SD reported on the emerging overspend on prescribing which is estimated in the region of 700,000. He advised that the cost of specific drugs have increased, primarily surrounding the Care Home Practice in which drugs have increased in cost by up to 100% in some cases. SD reported upon the challenges facing the CCG with being unable to address the drug company price increases. He advised of the work of the Greater Manchester Medicines Management Group, Greater Manchester Finance Group and the Greater Manchester Health and Social Care Partnership which will aim to influence any negotiation at a national level between NHS England and drug companies. SD reported upon the costs associated with the oral-anticoagulant drugs The Primary Care Commissioning Committee noted the contents of the report. 8 Minutes/Reports of Partnership Boards/Sub Committees 8.1 Primary Care Operational Group Report HG advised that the Operational Group has met three times since the last PCCC Meeting. He highlighted some significant issues to be brought to the attention of the PCCC. He advised that the contract holder who had been convicted of fraud had now removed themselves from the partnership, therefore this matter is now closed. HG referred to the decision made to recommission SRFT to provide the Care Homes Practice contract. HG reported that the business case for extended access for evening and weekend working had been approved and that a procurement process is being planned. SD noted that in relation to the extended access enhanced service, there has been a low uptake from practices across Salford. HG advised that this is correct AH noted that Salford is the worst performing CCG in the North of England for the work in registering patients for online services. SD reported that this matter will be raised with the Salford Information Management and Technology Group which is being held tomorrow. AG advised that the matter was also raised at the Neighbourhood Group Meetings and the Practice Manager Forums. SR reported that there are also national publications of data surrounding this area of work. BW asked that an update on actions being taken to improve performance comes to the November committee meeting. Action: SD to provide an update on Patient Online access at the PCCC Meeting in November Page 8 of 9 Primary Care Joint Commissioning Meeting 26 th September 2016 Part 1

209 8.1.3 The Primary Care Commissioning Committee noted the contents of the report. 9 Reflection 9.1 BW referred to the lessons which can be learnt from the Primary Care Commissioning Committee discussions during today s meeting, with reference to the challenges faced by the CCG for the commissioning of General Practice services. He believed that meaningful and effective communication with patients and partners is essential to support this area of work. He highlighted that the committee is becoming forward thinking; with the proactive work to anticipate population growth in Ordsall. Primary Care Joint Commissioning Meeting 26 th September 2016 Part 1 Page 9 of 9

210 30 November 2016 Agenda Item No 7 (e) NHS SALFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING AGENDA ITEM NO 7 (e) 30 November 2016 Item for Assurance REPORT OF: Chief Accountable Officer DATE OF PAPER: 14 November 2016 SUBJECT: Executive Team Report IN CASE OF QUERY PLEASE CONTACT: STRATEGIC PRIORITIES: Hannah Dobrowolska Director of Corporate Services Please tick w hich strategic priorities the paper relates to: Quality Community Based Care Integrated Care In Hospital Care Long Term Conditions and Mental Health Effective Organisation x PURPOSE OF PAPER: This is a report from the Salford Clinical Commissioning Group Executive Team Meeting, which is a formal committee reporting to the Governing Body. The report s purpose is to provide assurance relating to the functions undertaken by the Executive Team in line with the CCG s Constitution and the Executive Team Meeting s Terms of Reference. The report outlines key decisions made at the Executive Team Meetings and seeks, as appropriate, ratification of decisions. The NHS Salford Clinical Commissioning Group Governing Body is asked to: - note the content of the report, outlining the business undertaken through the Executive Team meetings in September and October note that for this period there are no decisions made by the Executive Team that require ratification by the Governing Body Page 1 of 8

211 30 November 2016 Agenda Item No 7 (e) Further explanatory information required HOW WILL THIS BENEFIT THE HEALTH AND WELL BEING OF SALFORD RESIDENTS OR THE CLINICAL COMMISSIONING GROUP? The Executive Team Meeting conducts the day to day operational business of the CCG, which allows the CCG to deliver against its Strategic Plan. WHAT RISKS M AY ARISE AS A RESULT OF THIS PAPER? HOW CAN THEY BE MITIGATED? N/A WHAT EQUALITY-RELATED RISKS MAY ARISE AS A RESULT OF THIS PAPER? HOW WILL THESE BE MITIGATED? N/A DOES THIS PAPER HELP ADDRESS ANY EXISTING HIGH OR EXTREME RISKS FACING THE ORGANISATION? IF SO WHAT ARE THEY AND HOW DOES THIS PAPER REDUCE THEM? N/A PLEASE DESCRIBE ANY POSSIBLE CONFLICTS OF INTEREST ASSOCIATED WITH THIS PAPER. Conflicts of interest are present for the GP members attending the Executive Team Meetings. These are inherent as clinical members are also providers of services. Any Conflicts of Interest are managed by the team in line with the CCG s policy. PLEASE IDENTIFY ANY CURRENT SERVICES OR ROLES THAT MAY BE AFFECTED BY ISSUES WITHIN THIS PAPER: N/A Footnote: Members of NHS Salf ord Clinical Commissioning Group Governing Body w ill read all papers thoroughly. Once papers are distributed no amendments are possible. Page 2 of 8

212 30 November 2016 Agenda Item No 7 (e) Document Development Process Yes No Not Applicable Comments and Date (i.e. presentation, verbal, actual report) Outcome Public Engagement (Please detail the method ie survey, event, consultation) Clinical Engagement (Please detail the method ie survey, event, consultation) Has due regard been given to Equality Analysis (EA) of any adverse impacts? (Please detail outcomes, including risks and how these will be managed) There are 2 GP members of the Executive Team who represent clinical views. Business conducted by the Executive Team involves EIAs as appropriate Legal Advice Sought Presented to the Programme Management Group Presented to the Health and Wellbeing Board Presented to the Integrated Commissioning Board Presented to any other groups or committees, including Partnership Groups This paper was shared with the CAO for comment. (Please specify in comments) Note: Please ensure that it is clear in the comments and date column how and when particular stakeholders were involved in this work and ensure there is clarity in the outcome column showing what the key message or decision was from that group and whether amendments were requested about a particular part of the work. Page 3 of 8

213 28 September 2016 Agenda Item No 7 (e) Executive Team Meeting Report 1 Executive Summary This report summarises the Executive Team Meeting s business. The Governing Body is asked to: - note the content of this report, outlining the business undertaken through the Executive Team meetings in September and October note that for this period there are no decisions made by the Executive Team that require ratification by the Governing Body 2 Introduction and Background 2.1 The Executive Team Meeting is a sub committee of the Clinical Commissioning Group (CCG) Governing Body, to which it is accountable. 2.2 This report summarises the business conducted at the Executive Team Meetings in line with the CCG s Constitution and the Executive Team Meeting s Terms of Reference. 2.3 The responsibilities of the Executive Team are: To oversee the day to day running of the organisation and therefore be responsible for a range of operational matters, including but not limited to: Human Resources, Communications Engagement Organisational development Financial management and those already mentioned Health, Safety and Risk IM&T including Information Governance Organisational Performance Continuing Healthcare (operational matters) Integrated Commissioning (operational matters) Safeguarding (operational matters) External commissioning support Strategic and operational estates planning Emergency planning, resilience and response To receive reports from the: Health Economy Resilience Group IM&T Programme Board Salford Strategic Estates Group To promote innovation in commissioned services and internal working practices. Page 4 of 8

214 28 September 2016 Agenda Item No 7 (e) To lead the development of governance frameworks with the CCG s principal partners to support the delivery of joint commissioning priorities To prioritise the business of the CCG to meet its annual objectives, providing the programme management framework and final decision making forum to enable realisation of the operational plan To provide assurances to the NHS Salford CCG in respect of their statutory requirements associated with day to day management of the organisation and its operations, including the development and management of corporate governance arrangements Where required, due to Conflict of Interest concerns, take decisions delegated to the Executive Team by other committees or groups of the CCG where the committee or group that would ordinarily take the decision cannot appropriately manage the Conflict of Interest concerns within its own membership. 3 Executive Team Meeting summaries September 2016 Noted a verbal update regarding the Greater Manchester Health and Social Care Partnership. Reviewed performance for the CCG s baseline position against the six clinical priority areas within the NHS England new CCG improvement and assessment framework September 2016 The Executive Team noted a verbal update regarding the Greater Manchester Health and Social Care Partnership and Salford Primary Care Together. The Executive Team discussed and agreed the proposed approach for planning for 2017/18, this will be further developed after national guidance is published next Tuesday and will also be the main item of the Executive Team Plus next week which involves the Executive Team and those who report directly to them. The Executive Team reviewed a paper relating to the future of a practice in Salford following the recent death of the single handed GP who was the contract holder for the practice, this will go to the Primary Care Commissioning Committee for decision. The Executive Team reviewed the Primary Care Workforce Strategy following comments from the Commissioning Committee and prior to approval at Governing Body later in September. The Organisational Performance and Risk Assurance Report for September s Governing Body meeting was also reviewed by the Executive Team. Page 5 of 8

215 28 September 2016 Agenda Item No 7 (e) September 2016 This meeting was one of the Quarterly Exec Team Plus meetings, which include the Executive Team and their direct reports. This wider group was briefed regarding the State of the City data, planning for 2017/18 and Salford Primary Care Together. There was a shared determination for the CCG to maximise its impact on reducing health inequalities. Colleagues were encouraged to undertake a free online course on the social determinants of health and to support work placements. The One You Fest was also discussed and staff encouraged to take part. The Executive Team noted an update report on Emergency Planning, Resilience and Response (EPRR) and agreed to include business continuity training within the mandatory training calendar. That afternoon s Healthier Together Committee in Common papers were discussed with support given to commit to an agreement regarding high risk elective general surgery which will be shared with providers as part of the CCG s commissioning intentions. The Executive Team reflected on a recent Integrated Commissioning Joint Committee meeting September 2016 The Executive Team noted a verbal update on the work of the Greater Manchester Health and Social Care Partnership and Association of Greater Manchester CCGs Governing Group (AGG) meeting. There was also discussion of a NE Sector HWBB. A verbal update on the Greater Manchester Shared Service (GMSS) was received this included news of the move of most GMSS staff to Oldham, the host CCG of GMSS. The Executive Team noted an update regarding planning, with particular discussion on the CQUIN requirements. A review paper on Covalent, the CCG s business management system, was discussed and agreement made to create a combined clinical leads access route due to low usage. A paper on Social Value was reviewed and proposals for action made prior to agreement by the Commissioning Committee. A Finance paper on corporate/running costs and the CCG s IM&T Board minutes were noted, the latter cover Information Governance, Primary Care and CCG elements. An HR/OD update report was received and a range of operational decisions made relating to the staff away day, mandatory training, recruitment, and training needs anaylsis October 2016 The Executive Team meeting was cancelled on 5 October due to other commitments of a number of members of the group. Page 6 of 8

216 28 September 2016 Agenda Item No 7 (e) October 2016 The Executive Team noted a verbal update on the work of the Greater Manchester Health and Social Care Partnership. The CCG s performance against the 6 Clinical Priority Areas (Cancer, Maternity, Diabetes, Dementia, Mental Health and Learning Disabilities) was discussed in detail with agreements about further work needed. The Executive Team agreed for the CCG to be part of a North West Streamlining Programme, this is work to improve various HR related elements such as recruitment and mandatory training. This would, for example, allow things such as people s DBS checks and mandatory training to transfer with them between different NHS organisations, thereby reducing duplication and cost. A temporary structure change, to 31 December 2017, was agreed within Corporate Services due to the new Joint Planning and Performance role October 2016 The Executive Team noted a verbal update on the work of the Greater Manchester Health and Social Care Partnership along with the monthly Association of Greater Manchester CCGs (AGG) infrastructure meeting summaries which provide an overview of various workstreams. The CCG s IM&T Board minutes were noted, these cover Information Governance, Primary Care and CCG elements. As part of this item, the Executive Team approved the recommendations in a paper on the Salford Integrated Record (SIR), namely a forward for SIR, including governance and consent matters. The Executive Team agreed the proposed approach around the Digital Innovation work, where following the successful market place 22 bids have been shortlisted down to six ahead of a Dragon s Den style event to choose the projects that will be funded. The Executive Team accepted the recommendations made following the recent admin review. The Executive Team agreed a process for agreeing a CCG response to the upcoming consultation regarding savings to be made by Salford City Council October 2016 The Executive Team meeting was cancelled on 26 October due to other commitments of a number of members of the group. Page 7 of 8

217 28 September 2016 Agenda Item No 7 (e) 4 Recommendations 4.1 The NHS Salford Clinical Commissioning Group Governing Body is asked to: - note the content of this report, covering Executive Team Meetings in September and October note that for this period there are no decisions made by the Executive Team that require ratification by the Governing Body Anthony Hassall Chief Accountable Officer Salford Clinical Commissioning Group Page 8 of 8

218 FINAL AGG MINUTES GM ASSOCIATION OF CCGs: Association Governing Group (AGG) 04 October :30-17:30 The Willows, AJ Bell Stadium Attendance: Trish Anderson (TA) NHS Wigan Borough CCG Wirin Bhatiani (WB) NHS Bolton CCG Philip Burns (PB) NHS South Manchester CCG Tim Dalton (TD) NHS Wigan Borough CCG Steve Dixon (SD) NHS Salford CCG (CFO Chair) Chris Duffy (left at 15:40) (CD) NHS Heywood, Middleton & Rochdale CCG Michael Eeckelaers (ME) NHS Central Manchester CCG Apologies: Ranjit Gill (RG) NHS Stockport CCG Denis Gizzi (left at 16:00) (DG) NHS Oldham CCG Nigel Guest (left at 15:22) Anthony Hassall (left at 15:00) (NG) (AH) NHS Trafford CCG NHS Salford CG Caroline Kurzeja (CK) NHS South Manchester CCG Melissa Laskey (ML) NHS Bolton CCG (HoC Chair) Gaynor Mullin (GMu) NHS Stockport CCG Stuart North (SN) NHS Bury CCG Paul Pallister (PP) NHS Tameside & Glossop CCG Kiran Patel (Chair) (KP) NHS Bury CCG Jo Purcell (JP) NHS North Manchester CCG Tom Tasker (TT) NHS Salford CCG Ian Williamson (arrived at 13:38) (left at 16:14) (IWi) NHS Central Manchester Simon Wootton (SW) NHS Heywood, Middleton & Rochdale CCG Alan Dow (AD) NHS Tameside & Glossop CCG Gina Lawrence (GL) NHS Trafford CCG Su Long (SL) NHS Bolton CCG Steve Pleasant (SP) NHS Tameside & Glossop CCG Martin Whiting (MW) NHS North Manchester CCG Ian Wilkinson (IW) NHS Oldham CCG In Attendance: Alison Bali (ABa) GM Association of CCGs (Minutes) Rob Bellingham (RB) Health & Social Care Reform Andrea Dayson (ADa) GM Association of CCGs Warren Heppolette (left at 15:00) (WH) Health & Social Care Reform Anna Coleman (AC) University of Manchester (Observer) Jon Rouse (arrived at 14:10) (left at 16:00) (JR) GM H&SCP Page 1 of 10

219 FINAL AGG MINUTES WELCOME & APOLOGIES FOR ABSENCE The Chair welcomed members to the meeting and introductions were made and apologies were noted. The Chair also extended a warm welcome on behalf of AGG to Trish Anderson on her return. 2. DECLARATION OF INTEREST Primary Care item for all GPs clinical chairs 3. MINUTES OF THE LAST MEETING The minutes of the last meeting were accepted as an accurate record. Review of Actions All to send written updates to AB Datawell SN will deliver updates in his IM&T SRO role Transformation Initiatives CFOs in terms of budgets SD will update at the next meeting as part of the CFO update. Collective assurance AD/WH to take this forward and report back to AGG. 4. CHAIR S UPDATE Primary Care Advisory Group AGG are working with the Primary Care Advisory Group - AGG members attending the Primary Care event this week co-designed by AGG and PCAG Chairs - Facilitators required for table top discussions JCB Meeting Dates AGG first Tuesday of the month. JCB third Tuesday of the meetings with shortened AGG before JCB for urgent business items and JCB prep MD Role AGGE met last week MD role and AGGE review discussed MD appointment process also discussed at the CO forum AD working with HR on MD recruitment which will be an internal process to attract GM leaders as such the closing date will coincide with the last HSCP executive appointment Page 2 of 10

220 FINAL AGG MINUTES Working on finalising the advert and awaiting confirmation of the date of the interview for the HSCP executive post Agreed by the Chairs that MS PMO role put on hold to allow the MD the opportunity to review the senior PMO function AGG Clinical Representation NG and RG as elected AGGE clinical representatives and still attend HSCP boards on behalf of all AGG Need to review how we divide ourselves up to ensure that AGG have an appropriate presence either managerial or clinical. KP will work with AD to progress in the interim to be reviewed by the MD when appointed COOs forum CO Chair role tenure ends in March TA noted thanks to SN for covering CO chair role for which she will still require support in the interim ACTION: AD to progress the MD recruitment via an internal process MS PMO role to remain vacant to allow the MD the opportunity to review the AGG senior PMO functions 5. GM H&SCP WH provided a HSCP brief:- WH and AD need further discussion in light of the emerging governance to structure AGG agenda to reflect the new landscape to facilitate proactive leadership To use part of the AGG agenda to review forthcoming items such as quality, performance, finance and the read across the 5 themes. This would then help discussions at executive meetings. Planning round will be a GM process which has been tested with Paul Bauman clarity will be provided on areas that need to align with national guidance Will use the FEG as leadership and blend through performance and delivery CSG and incentivising reform group use mechanisms to deliver what we need for contract sign off GM wide children s review Jim Taylor AGMA lead there is a gap which is now linked to the work progressed by Melissa Laskey as HOC Chair group to broaden the content around health and social care specifics Process LCO/ICO establishment first of the key funding decisions through the Transformation Fund much clearer pipeline of the next stages. Formal establishment of the provider models and the processes we need to follow may need consultancy support Discussion with SROs regarding a learning network around organisational form. New national assurance around the new models pursuing do once methodology Evaluation of the strategic plan through SPBE already a comprehensive process for evaluation vanguards also need to track the investment, outputs and impact of the themes. Key lines of enquiry for adult health and social care undergoing a refresh and focus will need to bring this back to AGG and determine how we link into locality plans Page 3 of 10

221 FINAL AGG MINUTES Comments Some similarities and differences with GM - WH to discuss with national team and will follow up on the material that need to be brought together and align to Transformation Fund process. Need to understand the scope of the Children s review and how it fits with theme 3 Not repeating what we went through and paid for 10 times; must utilise work that has already produced Jon Rouse joined the meeting and provided brief update:- Assurance Framework paper at SPBE board on Monday circulated soon Quality, finance and system performance one conversation this is the first iteration will await feedback not fait accompli. Already signalled to Manchester to commission an independent piece of work for underlying reasons for MH deficits across GM and pick up best practice Need to be aware of issues that are eroding confidence at national level to work through with CCGs. JR has committed to bring a paper to the SPB on future shape of GM commissioning At GM level thinking about our own commissioning framework but also specifically MH commissioning and primary care commissioning Need a stock take will do the work with AGG; outputs for the November meeting. Comments Need to involve patients and carers for the patient experience will focus on areas where we have data to include children AGG wants to be on the front foot with commissioning in GM and closely involved in co-design and work with JR GM, MH outcomes are poor should not just look at national standards but aim higher than the national standards but this will be starting point. GM leadership roles need to ensure we have the levers to effect change LD partnership may be time to bring in political leaders but need to be mindful of the mayor elections. Capacity and resources paper to next SPB - HSCP capacity not kept up with speed with the pace we want to move at ACTION: GM planning round leadership through the FEG Adult social care key line of enquiries refresh document to return to AGG to determine locality plan fit Future of Commissioning paper to return to the November AGG - JR 6. PRIMARY CARE Brief update from GM and RB on primary care:- Primary care at heart of all locality plans Collectively moved to level 3 commissioning with development of LCOs and provider landscape will need review Commitment to 7 day access as part of HT all areas has an element of 7 day access Need to check what we have done locally compared with the national specification Desktop exercise to compare 7 day access and GM Primary Medical Standards implementation highlighted significant variation in pricing and approaches. Risk that some areas will not deliver due to affordability and capacity constraints Page 4 of 10

222 FINAL AGG MINUTES Need to get the commissioning framework right, outcomes based approach to commissioning The proposed think tank will determine what should be developed and commissioned at a GM level and what is for local determination Comments Development of LCOs avoid 12 different ways; adopt GM approach Need to standardise the market to ensure every GM resident has equitable offer Some areas are more advanced than others need agreement on how we invest rather than minimising standards Independent evaluation of the 7 day access investment is it making a difference Primary Care strategy launch tomorrow emphasis on integrated care which needs to be embedded within the locality plans Trying to resolve solutions with today s structure with workforce and estates issues LCOs should resolve these issues A powerful efficient primary care/urgent care is a compelling argument Need facilitated discharge at weekends, with support from primary care, same day children assessment with 7 day access to reduce A&E demand Take proposals coming from the locality plans to the proposed working group. Tactical and strategic the standards will strengthen our commissioning framework Desktop exercise to reflect on the information circulated AGREED: To establish a multidisciplinary working group to determine a common approach across GM ACTION: To nominate clinical representatives to be involved in the think tank including CFOs/HOCs To undertake a deep dive session into primary care by locality. Share primary care desktop review with HOCs To report back with an update to AGG in one month 7. JCB planning RB provided update on the forward items for the JCB:- JCB in a couple of weeks useful to prep through AGG Meetings moved to Tuesdays to allow Steven Pleasant and KP to joint Chair Key items next agenda:- OG Cancer paper on the AGG agenda Theme 3 governance Transformation Unit input to theme 3 as a consultancy HT governance on AGG agenda Health & Justice custody health care, joint procurement in Alcatel period CK linking into this wider PSR opportunity health and justice PSR summary paper update on the work streams. Adult social care Final version of Commissioning for Reform Strategy no material changes Specialised Commissioning Intentions for 17/18 have been through SCOG Lead arrangements for Specialised Commissioning are being reviewed working on options appraisal to bring to AGG. Page 5 of 10

223 FINAL AGG MINUTES Comments Placeholder for LD for future JCB meeting may need sight at infrastructure groups Suite of papers around governance to progress through infrastructure Key item OG cancer decision point for next JCB Specialised Commissioning change in leadership must be co-designed through AGG Cancer board proposal Trafford continue to carry on that role. KP cannot attend so need another AGG rep on cancer board there is interest, from CK/South Manchester due to the strategic relationship with Macmillan Proposal to be included in RB options ACTION: Noted LD for JCB may require AGG infrastructure progression AD/CK Options paper on specialised commissioning leadership for the next AGG - RB 8. UPDATE ON THE TRANSFORATION PROCESS FOR THE COMMISSIONING OF SPECIALISED OG CANCER IN GM LW and NG presented an update in OG Cancer:- Paper provides an update on the history and background Highlights the 7 step transformation process and the commissioning specification signed off by SCOG in July The Transformation Unit was asked to review next step in terms of commissioning and options including full procurement In reviewing around 8-10 sources of data evidence on current performance of OG cancer surgery, future expectations and taking advice from NHSI the recommendation to SCOG was to consider directly awarding the contract Excellent way of reaching the decision and process for the future Need to streamline the process which has built up trust with providers Huge amount of learning in terms of patient and public engagement Formal process for the JCB to make recommendation to JR the Transformation Unit will then set out the steps that commissioners need to follow to award the contract Taken over a year but reaped a lot of learning and provider relationship building Finishing work on urology, detailing and documented lead provider responsibilities and can apply this then to other services All will be written up so clear and transparent AGREED: AGG agreed that the contract for the OG cancer transformed service can be awarded through a direct award ACTION: JCB need to endorse the recommendation to JR 9. HEALTHIER TOGETHER Ed Dyson briefed on HT governance and progress:- Some good progress and starting to see implementation in sectors. 2 practical asks of the AGG to strengthen the programme. Page 6 of 10

224 FINAL AGG MINUTES Governance and implementation challenges. Governance HT established in isolation prior to devolution now causing practical barriers Needs now to fit with theme 3 to include system ownership amongst HSCP leaders Jon Rouse as GMH&SC Chief Officer is the programme sponsor and Ed Dyson the programme SRO HT Programme Board (to be renamed Delivery Board) will report into the Theme Three Programme Board and report to the GM Joint Commissioning Board. The Joint Committee will be retained for the time being but should have a diminishing role with regard to oversight of implementation The formal establishment of the GM Joint Commissioning Board should enable commissioning decision making and leadership which sits within the GM governance. Positioning of HT Continue to use it but reframe with context of the strategic plan. Implementation risks Challenges capacity in sectors to do the work Developing BCs for implementation sectors developing Transformation Unit requested to draw together the progress on business cases and develop single business case for the programme, revenue element to Transformation Fund and capital ask through other sources. Comments JR as programme sponsor will unblock and deal with challenges. Already had some push back on the HT decision - we hold the line over this period and stay true to the process and push through to completion. Commissioning intentions circulated and agreed at Theme 3 Steering Group. Capital risk planning guidance will be harder to access capital need to have update on estates progress and other alternative funds Went to public consultation and we are now 21 months further on Need to be clear through contracting that the commissioning intentions are clear and non-negotiable. CFOs to get closer to capital case and revenue case HT financial coordinator linking into the Transformation Unit. Support single revenue and capital case CFOs Implementation is the hardest element the Transformation Unit role will be to unpick the difficult parts such as definition of high risk NEL we will ensure we implement this within the next few months. ACTION: AGG agreed to all recommendations proposed for governance and implementation SROs to inform ED and Transformation Unit when they hit issues Issues can be escalated to JR as programme sponsor 10. TRANSFORMATION INITIATIVES UPDATE NE SECTOR Page 7 of 10

225 FINAL AGG MINUTES Not had Pennine Improvement Board, meeting on Thursday, intention to sign off the improvement plan Will continue to brief AGG just to note small number of higher acute patients diverted from NMGH after 8pm has had no wider impact Dashboard development All parts of the trust to link into the improvement journey and if it works will seek to use elsewhere in GM. MANCHESTER SINGLE HOSPTAL SERVICE New governance structure to oversee SHS with LA representation and NE through SN and SW, CK and NG Clinical board going through nominations for lead clinician Financial advisors supported by Transformation Fund proposal for merger and competition authority In the Manchester Transformation Fund bid SHS decribes 75% of the benefits as sitting outside of Manchester but contribute through all of GM. PERFORMANCE DELIVERY BOARD Updated SPBE The next meeting is on Monday 10 th October 2016 IWG The next meeting is on Thursday 6 th October CFO UPDATE CFO/DCFO Work Plan Will need recalibrating in light of new governance structures o CFO and DCFOs aligned to all of the AGG priorities and GM work streams. Will refresh to align with emerging governance. o Reflection on some of the groups working well/less well. Workforce Not really been involved, the group is meeting; JR will address. GM MH Reinvigorating to make sure CFOs close to the work. Theme 3 Finance on that work stream Claire Yarwood and Steve Dixon. Logistical issue meets at same time as FEG. JR to follow up FEG increase membership 3 nominated finance leads from CCG, providers and LA. Discussion at CFOs around the planning guidance and shape the assurance from a finance regime how it might look different GM / locality / sector. Provider DoF, CCG and Treasurers workshop last month, what does assurance look like how we hold each other to account. CCG collaborate to ensure control totals the more supportive the less likely to actually get back into balance most concerned about Stockport and Tameside Needs to link to the wider assurance framework. Workshop in November some of the detail of the planning guidance and discussion on assurance Steve Wilson will be linked in next 3 months going to be very time critical to do as Page 8 of 10

226 FINAL AGG MINUTES much collectively as we can Planning financial challenges for next 2 years CCGs and providers Need a decision what is happening with 1% GM control offered up 1.3% argue 0.7% IM&T expected revenue case to the Transformation Fund capital monies have been approved National Digital Fund closed to us IM&T programme will be supported by underspend on GMSS UHSM is also this week negotiating itself out of special measures and how we work to support that trusts. Discussion at FEG how we would collectively support and for how long. UHSM did not accept control total or national monies Transformation Fund Paper Tameside element of approval had number of caveats the trust distress fund is converted to a non-repayable loan. SN will raise with Steve Wilson for clarification. ACTION: Address the logistical issues of FEG and Theme 3 Steering Group meeting at the same time JR Clarity on the non-repayable loan for Tameside SN 12. HOC UPDATE Purpose of HoCs: Provide strategic commissioning leadership to GM work programmes Delivery of outcome based service specifications to standardise care delivery, improve quality and reduce variation in outcomes Do once and share methodology and best practice Management and monitoring of new models of care and alignment of individual CCG work programmes Act as a gateway for cascading and translating GM strategy into tangible commissioning policy with all levels of CCG staff Management and oversight of business as usual and statutory CCG functions Key Activities and Outcomes: Development of a 16/17 work plan and identification of HoCs leads, including the following priority transformation programmes: - Maternity and Children s - Mental Health and LD - Cancer - Urgent Care - Planned Care - Primary Care - Acute Reconfiguration Establishment of GM commissioning sub-groups including Planned Care Leads and the GM Children s and Maternity Commissioning Consortium, consisting of CCG and local authority representatives to drive key work programme delivery across GM and local implementation Working collaboratively with the Strategic Clinical Network to influence the SCN s work plan and align it with GM commissioning priorities Development of GM service specifications, including maternity, TB, neuro-rehab and Page 9 of 10

227 FINAL AGG MINUTES stroke for local implementation to improve quality, outcomes and reduce variation Planning the implementation of Healthier Together at sector level Sharing best practice and learning in LCO and locality plan development Setting direction for the contracting round, including GM CQUINs and AQP Comments SN link for ambulance services performance is poor due to poor turnaround A&E Average turnaround time should never be more than 30 minutes current average 60 mins Pennine acute as an example there is variation of turnaround even on the different sites, needs to be focus on A&E Delivery Boards Funding awarded to our urgent care delivery boards focus is on primary care and social care bids but should be on a GM level Sent letter to chairs of delivery boards to focus on the ambulance turnaround Bed paediatric bureau whole system approach recommissioned for next 12 months Colin Kelsey pulling group together to discuss paediatric beds - small scoping meeting to discuss next steps need to make sure we have CCG rep. ACTION: Small working group for paediatrics ensure CCG representation AD 13. AOB No other business was discussed. NEXT MEETING DATE: 18/10/2016 TIME: 13:30 15:00 VENUE: Scrutiny Room, Manchester Town Hall Page 10 of 10

228 FINAL AGG Minutes GM ASSOCIATION OF CCGs: Association Governing Group (AGG) 18 October :00 15:00 Scrutiny Room, Manchester Town Hall Attendance: Apologies: In Attendance: Wirin Bhatiani (WB) NHS Bolton CCG Philip Burns (PB) NHS South Manchester CCG Julie Daines - for D (JD) NHS Oldham CCG Gizzi & I Wilkinson Steve Dixon for A (SD) NHS Salford CCG (CFO Chair) Hassall Chris Duffy (CD) NHS Heywood, Middleton & Rochdale CCG Michael Eeckelaers (ME) NHS Central Manchester CCG Ranjit Gill (RG) NHS Stockport CCG Gina Lawrence (GL) NHS Trafford CCG Su Long (SL) NHS Bolton CCG Stuart North (SN) NHS Bury CCG Paul Pallister (PP) NHS Tameside & Glossop CCG Kiran Patel (Chair) (KP) NHS Bury CCG Tom Tasker (TT) NHS Salford CCG Simon Wootton (SW) NHS Heywood, Middleton & Rochdale CCG Trish Anderson (TA) NHS Wigan CCG Alison Bali (ABa) GM Association of CCGs Rob Bellingham (RB) Health & Social Care Partnership Tim Dalton (TD) NHS Wigan CCG Alan Dow (AD) NHS Tameside & Glossop CCG Denis Gizzi (DG) NHS Oldham CCG Nigel Guest (NG) NHS Trafford CCG Anthony Hassall (AH) NHS Salford CG Warren Heppolette (WH) Health & Social Care Partnership Caroline Kurzeja (CK) NHS South Manchester CCG Melissa Laskey (ML) NHS Bolton CCG Gaynor Mullins (GMu) NHS Stockport CCG Steven Pleasant (SP) NHS Tameside & Glossop CCG Jo Purcell (JP) NHS North Manchester CCG Jon Rouse (JR) Health & Social Care Partnership Martin Whiting (MW) NHS North Manchester CCG Ian Wilkinson (IW) NHS Oldham CCG Ian Williamson (IWi) NHS Central Manchester Andrea Dayson (ADa) GM Association of CCGs (Minutes) Anna Coleman (AC) Observer University of Manchester Page 1 of 4

229 FINAL AGG Minutes WELCOME & APOLOGIES FOR ABSENCE The Chair welcomed members to the meeting and introductions were made and apologies were noted. 2. DECLARATION OF INTEREST None reported. 3. MINUTES OF THE LAST MEETING The minutes of the last meeting were accepted as an accurate record. Review of actions: MD recruitment Now secured an interview date with KP and JR Internal process will be finalised this week Future of commissioning paper On the forward plan for November Primary Care Received good response to represent the think tank including CFO and DOC representation OG Cancer On the agenda for the JCB this pm will be the first decision 4. Digital Roadmap JK presented the AGG update and progress on the digital roadmap: - Pulling together priorities and objectives ensuring alignment with all other IT work across GM and linking with SN as IMT lead Discussions with the wider groups including social care and children s group Iterative document that needs to keep reflecting and changing to align with the strategic direction Added additional assurance through NHSE who have reviewed the document with positive feedback Looking to develop a more easy read version for partners hopefully to be completed at the end of the month Looking at what this work means to professionals and citizens A lot of progress going on at localities level which is contributing to ongoing learning and ensuring that the work is in context with the locality plans Discussion Note Oldham approved direction of travel back in July Page 2 of 4

230 FINAL AGG Minutes Digital record feedback from NHSE is disappointing as there is a minimal ask which is to ensure we are at the minimal level nationally whilst we have higher aspirations Gap with connection to the 3 rd sector which needs further engagement IG and data sharing being moved forward by GM connect looking at how to break down barriers to sharing information and providing as minimal consent as possible Concerns of ownership and the required maintenance of records Sharing children s information is more complex GM connect has identified early years as a priority Keen to get nursing and care homes into the map need to get them onto the NHS mail in the first instance Still gaps on LAs completion of information now operating at a place should be able to contact the relevant CCG who can then to encourage their LAs partners to complete Design authority paper due out today for workshop on Thursday need to understand purpose JK to report back Out of Hospital access to records is crucial universal capabilities required Once have all of the information we need to look how we then shape the data to support the development of new models of care Clinical reference group includes hospital clinicians and CCG clinicians no one attended from social care ACTION: Feedback following the design authority workshop JK 5. Nominations for the Performance & Delivery Board KP has been written to by JR to confirm attendance at the Performance and Delivery Board. The main purpose of the Performance and Delivery Board is to provide oversight to the NHS Constitution and Mandate requirements, along with the review of GM system performance data and analysis. The letter requested 3 CCG members but following conversation with SN and JR it was agreed that the representatives could be on a sector basis. Also noted that JR has suggested that TA be part of the representatives due to the sustained performance at Wigan. AGREED: North East agreed this should continue to be SN North West agreed to TA as recommended by JR Manchester s and Trafford nominated Micelle Irvine as their performance lead ACTION: South sector to forward nominations to AD Page 3 of 4

231 FINAL AGG Minutes JCB Items Need to get into the discussions of clarity on what decisions we are going to make at the JCB could discuss further under commissioning for reform The dedicated session with COOs on what they have learnt across their LCO developments set to rest some myths regarding behaviours and cultures From the notes of this meeting we are looking to identify a set of common themes and differing approaches Noted that clinical representation required for theme 3 need to ensure this is a resurgence of HT approach which worked well Need to ascertain the level of commitment required as we may need to look at rationalising representation at board level ie possible sector basis Theme 3 was our priority but the governance proposal appears to side step AGG possibly need to look at aligning the governance closer to AGG Need to be involved in the design of the governance we are represented on all groups so need to take ownership and report Need review role AGG theme 3 is the health agenda Providers seem to have taken the lead and areas that are priorities for CCG such as orthopaedics/dermatology and neurology have been dropped off the list further discussion required Could still be an opportunity to do more work around out of hospital work at AGG as this is also our priority Papers to AGG should be used to help shape view for those that represent CCGs on the Portfolio Board Need to find solution that works for us need to be clear on what decisions are going to be made; need a plan of future decisions so we can be reassured that we are involved appropriately 7. AOB None reported. NEXT MEETING DATE: 01/11/2016 TIME: 13:30 17:30 VENUE: The Willows, AJ Bell Stadium Page 4 of 4

232 FINAL AGG Minutes GM ASSOCIATION OF CCGs: Association Governing Group (AGG) 01 November :30 17:30 The Willows, AJ Bell Stadium Attendance: Apologies: In Attendance: Trish Anderson (TA) NHS Wigan Borough CCG Philip Burns (PB) NHS South Manchester CCG Julie Daines for D Gizzi NHS Oldham CCG Chris Duffy (Chair) (CD) NHS Heywood, Middleton & Rochdale CCG Michael Eeckelaers (ME) NHS Central Manchester CCG Ranjit Gill (arrived at 13:50) (left at 15:30) (RG) NHS Stockport CCG Nigel Guest (arrived at 13:45) (left at 15.:33) (NG) NHS Trafford CCG Anthony Hassall (AH) NHS Salford CG Su Long (SL) NHS Bolton CCG Stuart North (SN) NHS Bury CCG Paul Pallister (PP) NHS Tameside & Glossop CCG Tom Tasker (TT) NHS Salford CCG Wirin Bhatiani (WB) NHS Bolton CCG Tim Dalton (TD) NHS Wigan Borough CCG Steve Dixon (SD) NHS Salford CCG (CFO Chair) Alan Dow (AD) NHS Tameside & Glossop CCG Denis Gizzi (DG) NHS Oldham CCG Warren Heppolette (WH) Health & Social Care Reform Caroline Kurzeja (CK) NHS South Manchester CCG Melissa Laskey (ML) NHS Bolton CCG (HoC Chair) Gina Lawrence (GL) NHS Trafford CCG Gaynor Mullins (GMu) NHS Stockport CCG Kiran Patel (Chair) (KP) NHS Bury CCG Steven Pleasant (SP) NHS Tameside & Glossop CCG Jo Purcell (JP) NHS North Manchester CCG Martin Whiting (MW) NHS North Manchester CCG Ian Williamson (IWi) NHS Central Manchester Ian Wilkinson (IW) NHS Oldham CCG Simon Wootton (SW) NHS Heywood, Middleton & Rochdale CCG Alison Bali (ABa) GM Association of CCGs (Minutes) Rob Bellingham (RB) Health & Social Care Reform Sandy Bering (SB) NHS Trafford CCG & Association of GM CCG Networks Anna Coleman (AC) University of Manchester Andrea Dayson (ADa) GM Association of CCGs Vicky Sharrock (VS) GM H&SCP Andrew White (AW) Greater Manchester Shared Services Page 1 of 9

233 FINAL AGG Minutes WELCOME & APOLOGIES FOR ABSENCE The Chair welcomed members to the meeting and introductions were made and apologies were noted. 2. DECLARATION OF INTEREST Chris Duffy declared had a relative with autism re: item 9 3. MINUTES OF THE LAST MEETING Accuracy approved but informed post meeting that Ranjit Gill had attended the meeting. Actions completed. 4. CHAIR S UPDATE Not reported. 5. H&SCP UPDATE RB provided a HSCP Brief: LCO development work ongoing with the national team on assurance re; the procurement of LCOs. Keen in GM to avoid duplication between GM and national process, and therefore seeking to dovetail to form a GM solution. All COs received STP submission copy with helpful summary. Producing half year report version that could go to boards and will be a public facing report will be produced next couple of weeks. Medicines round table held with pharmaceutical industry 2-3 weeks ago which KP attended with follow up GM meeting which PB attended. A paper is now being developed for the SPBE to include an MOU with pharmaceutical industry and describe how Medicines Optimisation and innovation is executed in GM. Proposal of a medicines strategy board not only looking at innovation but also optimising existing use. Need to be clear on governance with pharmaceutical; clarity required under what hospitality and gifts, conflicts of interest; need assurance from HSCP team. WH leading the Mental Health independent review and performance - share electronically. SPBE nothing on the agenda that has not been sighted by AGG. Steve Wilson will bring finance and Transformation fund update. Theme 4 governance, workforce prospectus, and IM&T strategy. Next meeting of AGG Jon Rouse attending commissioning review process to include Specialised Commissioning. SPBE papers to be circulated on Friday AD will circulate for comments to AGGE members. COMMENTS Urgent and emergency care video conference yesterday. Concerns noted that we were not appropriately represented across GM. Topics were improvement, winter, Page 2 of 9

234 FINAL AGG Minutes delivery and turnaround. Improvement urgent care and A&E delivery plan with a real clear steer that 95% target stands and is an important priority for Secretary of State. Sit Rep reporting, escalation of 12 hour breaches and ambulance handover delays high priority. Andrew Foster gave a presentation of good practice for circulation A&E delivery boards clear messages expectation that representation are director level or above. Clear message about performance and transformation balance. Good discussion on structures in GM, taskforce, urgent and emergency care network and how this links to new structures. Producing GM dashboard and dates nationally and regionally on workshops to be circulated. Senior managers should understand A&E access on a daily basis. Media interest Chief Officers have to report in the public part of the CCG governing body. Public has a part to play in this in attending A&E. Each locality must understand AE metrics this is dependent upon a number of factors including decision to admit policies and a variety of approaches across GM. Feedback on number of letters we have had in the last week. AH letter re: RRT, ambulance turnaround, 12 hour breach, MH IAPT we gave feedback on the number of individual letters. Jon Rouse did mention at the meeting SMT this morning on developing a more uniformed approach in the future ACTION: Andrew Foster presentation to be circulated AB Mental Health Independent review from WH AB 6. JCB Update provided by Rob Bellingham: - OG cancer decision went through smoothly concern noted that comms were delayed press release was issued to the SPB on Thursday evening and published on Friday. Approved final version of the Commissioning for Reform Strategy no material changes but wording changes following consultation. Custody health gone to consortium that includes 5 Boroughs, will be first of its kind in the country. JCBE last week some of the programmes not moving as quickly as we thought. Health and work programme not moved at pace but green paper published nationally. Social value needs to move quicker. Opportunities in health and justice through Devolution in draft format. Interesting and challenging conversation need to be clear of the role of JCB. Need to play into discussion re: future of commissioning. COMMENTS SPB Dementia Untied withdrawn paper had not been through appropriate governance structure. Page 3 of 9

235 FINAL AGG Minutes Will go to Reform Board next meeting and view was enough people from CCG to not have to put it through SPBE; concern noted on representation on Reform Board. Reform board chaired by interim mayor, PSR in its wider sense. AGG view is that all items to go to SPB should first go through the SBPE as per agreed governance. ACTION: To check AGG representation of the Reform Board AD All papers to go to the SPBE prior to the SPB RB to note 7. DEVELOPING GMMMG INTO A CLINICAL STANDARDS BOARD GM MEDICINES BOARD Andrew White presented papers: - Papers were part of GMMMC board and phama meetings attended by KP and PB both agreed papers should come to AGG for further discussion. A need for a change with a focus on pathways and High Cost Drugs. Sub groups formed in January have sponsors from AGG PB and DoCs and CFOs. Jon Rouse feels medicines should be a key enabler work stream to ensure medicines optimisation and innovation at faster pace. Given this pace a parallel paper is being produced which will need to be sighted by AGG; as such this may well supersede the current papers circulated but not the context. Paper targeted for the next SPBE will be distributed to members for comment. Delegated financial and decision making may need to go to CCG governing bodies. COMMENTS Proposed paper for SPBE next week will be for medicine strategy board and for medicines optimisation to become a key enabler HSCP work stream which will report to portfolio board. Need to build on existing legacy, sighting the system on an emerging enabler work with clear time frame of a MOU with pharmaceutical industry by April. Lack of adoption of decisions is an issue and we should be able to hold system to account. We need to have a decision making body outside of local area and may need delegation from CCGs and FTs. Some evidence of adoption (lack of) would be appropriate. Need to hold each other to account to get things progressed issues with failure to implement need to be addressed. Decommissioning is better and stronger together - final decision possibly be at JCB. Have a system that doesn t work, it works well in some aspects, be clear what we would do once e.g. at JCB and what aspects are local. Progress often depends on timings of CCG GB meetings. Equally implementation at GM level might fail as decision not owned by localities. Need local engagement to be able to address behaviours we should see where we are failing. Where you draw line high enough at GM level. Page 4 of 9

236 FINAL AGG Minutes Pushing back on delegated authority step too far requires further clarity. Want transparency on where we are failing where is the variation and why and what can we do to resolve through post implementation review. Prescribing on cost and outcomes what we can learn. The report needs to highlight more information in terms of implementation. Hold each other to account at AGG must align into the assurance process. Need to revisit GMMMG membership make sure senior representation. Concern over paper on SPBE, conflict of interest with pharma companies. Need to see next paper and feedback comments electronically. All papers will be sent to AGG for comment back to SPBE members. RB will brief WH as the sponsor. ACTION: AGG to comment on the developing paper to be distributed for SPBE members on Friday AD AGG did not agree to delegated authority much further clarity required 8. TRANSFORMATION UPDATES NE Sector A&E a temporary solution with support by consultants from South, Central predominantly may not sustainable longer than the identified 6 months. Sustainable solution is recruitment but no progress made on recruiting additional consultants for A&E. 5 middle grades expected at NMGH. Single hospital service would be helpful if NMGH brought forward. Working with David Dalton and team to work up appropriate proposition for single hospital service for Oldham, Fairfield and Rochdale. Debate on HT decision as part of SHS we made a decision on HT on certain criteria. Manchester Single Hospital Service Nothing to report. Performance & Delivery Board Change names IWG SPBE To be replaced by the Portfolio board Papers out on Friday for comments to AGGE members 9. LD UPDATE Sandy Bering and Vicky Sharock in attendance to provide an update: - Context continuing focus on the way the LD and autism is being micro managed. Expectation on service specification and locality plans. Page 5 of 9

237 FINAL AGG Minutes Need to reduce the number of patients over 2.5 years the issue how you therefore manage that size of work, whilst think about wider 33-46% spend in each locality. GM Devo programme cannot deliver unless we address whole of LD in the wider perspective broader group of people around 60,000 of people of IQs below 70. Social and domestic skills deficit over the longer term. Autism is the only disability linked to legislation. Statutory requirements for health and social services. A lot of areas overlap, more logical to have whole programme approach. Areas that are logical that we do on a GM footprint vs. locality focus are Calderstones, crisis beds, specialist support teams and commission and provider frameworks. at scale together. How locally those resources are pooled / coordinated capacity is an issue with demands and number of reports etc. Leads meeting to bring it together to make it more sustainable. Need to support bringing together of all the governance arrangements for LD in GM into one decision making Board Nationally we are failing on the number of patients in hospital and delays in relation to Calderstones. Care and treatment reviews have been checking on each patient care have confirmed they are safe. COMMENTS Spirit of Devolution need to keep local and determine what is best for GM but agree this is the right approach. We are about to be monitored for all Mental Health out of area placements, in designing what is appropriate for GM. Need a paper that confirms what we need to do together, provide clarity on CCG and councils and confirm delegated authority and pooled budgets. Working on improved governance arrangements to coordinate this approach. GM wide pathways for autism and ADHD and adult side links with health annual checks has been real break down since PCT transfer to CCG. Need to connect with primary care for Autism pathway done work for children and ADHD with practice guidance. New arrangement to develop more efficient ways of procuring LD providers and explore potential use of a Dynamic Purchasing System in GM to be operated via one organisation No standard care pathway across GM assessment should be behavioural approach rather than condition specific approach. Join up governance and direction of travel supported by AGG Need to clarify understanding of where we are direction of travel, governance and practical next steps to deliver this. More specific and understanding of what we think needs to happen at geographical levels GM, locality cluster levels. Understanding of what potential LD strategy and resources are required to deliver with timescale. On-going monitoring will discuss and how we approach once at GM level. Criteria that has been agreed through the JCBE what needs to be done at GM / locality level may be helpful. Page 6 of 9

238 FINAL AGG Minutes ACTION: AGG agreed direction of travel in the document More detailed governance paper required to describe GM / sector / local level decisions, delegated authority and resources required 10. IMPLEMENTING GM IM&T STRATEGY SN and Vicky Sharock gave an update on the IM&T strategy position: - Been number of iterations of the strategy with additional information to be included from the recent meeting with Chief Information Officers across the health sector but not all described in paper as yet. We have requested H&SCP digital collaborative will be the new name for the design agency. Need to be clear on CCG representation currently Chief Information Officers but not all CCGs have these so needs to be revisited. IM&T fund national funding level significant to support localities but not sure of breakdown. Having discussions at national level rather than bid for different pots of funding to have a single strategy with GM demonstrating delivery of the priorities for GM. Next few weeks hope to have a response to the GM proposition with GM becoming the 34 th national programme. H&SCP Digital Collaborative mechanism for delivery of the strategy will consist of board structured around the 5 pillars of the strategy. Using existing structures but with a supporting HSCP team to include a Chief Digital Officer to operate at GM level to help us understand the technical infrastructure and work with localities and manage the GM IM&T fund. COMMENTS Ensure we link with GM connect to ensure that we have the ability to pool information and exchange information as each locality are at varying levels of development. Crucial to capture activity across all domains to support developments Provider focus agreed and will redefine will ensure equal CCG representative. We will be clear on the resource coming into GM for delivery of the strategy. National funding will be invited by locality so phasing determined by national team which may not fit the GM plan. Funding identified for 6 months for the team part of the papers that we put through to SPBE and support for overall GM partnership programme, not dependent on getting national funding. CCGs, providers and councils contribute to the H&SCP team funding. Will produce final document with comments from AGG for information. ACTION: AGG agreed to the proposed direction of travel described in the paper Update to AGG when the paper has been finalised Page 7 of 9

239 FINAL AGG Minutes THEME 3 UPDATE Theme 3 Delivery Board this week AH, SL and RB provided an update: - Governance four quadrants with leads - clinical and managerial lead in each. GM commissioning - not all elements delivered at GM level at different footprints. Links to other themes properly worked through. Input from finance community - RB attending provider DoF meeting. Transformation Unit commissioned to support the development of the PIDs. Would need to agree how we do next steps. 7 individual PIDs considered through the Delivery Board. Theme 3 delivery to be discussed at the 23 November meeting. Paediatrics pressuring operational issues and strategic issues with the management of children mainly non elective and surgical management. COMMENTS Lot of progress ensuring rigor and challenge on activity and finance modelling. Need to ensure that we learn lessons from Healthier Together process where the modelling was not accurate; both Claire Yarwood and Steve Dixon supportive of this approach. Ambition is to move at pace to produce single GM vision for hospital services. To involve commissioner driven involvement, engagement, consultation and ensuring total alignment to all developing LCOs. Benign neurology co-dependency possibly with high acuity sites need alignment into Primary Care. Breast services need to be co-designed with other parts of the system as opposed to a single view of the system. Cardiology and respiratory more about a set of standards, important elements to support developments of the LCO. MSK orthopaedics set of standards led by Wigan with input from others. Discussed capacity and issues about ring fenced beds vs. non ring fenced. Neuro rehabilitation live issues tactically and operationally may need a sector approach to align. Need to challenge for those that do not commission neuro rehab commissioning services with supporting evidence of effectiveness. Vascular straight forward except for Wigan alignment with Preston rather than GM. There will be further iterations of PIDs and external support identified. Need to be clear on parameters of Theme 3 as delivery of this will be through a consultation. Challenge back to team and board is to sort out any issues and tension now rather than following any decisions. Need to understand the proposals around the Transformation Unit and how it will be funded in the future. May be more appropriate for the H&SCP team commission the Transformation Team as opposed to the CCGs. The Transformation Unit the team has developed a methodology style but for the pace required we may need a different approach rather than using old methodology. Need to out any immediate thoughts on areas that may be challenged. The single hospital surgeons and links to CMFT need to be thought through in the context of the Healthier Together. Page 8 of 9

240 FINAL AGG Minutes When we made the decision travel and transport was an important criterion. Delivery board will receive monthly updates from Healthier Together to ensure alignment. ACTION: Further iterations of the PIDs to a future AGG To distribute the PIDs electronically AB 12. DOC UPDATE ML not in attendance so item deferred to note minutes have been sent for information. 13. AOB MD role is out to advert once the MD role has been appointed I (Chris Duffy) will stand down as Vice Chair. The process for vice chair etc. will then be determined by the Chair and MD. NEXT MEETING DATE: 15/11/2016 TIME: Lunch from 1pm 13:30 15:00 VENUE: Scrutiny Room, Manchester Town Hall Page 9 of 9

241 Salford Children and Young People s Trust Summary of Board meeting 20 September 2016 Membership published at Attendance at this meeting recorded by the Trust s Business Manager. Members of the Youth Council attended to update us on their plans for this year s Seldom Heard Event which will take place on Thursday 20 October at Eccles College. This year the target audience will be years 6 and 7 pupils. Six high schools and their feeder primary schools have been chosen to attend. To support and strengthen the pledges that will be made by the City Leaders the young people involved will create a community manifesto. Youth Day took place for the fifth year on 12 August and was a huge success. We heard about events that took place within the community and how the day was well supported via social media. We agreed that an evaluation report will come to our next meeting. We noted that the ballots for this years Make Your Mark campaign have been distributed to all our secondary schools. Last year 37% of Salford s young people voted. The ballot decides what Members of the UK Youth Parliament should debate and vote on to be their campaign for The debate will take place in the House of Commons later this year. We heard an update on a series of workshops being developed by the Youth Council as part of the national campaign Don t Hate Educate. The workshops will look at Lesbian Gay, Bisexual and Transgender (LGBT), religion, racism and prejudice and will be offered to our secondary schools. An update on our Special Educational Needs and Disability (SEND) journey over the past five years highlighted our achievements and future challenges. We thanked Sue Woodgate for her contribution and support to the Trust Board and wished her well for the future. We noted an update on Early Help. A new 0-19 Health Service is being developed to integrate Health Visiting, Family Nurse Partnership (FNP) and School Nurses. We also noted the statistics for the Family Nurse Partnership programme. The 0-25 Emotional Health and Wellbeing Test Case continues to progress. We heard about a Community Eating Disorder Service that is being developed that will go live next April, the creation of dedicated web pages to support young people will be hosted on the WUU2 site and will go live at the end of September and the Emotional Health Directory has been launched via the partnership site. We noted progress with the Youth Partnership Group; a paper is currently being drafted and will be circulated to partners. Councillor Lisa Stone will chair the meeting. We want to ensure we continue to work together to provide the best possible youth provision. We noted that the Unintentional Injury Group will meet again from October with a focus on developing strategies to support prevention work around issues such as falls and dog bites. Our annual Development Session will take place on Tuesday 18 October. We will look at what is going well, where we need to improve and review our priorities. The Young Mayors Charity Ball will take place on Friday 7 October. The proceeds from the evening will be split between Salford Young Carers Service and Goal for The Gambia. Salford CYP Trust 20 September summary of meeting cyptrust@salford.gov.uk page 1 of 1