Agenda Governing Body Board (Part 1)

Transcription

1 Agenda Governing Body Board (Part 1) Date: 24 May 2017 Time: Venue: Chair: Boardrooms A, B and C, Kirkdale House, Leytonstone, E11 1HP Dr Anwar Khan Topic Action Required Clinical Lead/ Lead Lead Officer(s) Page No. General Business Apologies and announcements To discuss Dr Anwar Khan Declarations of interest (register on public view) Draft minutes from March s Board To discuss To approve ALL Matters Arising To discuss/ agree 1 Chair s update To receive Questions from Members and Public To respond 2 Governance 2.1 Performance and Quality Committee Terms of Reference To approve Dr Dinesh Kapoor Helen Davenport Planning and Innovation Committee Terms of Reference To approve Richard Griffin Jane Mehta 10 Agenda Governing Body Board (Part 1) [24 May 2017]

2 3 Performance and Quality 3.1 Quality Report For discussion and approval Dr Dinesh Kapoor Helen Davenport Stakeholder Survey To approve Richard Griffin Helen Davenport Special Educational Needs and Disability (SEND) Local Area Inspection Update To discuss Dr Tonia Myers Helen Davenport 36 4 Finance and QIPP 4.1 Finance Report To approve - Les Borrett 54 5 Strategy and Planning 5.1 Delivery Plan To approve - Jane Mehta Partnership Agreement To approve - Terry Huff 74 6 For information 6.1 Minutes of Audit Committee (March 2017) For info Vineeta Manchanda Les Borrett a&b Minutes of Performance and Quality Committee (March and April 2017) For info Dr Dinesh Kapoor Helen Davenport 110 & a&b Minutes of Medicines Optimisation Committee (March and April 2017) For info Dr Ravi Gupta Helen Davenport 144 & Minutes of Planning and Innovation Committee (March 2017) For info Richard Griffin Jane Mehta Minutes of Patient Reference Group (March 2017) For info Richard Griffin Helen Davenport Minutes of Finance and QIPP Committee (March 2017) For info Vineeta Manchanda Les Borrett 181

3 6.7 Minutes of IT Committee (April 2017) For info Dr Mayank Shah Les Borrett a&b Minutes of Primary Care Commissioning Committee (March and April 2017) For info Alan Wells Jane Mehta 199 & Actions from Leyton/Leytonstone, Chingford and Walthamstow Locality Meetings (March and April 2017) For info All Clinical Directors Jane Mehta AOB 8 Forward plan For discussion ALL 211 Next meeting Date: 28 June 2017 Time: Formal Board & Venue: Boardrooms A, B and C, Kirkdale House, Leytonstone, E11 1HP

4 Action log Waltham Forest CCG Governing Body Part 1 on 22 March 2017 including earlier Brought Forward Items Date: 22 March 2017 Time: 12-2pm Minute No. Action Lead/ Owner Due Date Status Status Approval Date Completed 048/16 The annual Health and Wellbeing Board report to be presented to our March 2017 Governing Body meeting. TH June 2017 Open HWBB have never produced an annual report before. They do plan to produce one this year which should be available for June GB 035/17 Post the final Strategic Outline Case (SOC) on the CCG website TH July 2017 Open a.nhse are currently reviewing the Strategic Outline Case Once approved this will be published on the CCG website. Closed b.the draft SOC has been shared with Governing Body members. b. March 2017 Page 1 Action Log Waltham Forest CCG Governing Body Part 1 on 22 March 2017 including earlier Brought Forward Items 24 May

5 Minute No. Action Lead/ Owner Due Date Status Status Approval Date Completed 050/17 Add risk maintenance score to BAF reporting template. HD 24 May 2017 s GB Board Closed April /17 Confirm appraisal rates being achieved at Whipps Cross hospital and link to safeguarding training. 051/17 Clarify Safeguarding Boards responsibilities in respect to safeguarding training compliance. HD May 2017 Open In progress for both Whipps Cross and NELFT awaiting providers responses. LRE May 2017 Closed Guidelines circulated 12 May /17 Resend letter outlining the details of the Healthy London Partnership programme. TH agreed to resend the letter. TH April 2017 Closed Letter recirculated on 5 April /17 Present updated Terms of Reference for the Planning and Innovation Committee to the Governing Body meeting May Changes should include: a. The Chair should be a Lay Member and b. The quoting should be a third of the members not seven. JM 24 May 2017 s GB Board Closed On May 2017 s GB Board agenda Page 2 Action Log Waltham Forest CCG Governing Body Part 1 on 22 March 2017 including earlier Brought Forward Items 2

6 Item 2.1 Title of report From Performance and Quality Committee review of Terms of Reference Helen Davenport, Director of Nursing, Quality and Governance - WFCCG Author Anne Walker, Deputy Nurse Director Quality and Clinical Governance - WFCCG Purpose of report The purpose of the report is to inform the Governing Body of the amendments to the terms of reference for the Performance and Quality Committee. Changes/additions/amendments to paper as a result of discussions held at Performance and Quality Committee Addition of section of groups/committees that formally report to the Performance and Quality Committee. Review of quoracy. Recommendations The Governing Body members are requested to: 1. Review and approve the updated terms of reference Impact on patients & carers With appropriate quality and governance in place patient safety and experience should be wholly assured. Failure to provide quality care leads to increased risk to patient safety and patient harm, poor patient experience and health outcomes. Risk implications Failure of all Waltham Forest CCG commissioned Providers to ensure the fundamental quality standards of clinical care across Waltham Forest health economy might lead to: Patients not receiving expected quality of care which would lead to poor patient experience and in some cases patient harm. Inhibit WFCCG from achieving its corporate objectives. Reputational risk. Financial implications Funding services that are not high quality do not meet the needs of the patient is poor value for money and may result in additional funding pressures. 3

7 Performance and Quality Committee review of Terms of Reference Equality analysis The WFCCG is committed to fulfilling its obligations under the Equality Act 2010 and to ensure services commissioned by the WFCCG are non-discriminatory on the grounds of any protected characteristics. The WFCCG will work with providers, service users and communities of interest to ensure that any issues relating to equality of service within this report are identified and addressed. Business Intelligence Source None Other committees/groups, including the CCG Reference Group and Rapid Feedback Group Performance and Quality Committee 12 April

8 NHS Waltham Forest Clinical Commissioning Group Performance and Quality Committee Terms of Reference 1.0 Introduction The Performance and Quality Committee is a committee of NHS Waltham Forest Clinical Commissioning Group (WF CCG) Governing Body as constituted by the Clinical Commissioning Group (CCG) Constitution, the Scheme of Reservation and Delegation and stated in these terms of reference, which will be reviewed annually by the CCG Governing Body. 2.0 Membership The Committee will be chaired by a Clinical Director and shall consist of not less than 5 members to include the following: Chair GP and Clinical Director Director Financial Strategy CCG Governing Body Nurse Representative Director of Nursing Quality and Governance 2 CCG Clinical Directors Deputy Nurse Director of Quality and Clinical Governance Deputy Director of Strategic Commissioning Senior Commissioning Manager Assistant Director of Contracting A Public Health representative from the Local Authority CCG representation Performance Directorate CCG representative Quality and Governance Directorate Director of Quality Clinical Support Unit Commissioning Support Director Clinical Support Unit Continuing Health Care/Safeguarding Adults Lead Designated Nurse for Safeguarding Children and Looked After Children Designated Nurse Safeguarding Adult Assistant Director Strategic Planning Associate Director Strategic Commissioning Assistant Director Medicines Optimisation Patient Experience and GP Alert Co-ordinator Assistant Director of Provider Performance WELC POD CSU Other attendees may be invited to attend for specific items with prior agreement of the Chair. Staff are expected to attend for 80% of the annual meetings and to ensure appropriate deputisation in their absence. Performance and Quality Terms of Reference April 2017 Final Approved 5

9 3.0 Key Relationships The key relationships for the Committee are: CCG Clinical Executive NHS England Local Area Team Clinical Commissioning Leads CCG Localities Care Quality Commission Links and other Community Participation groups recognised by Waltham Forest CCG. Commissioning Support Unit Audit Committee of CCG Remuneration Committee of CCG Local Authority 4.0 Secretary/Support The Performance and Quality meeting shall be minuted by an administrator from the Quality and Governance Directorate who will have expertise in the preparation of high quality minutes. 5.0 Quorum The quorum of the Performance and Quality Committee shall be 50% of its voting members. Which must include the Chair or Deputy Chair, the Director of Nursing, 2 Clinical Directors and senior representation of the Quality and Governance and Performance Directorates. The Committee must be quorate when any decisions are made or votes taken. 6.0 Frequency and notice of meetings The Performance and Quality Committee shall meet monthly on the second Wednesday of each month. Additional meetings may be called by the Chair if deemed necessary. The Committee will meet a minimum of 10 times per annum. 7.0 Remit and responsibilities of the committee 7.1 Purpose The Performance and Quality committee, which is accountable to the Governing Body serves the purpose of: Performance and Quality Terms of Reference April 2017 Final Approved 6

10 Ensuring that the Committee acts with a view to securing continuous improvement to the quality of services; Assisting and supporting NHS England in relation to the Governing Body s duty to improve the quality of primary medical services; Overseeing the execution of the Group s duties in relation to safeguarding of children and adults and ensure active and consistent engagement with the Local Children s Safeguarding Board and the Multi-agency Adult Safeguarding Board. Provide systematic assurance to the Governing Body on quality of all commissioned services relating to the population of the Waltham Forest. 7.2 Responsibilities The responsibilities as delegated to the Committee are: To monitor performance of the CCG s providers. In conjunction with the Clinical Executive the CCG will set the strategic direction for quality in commissioning, including the QIPP agenda; Oversee the operation of Clinical Quality Review Meetings, highlighting serious concerns to the Governing Body and reviewing the implementation of associated action plans; Agree a programme which may include clinical dashboards/balanced scorecards; Provide overview for the process of managing Serious Incidents Requiring Investigation (SIRIs) and highlight relevant incidents that have an impact on patients or the environment of care and ensure implementation of learning from such events; Ensure systems are in place to manage complaints and comments from patients, the public, members and other stakeholders and any learning is infused into the organisation; Ensure new services, pathways and treatments made available through the Group s commissioning functions are evidence based; Review reports from the Medicines Optimisation committee on: Outcomes of quality Assurance visits to local providers including care homes Quality issues arising from prescribing from all providers including GP practices Any other quality issues as they relate to the use of medicines. Take an overview on clinical risks including amongst other items infection control and ensure that CCG projects and newly commissioned services are clinically safe; Receive exception reports on implementation and compliance with NICE guidelines and other national guidance and make recommendations for future action; Receive reports from the Clinical Director and/or Director of Nursing Quality and Governance in relation to matters of concern in the performance of all providers and primary medical care and make recommendations for action; Performance and Quality Terms of Reference April 2017 Final Approved 7

11 Receive minutes of meetings of groups constituted to support clinical governance within the CCG. Liaise with NHS England LAT or other national organisations such as CQC in order to align CCG with national and area standards around quality and patient safety. 7.3 Scope of Authority and Decision Making The Committee is required to work in accordance with these Terms of Reference and the CCG s Standing Orders, Prime Financial Policies and Scheme of Reservation and Delegation. Decisions taken by the committee will be in line with those specified in the Scheme of Reservation and Delegation. The Committee will work to the professional and legal standards required of its members. The Committee will ensure that it reports to the CCG Governing Body on any matters which properly fall within the CCG Governing Body s Schedule of matters Reserved to the Board. The Committee is authorised by the Governing Body to investigate any activity within its terms of reference. It is authorised to seek any information it requires from any employee and all employees are directed to co-operate with any request made by the Committee. The Committee is authorised to create groups or working groups as are necessary to fulfil its responsibilities within its terms of reference. The Committee may not delegate executive powers delegated within these Terms of Reference (unless expressly authorised by the Governing Body) and remains accountable for the work of any such group. 8.0 Management of Committee The Deputy Nurse Director Quality and Clinical Governance will prepare the agenda in conjunction with the Committee Chair. The agenda and papers shall normally be circulated in secure electronic format to members 5 working days before the meeting date. The Performance and Quality committee is accountable to the Governing Body of the CCG. The minutes of the Committee shall be formally recorded and submitted to the Governing Body. The Committee Chair will provide reports on the work of the Committee to Part I or Part II of the CCG Governing Body meeting according to the nature of the business to be reported. The Committee Chair shall draw to the attention of the CCG Governing Body any issues which require full disclosure to the CCG Governing Body. Performance and Quality Terms of Reference April 2017 Final Approved 8

12 9.0 Committees The following committees report to the Performance and Quality Committee Whipps Cross Maternity Quality Group Learning Disability Health Improvement Group Service Performance Reviews as appropriate Clinical Quality Review Meetings Cancer Commissioning Group LAC Health Strategic Partnership Group Safeguarding and LAC meeting Safeguarding in the Health Economy Meeting SEND Project Board Child Protection Information Sharing (CPIS) Task and Finish Group Dashboard meetings for Barts Health (Designated Nurse collective for WEL) Medicines Optimisation Committee 10.0 Conduct of the committee The Committee shall operate in line with the requirements of the NHS Codes of Conduct and Accountability, the NHS Constitution and the CCG Constitution, reflecting the Nolan Principles. If any member has an interest, pecuniary or otherwise, in any matter and is present at the meeting at which the matter is under discussion, he/she will declare that interest as early as possible and shall not participate in the discussions The Chairperson will have the power to request that member to withdraw until the Performance and Quality Committees consideration has been completed If the Chairperson has a conflict then an alternative Chairperson will be nominated from the membership of the committee/group Decisions will generally be made on the basis of consensus. In certain circumstances it may be necessary for all members to vote, normally by a show of hands. In the case of an equality of votes, the chair shall have a second vote which will be the casting vote. The Committee will report in writing to the CCG Governing Body the basis for its recommendations. The CCG Governing Body will use that report as the basis for their decisions but will remain accountable for taking decisions on the remuneration, allowances and terms of service of the Chief Officer and the Chief Finance Officer. Minutes of the CCG Governing Body's meetings should record such decisions Review of Terms of Reference The Terms of reference will be reviewed annually at the start of each financial year. These will be approved by NHS Waltham Forest Governing Body in line with policy. Performance and Quality Terms of Reference April 2017 Final Approved 9

13 Item 2.2 Title of report From Planning and Innovation Committee Terms of Reference Jane Mehta, Director of Strategic Commissioning - WFCCG Purpose of report The Planning and Innovation Committee agreed updated Terms of Reference which set out the membership, remit, and responsibilities of the Committee at the April 2017 meeting. The key changes made relate to arrangements regarding quoracy. Changes/additions/amendments to paper as a result of discussions held at previous Committee The Planning and Innovation Committee reviewed and updated Terms of Reference. Recommendations The Governing Body is requested to: 1. Approve the updated Terms of Reference for the Planning and Innovation Committee. Impact on patients & carers The proposed changes to the Committee Terms of Reference help ensure that the CCG s business is conducted following due process and in an open and transparent way. Risk implications Up to date Terms of Reference assure adherence to principles of good governance and avoid a breach of regulations and subsequent reputational or financial impact. Financial implications The Terms of Reference are implemented within the CCG s financial arrangements. Equality analysis The Committee business considers any impact on equality and human rights Business Intelligence Source Not applicable Other committees/groups, including the CCG Reference Group and Rapid Feedback Group Not applicable. 10

14 1. Introduction Planning and Innovation committee Terms of Reference 1.1 The Planning and Innovation committee ( the committee ) is established in accordance with Waltham Forest clinical commissioning group s constitution. These terms of reference set out the membership, remit responsibilities and reporting arrangements of the committee and shall have effect as if incorporated into the constitution. 1.2 The Committee will: Identify opportunities for new, evidence-based ways of working in the context of our strategic plans Review and comment on new care pathways the CCG plans to introduce; Consider the Joint Strategic Needs Assessment and ensure it is factored into future plans, including the Sustainable Transformation plan and associated delivery plans; Ensure feedback from relevant stakeholders is considered in future plans, including the Commissioning Strategy Plan; and Oversee from a clinical perspective groups and functions within the CCG that have responsibility for planning and redesigning services. Comment on the clinical efficacy of business cases Consider implications for research and education of new pathways, models of working, business cases etc. 2. Membership 2.1 The Committee shall be appointed by the clinical commissioning group as set out in the clinical commissioning group s constitution and may include individuals who are not on the Governing Body. 2.2 The Committee shall consist of a Chair, who will be a lay member of the Governing Body. 2.3 The membership of the Committee will comply with provisions set out in regulations and within the CCG s Constitution and associated standing orders. 2.4 The members of this Committee will be: 8 Clinical Directors Director of Strategic Commissioning Associate director of strategic commissioning Lay Member(s) Deputy director of finance Deputy director of quality and governance 2.5 The Committee is presently chaired by the lay member and this will be reviewed annually in April. Page 1 of 3 11

15 3. Attendance 3.1 The Chief Officer and other senior CCG managers should be invited to attend, and particularly when the Committee is discussing areas of risk or operation that are the responsibility of that manager. 3.2 The Chief Officer should be invited to attend and should discuss at least annually with the Committee the CCG s Commissioning Strategy Plan. 4. Secretary 4.1 The personal assistant to the Chair and secretary for governing body committees shall be Secretary to the Committee and shall ensure that a minute of the meeting is taken and provide appropriate support to the Chair and Committee members. 5. Quorum 5.1 A quorum shall be a third of members of the committee including 2 clinical directors. 5.2 In the event of the Chair of the Committee being unable to attend all or part of the meeting, he /she will nominate a replacement from within the membership to deputise for that meeting. 6. Frequency and notice of meetings 6.1 Meetings of the Committee will normally be held monthly, with the exception of August. The Committee may also hold a number of informal meetings during the year. 7. Authority 7.1 The Committee is authorised by the Governing Body to pursue any activity within these Terms of Reference and within the Scheme of Reservation and Delegation, including (without limiting the generality of the foregoing) to: a) Seek any information it requires from CCG employees, in line with its responsibility under these terms of reference and the Scheme of Reservation and Delegation. b) Require all CCG employees to co-operate with any reasonable request made by the Committee, in line with its responsibility under these terms of reference and the Scheme of Reservation and Delegation. c) Review and investigate any matter within its remit and grants freedom of access to the CCG s records, documentation and employees. The Committee must have due regard to the Information Governance Policies of the organisation regarding Page 2 of 3 12

16 personal identifiable information and the organisation s duty of care to its employees when exercising its authority d) Obtain outside legal or other independent advice and to secure the attendance of persons with relevant experience and expertise if it considers this necessary. e) Set up any joint working arrangements with other bodies. f) Establish task & finish groups to deliver its objectives. 7.2 In exercising its authority, the Committee is required to comply with: a) The CCG s Standing Orders and Prime Financial policies b) The CCG s Conflict of Interest Policy c) The section of the Scheme of Delegation which refers to this Committee 7.3 The Planning and Innovation Committee is not a decision-making body, but will make recommendations to the Governing Body. 8. Remit and responsibilities of the committee 8.1 The minutes shall be formally recorded by the personal assistant to the Chair and governing body committee and submitted to the Governing Body. 8.2 The chair of the committee shall draw to the attention of the Governing Body any issues that require disclosure or executive action. 9. Conduct of the committee 9.1 The committee will conduct its business in accordance with any national guidance and relevant codes of conduct / good governance practice, including Nolan s seven principles of public life. 9.2 The committee will review, at least annually, its own performance, membership and terms of reference. Any resulting changes to the terms of reference or membership will be approved by the Governing Body. Page 3 of 3 13

17 Item 3.1 Title of report From Quality Dashboard and Exception Report Helen Davenport, Director of Nursing, Quality and Governance - WFCCG Author Anne Walker, Deputy Nurse Director Quality and Clinical Governance - WFCCG Purpose of report The purpose of the report is to inform the Governing Body of the quality provided to the patients of Waltham Forest at its Provider Organisations, indicating by exception where quality does not meet agreed targets. Changes/additions/amendments to paper as a result of discussions held at Performance and Quality Committee None Recommendations The Governing Body members are requested to: 1. Review the contents of the report. 2. Consider whether the report provides assurance regarding the quality and safety of care and patient experience delivered to the residents of Waltham Forest. 3. Agree where contract performance notices (CPNs) be served in view of non-compliance with statutory/ contractual performance requisites. Impact on patients & carers With appropriate quality and governance in place patient safety and experience should be wholly assured. Failure to provide quality care leads to increased risk to patient safety and patient harm, poor patient experience and health outcomes. Risk implications Failure of all Waltham Forest CCG commissioned Providers to ensure the fundamental quality standards of clinical care across Waltham Forest health economy might lead to: Patients not receiving expected quality of care which would lead to poor patient experience and in some cases patient harm. Inhibit WFCCG from achieving its corporate objectives. Reputational risk. 14

18 Quality Dashboard and Exception Report Financial implications Funding services that are not high quality do not meet the needs of the patient is poor value for money and may result in additional funding pressures. Equality analysis The WFCCG is committed to fulfilling its obligations under the Equality Act 2010 and to ensure services commissioned by the WFCCG are non-discriminatory on the grounds of any protected characteristics. The WFCCG will work with providers, service users and communities of interest to ensure that any issues relating to equality of service within this report are identified and addressed. Business Intelligence Source Barts Health Performance Dashboard NELFT quality intelligence dashboard CQC inspection website Serious Incident Reports NELCSU STEIS database Other committees/groups, including the CCG Reference Group and Rapid Feedback Group Performance and Quality Committee 10 May

19 Quality Report Quality Dashboard and Exception Report May

20 Quality Dashboard Whipps Cross Quality Report May

21 Quality Dashboard NELFT Quality Report May

22 Areas of Good Practice Key Headlines Areas for Improvement NELFT Zero MRSA cases reported Zero overdue SI reports Zero Clostridium Difficile 100% of complaints were responded to within the agreed timeframe Compliance achieved with all Safeguarding Children and Adults training. Whipps Cross Maternity FFT 15% response rate exceeded target achieving 50%. No grade 4 pressure ulcers reported. No MRSA cases reported. No Never Events reported Statutory compliance with Safeguarding Adults training Level 1 and 2, Safeguarding Children Level 2 and 3. NELFT Compliance with Life Support Training Whipps Cross 3 Serious Incidents overdue 60 days, this is a significant improvement from January at % of Venous Thrombo Embolism (VTE) risk assessments were completed, not achieving the 95% target. 5 grade 3 pressure ulcers reported 64% of complaints were responded to within the agreed timeframe, not achieving the 80% target, however improvement from 42%. Compliance with Safeguarding Adults training Level 2 at 74% below 85% target Continued low FFT response rate in ED achieving 2%. 3 Mixed Sex Accommodation breaches reported. Duty of Candour compliance at 63% against target of 100% Quality Report May

23 Exception Report Whipps Cross Indicator Perf Further Intelligence Action taken by CCG Serious Incidents overdue 3 (March) Duty of Candour 63% (Feb) Whipps Cross Whipps Cross acknowledge capacity and capability of governance team to deliver timely closure. Medical Director leading improvement plan. Trajectory for compliance has been produced. Improved position from 9 overdue reports last month Non compliance with Duty of Candour throughout the financial year. Note data will be reported a month in arrears. Contract performance notice has been issued. Compliance with 90% of all reports closed within STEIS 60 day deadline will be delivered by end Quarter /18. Contract performance notice issues. Compliance with 100% of applicable incidents having the duty of candour applied within 10 working days will be delivered by end Quarter /18. FFT Response Rate ED 2% (March) Response rate for ED has not exceeded 7% for 16/17 against a target of 20%, achieving 2% this is 7% below the predicted response rate outlined in the remedial action plan for March Amended action plan received with trajectory of compliance for August 2017 this has been accepted by commissioners. Deputy Nurse Director Quality and Clinical Governance WF CCG attending SIRMAP and compassionate care and patient experience meetings. Patient Experience Lead post has been recruited to. CCG to offer additional support to provider. Quality Report May

24 Exception Report Whipps Cross Indicator Perf Further Intelligence Action taken by CCG/Trust Complaint 64% (Mar) Whipps Cross Complaints responded to within 25 working days target of 80% has not been met in 16/17. Governance team at Whipps Cross has capacity and capability concerns impacting on ability to facilitate timely complaints responses. Contract Performance Notice issued. Compliance with 80% of all complaints responded to within 25 working days deadline will be delivered by end Quarter /18 VTE Risk assessment Basic Life Support Training 91% (Mar) 79% (Feb) Improvement on previous month position from 42% to 64% The target set for Barts Health is 95%, achieved 91% in February Ascertained that there have been no serious incidents of deaths related to VTE. Underutilisation of training sessions continues to be an issue across all sites, with only 50% of available capacity being utilised. Support requested from site leadership operational model (LOM) senior management teams to address. Use of enhanced advertising to improve attendance. Drop in sessions being held to improve access. Data not available for March 17 Review at April CQRM. Previous trajectory for compliance with target was due end of March Review of action plan post CQC inspection and report indicates further actions required. Trust requested to provide updated remedial action plan. Reviewed at CQROA meeting and assurance sought that no areas at risk due to low numbers of staff trained. Deputy Nurse Director Quality and Clinical Governance WF CCG attending SIRMAP and compassionate care and patient experience meetings. Quality Report May

25 Exception Report Whipps Cross Indicator Perf Further Intelligence Action taken by CCG/Trust Whipps Cross Safeguarding Adults Level 2 74% (Mar) Non compliant with the 90% during financial year thus far. Review at the monthly CQROA and KPI meetings. Specific question and agenda item April CQROA meetings Formal request for remedial action plan for May CQRM review. Grade 3 Pressure Ulcers 3 (Mar) Target of 0 not been achieved during the financial year thus far. Review at the monthly CQROA. CCG to establish joint working with NELFT and Whipps Cross. Mixed Sex Accommodation Breaches 3 (March) Non compliant during January and February Overall most breaches relate to delayed step down from critical care beds. Review at the monthly CQROA. Visual observation during quality assurance visits and discussion with patients and staff. Infection Prevention Level 1 and 2 clinical staff 86% (Jan) Non compliant with 90% target. Data not available March 17. Review at the monthly CQROA. Assurance that there are no areas of risk for the site via CQROA. Quality Report May

26 Exception Report - NELFT Indicator Perf Further Intelligence Action taken by CCG/Trust NELFT Life Support Training 81% (Mar) 85% target not achieved since August 2017 however improvement noted to 81% from 76% in previous two months. Reviewed at CQROA meeting. Quality Report May

27 Care Homes During March residential homes were inspected. 5 reports have been published with 1 pending. The table demonstrates the CQC rating for each residential and nursing home against the 5 domains of care. Key Outstanding Good Home Spinney (The) Residential Older People Chingford Sable Care Limited- 22 Ashbridge Road Residential Older People Leytonstone St. Michaels Lodge Residential Mental Health Leytonstone Almadene Care Home (Goodcare Limited) Residential Older People Highams Park Primrose Road Residential Learning Disabilities Leyton Requires improvement Effective Inadequate Safe Well-led Caring Responsive Overall Quality Report May

28 Care Home Exception Report Home Area rated amber or below Reason for rating Almadene Care Home (Goodcare Limited) Residential Older People Highams Park Safe, effective, caring, responsive and well-led Records of incidents was not maintained Plan in place to reduce risk has not always been reviewed and updated Safe management of medicines checks were not consistently completed People who lacked capacity to consent to their care and treatment had been unlawfully deprived of their liberty Staff did not always receive supervision in line with the provider s policy. Involvement of healthcare professionals in care plans was not always documented. People were not always involved in making decisions about their care and treatment Did not ask people about their sexuality so did not provide appropriate support to people who may identify as lesbian, gay, bisexual or transgender Care plans did not provide information to provide personalised support People appeared to be bored and were under-stimulated. Systems in place to ensure regular audits were not being followied in the absence of the registered manager Quality Report May

29 Care Home Exception Report Home Area rated amber or below Reason for rating Spinney (The) Residential Older People Chingford Safe Selection and recruitment processes were not always safe Policy for recruiting staff was not being followed. Quality Report May

30 Quality Review Visit Whipps Cross April 17 Area 7 April 2017 Whipps Cross Hospital The Deputy Nurse Director Quality and Clinical Governance assisted the Directors of Nursing with an Internal quality review focused on nursing documentation. The reviewer undertook the audit using a proforma focusing on; Record Keeping Standards Care Planning/Evaluation Nursing Documentation Bundle Key Themes and Highlights The team undertook the audit across the divisions of medicine, medicine for older people, surgery and critical care. The CCG reviewer attended the older peoples services. Overall the reviewers identified that the standards had improved since previous audits. However there were some common themes and areas for improvement as stated below; Not all patient data on individual sheets Care planning did not document patient/family involvement Discharge planning on admission was not documented/completed Care planning was not personalised/individualised Fluid balance charts not totalled to indicate positive or negative balances Nurses were not printing their names in line with policy and stamps not being consistently used especially in older people wards Pain score not documented on care plan but was NEWS scores include pain score and were fully documented and correct Overall very little form of nursing documentation in notes or care plans Bed rail assessments not being completed appropriately and two patients with rails insitu without appropriate rationale/evidence Recommendations Above findings to be taken into consideration in review of Nursing documentation bundle. Findings to be discussed with all nursing teams and clear expectations set. Quality Report May

31 CQC Celebrating Good Care, Championing Outstanding Care Care Quality Commission (CQC) published their report celebrating good care, championing outstanding care during April This report outlines what good care looks like and how other trusts, care homes and GP practices have achieved outstanding in the 5 key questions, covering topics such as; what does outstanding look like?, making a real difference, innovative environment and continuous learning. The providers included as demonstrating outstanding practice in different areas of the 5 key questions are below: Rose Lodge, Exmouth, Devon Getta Life Limited, Coventry Harley House Care Home Limited, Leicester University Hospitals Bristol NHS Foundation Trust Birmingham Children's Hospital NHS Foundation Trust Northumbria Healthcare NHS Foundation Trust Woodgrange Medical Practice, Forest Gate, London Southdene Medical Centre, Shotton Colliery, County Durham The Forum Health Centre, Conventry Southdene Medical Centre achieved an outstanding rating for safe, a piece of work that contributed to this is that the practice manager has overall responsibility for recording significant events, these were scheduled and it was noted where they met the criteria and they were added to the local CCG s risk management system. Birmingham Children s Hospital NHS Foundation Trust was rated outstanding for caring, it was noted during their CQC inspection that although there were areas where improvement was needed the inspectors observed genuine compassionate care this included the trust having storytelling therapists to assist the children in dealing with their emotions and anxiety whilst they were in hospital. The full report can be found in the following link Quality Report May

32 Item 3.2 Title of report CCG 360 Stakeholder Survey 2017 From Author Helen Davenport, Director of Nursing, Quality and Governance - WFCCG Julia Walsh, Head of Communications and Community Participation - NELCSU Purpose of report To inform (in summary) NHS Waltham Forest Clinical Commissioning Group s Governing Body of the results of the 2017 CCG 360 Stakeholder Survey. Changes/additions/amendments to paper as a result of discussions held at previous Committee None Recommendations To note the summary report. Impact on patients & carers Findings from the report in respect to public and patient involvement will be used to inform future public engagement in the commissioning process. Risk implications None Financial implications None Equality analysis Findings from the report will be used to inform future communications and engagement activity with seldom heard groups. Business Intelligence Source None Other committees/groups, including the CCG Reference Group and Rapid Feedback Group None 29

33 CCG 360º Stakeholder Survey 2017 Summary results report 30

34 CCG 360 Stakeholder Survey 2017 Contents 1 Background 1 2 Summary Rise in confidence Improved communication Better engagement needed Member practices 3 3 Conclusion 3 Page ii 31

35 CCG 360 Stakeholder Survey Background Each year Ipsos MORI, on behalf of NHS England, contacts the stakeholders of all clinical commissioning groups asking them to complete a CCG 360º Stakeholder survey. The survey is a series of set questions that goes to set stakeholder groups. Each CCG supplies Ipsos MORI with the stakeholder contact details. The stakeholder groups are as follows: GP member practices up to one from each practice 43 in Waltham Forest Health and Wellbeing Boards up to three per board Local Healthwatch up to three per Healthwatch Other patient groups up to five NHS Providers (acute, mental health and community trusts) up to two per provider Other CCGs up to five Upper tier or unitary local authority (LA) up to five per LA As shown above, the largest stakeholder group is made up of the CCG s member practices. This year (2017), just over half (39 out of 73) of the stakeholders asked to take part in the CCG 360 Stakeholder Survey for NHS Waltham Forest Clinical Commissioning Group did so. Questions asked fall into the following summary categories: Overall engagement Commissioning of services Leadership of the CCG Monitoring and reviewing of services Plans and priorities. Each CCG is given the opportunity to ask a number of questions of their stakeholders specific to their CCG. Each question starts with same stem question: This year in Waltham Forest we asked the following: How would you rate the CCG on each of the following? Working with the local authority to join up health and social care services Working with providers and neighbouring CCGs on Transforming Services Together across East London Improving access to mental health services Helping to improve digital (IT) connectivity between healthcare providers Supporting prescribers to make the best use of medicines for the local population. The results of the survey assist the CCG in its on-going organisational development, helping to evaluate progress and inform decisions and feed into improvement and assessment conversations with NHS England. Please note when stakeholders is used in the summary report below, it should be taken to refer to the stakeholders who responded to the survey overall unless otherwise specified. Page 1 32

36 CCG 360 Stakeholder Survey Summary The º stakeholder survey results show, year-on-year: a rise in confidence in the CCG, specifically in the leadership improved communication, particularly with member practices the need for increased stakeholder engagement in the commissioning process The results for the local questions asked are detailed below: How would you rate the CCG on each of the following? % very good or fairly good Working with the local authority to join up health and social care services 64 Working with providers and neighbouring CCGs on Transforming Services Together across East London 74 Improving access to mental health services 57 Helping to improve digital (IT) connectivity between healthcare providers 61 Supporting prescribers to make the best use of medicines for the local population Rise in confidence The confidence levels in the CCG to effectively monitor the quality of services remain at 67% but the survey s summary results show a year-on-year rise in the level of confidence, among stakeholders overall, in the CCG to commission high quality services, rising from 58% in 2016 to 64% in Stakeholders opinions of the CCG s leadership also show improvement on last year. 7% more stakeholders (82%) feel that there is clear and visible leadership (75% 2016) 10% rise (74%) in confidence in the leadership of the CCG to deliver its plans and priorities (64% 2016) 3% increase in stakeholders (67%) confidence that the CCG will deliver improved outcomes for patients (64% 2016) 2.2 Improved communication Stakeholders overall also felt that the CCG has improved in its communication, with the majority (82%) feeling that they know a great deal or a fair amount about the CCG s plans and priorities (75% 2016). Page 2 33

37 CCG 360 Stakeholder Survey Better engagement needed However, alongside the improvements in leadership and communication, the survey s results also tell us that despite knowing more, overall stakeholders feel the CCG could engage better with some groups. Results show a significant drop in stakeholders opinions that the CCG is contributing to wider discussions in local groups 1, with this year only 54% strongly agreeing/agreeing that the CCG does contribute in this way (72% in 2016). A low percentage of stakeholders overall (36%) also felt that the CCG acts on the views of patients and the public when making commissioning decisions. Feedback was not all negative though: I think Waltham Forest CCG is moving in the right direction with regards to engagement. The reshaping of the PRG is a very good move. However, much more needs to be done involve patients and the public in service development and improvement. Too many decisions are made without capturing the patient or public voice. I would like to see service users involved in the commissioning of services. The majority of stakeholders overall (72%) still feel they can raise concerns with the CCG, although this is down on last year (81%). There is a greater year-on-year fall in the percentage of stakeholders overall (59%) who have confidence in the CCG to act on the feedback it receives about the quality of services (75% 2016). There was also a very slight drop in stakeholders overall (59%) feeling they have been given the opportunity to influence plans and priorities (61%), with only 44% of stakeholders overall feeling their comments have been taken on board (50% 2016). 2.4 Member practices As noted above, the largest group of stakeholders approached to complete the stakeholder survey is that of the CCG s member practices. On the whole member practices (who responded) were largely (76%) very or fairly satisfied with the way the CCG engages with them, and the majority (77%) rated their working relationship with the CCG as very or fairly good. While a low percentage (45%) felt they had been given the opportunity to influence the CCG s plans and priorities, there was a nine per cent increase in member practices (64%) feeling that the CCG has very or fairly effective arrangements in place for member participation in decision making at the CCG. This shows a year-on-year improvement over the last three years (55% 2016, 60% 2015), and was coupled with an increase in numbers who feel they can influence the CCG s decision making (45% 2017, 40% 2016). 3 Conclusion It s felt the improvements in communication and engagement with GP member practices are in part the result of the introduction of the Practice Portal, regular monthly Practice Bulletins, and locality meetings, and is a reflection on the CCG s employment of a Communications and Engagement Officer, whose time in part is dedicated to managing communications with GP practices through the portal and bulletin. 1 Question asked of stakeholders: Please now think about discussions that take place about the wider health economy in your area, through local groups. This may include groups such as the Quality Surveillance Group, Urgent Care Working Group, Council for Voluntary Services, Strategic Clinical Networks, Clinical Senate Assemblies, clinical or non-clinical networks, forums and any other relevant local groups. To what extent, if at all, would you say the CCG has contributed to wider discussions through these groups? Page 3 34

38 CCG 360 Stakeholder Survey /17 also saw the employment of a Communications and Engagement Manager and the development of a Communications and Engagement toolkit to aid commissioning teams in public engagement activities. It s felt that these resources, along with the review and development of the CCG s Patient Reference Group, will be vital in improving public and patient involvement groups in the commissioning process. 2017/18 will see the development of a Children s and Young People Community Participation Strategy and an increased focus on engaging with the borough s diverse cultural community groups. Page 4 35

39 Item 3.3 Title of report From Author Special Education Needs and Disabilities Progress Report Helen Davenport, Director of Nursing, Quality and Governance - WFCCG Kelvin Hankins, Associate Director of Contracting - WFCCG Purpose of report The report provides detail on the action taken since the Special Education Needs and Disabilities Local Area Inspection in January Changes/additions/amendments to paper as a result of discussions held at Performance and Quality Committee Review of timeline. Recommendations Governing Body are asked to: 1. Note progress made to date. 2. Agree for Performance and Quality to approve the draft Statement of Action for submission to Ofsted / CQC. 3. Agree for update report, and to receive the final Statement of Action, at the July 2017 Governing Body meeting. Impact on patients & carers An improvement in the SEND process and pathway will support improved care received in education. The CCG has engaged with the Waltham Forest Parents Forum and will continue to in the development, implementation and business as usual process for the SEND reforms Risk implications As detailed within the report. Financial implications The implementation of the composite action plan may result in additional funding being required 36

40 Special Education Needs and Disabilities Progress Report Business Intelligence Source N/A Other committees/groups, including the CCG Reference Group and Rapid Feedback Group SEND Project Board Joint Commissioning Board Waltham Forest Parents Forum NELFT CQRM NELFT SPR 37

41 Special Education Needs and Disabilities Progress Report 38

42 Special Education Needs and Disabilities Progress Report Contents 1 Background 1 2 Joint Ofsted and CQC Local Area Inspection 1 3 Timeline 2 4 Timeline for Sign off 2 5 Action Undertaken 3 6 Recommendations 4 Appendix 1 5 Page ii 39

43 Special Education Needs and Disabilities Progress Report 1 Background The Children and Families Act came into force in September 2014 and contained within it a mandate to improve the experience of children and young people with special educational needs and disabilities and their families and to ensure that they get the support they need, focusing on relevant outcomes that matter to them. From September 2014, the Children and Families Act 2014 made it a requirement for each local area to have: a clear, transparent local offer of services across education, health and social care with children, young people and parents involved in preparing and reviewing it services across education, health and care to be jointly commissioned Education, Health and Care (EHC) plans to replace statements and Learning Difficulty Assessments (LDAs) with the option of a Personal Budget for families and young people who want one new statutory rights for young people in further education, including the right to request a particular institution is named in their EHC plan and the right to appeal to the First-tier Tribunal (Special Educational Needs and Disability), and; a stronger focus on preparing for adulthood, including better planning for transition into paid employment and independent living and between children s and adult s services 2 Joint Ofsted and CQC Local Area Inspection On Monday 16 th January 2017 the Local Area were informed of the inspection taking place. The inspectors carried out their fieldwork during week beginning 23 rd January Prior to this there had been 21 inspections of the 150+ local areas to be inspected. The outcome of the inspection was formally published on 30 th March 2017 and is available in Appendix 1. The main findings in the letter identify some strong characteristics of progress relating to strategic developments, leadership, involvement of parents and families and the satisfaction of parents and families. The balance of strengths identified under the 3 specific inspection areas, significantly outweigh the continuing areas for development. Along with the identified area for development the inspectors have issued a Statutory Order on the Area to produce a Statement of Action. This is because the Inspectors identified significant areas of weakness in the local area s practice. The letter details them as: The CCG has not ensured that the DMO role has sufficient capacity to address the areas for improvement that have been identified. For example, arrangements for ensuring that medical assessments are carried out for young people aged 19 to 25 years have still to be agreed. The CCG do not have an agreed role in reviewing and finalising EHC plans. They are not aware of the proposed health care provision prior to the plan being shared with families. This limits the CCG s understanding of the services that will need to be commissioned. The CCG has not ensured that a robust process is in place for health providers to contribute to EHC plans. Arrangements for practitioners to check the draft plan once completed, or to offer feedback before the plan is finalised, are not in place. As a result, many plans are not of a good enough quality. Page 1 40

44 Special Education Needs and Disabilities Progress Report The 3 key areas identified by inspectors for the Statement of Action to address, relate to health services and the responsibilities of the CCG. The composite action plan will also review the current governance structure to understand how these issues were not identified locally and put in place appropriate assurance to ensure issues are identified at an earlier point. Although the three identified areas are detailed as the responsibility of the CCG the pathway is a joint health and social care pathway which requires all partners to work together to implement the best pathways possible. 3 Timeline The requirement to produce the Statement of Action is placed on the Local Area with the Local Authority and the Clinical Commissioning Group having joint responsibility for completion and submission. The Statement of Action will need to be submitted to Ofsted for approval within 70 days of the 30 th March publication date of the letter. A Department for Education adviser and NHS England support will provide advice on the process of the production of the Statement of Action. The Statement of Action has to be approved by Ofsted and once approved, progress against the priorities and actions will be regularly monitored by Ofsted before the concerns are dispensed with. The final submission date for the Statement of Action agreed by the Local Area Partnership is 3 rd July 2017, which is a few days before the 70 day deadline of 12 th July Timeline for Sign off Both the CCG and LBWF need to have signed off the Statement of Action prior to submission, for good practice the intention is also for NELFT to sign off. The below timeline shows the current expected timeline for signoff, this is subject to change as the Statement of Action and composite action plan is developed: Statement of Action May Wk 1 Communication with Stakeholders May Wk 2 May Wk 3 May Wk 4 June Wk 1 June Wk 2 June Wk 3 June Wk 4 July Wk 1 First Draft SOA & SEF FInal Draft SOA & SEF Project Board WFCCG Project Board Review WFCCG Submit Final Action Plan WFCCG Meeting with Inspectors June Project board Sign Off SOA & SEF WFCCG Quality & Performance Committee Sign Off SOA WFCCG Governing Body Sign Off SOA Integrated Commissi Local Authority NELFT NELFT submit FInal Action Plan LA submit final action plan NELFT Sign Off SOA at xxxx London Borough WF sign off SOA & SEF at Integrated Governance Board Communication with Stakeholders / Parenting Forum Joint Commissioning Board sign off SOA Health & Wellbeing Board Approve Submit SOA to Inspectors 3 July Page 2 41

45 Special Education Needs and Disabilities Progress Report 5 Action Undertaken In response to the inspection, both the identified areas for development and the required Statement of Action, a Special Educational Needs and Disabilities Project Board has been established by the CCG, which is meeting monthly for the next 8 months. The expectation is that the project will then transfer into business as usual and report to the Better Care Fund for Children and Young People governance structure. The responsibilities of the board are to: To ensure there is a local designated medical officer (DMO) and / or designated clinical officer (DCO) appointment with sufficient capacity in line with the British Association of Childhood Disability (BACD) and British Association for Community Child Health (BACCH) recommendations to support local joint commissioning arrangements and working practices across Waltham Forest health and social care economy. These would include: - Processes for the robust identification of disabled children and young people with special educational needs and disabilities including pre-school children. - The process for securing relevant up to date assessments by health professionals and health sign off in EHC Plans. - Oversight and quality assurance by the CCG of health provision specified in EHC Plans. - Ensuring young people aged receive a medical assessment. To improve how health and partnership agencies will monitor the changing needs of children and young people with SEN and disability from 0-25 in the local population and more effectively assess whether or not the available provision is improving their outcomes using appropriate outcome measures. To establish a communication and governance framework between the CCG the Local Authority and Education, that monitors progress against these outcomes on an ongoing basis, and this process must involve the views of children and young people with SEN and disability, and their parents. To clarify the services commissioned to support children and young people with SEND by both health and social care and Education within the local offer. The local offer must cover available provision across education, health and social care from the ages of 0 to 25, with details of how these services can be accessed and any admission or eligibility criteria. To ensure the voices of children, young people and their parents are taken into account within the SEND pathway and in line with expectations within the Children and Families Act (2014) and the NHS constitution. Waltham Forest local area will demonstrate they have a mechanism for engagement with children and young people and their families who are able to co-construct their EHC plans alongside professionals. Page 3 42

46 Special Education Needs and Disabilities Progress Report The members of the Project Board are: Waltham Forest SEND Project Board Membership Name Title Organisation e mail Helen Davenport (Chair) Director of Nursing, Quality and Governance Waltham Forest CCG Helen.Davenport@walthamforestccg.nhs.uk Mark Mclaughlin Project Lead SEND Waltham Forest CCG Mark.McLaughlin@walthamforestccg.nhs.uk Korkor Caesar Designated Nurse for Safeguarding children and Looked After Children Waltham Forest CCG Korkor.Ceasar@walthamforestccg.nhs.uk Kelvin Hankins Associate Director of Contracting Waltham Forest CCG Kelvin.Hankins@walthamforestccg.nhs.uk Zitha Moyo CHC / adult safeguarding lead Waltham Forest CCG Zitha.Moyo@walthamforestccg.nhs.uk Siobhan Hawthorne Maternity and Children s Commissioning manager Waltham Forest CCG Siobhan.Hawthorne@walthamforestccg.nhs.uk Rebecca Waters Communications and Engagement Manager Waltham Forest CCG Rebecca.Waters@walthamforestccg.nhs.uk Sue Boon Director of Integrated Care Waltham Forest NELFT Sue.Boon@nelft.nhs.uk Lynne McBride Operational Lead Targeted Services NELFT Lynn.McBride@nelft.nhs.uk Andy Beckett Director, Disability Enablement Service London Borough of Waltham Forest Andrew.Beckett@walthamforest.gov.uk Darren Newman Assistant Director of Commissioning London Borough of Waltham Forest Darren.Newman@walthamforest.gov.uk Dr Corina O'Neill Consultant community paediatrician NELFT Corina.O'Neill@nelft.nhs.uk Dr Tonia Myers Clinical Director Children and Maternity Waltham Forest CCG Tonia.Myers@walthamforestccg.nhs.uk Joe Lindo Assistant Director Universal Services Children NELFT Joseph.Lindo@nelft.nhs.uk Jessica Pokuah Safeguarding Administrator London Borough of Waltham Forest Jessica.Pokuah@walthamforestccg.nhs.uk Joe McDonnall Consultant in Public Health (Acting Director of Public Health) London Borough of Waltham Forest Joe.McDonnell@walthamforest.gov.uk John Mcshane Group Manager North Team Disability Enablement Service London Borough of Waltham Forest Barbara Thurogood Manager London Borough of Waltham Forest Barbara.Thurogood@walthamforest.gov.uk Vanessa Moore Forum Chair WF Parents Forum walthamforestparentforum@live.co.uk Each partner (CCG / Local Authority / NELFT / Public Health) has been asked to develop an action plan in response to the inspection which will then be converted into a composite action plan monitored by the Special Education Needs and Disabilities Project Board. Alongside the development of the action plan the written statement of action is being developed which is aimed to be drafted for sign off by the CCGs and Local Authorities governance structures by the last week in May 2017 as detailed above. 6 Recommendations Governing Body are asked to: 1. Note progress made to date. 2. Agree for Performance and Quality to approve the draft Statement of Action for submission to Ofsted / CQC. 3. Agree for update report, and to receive the final Statement of Action, at the July 2017 Governing Body meeting. Page 4 43

47 Special Education Needs and Disabilities Progress Report Appendix 1 Page 5 44

48 Ofsted Agora 6 Cumberland Place Nottingham NG1 6HJ T Textphone enquiries@ofsted.go.uk lasend.support@ofsted.gov.uk 21 March 2017 Ms Linzi Roberts-Egan Deputy Chief Executive, Families Directorate Waltham Forest Town Hall Forest Road Walthamstow E17 4JF Kelvin Hankins, CCG Assistant Director Contracting Andy Beckett, Director of Disability Enablement Service (DES), Local area nominated officer Dear Ms Roberts-Egan Joint local area SEND inspection in Waltham Forest Between 23 January 2017 and 27 January 2017, Ofsted and the Care Quality Commission (CQC) conducted a joint inspection of the local area of Waltham Forest to judge the effectiveness of the area in implementing the disability and special educational needs reforms as set out in the Children and Families Act The inspection was led by one of Her Majesty s Inspectors from Ofsted, with a team of inspectors including an Ofsted Inspector and a children s services inspector from the Care Quality Commission (CQC). Inspectors spoke with children and young people with special educational needs and/or disabilities (SEND), parents and carers, local authority and National Health Service (NHS) officers. They visited a range of providers, and spoke to leaders, staff and governors about how they were implementing the special educational needs reforms. Inspectors looked at a range of information about the performance of the local area, including the local area s self-evaluation. Inspectors met with leaders from the local area for health, social care and education. They reviewed performance data and evidence about the local offer and joint commissioning. As a result of the findings of this inspection and in accordance with the Children Act 2004 (Joint Area Reviews) Regulations 2015, Her Majesty s Chief Inspector (HMCI) has determined that a Written Statement of Action is required because of significant areas of weakness in the local area s practice. HMCI has also determined that the local authority and the area s clinical commissioning group(s) are jointly responsible for submitting the written statement to Ofsted. 45

49 This letter outlines our findings from the inspection, including some areas of strength and areas for further improvement. Main findings The Waltham Forest local area has reviewed the roles and responsibilities of strategic leaders from education and social care services to take account of the SEND reforms. The resulting Disability Enablement Service (DES) has allowed a joined-up approach to working, which ensures that children and young people with SEND and their families are well supported. Working practices have been strengthened, and professionals support and challenge each other to be increasingly effective. Leaders have an accurate understanding of the area s strengths and weaknesses because professionals work and communicate well with each other. They have ensured that there are effective systems in place for keeping children and young people who have SEND safe. The clinical commissioning group (CCG) has appointed a designated medical officer (DMO). However, the strategic planning and operational functions of the DMO have not been effectively developed or monitored. Significant areas for improvement identified by the CCG have still to be addressed. For example, some health professionals are still not making a strong enough contribution to education, health and care (EHC) plans because the systems for doing this are underdeveloped. The quality of EHC plans is very variable. Although most new plans are completed within the required timescale of 20 weeks, the final version shared with parents often lacks sufficient detail to be useful. Some plans are finalised before contributions from health professionals have been included or checked. In some cases, parents and their children have not been actively involved in agreeing the content of the plan. There is too much jargon or confusing terminology that has been cut and pasted from professional reports. Very few plans include desired outcomes that are specific or measurable. Parents and professionals are therefore unable to judge how well children and young people have been supported. The parent carer forum is influential and widely appreciated. It has ensured that the local offer is regularly updated and is useful to parents. The success of this work can be seen in the increasing number of visits being made to the local offer webpages every month. The majority of parents within Waltham Forest who shared their views with inspectors were generally satisfied with the support provided for their children. The parent carer forum works closely with the independent information and advice service, provided by the Citizens Advice Bureau, to ensure that any concerns are addressed as quickly as possible. This is reflected in the low number of requests for mediation support and tribunal hearings, compared to other areas. 46

50 The effectiveness of the local area in identifying children and young people s special educational needs and/or disabilities Strengths Many parents are complimentary about the work of the early years service and children and family centres. Professionals build positive relationships with families and understand their needs well. An increasing range of services can be accessed within the same centre, and joint assessments are carried out whenever possible. This saves time and leads to speedier identification of SEND and fast-tracking to appropriate services. Transitions from nursery providers to schools are planned and supported well. This ensures that the needs of the child are fully identified and understood as soon as they start school. The identified needs of children and young people are regularly reviewed to ensure that any further support that may be needed can be planned well in advance. For example, professionals from all services meet regularly and work closely together to ensure that a wide range of options are available for young people when they leave school or college. Neo-natal screening is well-established and initially undertaken by the midwifery services. Health visitors follow up any issues, with effective systems in place for identifying and recalling new-borns. Infants and families new to the country are offered neo-natal screening when they arrive in Waltham Forest to ensure that any needs are quickly identified. Children benefit from a review of their health by school nurses when they first start school, but also at Year 6 and Year 10. Children are able to access advice and support through regular drop-ins, which offer them an opportunity to discuss any health concerns and be signposted to appropriate services. Some schools ensure that all education, health and care needs are fully explored as soon as pupils receive SEN support. This allows a request for statutory assessment to be prepared quickly, should it become necessary. Areas for development It is taking too long for statements of special educational needs to be converted to EHC plans. Far fewer children and young people with statements in Waltham Forest have been issued with a plan, compared to other areas. This means that some care and health needs may not be fully identified. Leaders have taken appropriate action to address the existing backlog, and some early improvements in the rate of conversion are starting to be seen. Not all parents have been supported to make a full and complete contribution to their child s EHC plan. Sometimes, the information gathered from parents and their child fails to identify all their needs. In some cases, social care and health professionals have not been invited to make a contribution to the plan because 47

51 no one has realised that they are supporting the family. Families new to the area and children under five are not yet benefiting from a comprehensive offer from the health visiting service. Plans to address this have been agreed. However, expectant mothers are not routinely receiving an antenatal visit. The two and a half year integrated health check is not yet well established across Waltham Forest. Assessments to support early identification of SEND through the mandated checks are not at the expected level. Consequently, the health needs of some children with SEND have still to be identified. Medical assessments are not being commissioned for young people aged 19 to 25 years who have SEND. The health needs of this group of young people are not being identified or supported well. The effectiveness of the local area in meeting the needs of children and young people with special educational needs and/or disabilities Strengths Professionals within education and social care work together closely. Information is shared through electronic records that align across services and inform face-toface meetings. Service leaders challenge each other to make further improvements as part of regular review cycles. Children, young people and their families are supported well by staff who are well informed and respond quickly to any concerns that arise. As part of the integrated approach to delivering services, the transition to adult social care services is planned well in advance with parents and young people. Families usually remain with the same allocated social worker, whom they know and trust. Some social workers have worked closely with families over a long and sustained period of time to provide continuity of care. Leaders regularly consult with parents to determine how their needs can be met more effectively. Such consultations form part of the area s review cycles and have led to improvements in the support offered. For example, the short breaks offer has been expanded and now offers more choice. This allows parents to select from a menu of options to match their individual circumstances. Children and young people are provided with regular opportunities to share their opinions. Leaders listen to and act on their views. For example, leaders have provided more opportunities for volunteer and work placements in the areas that young people with SEND have expressed an interest in. The child and adolescent mental health service (CAMHS) has reviewed how it communicates with young people since they expressed a preference for receiving electronic notifications of their appointments. Most children and young people who are referred to CAMHS are seen within 18 weeks. The service also supports parents well. A recent initiative has been the successful introduction of a parenting group that provides group therapy to improve parenting skills and promote well-being. 48

52 The fair access panel includes professionals from a range of services who support children and young people who have SEND. The panel identifies appropriate school places, but also ensures that children and young people have access to a wider range of services within the local area. For example, some apprenticeship and internship opportunities have been ring-fenced for young people who have SEND to allow them to take their next steps towards independence. Schools are increasingly commissioning services to provide bespoke packages of care that meet the different needs of their pupils very well. The speech and language therapy (SALT) service, the educational psychology service and CAMHS all work closely with school leaders to provide training and support for staff and parents, as well as planned interventions for pupils. This work is promoting better communication skills and a wider understanding of mental health issues. Children under the age of five who need additional help to communicate are able to access early support. This is provided by the SALT team who work as part of the health, exercise and nutrition for the really young (HENRY) group. This targeted support has been very positively evaluated by parents. Schools are taking the most helpful information from EHC plans and ensuring that the needs of children and young people are well supported. Person-centred reviews are used very effectively to ensure that aspirational targets are agreed and all progress is carefully evaluated. This allows schools to judge what support has been effective and when further changes need to be made. Children and young people attending special schools are supported effectively by the special school nursing service. Nurses provide direct care for pupils as well as supporting staff with health care plans and training. Some schools have employed their own staff to liaise with nurses, disseminate training and support the daily health needs of pupils. This allows schools to tailor support to match the needs of their pupils, staff and settings more closely. Detailed health assessments are completed by specialist nurses for children looked after. They visit out of area placements to check that the health needs of this group are supported appropriately. Special school nursing, child development nursing and community children s nursing services provide an integrated children s nursing service. They work together closely to provide high-quality care to children and young people who have more complex needs. The children s development centre (CDC) ensures that most assessments are carried out jointly by a range of health professionals. Families receive a simple written summary of the discussions and actions agreed after each assessment. As a result, parents can hold professionals to account more strongly for the quality of support their child receives. Most children who are referred to community paediatricians benefit from early assessment and support from therapists before the appointment. Children and their parents are able to access the CDC playgroup which offers a further opportunity for assessment and support. As a result, paediatricians are better 49

53 informed when they meet the family for the first time. Areas for development The CCG have been slow to implement some of the necessary reforms. They have not yet addressed the significant areas of concern identified a year ago as part of the CCG action plan. These include improving communications between health agencies and other professionals at a strategic level, improving the capacity of the DMO role to deliver the SEND reforms and ensuring that all health professionals make a full contribution to EHC plans. Health practitioners are not consistently or sufficiently involved in the EHC plan process. Health visitors and most universal school nurses are not being asked to contribute to plans. Some health professionals do not receive copies of draft plans to allow them to check the accuracy of their contributions. Not all health practitioners are routinely using the agreed template for writing health input to plans and instead submit discharge summaries or assessment reports. Consequently, the plan is not appropriately focused on outcomes. In some cases health practitioners were unaware that a child or young person had an EHC plan because the systems in place to alert them to this are unreliable. Some children and young people are waiting unacceptably long periods of time to receive an assessment and support from the occupational therapy services. This can be as long as 39 weeks for non-urgent cases. Children and young people who are referred to CAMHS with autistic spectrum disorders are not benefiting from a physical assessment to inform their support plan. This is not in line with the recommendations made by the National Institute for Health and Care Excellence (NICE). The effectiveness of the local area in improving outcomes for children and young people who have special educational needs and/or disabilities Strengths Children and young people who receive SEN support generally make good progress across all phases of education within Waltham Forest. In 2016, those at the end of key stage 2 had made better progress from their different starting points in reading, writing and mathematics than all pupils nationally with the same starting points. This was particularly the case for pupils receiving SEN support who had low prior attainment. Pupils receiving SEN support continue to achieve well when they move to secondary schools. More pupils acquired five GCSE passes at grades A* to C last year than in previous years. Pupils with low prior attainment made above-average progress in English and mathematics compared to other pupils with the same prior attainment nationally. More young people receiving SEN support go on to achieve level 2 qualifications in English and mathematics by the time they are 19 years old than in other areas. Significantly 50

54 more acquired level 3 qualifications by the same age. Children and young people with SEND supported by the young offender teams receive a very effective package of support. A large majority of families supported through functional family therapy express high satisfaction rates, and recognise the progress being made by their children. The reoffending rates within Waltham Forest are the second lowest in London. The school link project, delivered by CAMHS, identifies a named person to provide information, advice and guidance to schools about emotional health and wellbeing. Schools involved in this project have significantly reduced the number of pupils who have been referred to CAMHS. The number of young people who have SEND who are not in education, training, supported placements or employment is low. Young people usually sustain their placements when they leave school or college, because they are provided with a wide choice of pathways and options that closely match their needs and aspirations. For example, more young people last year successfully took up paid employment within the Barts NHS Trust hospitals, as a result of the expansion of the Project Search initiative. The number of young people living in residential care settings is low. This is due to the increasing number of supported living opportunities being developed within and outside the area that are made available to young people within Waltham Forest. Increasing numbers of young people are engaging with their Year 10 health review. School nurses have developed a health questionnaire with youth advisers for Year 10 pupils, and the response rate has increased from 24% to 40% in one year. Areas for development Children and young people with a statement of special educational needs or an EHC plan made less progress in reading, writing and mathematics than all other pupils nationally with the same starting points by the end of key stage 2. They made significantly less progress in English by the end of key stage 4. More pupils with a statement of special educational needs or an EHC plan are absent or temporarily excluded from schools in Waltham Forest, compared to all other pupils within the area and nationally. Senior leaders from all agencies are not gathering or evaluating a broad enough range of assessment information from schools and providers. They are sometimes unclear how outcomes for children and young people who have SEND are improving. For example, they are not checking that they are achieving good and improving outcomes in their social and emotional aspects of learning, health, well-being, skills for life or engagement with their community. Quality assurance arrangements to ensure that EHC plans are of an acceptable quality are weak. Although audits and evaluations take place regularly, they are not keenly focused on improving the quality of the plan, or providing helpful 51

55 feedback to those who write them. The health outcomes for young people with SEND who are 19 to 25 years old are not monitored or evaluated by health providers and commissioners. Health visitors and school nurses do not consider what the desired outcomes might be when working with children, young people and their families. They are therefore not able to evidence the impact of their work. The inspection raises significant concerns about the effectiveness of the local area. The local area is required to produce and submit a written statement of action to Ofsted that explains how the local area will tackle the following areas of significant weakness: The CCG has not ensured that the DMO role has sufficient capacity to address the areas for improvement that have been identified. For example, arrangements for ensuring that medical assessments are carried out for young people aged 19 to 25 years have still to be agreed. The CCG do not have an agreed role in reviewing and finalising EHC plans. They are not aware of the proposed health care provision prior to the plan being shared with families. This limits the CCG s understanding of the services that will need to be commissioned. The CCG has not ensured that a robust process is in place for health providers to contribute to EHC plans. Arrangements for practitioners to check the draft plan once completed, or to offer feedback before the plan is finalised, are not in place. As a result, many plans are not of a good enough quality. Please accept my thanks for the time and cooperation all representatives from the local area gave to the inspection team. I hope you find the content of this letter useful in helping you to tackle the areas identified for further development. Yours sincerely Lesley Cox Her Majesty s Inspector 52

56 Ofsted Care Quality Commission Mike Sheridan HMI Regional Director for London Lesley Cox HMI Lead Inspector Ursula Gallagher Deputy Chief Inspector, Primary Medical Services, Children Health and Justice Elizabeth Fox CQC Inspector Rosemary Henn-Macrae Ofsted Inspector Cc: DfE Department for Education Clinical commissioning group(s) Director Public Health for the local area Department of Health NHS England 53

57 Item 4.1 Title of report From Author Finance Report Les Borrett, Director of Financial Strategy - WFCCG Ian Clay, Deputy Director of Financial Strategy - WFCCG Purpose of report To provide an update to the Governing Body covering the financial position of the CCG as at the end of March Changes/additions/amendments to paper as a result of discussions held at previous Committee Not applicable. Recommendations The Governing Body is asked to approve this report. Impact on patients & carers None Risk implications Subject to audit there are no financial risks associated with the closing 2016/17 financial position. Financial implications The CCG achieved a surplus of 8.76 million against our plan for 2016/17 of 8.6 million; maintained running costs within the cap set by the Department of Health and stayed within our maximum cash drawdown allowance. Equality analysis Not relevant for this report. Business Intelligence Source Income and expenditure is reported from Non ISFE (the CCG ledger) and activity from provider SLAM (Service Level Agreement monitoring) returns held on the NELIE (North East London Information Exchange) database. Other committees/groups, including the CCG Reference Group and Rapid Feedback Group The Finance and QIPP Committee receives a more detailed report covering financial performance. 54

58 Finance Report Update regarding the financial position of the CCG as at the end of March

59 Finance Report Contents 1 Introduction 1 2 CCG summary income and expenditure position Key headlines for M Balance sheet, cash management and PSPP 2 4 Conclusion and recommendation 2 Appendix A Detailed income and expenditure position 3 Appendix B Detailed QIPP performance 4 Appendix C Statement of financial position (balance sheet) 5 Page ii 56

60 Finance Report 1 Introduction The purpose of this report is to update the Governing Body on the financial position as at the end of March (month 12). This represents the final draft position for 2016/17 subject to audit. The Governing Body is asked to note that the CCG delivered a surplus of 8.76 million compared to the planned surplus of 8.6 million. 2 CCG summary income and expenditure position A detailed budget position is attached at Appendix A and a summary position is shown in the following table: Annual Budget 000 M12 Variance 000 Barts Health 139,313 (245) Other Acute 60,896 4,853 Mental Health 33,966 (184) Other Non-Acute 65, Prescribing 35,113 (510) Delegated Primary Care 35,628 (11) Corporate 9,592 (72) Sub-Total 379,810 3,880 CCG Reserves 4,040 (4,040) TOTAL EXPENDITURE 383,850 (160) TOTAL INCOME 392,450 - NET CCG POSITION 8,600 (160) 2.1 Key Headlines for M12 to note are: The CCG has reported a surplus of 8.76 million compared to the plan of 8.6 million at year after the application of reserves. Full details have been provided at Appendix A. Based on M11 acute performance data the CCG is projected to deliver 7.33 million of net QIPP in line with our plan. Details have been provided at Appendix B. The CCG has met the duty to maintain running costs within the mandated cap. Page 1 57

61 Finance Report The CCG met its requirement to manage cash within the maximum cash drawdown value set by the Department of Health. 3 Balance sheet, cash management and performance against public sector payment policy (PSPP) Details of the CCG s draft closing statement of financial performance or balance sheet along with comparable figures are shown within Appendix C. The CCG had minimal cash holdings ( 19k) as at the end of March which is approximately 0.05 percent of the cash drawn down in the month. Cash management rules require that we minimise the level of cash held at month end to at no more than 1.25 percent and we have therefore achieved this performance measure for March. The CCG, in common with all public sector bodies, is mandated to pay suppliers within 30 days from submission of a valid invoice and has a target of 95 percent achievement. As at the end of March the CCG s cumulative performance was measured at 99.4 percent (based on the value of invoices paid) and 95.8 percent (based on volume of invoices paid). 4 Conclusion and recommendation The Governing Body is asked to note this report. Page 2 58

62 Finance Report Appendices A. Detailed income and expenditure position Summary Position Full Year Budget Actual Variance '000 '000 '000 Confirmed (392,450) (392,450) 0 Acute SLA's 187, ,714 3,323 SLA Exclusions and Other Acute 12,818 14,103 1,285 Acute & Integrated Care Total 200, ,817 4,608 Mental Health 33,966 33,782 (184) Learning Disabilities 5,401 5, Continuing Care 14,857 15, Community Services 34,202 33,357 (845) Programme Spend on Additional Activities 7,703 7,233 (470) CSS Services 3,138 3, Prescribing 35,113 34,603 (510) Co Commissioning 35,628 35,617 (11) Non Acute Total 170, ,353 (656) Total Commissioning Expenditure 370, ,170 3,952 Running Costs Admin 6,235 6,224 (11) Running Costs Programme 1,247 1, Operating Costs Total 7,482 7, GP IT 1,185 1,119 (66) Programme Corporate Costs Total 1,185 1,119 (66) Premises Void Costs (202) Estates Costs Total (202) Contingency (0.5%) 1,877 0 (1,877) Headroom Reserve Other Reserves 2,163 0 (2,163) Reserves and Contingencies Total 4,040 0 (4,040) Total Expenditure 383, ,690 (160) Unadjusted Surplus / (Deficit) 8,600 8, Page 3 59

63 Finance Report B. Detailed QIPP performance Integrated care Heading Proposed Project Planned Gross Savings M Urgent and Amnulatory Care Integrated Care Phase 4 Self Care, Prevention & Early Intervention Care Homes Support Programme Falls and Bone Health Service Maximising Utilisation of Beds Ambulatory Care Urgent Care Procurement DVT Pathway Investment M Planned Net Savings M Forecast Gross Savings M Continuing Health Care CHC Proposals Primary Care Enhanced Services Contract Reviews Mental Health Planned Care Women & Children Primary Care MHS Pilot Development of Primary Care Model by NELFT Reduction in Alcohol Related Admissions MSK Pathway Procurement Opthalmalogy Pathway Procurement Renal Pathway Pilot Gynaecology Pathway Integrated Care co ordination CHC for Children Various pathway redesign Medicines Management Medicines Management All Acute Providers Productivity & Contract Efficiencies NELFT All other non acute providers RISK Assessmen t Primary Care Business Rates Corporate Reduce Property Voids % Page 4 60

64 Finance Report C. Statement of financial position (balance sheet) Statement of Financial Position as at 31 March '000 '000 Non-current assets: Property, plant and equipment 0 0 Total non-current assets 0 0 Current assets: Trade and other receivables 4,112 5,913 Cash and cash equivalents Total current assets 4,131 5,991 Total assets 4,131 5,991 Current liabilities Trade and other payables (25,855) (29,661) Total current liabilities (25,855) (29,661) Non-Current Assets plus/less Net Current Assets/Liabilities (21,724) (23,670) Assets less Liabilities (21,724) (23,670) Financed by Taxpayers Equity General fund (21,724) (23,670) Total taxpayers' equity: (21,724) (23,670) Page 5 61

65 Item 5.1 Title of report Planning for delivery 2017/18 From Author Jane Mehta, Director of Strategic Commissioning WFCCG Sharon Yepes-Mora, Associate Director of Strategic Planning - WFCCG Purpose of report This report presents the 2017/18 Delivery Plan to the Governing Body which has been developed to support the achievement of ambitions of the two year 2017/19 Operating Plan and national planning requirements. It also provides an update on early progress made against achieving the actions contained in the Delivery Plan. The Transformation Grid which summarises the CCG s work programme has been refreshed accordingly to reflect the year ahead and is presented to the Governing Body for approval. Changes/additions/amendments to paper as a result of discussions held at previous Committee The updated plan has not been discussed at Committee level. Recommendations The Governing Body is requested to: 1. Approve the 2017/18 Delivery Plan 2. Review the early progress made to date on achieving the actions and milestones set out in the Delivery Plan. 3. Approve the 2017/18 Transformation Grid Impact on patients & carers Good business planning provides the foundation for high quality health care provision for residents by ensuring CCG commissioned services are appropriate and sustainable. Risk implications Failure to meet national performance targets will have a detrimental impact on patients and may result in reputational damage to the CCG. 62

66 Planning for delivery 2017/18 Financial implications Implementation of the delivery plan is required to ensure that the CCG remains in a financially viable position and delivers QIPP efficiency targets. Equality analysis The individual work programmes have considered the CCG s equality duty and where relevant has identified relevant actions which address any likely impact on equality and human rights. Business Intelligence Source Constitution Mental Health Other Commitments RTT Incomplete Aug 16 Consultant led Referral to Treatment Waiting Times; Unify2 Diagnostics Aug 16 Monthly Diagnostics Waiting Times and Activity; Unify2 Cancer Waiting Times 2 Week Wait Aug 16 Monthly Cancer Waiting Times Cancer Waiting Times 2 Week Wait (Breast Symptoms) Cancer Waiting Times 31 Day First Treatment Cancer Waiting Times 31 Day Surgery Cancer Waiting Times 31 Day Drugs Cancer Waiting Times 31 Day Radiotherapy Cancer Waiting Times 62 Day GP Referral Cancer Waiting Times 62 Day Screening Cancer Waiting Times 62 Day Upgrade Ambulance Calls Closed by Telephone Advice Aug 16 statistics; Open Exeter Ambulance Quality Indicators; Unify2 Incidents Managed Without Need for Transport to A&E Departments A&E Performance Provider 1 Aug 16 A&E Attendances and Emergency A&E Performance Provider 2 A&E Performance Provider 3 Admissions Monthly Return; Unify2 Dementia Sep 16 Monthly Dementia Registers Publication; NHS Digital IAPT roll out Q1 16/17 Monthly IAPT return; Unify2 IAPT Recovery IAPT Waiting Times 6 Weeks IAPT Waiting Times 18 Weeks EIP Psychosis treated with a NICE approved package within two weeks Children Waiting more than 18 Weeks for a Wheelchair Q1 16/17 Q1 16/17 Mental Health Services Data Set; NHS Digital / Early Intervention in Psychosis Waiting time return; Unify2 National Wheelchair Data Collection; UNIFY2 63

67 Planning for delivery 2017/18 Other committees/groups, including the CCG Reference Group and Rapid Feedback Group The Delivery Plan and associated progress report and the Transformation Grid was developed following discussions at the MDT (Multi-Disciplinary Meeting) Officer s meeting and directorate team meetings. 64

68 Planning for Delivery 2017/18 May

69 Planning for Delivery 2017/18 Contents 1. Introduction 1 2. Delivery Plan 2017/ Delivery areas 1 3. Transformation Grid Recommendation 3 Appendices 4 Appendix A Delivery Plan 2017/18 4 Appendix B Transformation Grid 2017/18 4 Page ii 66

70 Planning for Delivery 2017/18 1. Introduction In order to deliver the Operating Plan ambitions and implement priority work programmes, the CCG has developed a detailed 2017 Delivery Plan which summarises key organisational actions designed to deliver the organisation s business and transformation. The plan is aligned to the two year Operating Plan 2017/19 targets and national and local planning requirements. The Governing Body received a final update of the 2016/17 Delivery Plan in March 2016 detailing the significant progress made in achieving last year s milestones. This report presents the 2017/18 Delivery Plan and provides an update on early progress made to date against achieving the actions contained in the 2017 Delivery Plan. In addition the Transformation Grid which summarises the CCG s work programmes has been refreshed accordingly to reflect the year ahead and is presented to the Governing Body for approval. 2. Delivery Plan 2017/18 The 2017/18 Delivery Plan including highlights of progress to date is attached in Appendix A. Members will notice an emphasis on the development of the Accountable Care System development throughout the plan. Actions where appropriate are also aligned to the national Right Care programme which benchmarks CCGs and highlights opportunity areas for financial and quality savings based on a population based approach. The Delivery Plan has transferred into an excel format and will be completed as a live document that will be reviewed and updated on a regular basis. Progress is monitored through Directorate team meetings and the MDT (Multi-Disciplinary Team) group on a regular basis and the document will be updated routinely. Similar to previous years, a simple RAG rating system will be applied to assess achievement of actions: Complete On Track On Track with issues Not on track Will not be complete in year due to external factors C G A R X There are instances where factors out of the CCG s control will affect the delivery time scales, this will be noted and where appropriate the action will be carried forward into future plans. Where an action is Amber this means project leads have flagged that delivery is at risk; these milestones will be addressed at directorate level and MDT officer meetings. 2.1 Delivery areas The Delivery Plan is structured according to the following programmes and actions detailed for these delivery areas which reflect last year s plan: Page 1 67

71 Planning for Delivery 2017/18 Priority Programmes ACS Development - Home Support Pathways ACS Development Integrated Urgent Care Mental Health End of Life Care Cancer Children and Young People Maternity Personal Health Budgets Learning Disabilities Primary Care Long Term Conditions Planned Care Performance, Quality & Safety Improvement Maintaining the Business Medicine Optimisation Contracts & Procurement Registered Care Market Finance Delivering QIPP & Efficiency Estates Communication Information and Technology Organisational Development Workforce Underpinning the Delivery Plan are Clinical Director and Clinical Lead work programmes which have been fully aligned with these programmes. The BCT (Better Care Together) work streams are contained within the programmes in particular End of Life Care, Integrated Urgent Care and Home Support Pathways. An exercise has also been carried out to align the Delivery Plan with the requirements of Next Steps on the NHS Five Year Forward View (March 2017) and the current local three year CSP (Commissioning Strategic Plan) which provides a good level of assurance that there are no significant gaps. 3. Transformation Grid 2017 The Transformation Grid (Transforming Services Together Local) contains the core CCG business on a page and has been refreshed for the year ahead and simplified. The update document is contained in Appendix B. The most significant changes are summarised as: Page 2 68

72 Planning for Delivery 2017/18 The CCG s strategic objectives have been aligned to the STP (Sustainability and Transformation Plan) ambitions rather than a separate section on the BCT and Transforming Services Together (TST) programmes The grid is framed by updated national drivers such as the NHS Mandate 2017/18, the Sustainability & Transformation Plan and financial context Two programme areas have new titles Urgent Care and Surge Management has changes to Integrated Urgent Care to reflect a system approach. Co-ordinated Pathways has changed to Home Support Pathways The Cross Cutting themes have been simplified 4. Recommendation The Governing Body is requested to: 1. Approve the 2017/18 Delivery Plan 2. Review the early progress made to date on achieving the actions and milestones set out in the Delivery Plan. 3. Approve the refreshed 2017/18 Transformation Grid Page 3 69

73 Planning for Delivery 2017/18 Appendices Appendix A Delivery Plan 2017/18 Circulate Appendix B Transformation Grid 2017/18 Page 4 70

74 CORPORATE GOVERNANCE Sustainability and Transformation Plan GOVERNANCE Five Year Forward View - Driving Transformation CCG & STP Strategic Objectives 9 National Must Dos 2017/18 WFCCG Transformational Programme TST Local Long Term Conditions To improve the health outcomes of our local population through system leadership and the effective commissioning of high quality services by: CCG: Meeting our statutory requirements & achieving national must dos Integrated Urgent Care STP: System wide Productivity & Improvement Plans CCG: Strengthening collaboration and partnership working across NEL CCGs & providers to transform services and deliver national strategy STP: Collaborative working STP: Working towards fit-for-purpose infrastructure STP: Working in partnership to commission, contract and deliver service efficiently and safely CCG: Improving the patient experience across all services STP: Matching demand with capacity STP: To measurably improve health and wellbeing outcomes for all STP: Develop new models of care to achieve better outcomes for all CCG: Involving patients, communities and hard to reach groups STP: System-wide decision making CCG: Strengthening access to high quality GP services End of Life Care Home Support Pathways Mental Health Children & Young People Primary Care Cancer Maternity Planned Care Performance, Quality & Safety Improvement Learning Disabilities TST Local WF Transformational Priority Programmes 2017/18 INFORMATION GOVERNANCE Maintaining the Business Delivering QIPP & Efficiency Right Care Financial Sustainability 71 CLINICAL GOVERNANCE NHS Mandate

75 WFCCG Business Grid 2016/2017 Vision Strategic Objectives TST & BCF Priority Programmes Enablers Cross Cutting Themes Framed by Sets out WFCCG s ambition that the business grid plans to achieve High level goals we need to deliver to achieve our vision Major transformation programmes aligned to STP across WF and local CCGs that work programmes are designed to deliver Clinically led work programmes that drive forward the action plans to deliver our objectives All encompassing priority areas that need to feature across programmes Support functions that enable the delivery of programmes National Policy Financial Sustainability Governance that holds the transformation structure together 2 72

76 Business Planning Process Operating Plan National planning requiremen ts National Must Dos TST & STP STP and STB processes Work Plans Delivery Plan CD / CL/ Officer Work Plans PDPs Assurance of Delivery Local Scorecard Delivery Plan Review CCG IAF Engagement at Committee and other levels Joint CD/CL/Officer discussions to shape work plans & Delivery Plan NHSE Assurance P&Q MDT 3 73

77 Item 5.2 Title of report From Author East London Health and Care Partnership Agreement Terry Huff, Chief Officer - WFCCG Jane Milligan (Lead for ELHCP) Purpose of report The ELHCP is a partnership of commissioning and provider organisations in East London it includes local authorities, community and mental health trusts, hospital trusts and 7 east London CCGs. Attached is the proposed partnership agreement explaining how the partnership will operate and specifically the partnership board. The Agreement is not legally binding, but is intended to ensure a common understanding and commitment between the partner organisations of the ELHCP about the governance arrangements, specifically: The scope and objectives of the ELHCP governance arrangements The principles and processes that will underpin the ELHCP governance arrangements The governance framework / structure that will support the development and implementation of the EL STP confirming that the Governing Bodies/Boards are not being asked at this stage to delegate any decision making to the ELHCP other than for those things listed in section 8 of the Partnership Agreement It is acknowledged the governance arrangements will continue to develop as the work of the Partnership unfolds and may need to adapt accordingly. Further reports will be presented on a quarterly basis reviewing governance arrangements, taking into account any feedback received, and propose changes as appropriate. Changes/additions/amendments to paper as a result of discussions held at STP Governance working party. The Agreement was originally developed by the STP Governance Working Group, which was chaired by Marie Gabriel, Chair of East London NHS Foundation Trust, and involved nominated representatives with expertise in governance from across the partner organisations. It has since been presented (in its MOU and latest form) to all members of the ELHCP Board during its development and iterated a number of times. Recommendations The Agreement is being circulated to all East London Trust Boards, CCG Governing Bodies and the Local Authorities during April and May. The Governing Body members are asked to approve and sign the Agreement in its current form recognising that the current arrangements will be reviewed on a quarterly basis. 74

78 East London Health and Care Partnership Agreement Impact on patients & carers None specific Risk implications Without a partnership agreement in place there will be ambiguity on the role and responsibilities of the newly established East London Health and Care Partnership and that of the CCG Governing Bodies. This could lead to duplication of effort and disconnect between partnership and local communities. Financial implications None specific. However, with greater collaboration there may be requirement to fund a number of joint posts; any funding arrangements would need to be agreed by the Governing Body. Equality analysis None Business Intelligence Source None Other committees/groups, including the CCG Reference Group and Rapid Feedback Group None 75

79 East London Health and Care Partnership Partnership Agreement Version March

80 1. Purpose This Partnership Agreement describes how the health and social care partners in East London (EL) (listed in Appendix D) will co-operate as The East London Health and Care Partnership (ELHCP), setting out the partnership arrangements to support the implementation of the East London Sustainability and Transformation Plan (EL STP). This Partnership Agreement, built on the EL STP Memorandum of Understanding (MOU), is separate to the East London Sustainability and Transformation Plan (STP). Sign- off or endorsement of the overarching STP will take place on an individual organisational or borough level. PART 1 PARTNERSHIP ARRANGEMENTS 2. Introduction Delivering the Forward View NHS Planning Guidance to released in December set out a requirement for local areas to come together develop a shared five-year sustainability and transformation plan. The launch of the sustainability and transformation planning process signalled a new paradigm, with a move towards greater local co-operation including the need to work in the partnership to develop strategy and change at a local level. In response to this guidance 20 organisations across East London in The City of London, Barking and Dagenham, Hackney, Havering, Newham, Redbridge, Tower Hamlets and Waltham Forest - have been working together to develop the EL STP: The EL STP describes how these Parties will co-operate to turn the ambitions of the NHS Five Year Forward View into reality and deliver the vision of better health and wellbeing, improved quality of care and stronger NHS finance and efficiency. The EL STP acts as a system level plan for change supported by and aligned to a number of local plans to address certain challenges, such as: City and Hackney (CH): Hackney devolution pilot, bringing providers together to deliver integrated, effective and financially sustainable services. Barking and Dagenham, Havering and Redbridge (BHR): bringing together health and social care services under a single local accountable care system (devolution pilot) Newham, Tower Hamlets and Waltham Forest (WEL): Transforming Services Together programme to improve the local health and social care economy. 1 Delivering the Forward View, NHS Planning Guidance to , NHS England, December 2015, Page 2 of 29 77

81 An initial set of governance arrangements was established to oversee and manage the development of the draft EL STP that was submitted to NHS England and NHS Improvement on 30 June Following this submission the programme moved into the next phase, focused on detailed planning and the mobilisation and implementation of the delivery programmes. The partnership arrangement now needs to be updated to reflect these changes agreed by the STP Board in focus and branding, so that it supports the prioritisation of the different elements of the EL STP projects. 3. Objectives of the ELHCP Partnership arrangements The objectives of the ELHCP Partnership arrangements are to: Support effective collaboration and trust between commissioners, providers, people and carers to work together to deliver improved health and care outcomes more effectively and reduce health inequalities across the EL system Provide a robust framework for system level decision making, and clarity on where and how decisions are made on the development and implementation of the EL STP To review and ensure clinical sustainability of services at STP level Provide clarity on system level accountabilities and responsibilities for the EL STP Enable opportunities to innovate, share best practice and maximise sharing of resources across organisations in East London Enable collaboration between Parties to achieve system level financial balance over the 5 year STP timeframe and deliver the system control total (once agreed), while safeguarding the autonomy of organisations Ensure learning and capacity building across the three accountable care systems. 4. Scope of the ELHCP Partnership arrangements 4.1. In scope Partnership arrangements for the East London STP Partnership arrangements for the implementation of the STP schemes defined in the East London STP Alignment with the wider health system plans and partnership, including devolution programmes and regional boards Development and operation of the partnership arrangements for the EL STP Financial Strategy to achieve the system control total Support the development of Accountable Care Systems to enable working towards a sustainable health economy by moving away from tariff based system to a capitation based system to achieve financial stability and to incentivise the right clinical behaviours Page 3 of 29 78

82 4.2. Out of scope Organisational governance arrangements for CCG Governing Bodies, Provider Trust Boards and Local Authorities Local partnership arrangements for the delivery of local (non-east London wide) programmes: o Hackney devolution pilot o Barking and Dagenham, Havering and Redbridge (BHR) Accountable Care System (devolution pilot) o Transforming Services Together programme. 5. Principles for the ELHCP Partnership The development of effective system level partnership arrangements, mobilisation and implementation of the delivery programmes in the EL STP requires collaboration and active engagement (where relevant) from all Parties to ensure the interests of all Parties are appropriately represented. A key aspect of this process is the agreement of a common set of principles for partnership ways of working and culture. Accordingly, the Parties have adopted the following as a basis for collaborative working between the parties: ELHCP Principles (as set out below) ELHCP Financial Principles (agreed by the Finance Strategy Group in March 2017 as set out at Appendix B) The Nolan Principles (as set out at Appendix B) ELHCP Principles Participation: Representation and ownership from health and social care organisations ( The Parties ), local people and lay members to clearly demonstrate collaborative and representative decision making Collaboration: All Parties will work collaboratively to deliver the overall EL STP strategy, in the best interests of the wider system and local people Engagement: Local people will be engaged and involved in the ELHCP governance to ensure their views and feedback are considered in the decision making processes. This engagement should operate at 2 levels; individual level and organisational level (i.e. via patient representative forums and other local community groups) Accountability: Define clear accountabilities, delegation procedures, voting arrangements and streamlined governance structures to support continuous progress and timely decision making. Delegation of work to the groups with the relevant expertise and authority to deliver it Page 4 of 29 79

83 Autonomy: Recognise the autonomy of the Parties (health and social care partners) of the ELHCP Partnership. Operate in a manner that is compliant with legal duties and responsibilities of each constituent organisation and the NHS and Local Authorities as a whole (e.g. legal responsibility for consultation on service changes). Ensure alignment with the local organisations governance and decision making processes recognising statutory and democratic procedures Subsidiarity: Ensure subsidiarity so that decisions are taken at the most local level possible, and decisions are only taken at a system level where there is a clear rationale and benefit for doing so Professional Leadership: Demonstrate strong professional leadership and involvement from clinicians and social care to ensure that decisions have a robust case for change and senior level support Accessibility: Ensure complete transparency in all decision making to support the development of mutual trust and openness between organisations. Provide the necessary assurance to system partners on key decisions. Collaborative working and information sharing between working groups to ensure consistency. Good Governance: Recognise that good system level governance will require robust planning and horizon scanning to ensure that proposals are presented to the statutory organisations in a timely way, that align with their local governance and decision making processes. However, where necessary local organisations will try to be flexible to support the system level governance. 6. Governance structure The current proposed governance structure for the ELHCP Partnership is included in Appendix A. This appendix also includes draft summary terms of reference for the key governance groups in this structure, which will be refined further by the groups. 7. Voting rights and process Voting rights and processes will be defined in relevant terms of reference. 8. Major system changes The key system level decisions that will fall under the scope of the ELHCP Partnership arrangements are outlined below. This list will be updated from time to time to reflect the latest set of EL system level decisions: Approval of the EL STP Budget for the EL STP programme System level financial strategy and system control total Whipps Cross Hospital re-development strategy Page 5 of 29 80

84 Changes to King George Hospital Emergency Department The relevant elements of the East London Mental Health strategy The relevant elements of the East London Primary Care strategy East London system level estates plan The approach to specialised commissioning for the East London sector Risk pooling principles and financial arrangements Delegation in place to allow Tower Hamlets CCG Remuneration Committee to approve Very Senior Management posts on behalf of all the other ELHCP CCGs. Decisions about capital allocations PART 2 MISCELLANEOUS LEGAL PROVISIONS 9. Liability This Partnership Agreement describes arrangements for aligned decision making of the Parties which they agree is necessary to achieve the objectives in Clause 3. Parties agree that the governance bodies set up under this Partnership Agreement do not have any authority to make binding decisions on behalf of the Parties and that each Party (and not the governance bodies) will retain liability for the actions of the relevant Party. 10. Duration of the Partnership Agreement This Partnership Agreement replaces shadow arrangement and takes effect from 1 April The Parties expect the duration of the Partnership Agreement to be for the period of in line with the duration of the STP or otherwise until its termination in accordance with Clause Effect of the Partnership Agreement This Partnership Agreement does not and is not intended to give rise to legally binding commitments between the Parties. The Partnership Agreement does not and is not intended to affect each Party's individual accountability as an independent organisation. Despite the lack of legal obligation imposed by this Partnership Agreement, the Parties: Have given proper consideration to the terms set out in this Partnership Agreement; and Agree to act in good faith to meet the requirements of this Partnership Agreement. Page 6 of 29 81

85 12. Subsidiarity The Parties acknowledge and respect the importance of subsidiarity. The Parties agree for the need for many decisions to be made as close as possible to the people affected by them. 13. Dispute resolution process All Parties will make every effort to work collaboratively in the best interests of the East London system, and to avoid disputes. Should disputes arise the parties will follow the agreed dispute resolution process to resolve the disputes as quickly as possible and to minimise impact on delivery. Individual Party s concerns should be raised in the first instance with the Independent Chair of the ELHCP Partnership Board. This should be in writing clearly stating the basis of the concerns, including where applicable the concerns and the rationale behind the dispute. The Independent Chair will endeavour to find an informal resolution to the dispute through discussion and mediation. Where agreement cannot be reached using informal resolution processes the Independent Chair will propose a formal resolution process, which may involve reference to national guidance and best practice. 14. Termination Each Party may terminate its participation in this Partnership Agreement by giving the other Parties no less than 30 days notice in writing. The Independent Chair will endeavour to find an informal resolution to the dispute through discussion and mediation. Where agreement cannot be reached using informal resolution processes the Independent Chair will propose a formal resolution process, which may involve reference to national guidance and best Practice. Parties may terminate the Partnership Agreement with the written agreement of all of the Parties. 15. Law This Partnership Agreement will be governed by the laws of England and the courts of England will have exclusive jurisdiction. 16. Review process This Partnership Agreement will be reviewed and updated from time to time to enable good practice governance to be recognised and built upon to identify and address areas for development. 17. Code of conduct Page 7 of 29 82

86 The Finance Strategy Group has agreed ELHCP principles which are listed in Appendix B. The Committee on Standards in Public Life (Nolan Committee) has set out seven principles of public life which it believes should apply to all in public service. The seven Nolan principles are listed in Appendix B. The Parties are asked to adopt these above principles as the basis for collaborative working across the partnership arrangements. 18. Amendment Parties agree that this Partnership Agreement may be varied only with the written agreement of all of the Parties. Such amendments will be included in an addendum/appendix to this Partnership Agreement. Appendices Appendix A Governance Appendix B Principles Appendix C Roles Appendix D Sign off by the Parties Page 8 of 29 83

87 Appendix A.1 Governance Structure for the East London Health and Care Partnership Governance structure CCG Governing Bodies (x7) Provider Trust Boards (x5) Local Authority Regulators Cabinets (x8) NHS E NHS I CQC BHR Integrated Care Partnership Board Local Accountable Care Systems Hackney Transformation Programme Board WEL / TST Board ELHCP Mayors and Leaders Advisory Group Political advisory leadership ELHCP Community Group System wide engagement and assurance ELHCP Assurance Group Independent assurance and scrutiny ELHCP Partnership Board Independent Chair Strategic direction and programme leadership ELHCP Executive Group Operational direction, delivery and assurance ELHCP Social Care & Public Health Group Social care and public health leadership ELHCP Clinical Senate Clinical leadership and assurance ELHCP Finance Strategy Group Oversight and assurance of finance strategy Project Steering Groups established as required to deliver plans 84

88 Appendix A.2 Draft Terms of Reference for ELHCP Governance Groups A 2.1 Draft Terms for Reference for the ELHCP Partnership Board Purpose To provide strategic direction to the ELHCP STP programme (based on the decisions by the statutory organisations) To oversee and assure the delivery of all elements of the ELHCP STP Plan To address / resolve escalated system-level risks and issues To generate effective partnership working and a sense of common purpose between the system partners To provide oversight and assurance of the funding for the ELHCP STP programme To approve initiatives/frameworks/tests/plans/collaborative commissioning/standards Membership 1 x Independent chair 1 x ELHCP STP Executive Lead 1 x Chief Executive of Barts Health NHS Trust 1 x Chief Executive of the Homerton University Hospital Foundation Trust 1 x Chief Executive of Barking, Havering and Redbridge University Hospital NHS Trust 1 x Chief Executive of East London Foundation Trust 1 x Chief Executive of North East London Foundation Trust Nominated Representative/s of East London Commissioners (CCGs) 1 x Chair of Local Workforce Action Board [1] 2 x Co-Chairs of the Clinical Senate 1 x Acute Sector Clinician [2] 1 x Mental Health Sector Clinician 2 2 x Nominated representative from the Community Group 1 x Local Authority Chief Executive representative from Barking, Havering, Redbridge area 1 x Local Authority Chief Executive representative from City and Hackney area 1 x Local Authority Chief Executive representative from Tower Hamlets, Waltham Forest, Newham area 1 x Representative from the Mayors and Leaders Advisory Group 1 x Representative from a Director of The Social Care and Public Health Group Additional Attendees / Advisory Representatives of GP federations 1 x HealthWatch observer 1 x representative from the ELHCP Finance Strategy Group 1 x NHS England representative (regulator) 1 x NHS Improvement representative (regulator) 1 x NHS England Specialised Commissioning representative 1 x Local Authority representative for prevention commissioning 1 x Health Education England representative 1 x UCLP [1] The chair of the Local Workforce Action Board (LWAB) will be represented as an accountable office of one of the Parties [2] Endorsed by the ELHCP Clinical Senate 85

89 Quorum At least three quarters of the membership of the ELHCP Partnership Board, including: An Independent Chair (or an agreed deputy) 1 x acute trust representative 1 x mental health trust representative 1 x CCG representative 1 x Clinical Senate representative 1 x Local Authority representative 1 x Community Council representative Voting arrangements This is a unitary board, where motions will be passed by a majority vote, where a majority is defined as at least three quarters of the votes cast. In advance of any vote all voting members must declare any potential conflicts of interest. The Independent Chair will decide on whether any potential conflict of interest should preclude a member from voting on a particular issue. Reporting This ELHCP Partnership Board reports and is accountable to the statutory organisations in the ELHCP system Frequency Monthly. Alternative month seminar meeting. Under exceptional circumstances extra ordinary meetings of the ELHCP Partnership Board may be arranged. Requests for extraordinary board meetings must be raised to the Independent Chair for consideration. Page 11 of 29 86

90 A.2.2 Draft Terms for Reference for East London Health and Care Partnership (ELHCP) Executive Group Purpose Provide operational direction and assurance to the delivery of the STP plan, ensuring it provides high quality, sustainable integrated care for the people of East London (EL) Provide a forum for the Executive Group to identify and appraise solutions and options for addressing the major system-wide service, quality and financial challenges. Ensure a pipeline and forward plan/work programme of to take forward solutions. Provide oversight and assurance to the key governance groups in the ELHCP governance that report into the Executive Group, reviewing quality, operational delivery, transformation, performance and financial management. Hold Senior Responsible Officers (SROs) to account for the development and delivery of the STP delivery plans, addressing the service, quality and financial challenges Ensure opportunities for bidding for transformational funding are maximised and provide oversight to bid. Provide oversight and assurance to the Finance Strategy Group in developing the financial strategy Assure the collective delivery of Quality, Innovation, Productivity and Prevention (QIPP)/Cost Improvement Programme (CIP) across the system, providing oversight to the three system delivery Boards. Drive the delivery of the EL STP programme at pace Manage risk and mitigation plans, escalating key risks and issues to the East London Health and Care Partnership (ELHCP)Board Oversee the development of a programme of organisational development (at system level) to support the strengthening of the ELHCP and the delivery of the STP Identify the key messages and communications required to enable local people and staff in EL to understand the ambitions and impacts of the STP on health and care services and outcomes Ensure adequate resource is available to support the ELHC STP programme of work, including providing oversight to the sourcing of support external to EL from other parts of the wider system, e.g. Healthy London Partnership, NHS England/Improvement resources. Analyse the gap in the system Membership 1 x ELHCP STP Executive Lead(Chair) 1 x ELHCP STP Finance Lead 1 x Chief Executive, Barking, Havering and Redbridge University Hospitals NHS Trust 1 x Chief Executive, Homerton University Hospital Foundation Trust 1 x Chief Executive, Barts Health NHS Trust 1 x Chief Executive, East London NHS Foundation Trust 1 x Chief Executive, North East London NHS Foundation Trust 1 x Chief Executive, London Borough of Waltham Forest, ELHCP LA Lead & representing the Waltham Forest and East London (WEL) system 1 x Chief Executive, London Borough of Hackney, representing the City and Hackney system 1 x Chief Executive, London Borough of Havering, representing the Barking, Redbridge and Havering system 1 x Chief Officer, Barking, Havering and Redbridge CCGs 1 x Chief Officer, Newham CCG 1 x Chief Officer, Tower Hamlets CCG 1 x Chief Officer, City and Hackney CCG 1 x Chief Officer, Waltham Forest CCG Page 12 of 29 87

91 1 x BHR & WELC POD Director, North East London and Anglia Commissioning Support Unit 1 x ELHCP STP Programme Director 1 x ELHCP STP Director of Communications 1 x ELHCP STP Director of Provider Collaboration 1 x representative from the Clinical Senate Reporting Reports and is accountable to the ELHC Partnership Board The following groups report to the Executive Group: Operating Planning Group Finance and Activity Group Transformation Steering Group (TSG) (N.B. The steering groups associated with the 8 delivery plan work streams report into the TSG e.g. Local Workforce Action Board, Digital etc.) The delivery Boards for the three systems: City & Hackney, WEL, BHR Frequency Monthly Quorum Chair of the group or the delegated member to represent the chair. 2 x Chief Executives of provider trusts 3 x Chief Officers of CCGs 1 x Chief Executive of LA 3 x ELHCP Directors Deputies Where members of the group are unable to attend a specific meeting, deputies with executive level accountabilities may be substituted. Standing Items Reports from: Operating Delivery Group Finance and Activity Group Transformation Steering Group (N.B. The steering groups associated with the 8 delivery plan work streams report into the TSG e.g. Local Workforce Action Board, Digital etc.) The delivery Boards for the three systems: City & Hackney, WEL, BHR Items as required on: communications and engagement, OD, governance Page 13 of 29 88

92 A.2.3 Terms for Reference for ELHCP Clinical Senate Purpose To develop the clinical strategy that will deliver the requirements set out in the East London Sustainability and Transformation Plan, considering the three main areas that the STP addresses: o The health and wellbeing gap o The care and quality gap o The financial gap Not only addressing current issues but addressing needs beyond the horizon of the 5-Year Forward View To ensure that this strategy reduces the variation in care with the aim of giving every resident of East London access to the same standard of care and chances of good health and good healthcare outcomes; it being understood that local delivery systems will vary in structure and function The Clinical Senate will look for cost-effective solutions that free up resource to be directed to appropriate priority areas Their advice should support the development of appropriate commissioning and contractual arrangements To ensure that quality and safety of care is properly considered in its work and recommendations and provide relevant assurance especially around reconfiguration and service redesign To oversee arrangements for measuring the access to and quality of care on a systematic basis across key results areas to enable benchmarking Discuss options for changes to services, making joint recommendations to the Boards of the various NHS Organisations across East London, both commissioner & provider; To monitor system issues or vulnerable services To work together to identify system solutions To design and recommend clinical change to the Transformation Steering Group for initiative work-up Principles To be ambitious for the population we serve and act as their advocates To be a collaborative coalition of professionals who can think, advocate and advice beyond the walls of our individual organisations to support this common purpose, in so doing gaining understanding of the whole care pathway Provide a forum where collective knowledge on clinical issues and strategic options for reconfiguration and transformation can be shared and discussed Provide a mechanism for increased participation and advice from clinicians and other professionals in strategic direction setting in East London Thus being able to lead transformational change across the whole care pathway To attend regularly, contribute regularly and be encouraged and supported to do so and to build a powerful, authoritative, collaborative body To be focused, use our time wisely and complete our business effectively Seek and commission expert advice from within East London and beyond as necessary and look to learn from successes here and elsewhere To commit to develop as leaders and visibly support the development of clinical leadership among the wider body of clinicians in East London To demonstrate that we can deliver recommendations for transformational change to build confidence in our capability Page 14 of 29 89

93 Membership Co-chair, Appointed from CCG Chairs below Co-chair, Appointed from Medical Directors below CCG Chair, City & Hackney CCG CCG Chair, Tower Hamlets CCG CCG Chair, Newham CCG CCG Chair, Waltham Forest CCG CCG Chair, Havering CCG CCG Chair Barking and Dagenham CCG CCG Chair, Redbridge CCG Medical Director, Barts Health NHS Trust Medical Director, Homerton University Hospital Foundation Trust (HUH) Medical Director Barking, Havering and Redbridge University Hospital NHS Trust (BHRUT) Medical Director, East London Foundation Trust (ELFT) Deputy Medical Director North East London Foundation Trust (NELFT) NHS England Medical Director for North East London NHS England Medical Director for Specialised Commissioning London Director of Nursing, Barts Health NHS Trust Director of Nursing, HUH Director of Nursing, BHRUT Director of Nursing, ELFT Director of Nursing, NELFT A GP provider lead nominee to be agreed by GP Federations A Director of Adult Social Services Director of Public Health, Newham STP PH Lead SRO, Transformation Programme ELHCP STP STP and Accountable Officer BHR CCGs Queen Mary University London Representative UCL Partners CAG Medical Directors Barts Health Hospital Sites (N=3) Nurse Directors Barts Health Hospital sites (N=3) Page 15 of 29 90

94 Decision Making & Quorum Quorum: At least 1 Co-chair 2 CCG Chairs and 2 Provider Directors (Medical or Nursing), SRO (or their representatives), and ensuring all three of the local areas are represented Administration and Handling of Meetings The ELHCP STP PMO will be responsible for providing administrative support to the meeting and for circulating agenda and papers at least seven days in advance of the meeting taking place. Frequency, conduct and reporting of Meetings There should be an annual planned work programme that sets out the priorities based on the Sustainability and Transformation Plan that is agreed with the STP Programme Board. Meetings should be held 2-monthly to synchronise with the STP Board. In alternate months the Clinical Senate should meet to discuss key clinical issues related to other STP programmes, for political awareness and horizon scanning and to support its development The Chair and the SRO for Transformation supported by any other Clinical Senate Members present, will present findings and recommendations to the STP programme board so that accountable officers can consider and enact them as individual organisations and in the collaborative systems emerging in north eat London Each paper presented should have clear rationale in regard to the above and clearly set out what decisions are required A clear annual work programme based on transformation programme with clear links to STP deliverables; this should include quick wins Ensure appropriate interaction and alignment with other work programmes the particularly the Workforce Programme through specific papers but through regular updates and attendance which could be scheduled into the work programme The clinical senate should continuously reflect on its effectiveness and could briefly review this at the end of each meeting and could use local resources such as the Staff College to support this Action notes from each meeting will be taken and approved at the subsequent meeting. Action notes will be forwarded to the Integrated Care Coalition (ICC), Transforming Services Together Board (TSTB) and Hackney Health and Social Care Transformation Board. Resources Members of the Clinical Senate will be supported in their attendance and work by their individual organisations and these roles are not additionally remunerated Administrative and analytic support will be provided by the STP Programme and through its PMO. The Co-chairs are expected to commit one day a month each to the programme, again resourced by Page 16 of 29 91

95 their organisation Accountability/Governance The clinical Senate is accountable to the East London Health and Care Partnership Board. Page 17 of 29 92

96 A.2.4 Terms for Reference for Social Care and Public Health Group Purpose To provide professional leadership and assurance in social care and public health ToR to be confirmed by the Group in Membership Directors of Public Health Directors of Social Care Other TBC Quorum To be confirmed Reporting Advisory to ELHCP Partnership Board. The Group will provide a social care and public health view on all issues before these are presented to the ELHCP Partnership Board (and these meetings will be scheduled to enable this flow of business). Frequency To be confirmed Page 18 of 29 93

97 A.2. 5 Draft Terms for Reference for ELHCP Finance Strategy Group Terms for Reference for ELHCP Finance Strategy Group Purpose To lead the development of the ELHCP integrated financial strategy To provide strategic direction on the approach to achieving the overall system control total making recommendations to the ELHCP Board for onward recommendation to partner governing bodies/boards. To oversee and make recommendations on the allocation of the Sustainability and Transformation Funding including Estates and Technology Transformation funding To manage the central CCG risk pool and other matters as requested by the STP Board Membership 1 x ELHCP STP Independent Chair 1 x ELHCP STP Executive SRO 1 x ELHCP STP Finance Lead 5 x Trust Directors of Finance 3 x CCG representatives 2 x Audit Chair 1 x NHSE London Finance Director 1 x NHSI representative 3 x nominated Local Authority Director of Finance Reporting Reports and is accountable to the ELHCP Partnership Board Frequency Bi-monthly / quarterly Page 19 of 29 94

98 A.2.6 Draft Terms for Reference for the ELHCP Community Group Purpose: The Community Group is established as a subgroup of the East London Health and Care Partnership. Representing key partners and stakeholders, community (patient and public involvement groups) and the Voluntary Community Social Enterprises sector, its purpose is to act as a reference group to the Partnership helping it to develop strategies, plans and activities and recommending the most effective ways for it to communicate and engage with its target audiences. The Group will be formed of key organisations and individuals, who through their pooled knowledge, skills and expertise of the east London health and care landscape, can bring a unique perspective on the changes that may be needed in order to achieve the Partnership s goal of helping the people of east London live happy, healthy and independent lives. In its capacity, the Group will have the scope to contribute to decisions taken at Board or Executive level, through Group member representation at the Board and any other relevant committees or groups. Aims: 1. To collaborate with the wider Partnership (i.e. Board, other committees and member organisations) acting as a reference group for the development of strategies, plans and activities; 2. To recommend the most appropriate ways in which the Partnership should seek to engage, involve, consult and collaborate with local people; 3. To support effective Partnership communications and engagement activity, especially through the Group members existing channels; 4. To support the Partnership s STP delivery plans and priorities The STP delivery plans are: Delivery plan 1 - Promote prevention and personal and psychological wellbeing in all we do; Delivery plan 2 - Promote independence and enable access to care close to home; Delivery plan 3 - Ensure accessible quality acute services ; Delivery plan 4 - Provider Productivity; Delivery plan 5 - Estates Infrastructure; Delivery plan 6 - Specialised Commissioning; Delivery plan 7 - Workforce; Delivery plan 8 - Digital Enablement Objectives: An initial objective of the Group will be to review and agree the purpose, proposed structure and ways of working. This will also be reviewed and agreed on an annual basis. More broadly, and once the Group is formally established, its longer terms objectives as a reference group and communications and engagement network are outlined below. 1. Devise an effective working model for the Group to engage with the wider Partnership; 2. Ensure the interests of the organisations and groups/bodies the Group represents are epitomised; 3. Work closely with the Partnership s communication and engagement leads to ensure information and communication/ engagement activity and inputs are well designed and effective, adhere to best practice, and reach intended audiences; 4. Contribute to policy development through the creation of time limited reference groups, which considering how specific goals and challenges of the STP can best be met, taking information and views from external groups. Page 20 of 29 95

99 Accountability and Reporting Arrangements: The Group is accountable to the Partnership Board. The Group will have two nominated representatives at every Partnership Board; however, there may be occasions where representation from more than two Group members is required, for example, to present/update on a specific piece of work. The Board will nominate one representative (other than the Group representative) to attend Group meetings. Equally, a nominated representative from one of the other committees may be required to attend Group meetings. Membership: The proposed membership takes account of the various patient/public groups, voluntary, community and third sector organisations, specialist charities, education, business and professional representatives (such as the Police). Each organisation is invited to put forward two members that will represent them at the Community Group. Members should be at a senior level within their organisations, and have a comprehensive understanding of the health and social care agenda, at a local, regional and national level. The full Group will be expected to meet at least twice a year. Outside of the formal Annual General Meeting type meetings, there is an expectation that relevant members will meet to deliver or support more focused pieces of work, including undertaking equalities impact assessments e.g. around Prevention. The membership has been grouped within their relevant sector. 1. Patient/public groups 2. Voluntary/third 3. Community group sector/specialist orgs Healthwatch Age UK Faith Groups Patient Advisory Board Stroke Association Patient Participation Diabetes UK Networks Cancer Research UK Macmillan Cancer British Heart Foundation Mind Alzheimer s Society Community Waltham Forest 4. Education 5. Business 6. Professional/other Queen Mary University Chambers of Commerce London Ambulance Service Youth Parliament East London Business Police University of East London Alliance Fire Service Local Colleges Canary Wharf Group Local Medical Committee Local Schools City of London Local Pharmacy Committee Local Opticians Staff-side Representatives/Unions Independent Influencers Foundation Trust Council/s Equalities Group/s Page 21 of 29 96

100 Nomination and the Role of the Chair, Vice Chair and Sub-Group Leaders: The Community Group must nominate a chair and vice chair. It will ultimately be for the Group to decide the process for doing this; however a suggestion could be through a ballot process. The Group might also want to nominate two chairs; one representing the patient voice and the second, representing the professional, statutory and business organisations. These are essentially the two overarching and distinct membership groups of the Group. They might comprise both a chair and vice chair. The Chair/s or vice chair/s represent the Group at Programme Board level, and as such represent the interests and consensus view of the Group. Sub-group leaders will be selected by members for discreet, targeted pieces of work. They will be responsible for leading the delivery for a specific project, and will feed back to the Programme Board and the wider Group on the outcomes/outputs of their work. Quorum: While the Group is not a formal decision making body, and more of a reference group, it is suggested there be a quorum for meetings of the whole Group namely 50% membership, including at least the Chair or Vice Chair. Frequency of Meetings: It is suggested the Group will meet twice a year unless otherwise agreed. Any sub-groups of the Group may meet more often as appropriate. Authority: The Group is authorised to investigate any activity within its terms of reference. It is authorised to seek and may secure the information it requires from any Partnership organisation and all employees are directed to co-operate with any request made by the Group. Monitoring Effectiveness: In so far as is required, in order to support the continual improvement of the Group will complete an annual self-assessment of the effectiveness of the Partnership; present a report to each Partnership Board meeting; and undertake an annual review of the terms of reference for the Group, reaffirming its purpose and objectives. This Group will review the results of the assessment of its effectiveness and adjust its terms of reference accordingly. Review of Terms of Reference: The terms of reference will be reviewed annually and sent to the Board for ratification. Additional: The Partnership communications and engagement team will coordinate and provide administrative support to the principal meetings of the Group. However, any sub-groups of the Group may need to nominate one of its members (on a rotational or static basis) to coordinate and administer its own activities. Page 22 of 29 97

101 The Group will have access to the East London Health and Care Partnership s dedicated online resource the Briefing Room and will be able to use all available materials for their communication and engagement activity. Members of the Group will be able to submit content to the Briefing Room but would need to adhere to the site s editorial style and protocol and seek approval from the Partnership communications and engagement. A small budget may be available from the East London Health and Care Partnership for the facilitation of meetings. Page 23 of 29 98

102 A.2.7 Draft Terms for Reference for ELHCP Assurance Group Purpose To provide independent challenge and assurance to the ELHCP STP Board on the STP Plan and its delivery. To provide independent assurance to the constituent organisations within the ELHCP STP about the objectivity and transparency of the STP Plan and its delivery. Membership NHS Trust audit chairs (5 members). CCG audit chairs (7 members, currently 4). Local Authority audit chairs (7 members). Reporting To the ELHCP STP Board. To the Boards, Governing Bodies and Councils of the constituent organisations within the ELHCP STP. This would be through the audit chair of each organisation or other arrangements to be determined locally. Remit Assess the effectiveness of the Board Assurance Framework established by the ELHCP STP, including commenting as necessary on developing governance and accountability arrangements. Assess compliance with the Memorandum of Understanding (MoU) agreed by the ELHCP STP. Assess the adequacy of the arrangements established to account for the funds available to the ELHCP STP from the NHSE and constituent organisations. Ensure that there are effective arrangements in place for the external and internal audit of the resources available to the STP. Assess the arrangements established by the ELHCP STP to secure economy, efficiency and effectiveness in the use of resources. Assess the effectiveness of the arrangements established to manage conflicts of interests that might arise. The Group may, as necessary, request the attendance of any ELHCP STP officer or Board member to a `meeting of the Group to seek explanations about the issues under consideration. Frequency At least four times a year. Quorum A minimum of three members, including at least one audit chair from an NHS Trust, a CCG and a local authority. Resources ELHCP STP officers to provide support and advice to the Group as requested. Page 24 of 29 99

103 A.2.8 Terms for Reference for Mayors and Leaders Advisory Group Purpose To provide a forum to represent the views of political leaders in East London on the ELHCP Partnership To provide feedback to the ELHCP Partnership Board on elements of the plan To provide a forum for political engagement on the EL STP Membership Leader or nominated representative of London Borough of Waltham Forest 1 Mayor or nominated representative of London Borough of Hackney 1 Chair of Policy & Resources Committee or representative of City of London Corporation 1 Mayor or nominated representative of London Borough of Tower Hamlets 1 Mayor or nominated representative of London Borough of Newham 1 Leader or nominated representative of London Borough of Barking and Dagenham 1 Leader or nominated representative of London Borough of Havering 1 Leader or nominated representative of London Borough of Redbridge 1 Independent EL STP Chair Reporting Advisory to the ELHCP Partnership Board Frequency Quarterly 1 To be nominated by the respective local authority Page 25 of

104 Appendix B Principles In addition to the ELHCP Principles in Section 5, the Parties have adopted the following: ELHCP Financial Principles (agreed by the Finance Strategy Group in March 2017) The Nolan Principles B.1. ELHCP Finance Principles The following principles were approved by the Finance Strategy Group in March 2017: All members of the ELHCP Partnership pledge the following: B.1.1 System Control: Commitment to delivering a system control total. B.1.2 Openness and transparency: Openness and transparency, with all parties agreeing to share information. B.1.3 Shared objectives: A shared objective of mutual support. Joint and shared accountability for system income & expenditure (I&E) between providers and commissioners and shared mutual responsibility and accountability for the control of operational expenditure. B.1.4 Accountability: That providers and commissioners are equally accountable for planning and managing the delivery of care in a way that meets demand and delivers constitutional standards. B.1.5 Clinical strategy: That commissioning, service planning and transformation must be based on a clinical strategy that is constrained within a determined financial envelope. B.1.6 Incentives: Current payment systems do not incentivise delivery of improved outcomes. Changes to the reimbursement of patient pathways is needed to incentivise whole system efficiency and effectiveness and improved outcomes delivered through better system integration. B.1.7 Transformation Programme: A clinical transformation programme must be jointly owned by providers and commissioners. It must be operationalised and delivered by provider clinicians and operational professionals and they must be properly resourced, incentivised and held to account for delivery. B.1.8 Compensation: Where key strategic decisions may be in the best interests of the patient but may have a differential impact on individual organisations, the beneficiaries of any change must fairly compensate the losing entity. Page 26 of

105 B.1.9 Transitional support: Transitional support must enable acute providers to deal with stranded costs associated with moving to new models of care. B.1.10 Prevention: Prevention and upstream investment need to be prioritised to enable our residents to lead healthier lives. B.2 The Seven Nolan Principles B.2.1 Selflessness: Holders of public office should act solely in terms of the public interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends. B.2.2 Integrity: Holders of public office should not place themselves under any financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties. B.2.3 Objectivity: In carrying out public business, including making public appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit. B.2.4 Accountability: Holders of public office are accountable for their decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office. B.2.5 Openness: Holders of public office should be as open as possible about all the decisions and actions that they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands. B.2.6 Honesty: Holders of public office have a duty to declare any private interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest. B.2.7 Leadership: Holders of public office should promote and support these principles by leadership and example. Page 27 of

106 Appendix C Roles of the governance bodies 1. Partnership Board The ELHCP Partnership Board will: a) approve the EL STP; b) review and update the EL STP, when necessary; c) prepare a EL STP programme plan, which will: convert the high level EL STP into individual projects; prioritise the projects taking into the account, for example, the following: benefits - which projects are "low hanging fruit', which can be implemented quickly and simply to achieve a material benefit and which projects will lead to the greatest benefits; funding - which projects do not require funding, which projects do require funding, but the funding can be procured and which projects require funding and the funding will not be available at this stage; dependencies - which projects have dependencies upon the implementation of other projects; complexity which projects are complex and might be better implemented once the Parties have more experience of working together; allocate projects to different phases, starting with phase 1; offer an initial view as to which Parties may be interested in each relevant project or whose services may be affected by the project e.g. if the project affects acute care; communicate the programme plan and the reasoning behind it clearly to the Parties; d) prepare a communication plan, which will generate effective partnership working and a sense of common purpose between the Parties; e) circulate "Lessons Learned" reports from the ELHCP Project Boards, with its comments. 2. ELHCP Clinical Senate/ ELHCP Finance Strategy Group/ ELHCP Community Group/ ELHCP Assurance Group The ELHCP Clinical Senate/ ELHCP Finance Strategy Group/ ELHCP Community Group/ ELHCP Assurance Group will: a) provide advice to the EL STP on all matters referred to in Paragraph 1; and b) on request, provide advice to the EL STP Project Boards. Page 28 of

107 Appendix D Sign Off by the Parties Through signing this East London Health and Care Partnership Agreement the Parties listed below will: Agree to the objectives in this document and work collaboratively to achieve these Agree to the partnership principles and processes outlined in this document Recognise the partnership structure outlined in this document for the ELHCP and support this locally The signatories to this Partnership Agreement should be properly authorised to represent their respect organisations in entering into the commitments outlined in this document. Signed on behalf of: Signature: Name: Title: Date: Barking and Dagenham CCG Barts Health NHS Trust Barking, Havering and Redbridge University Hospitals NHS Trust City and Hackney CCG City of London Corporation East London NHS Foundation Trust Havering CCG London Borough of Barking and Dagenham London Borough of Hackney London Borough of Havering London Borough of Newham London Borough of Redbridge London Borough of Tower Hamlets London Borough of Waltham Forest Newham CCG North East London NHS Foundation Trust The Homerton University Hospital NHS Foundation Trust Tower Hamlets CCG Redbridge CCG Waltham Forest CCG ENDS Page 29 of

108 Item 6.1 Committee Minutes From Audit Committee March 2017 Rizwan Hasan, Acting Chair of Audit Committee - WFCCG Key highlights Usual review of directorate risk registers and BAF reports. Agreed that the level of detail provided within the existing reports meet the needs of the Audit Committee in order for it to continue to provide relevant assurances to the Governing Body in respect to the CCGs risk management processes Update on progress against the CCG s Information Governance tool kit requirements. Confirmation that there are no anticipated concerns in achievement against required standards. Internal Audit reports in respect to: o Draft Head of Internal Audit Opinion o Progress against the CCG s 2016/17 internal audit plan o Progress against the CSU 2016/17 internal audit plan o Draft 2017/18 Internal Audit Plan and 3 year strategy approved Presentation and agreement on the Local Counter Fraud Services (LCFS) plan in respect to the proactive Counter Fraud tasks proposed to be undertaken during 2017/18. Highlights [Audit Committee] [22 March 2017] 105

109 Minutes of the Waltham Forest Clinical Commissioning Group Audit Committee (Part 1) Date: Wednesday 22 March 2017 Time: 9:30 am 11a.m. Venue: Kirkdale House Members Present Rizwan Hasan (RH) Alan Wells (AW) In Attendance Terry Huff (TH) Les Borrett (LB) David Pearce (DP) Auditors Nick Atkinson (NA) Gemma Higginson (GH) Ali Azam (AA) Zeb Alam (ZA) Chair Lay Member and CCG Deputy Chair Chief Officer Director Financial Strategy Head of Governance RSM (Internal Audit) RSM (Counter Fraud) KPMG (External Audit) IG Lead NELCSU Item Action Apologies for absence Vineeta Manchanda Declarations of Interest In line with statutory guidance a declarations of interest checklist was reviewed by the Chair ahead of the meeting in order to identify any conflicts / potential conflicts of interest relative to the meeting agenda. There were no identified conflicts of interest and there were no declarations of interest advised during the meeting. Minutes of the meeting held on 4 January 2017 Minutes were agreed as accurate. RH RH 1. Matters Arising RH See separate Table provided. 2 Risk Management Directorate Risk Register DP advised that there are a total of 57 risks recorded on the directorate risk register. This represents an increase of 1 risk since the last report to the Audit Committee. There are 5 of the risks that are identified for escalation to the BAF. The committee discussed the level of detail provided for the risks and agreed that this level of detail was adequate and should continue as the reporting framework for 2017/18. DP advised that he would seek to further align the individual directorate risk registers to meet minimal risk reporting requirements whilst maintaining appropriate degrees of freedom of individual directorate s management styles. DP Audit Minutes March 2016 Page 1 of 4 106

110 BAF DP advised that due to timings of meetings, the BAF as presented to the Audit Committee was the same as that which would be presented to the March Governing Body meeting. Continuing discussion took place in respect to the further development of the BAF through inclusion within the reporting template of the degrees of influence the CCG could exert over internal and external risk mitigation factors. DP AW pointed out that the CCG retain the level of the risk in areas where they have little control and influence. NA agreed that in these areas where the CCG has limited control they managed the risks particularly well. TH used RTT as an example of a risk where commissioners have direct control over two of the areas relating to the risk but predominantly the control lies with the provider and this needs to be clear within the BAF. 4 CCG Report Information Governance ZA provided an update on the CCG s IG toolkit status based on the current levels of evidence obtained from the CCG and the work carried out to date. The CCG is on track for a level 2 satisfactory IG Toolkit score as per IG work plan 2016/17 maintaining its year on year improvement against an increasingly rigorous assessment criteria. The committee were asked to note the report content and progress on the pre-submission IG Toolkit. Note that the SIRO has recently approved the following:- Pre-submission IG Toolkit Report Network Checks Report Physical Records Checks Report Data Flow Mapping Report The toolkit will be submitted ahead of the 31st March 2017 deadline. ZA informed the committee that he will be moving on to another role within the CSU. There are plans to hand over from 1 st April. The committee thanked him for his work to date. Internal Audit Review of Information Governance at the CSU Currently waiting the final CSU Information Governance report however there are no concerns for Waltham Forest from what has been seen to date. 5. Internal Audit Head of Internal Audit Opinion: NA advised that the Draft Head of Internal Audit Opinion (HOIAO) had been issued based on the work carried out up to 15 March NA advised that: The CCG has an adequate and effective framework for risk management, governance and internal control. Audit Minutes March 2016 Page 2 of 4 107

111 However our work has identified further enhancements to the framework of risk management, governance and internal control to ensure that it remains adequate and effective. The enhancements relate to the area of Cyber Security based upon our work conducted at the NEL Commissioning Support Unit (CSU) on behalf of the CCG. In all other areas reviewed by Internal Audit at both the CCG and CSU positive opinions have been provided through 2016/17. CCG Internal Audit Plan: NA presented a progress report against the CCG s internal audit plan. NA advised that all fieldwork had been completed with recent reports finalised for : Board Assurance and Risk Management ADVISORY (No management recommendations raised) NELFT Outcomes Based Commissioning and Contracting (SUBSTANTIAL ASSURANCE) Two reports have recently been issued in draft relating to: Conflicts of Interest Primary Care Delegated Commissioning NA noted that across all final issued reports there were no outstanding actions that were due for implementation. CSU Internal Audit Plan NA presented a progress report against the CSU Quality Assurance Plan. NA advised that the following reports had been completed since the last report to the Audit Committee: Medicines Management REASONABLE ASSURANCE Providers - Quality Management (covering the 5 NCL POD CCGs for the quality element and all 12 CCGs for serious incident monitoring and reporting) REASONABLE ASSURANCE Acute; Non-acute Contracting and Non-contracted activity REASONABLE ASSURANCE NHS Continuing Healthcare (CHC) & Personal Budgets (covering the WELC Pod) REASONABLE ASSURANCE NA noted that CHC is now only delivered to the WELC CCGs. There were a number of individual contracts that were not signed off. The committee agreed the importance of ensuring that contracts are signed and that processes are in place to do this. DRAFT 2017/18 Internal Audit Plan and three year strategy NA advised that planning for the 2017/18 Internal Audit Plan commenced in January 2017 with the Director of Financial Strategy for input into the plan. NA further advised that the draft plan was subsequently presented and discussed with the CCG s Executive Management Team who approved the plan. Audit Minutes March 2016 Page 3 of 4 108

112 TH requested that the work Deloitte are currently working on in regard to QIPP is considered in the planning of the QIPP internal audit for next year. NA agreed that this would be the case. NA noted that formal approval of the draft internal audit plan for 2017/18 and the three year strategy was sought from the Audit Committee. The Audit Committee approved the plan. 6. Internal Audit LCFS Plan GH presented details of the Local Counter Fraud Services (LCFS) plan in respect to the proactive Counter Fraud tasks proposed to be undertaken at NHS Waltham Forest Clinical Commissioning Group during 2017/2018. GH advised that the work plan had been designed to be compliant with the NHS Protect Standards for Commissioners and drafted in agreement with the Director of Financial Strategy. GH noted that formal approval of the draft LCFS for 2017/18 was sought from the Audit Committee. The Audit Committee approved the plan. 8. Forward Plan Deep dive subject areas to be agreed at the July Audit Committee meeting 9. ABO None VM 10. Private discussion between Audit Committee and Auditors No discussions were deemed necessary. 11. Next Meeting Tuesday 23 May 2017: Final Accounts and Annual Report Signed Date. Audit Minutes March 2016 Page 4 of 4 109

113 Item 6.2a Committee Minutes Performance and Quality Committee March 2017 From Dr Dinesh Kapoor, Clinical Director Quality and Performance - WFCCG Key highlights DK informed the committee of the meetings that he attended over the last month. DK chaired the Whipps Cross Clinical Forum which focused on rapid chest pain clinic and EMIS service. The GPs raised the issue of consultants not responding to their correspondence. Dr Sarah Frankton is meeting with senior clinical directors to establish their position. Following on from this meeting DK will meet with LB to discuss the outcome and what should be expected by way of current service level agreement. DK will report back on cardiology to the April meeting. HD suggested that if a resolution could not be made at the clinical forum the matter should be escalated to joint executive monthly meeting. DK attended the Diagnosis Working Group on 28 February. This focussed on pathway request and the MRI request form across all CCGs for pathology tests. T-Quest has now reached 52%. Child Obesity was discussed at Primary Care meeting. Medicines Optimisation Medicines Optimisation Team will be monitoring the patient safety incidents via the Barts Health contracting monitoring meetings on a quarterly basis. Barts Health are working on a number of individual work streams to prevent the occurrence of incidents via mitigation from regular assurance visits and also via the learning from the incidents that have occurred. Medicines Optimisation Team will be reviewing the incidents via the Barts Health Contract meetings. This information will be shared with the Performance and Quality. Quality Serious Incidents In Quarter 3 Whipps Cross has reported a total of 20 serious incidents a reduction of 1 from Quarter 2. Never Events There was one reported Never Event at Whipps Cross this was due to a misplaced nasogastric tube. Highlights [Performance and Quality Committee] [March 2017] 110

114 North East London Foundation Trust (NELFT) NELFT have declared 6 Serious Incidents in Quarter 3 a decrease of one from quarter 2. In both Quarters 1 and 2 there were no overdue serious incident reports. Duty of Candour Whipps Cross has not met the 100% compliance rate and is currently at 77%. Subsequently a Contract Performance Notice (CPN) has been issued. In Quarter 3 NEFLT achieved 100% compliance target for Duty of Candour. Patient Experience Report Accident and Emergency (A&E) Whipps Cross Friends Family Testing (FFT) response report has been achieved in December at 1%. The remedial action plan has been received showing Whipps Cross should be compliant by August GP Alerts WF CCG received 8 GP Alerts during January 2017 which is a significant decrease compared to December when 18 alerts were raised. WF CCG Complaints The 80% target for percentage of complaints responded to within the agreed time frame has not been achieved only achieving 46%. Maternity Service Update KH confirmed that following on from previous data issues in December 2016 where the number of antenatal referrals had decreased. The rate of referrals are currently at the required level. There has been a reduction in home births supported by Whipps Cross Good progress has been made to meet an average of 10 a month, some months 15/16. There have been two changes WFCCG are working to understand what the impact has been. Please put as action for KH. Performance EP highlighted the main issues from the first report. Currently the CCG is predicting that 15 out of 26 targets will be achieved at the end of the year (58%). 80% are showing improvement. Three targets considered high risk are Cervical Cancer Screening, Accident and Emergency 4hr Performance and Whipps Cross Family and Friends Test, which are rated red. Cancer There have been 13 breaches over 100 days for Waltham Forest Patients in 2016/17. One of these remains open. Highlights [Performance and Quality Committee] [March 2017] 111

115 Performance and Quality Committee Meeting Date: Wednesday 8 March 2017 Time: Venue: 10.00am 12.00pm Boardroom, Kirkdale House, Leytonstone Chair: Dr Dinesh Kapoor (DK) Attendees: Dr Ken Aswani (KA) Helen Davenport (HD) Les Borrett (LB) Zitha Moyo (ZM) Diane Clements (DC) Carl Edmonds (CE) Sultana Rahman (SR) Dr Jacqui Lindo (JL) Apologies: Dr M Shah (MS) Dr Sabeena Pheerunggee (SP) Anne Walker (AW) Dr Tonia Myers Enrico Panizzo Isabelle Davies Tutt Korkor Ceasar Kelvin Hankins Kay Saini (TM) (EP) (IDT) (KC) (KH) (KS) Minutes 1. Welcome and apologies DK DK welcomed all and apologies received. 2. Declaration of interest register HD There were no declarations of interest raised at the meeting. 3. Minutes of last meeting No corrections were made to minutes and signed as an accurate record of the meeting. Actions outstanding from previous meeting / Matters Arising The action tracker was reviewed and actions completed were closed. All outstanding actions were updated on the action log. 5.2: IDT and TM to discuss the single point of access number for GP Alerts. Action 112

116 Correction it should read NELFT Service Performance Review (SPR) not GP Alerts. TM discussed the issues and addressed with Philomena Arthur where it was agreed the matter would be discussed at locality meetings. Action CE: NELFT SPR to be addressed at locality meetings. 6.1: JL to confirm if flu vaccination figures within public health include pharmacy figures and report back to March Committee. JL confirmed this has not been actioned and will provide a breakdown of practices which will be taken to locality meetings. Action: SR/JL - A breakdown of practices for flu vaccination figures within public health to be circulated at Locality meeting. 5.3: DP Figures for clinical effectiveness to be adjusted to show percentages within the community DP was not present, action to be carried forward. 5.1: LB to speak to Lee Eborall relating to the two patients that may have attributed to the lower percentage. DP will follow up the action to ensure a clear management process on 62 day breaches is in place. DP to speak to NA to discuss. LB confirmed regular monthly meetings have been put in place with the agreement to report back through the cancer report showing 62 day and 104 day breaches. Chair s Report Briefing Whipps Cross (WX) Clinical Forum Minutes DK informed the committee of the meetings that he attended over the last month. DK chaired the Whipps Cross Clinical Forum which focused on rapid chest pain clinic and EMIS service. The GPs raised the issue of consultants not responding to their correspondence. Dr Sarah Frankton is meeting with senior clinical directors to establish their position. Following on from this meeting DK will meet with LB to discuss the outcome and what should be expected by way of current service level agreement. DK will report back on cardiology to the April meeting. HD suggested that if a resolution could not be made at the clinical forum the matter should be escalated to joint executive monthly meeting. DK attended the Diagnosis Working Group on 28 February. This focussed on pathway request and the MRI request form across all CCGs for pathology tests. T-Quest has now reached 52%. Child Obesity was discussed at Primary Care meeting. Chair DK 113

117 4.0 Medicines Optimisation AO Report on Medication related incident reporting KS explained that the Medicines Optimisation Team will be monitoring the patient safety incidents via the Barts Health contracting monitoring meetings on a quarterly basis. Barts Health are working on a number of individual work streams to prevent the occurrence of incidents via mitigation from regular assurance visits and also via the learning from the incidents that have occurred. Medicines Optimisation Team will be reviewing the incidents via the Barts Health Contract meetings. This information will be shared with Performance and Quality. KA raised concerns with regards to current process of shared care and the risk it posed to patient safety due to the lack of clarity in relation to monitoring of the patients. KS confirmed that the Medicines Optimisation Committee are aware of this issue and for this reason shared care guidelines have been entered onto the Medicines Optimisation risk register. The concerns have also been raised at the Barts Health Contract meeting where Barts Health have been given a deadline of March 2017 to devise an action plan regarding out of date shared care guidelines and how they intend to update these. Medicines Optimisation team have uploaded some of the shared care guidelines on the GP practice portal. TM stated this should be as a written consent and not assume this will be followed up and stated on their generic . KS will follow up and raise at the next meeting. KS presented the Quality Assurance Visits that were undertaken by AW at Whipps Cross and also the work being undertaken with Barts Health reporting incidents. This is one of the first active steps they have taken addressing patient safety incidents relating to incidents. The matter will be discussed in detail at the Medicines Optimisation Committee meeting. Medicines Optimisation Dashboard Review KS highlighted the key issues showing an analysis of month 9 dashboard indicators. These are amber, where Waltham Forest Clinical Commissioning Group (WFCCG) are actively trying to promote the increase in prescribing where indicators are based on quality and safety. WFCCG are encouraging practices to adopt the indicators, full details are set out within the report. KS advised they are aware this is an issue across all CCGs where all indicators are looked at and lessons learnt and will be discussed at a Service Transformation Plan (STP) level. 114

118 DK highlighted the absence of green indicators; KS confirmed the dashboard is only showing the amber indicators. Highlighting the practices that have not achieved the targets. An action plan is in place on overspending practices. This has been circulated accordingly to the relevant practices TM requested an update regarding the minor ailments scheme. KS advised this is an NHSE commissioned service. KS will provide an update at the next meeting. Implementing Hot Spot Safety Audits KS highlighted the measures Barts Health will take to improve patient safety following the issues identified by Waltham Forest CCG. 5. Quality 5.1 Quality and Governance Q3 Report HD highlighted the key issues to the committee. Serious Incidents In Quarter 3 Whipps Cross has reported a total of 20 serious incidents a reduction of 1 from Quarter 2. The overall reduction in numbers of serious incidents reported can be attributed to the fact that the Trust is no longer reporting all grade 3 and 4 pressure ulcers and is complying with the Serious Incident Framework 2015/16, which requires that only pressure ulcers meeting set criteria be reported. The top three reasons for reporting are: Sub optimal care/deteriorating patient Diagnostic Incident Treatment delay Themes and trends are discussed at the Whipps Cross Clinical Quality Review Oversight and Assurance Meeting on a monthly basis. Never Events There was one reported Never Event at Whipps Cross this was due to a misplaced nasogastric tube. North East London Foundation Trust (NELFT) NELFT have declared 6 Serious Incidents in Quarter 3 a decrease of one from quarter 2. In both Quarters 1 and 2 there were no overdue serious incident reports. 115

119 Duty of Candour Whipps Cross has not met the 100% compliance rate and is currently at 77%. Subsequently a Contract Performance Notice (CPN) has been issued. In Quarter 3 NEFLT achieved 100% compliance target for Duty of Candour. Venous Thromboembolism (VTE) Risk Assessments Barts Health as a Trust is compliant with a performance rate of 95.8% in Quarter 3. However Whipps Cross continues to be non-compliant. Pressure Ulcers In Quarter 3 there has been a marked increase in the number of hospital acquired grade 3 pressure ulcers with a total of 27, this is three times higher than in the previous quarter. The Director of Nursing Whipps Cross undertook a review of pressure ulcer management to ascertain the causative factors of the increase and it has been confirmed that the increase relates to the increase in attendances to the A&E and the length of time in the department as well as delay in assessment and commencement of early interventions. London Ambulance Service are also having a significant increase in waiting time thus this is impacting on the increased time patients wait to be transferred onto a trolley/bed. KA highlighted concern and requested assurance around the actions Whipps Cross staff would take to better understand and address the causative factors. Infection Control At the end of Quarter 3 Barts Health had reported 45 cases of C difficile. This is seventeen cases below their expected trajectory. Whipps Cross reported 20 by the end of Q2. Performance was discussed at the Multidisciplinary Team meeting 6 March in relation to the WFCCG Scorecard no lapses of care were attributed. Methicillin-resistant Staphylococcus aureus (MRSA) Two cases attributed to Whipps Cross which are detailed within the report. One was stepped down and assigned to a third party the second case will be assigned post investigation. HD highlighted the significance of the Post Infection Review process to include the role and responsibility of WFCCG. MHRA/NPSA Alerts Both main providers, Whipps Cross and NELFT, have managed alerts and have responded to within time scale. 116

120 Quality Assurance Visits Four visits were undertaken in October, November and December, each having a different focus and theme. HD highlighted the extent to which the visits were taken across the Whipps Cross site. This demonstrates a comprehensive assurance across commissioned services. HD highlighted the significant concerns raised in relation to the findings on each quality assurance visit and how that quality and safety remained a concern for WFCCG taking into consideration Whipps Cross remained in special measures. HD requested the committee to note the clinical risk and patient safety and experience issues in relation to catheter care in the Emergency Department. The Deputy Director for Nursing and Quality has escalated concerns to the Whipps Cross Director of Nursing at the time of each visit. Standardised Hospital Mortality Index (SHMI) HD raised the issue that requisite information has not been received from CSU. DP needs to bring back data to the committee as to why there has been increase. TM raised the question regarding the SHMI numbers increasing as we do not have a local hospice and patients are dying in hospital where they should have been transferred to the hospice. HD advised this is relevant and the issue has been discussed at the joint Executive Meeting. HD advised WFCCG are working to obtain the correct information in relation to the coding of patients at the Margaret Centre. HD highlighted that there has been an increase in SHMI that must be fully understood and accounted for. As Whipps Cross hospital figures remain above the national average. 5.1: HD to circulate the request of information from DP regarding SHMI to LB to process the action Care Homes The table within the report sets out the system and governance process in place where ZM is meeting with the local authority and Care Quality Commission (CQC) on a monthly basis to understand the inspections and measures taken to address risk for CHC funded patients when the inspection reports highlight risks amber/red. Primary Care In Quarter 4 the Primary Care Commissioning Committee approved 4 practice breach notices relating to the outcomes of CQC visits. These related to governance, storage of vaccines and emergency medicines, requirements to comply with relevant legislation in regard to controlled 117

121 drugs and employment checks, compliance with mandatory training, audits, health and safety and infection control. SR explained that at the Primary Care Commissioning Committee, data was circulated from all the practices to highlight their CQC inspection status and achievements. SR will provide this information accordingly. 5.2: Action SR: To circulate data from the Primary Care Commissioning Committee regarding the CQC achievements. Commissioning and transformation Proposals approved The committee was asked to note that a violent patient DES has been reviewed and recommendations made to improve the delivery of this service for patients and for practice as well as improving value for money. ZM/SR/SP to liaise and establish if the level of risk management required. CQUINS Please note at time of reporting the Quarter 3 achievements have not been formally reported where non-payment was made. The national indicators and achievement for Quarter 2 are SEPSIS, End of Life Care and Ambulatory Care. National CQUIN NELFT The National and Local CQUINS for NELFT have been achieved in both Quarter 1 and Q2. Quarter 3 data is currently being reviewed. These are reviewed and approved as part of the SPR governance and structure. Governance HD requested the committee to note that NHS England have determined that from 1st April 2017 the use of NHS Numbers for non - direct care commissioning purposes is illegal and therefore not permitted. This has led to changes in the way that NELCSU and Redbridge CCG provide WFCCG with commissioning data, via NELLIE and Health Analytics, where future commissioning data will be provided using a local identifier. Conflicts of Interest In response to the publication of the revised statutory guidance for the management of conflict of interest in CCGs, WFCCG are compliant by: 118

122 Reviewing and updating the Standards of Business Conduct and the Management of Conflicts of Interest policy Published a Standard Operating Procedure (SOP) for declaring and recording conflicts of interest Prepared trackers to support the management of declarations of interest for: Governing Body members All staff GP staff who are involved in CCG decision making processes Declaration of interest forms will be issued to all staff for completion by end January / early February On 19 th January 2017 the CCGs Members Council met to approve the changes to the Constitution that are a consequence of the revised statutory guidance. The Members Council voted unanimously to accept the changes. An application to formally incorporate the changes into the Constitution will now be made to NHS England. The requirement for all staff to complete mandatory on-line conflicts of interest training has been delayed until early 2017/18 and will therefore not form part of any assurance processes to NHS England for 2016/17. Emergency Planning and Resilience and Response (EPRR) WFCCG rated as compliant with actions in place to address further improvements. Directorate risk Register The directorate risk register is currently reporting 21 risks. Internal Audit Fully compliant, green rated. EP advised there have been issues of concern specifically in relation to the emergency department where the CCG and WX have agreed to focus on triangulating issues within CQRM. KA raised the query relating to pressure ulcers where more information is required around the increase of pressure ulcers on the wards. KA noted the large increase in pressure ulcers could not be explained by changes in attendances. Walk in A&E Attendances are not the patients that obtain pressure ulcers. HD advised that pressure ulcers are developing over a couple of hours, where the patient is at risk at a very early stage. KA highlighted concern and requested assurance around the actions Whipps Cross staff would take to better understand and address the causative factors. Can you document this as an action for Anne and Helen. 119

123 DK referred back to the violent patient where more interest should be taken within the CCG to deal with this type of incident. SR confirmed that arrangements are in place for tracking of the incidents. 5.2 Patient Experience Report IDT highlighted the key issues to the committee. Accident and Emergency (A&E) Whipps Cross Friends Family Testing (FFT) response report has been achieved in December at 1%. The remedial action plan has been received showing Whipps Cross should be compliant by August GP Alerts WF CCG received 8 GP Alerts during January 2017 which is a significant decrease compared to December when 18 alerts were raised. WF CCG Complaints The 80% target for percentage of complaints responded to within the agreed time frame has not been achieved only achieving 46%. DK raised the question around Friends and Family (FFT) requesting a breakdown of practices that are not submitting results. IDT confirmed this is within the report. DK asked if this data can be circulated between the practices to challenge each individual practice. SR confirmed that Primary Care are contacting GPs if they have not responded within two months as this would be a breach of contract. The objective is to be 100% compliant. HD stated that Newham have had a good response rate, it would be helpful for a comparison report to be circulated to locality meetings. HD explained that whilst the numbers were low some very good work and quality improvements achieved from alerts raised. HD gave an example of an alert received 7 March that provided very helpful information to WFCCG officers. This in turn will inform commissioning and support a much better oversight and assurance of services commissioned for patients with Learning Difficulties. IDT confirmed this will be on the agenda for the next locality meeting for comparisons to be discussed. 5.3 Stroke Peer Network Review Whipps Cross Report HD explained that the Stroke Peer Report is conducted annually and took place 20 January 2017 led by Professor Rudd the National Clinical Director for Stroke and Chair of the London Stroke Network. The review team representation comprised of the North East London Stroke Operations Lead, Manager London Stroke Clinical Network, the Deputy Nurse Director Quality and Clinical Governance WFCCG, Lead Consultant for Stroke Services, Associate Director of Nursing, Senior Nurse and Matron for Stroke Services, the service manager and 120

124 representation from the medical and allied health professional teams at Whipps Cross Hospital Site. The report concludes that significant progress has been made since last year following the recommendations made being: Recommendation 1: The Stroke team to review usage of specialist chairs and current cost and consider purchase if more cost effective. Business case to be developed by site team if appropriate. Recommendation 2: The Stroke team to review the recording of patients requiring psychological support as reported on SSNAP. TB to sign post the appropriate person at Whipps Cross to AW to commence discussion around funding stream for the service. Consider whether IAPT is appropriate. Recommendation 3: The Stoke team to develop the options appraisal team and share with the commissioners for further discussion. Recommendation 4: The stroke team should undertake an internal audit of direct admissions to discuss with commissioners. HD further explained the Stroke Unit Team will formulate an action plan too in response to the 5 recommendations as set out in the report. Progress will be reviewed at the CQRM. KA acknowledged that it was beneficial the reviewers are looking at evidence which is robust. KA suggests that the CCG share this information with GPs to confirm their position in relation to 100% referral. It was agreed that the information be circulated at locality meetings to ensure GPs are clear about the pathway for assessments and use of the referral form. The report was approved. 5.3: CE: Stroke Peer Network Review is circulated at locality meeting. Feedback to be obtained how they perceive the rate of referrals and the status of the existing referral form 5.4 Monthly Quality Report Covered under agenda item

125 5.5 Maternity Service Update KH confirmed that following on from previous data issues in December 2016 where the number of antenatal referrals had decreased. The rate of referrals are currently at the required level. There has been a reduction in home births supported by Whipps Cross. Good progress has been made to meet an average of 10 a month, some months 15/16. There have been two changes WFCCG are working to understand what the impact has been. Please put as action for KH. 1. The dedicated home birth service that is provided by Whipps Cross is no longer in place and now merged with the community midwifery team. This was a decision taken by Barts Health because of the quality and safety concerns raised. 2. The impact of neighbourhood midwives, the service is now a different model. WFCCG believe that neighbourhood midwives is a more attractive model for home births and in time WFCCG expect to see the impact of improved uptake. TM raised the question of sustainability if Barts Health has responded by taking away home births. KH confirmed there were two separate issues where Barts Health would have preferred to have kept the home birth service. We need to recognise that three years ago this service ceased. KH has been liaising with Barts Health to establish where they are able to offer a sustainable home birth service and also looking at the increase of the use of Lilac Ward. KH will present an update at the April meeting on the work Barts Health are undertaking. HD requested that the report included an update on the effectiveness of the Maternity Services Liaison Committee. 5.5: Action KH: to provide information within April report of the coverage of effectiveness for the maternity service liaison community and their contribution of quality of care and patient experience. KA raised at the last meeting it was discussed about the full capacity for women having home births. KH confirmed the service was full for people who are due to give birth before 1 April where patients had chosen to move to Neighbourhood Midwives. KH confirmed a new patient can be referred within the area. Neighbourhood Midwives are increasing their capacity. As this is a pilot scheme it is being managed and patients that are unable to come under Neighbourhood Midwives will be supported to either access or acute trust of their choice. Neighbourhood Midwives are taking bookings and if they are unable to take a booking for a patient they have actively supported them to access Homerton or Whipps Cross. 122

126 6.0 Performance EP advised the committee that two reports have been circulated to the committee the first being the most up to date scorecard the second being the draft proposal for next year 17/18 where approval is required. EP highlighted the main issues from the first report. Currently the CCG is predicting that 15 out of 26 targets will be achieved at the end of the year (58%). 80% are showing improvement. Three targets considered high risk are Cervical Cancer Screening, Accident and Emergency 4hr Performance and Whipps Cross Family and Friends Test, which are rated red. EP highlighted one change from last month being the Personal Health Budget indicating the target will be met. EP highlighted that although WFCCG are reporting Referral To Treatment (RTT) as green, this is due to Barts Health not reporting their position at the time of deterioration. The position has deteriorated each month. LB confirmed that a two year recovery plan is in place with Barts Health to reduce this where believe Whipps Cross will be compliant with 18 weeks by end of 17/18. DK raised the query regarding the effect of Cervical Cancer screening programme, which is being sourced through Fednet. DK asked when we would know the uptake of a result of the active content for the patients. SG stated that Fednet are reporting on a monthly basis where they are unable to allow for enough bookings to meet target. The data will show how effective the system is working with the booking of appointments which is currently on 11%. TM raised the issue around negative feedback of the administrators for booking onto the system for Fednet where a process needs to be put into place as the CCG are funding the system. SG confirmed that only one administrator was in place where this has now been resolved and two additional administrators have been employed. SG advised the data for the next financial year is being reviewed and how this can be reported against NHSE data. Unfortunately the coding is difficult to compare. SG is meeting with colleagues 8 March to discuss the best options to replicate their system. 6.2 Scorecard Proposal 17/18 EP requested the committee to approve the proposed 17/18 scorecard where it is important to choose the right targets in line with what the CCG considers is important. EP presented the proposal and highlighted the changes to the scorecard. IAPT Access Rate - This has been included as new target where WFCCG always measured the recovery rate but the access rate is 123

127 about the number of people going into the IAPT service where there is a target of 16.8% for next year. Discussions took place around an assessment of how many people are eligible for IAPT. This is a national target where 16.8% of patients need to be in treatment. Home Births is a new target instead of reporting 12 plus 6 early booking standard. The target has been set at 2.5%. HD expressed concern regarding the target for annual health assessments for patients age 14+ on the LD register. This was discussed at MDT where the number of patients aged 14+ on the LD register. In view of the improvements required to address the SEND inspection, it is important to note it will involve this cohort of patients. HD emphasised that the CCG would not meet its statutory duty with a 45% local target. KH confirmed we need to set an increased target based on next year taking into consideration the out turn position for 16/17. The final figures are not available this is due to GPs not updating the GP system until end March LB confirmed that once the data is received for March 2017 a stretched target will be set for next year taking this data into consideration. HD stated there is a legal requisite for all LD patients have to have an annual health assessment. Discussions took place around the age of children with LD and who should be on the register and asking GPs to look at their register to ensure that the annual health check and the SEND process could be linked together. HD confirmed that a pathway needs to be commissioned following the SEND review for young people aged In conclusion it was agreed that as some targets were not agreed EP will circulate the proposed 17/18 scorecard requesting feedback within the next week where targets can be reviewed and feedback taken into consideration for targets to be reset if necessary. 6.2: Action EP: Circulate proposed 17/18 scorecard requesting feedback on targets from the committee. 7.0 Cancer There have been 13 breaches over 100 days for Waltham Forest Patients in 2016/17. One of these remains open. A recent audit by Barts Health identified a number of practices which have been sending 2 Week Wait referrals for suspected lung cancer using old referral forms. The CCG s Clinical Director for cancer will be 124

128 8.0 AOB writing to the relevant practices to remind them of the need to download and install the latest forms, which were launched in April NA Details of next meeting: Date: 12 April 2017 Time: 10.00am 12.00pm Venue: Boardroom Kirkdale House 125

129 Item 6.2b Committee Minutes From Performance and Quality Committee April 2017 Dr Dinesh Kapoor, Clinical Director Quality and Performance - WFCCG Key highlights DK informed the committee of the meetings he attended last month. The Whipps Cross Clinical forum discussion related to abnormal radiology results and the lack of follow up received. John Peters will raise this with the Royal London Hospital to ascertain if a process can be arranged. A full debate took place around the Advice and Guidance Service. Governing Body The Stroke report was presented which received positive feedback and the chair made a special note of the great work undertaken within the Quality and Governance team. Local Medical Committee raised no performance issues. DK informed the group that he had an annual appraisal on 5 April and confirmed the following changes to his portfolio. The cessation as Clinical Lead for Independent Funding Requests (IFR s) and replaced with Lead for Safeguarding Adults and Children. DK also confirmed that he will be attending two Quality Assurance Visits going forward. In regards to Freedom of Information (FOI) request a clinical lead be identified to ensure ownership. Quality Quality Assurance Visit for Ross Wyld A report was provided within the committee papers where Waltham Forest Clinical Commissioning Group (WFCCG) have requested long term actions. Ordering, Storage and disposal of medication Controlled Drugs (CD) General medicines management issues Patient Experience Report WF CCG Complaints Waltham Forest CCG received 2 complaints during February 2017: 1. Delay by the CCG to order a specialist wheelchair 2. Concerns a patient had with a nurse assessor. Highlights [Performance and Quality Committee] [April 2017] 126

130 Healthwatch Waltham Forest Healthwatch Waltham Forest held Sustainability and Transformation Plan (STP) engagement events throughout the months of February and March Concerns were raised by members of the public around: 1. Transfer of patients out of hospital to receive care into a community setting 2. How Whipps Cross hospital s redevelopment fits into the plans 3. There was an emphasis that better public engagement is needed throughout the STP process. Waltham Forest Parent Forum Members of WF CCG met with the Waltham Forest Parent Forum during January During this meeting concerns were raised by the forum around Education, Health and Care Plan s (EHC), phlebotomy and Continuing Healthcare (CHC). Following this the CCG has met with the forum to discuss how we can work together going forward. GP Alerts WF CCG received 13 GP Alerts during February 2017 which is an increase on the number received during January It has been suggested by colleagues at Whipps Cross hospital for the CCG to create a new system similar to the GP Alerts system so that the provider can raise quality and safety concerns with GP practices. Monthly Quarterly Report Key highlights were presented to the committee also stating areas of improvement. NHS Litigation Authority Update The committee were informed of the proposed changes to NHS Litigation Authority as of April NHS Litigation Authority will become NHS Resolution and has published its five year strategy Delivery fair resolution and learning form harm Our Strategy to The service is to focus on prevention and improve safety. An extranet is in place where learning for claims is shared and each organisation will receive a quarterly report to show the litigation information which will be shared for discussions. Performance The committee were advised of the CCG s performance against the CCG Scorecard and other national performance and quality standards at the end of March 2016 (Month 12). The CCG is predicting that 16 out of 26 targets will be achieved at the end of the year (62%). The CCG is also predicting that 6 further indicators, a total of 22 (85%), are showing improvement from the previous year or baseline position. Cancer 2 waits from urgent GP referral (6 breaches in total 2 breast, 1 gynaecology, 1 haematology, 2 urology) and 62 day wait from screening (1 breach lower GI). Three of the 62 day wait from urgent GP referral breaches were related to capacity, and the other three were administrative. The 62 day wait from screening breach was capacity related. Highlights [Performance and Quality Committee] [April 2017] 127

131 Performance and Quality Committee Meeting Date: Time: Venue: Wednesday 12 April 10.00am 12.00pm Boardroom, Kirkdale House, Leytonstone Chair: Dr Dinesh Kapoor (DK) Attendees: Helen Davenport (HD) Les Borrett (LB) Diane Clements (DC) Anne Walker (AW) Jonathon Cox (JC) Dee Parker (DP) Isabelle Davies Tutt (IDT) Kelvin Hankins (KH) Ada Onyeagwara (AO) Dr Sabeena Pheerunggee (SP) Hassan Serghini (HS) Apologies: Carl Edmonds (CE) Dr Tonia Myers (TM) Dr Mayank Shah (MS) Enrico Panizzo (EP) Dr Ken Aswani Zitha Moyo Sultana Rahman Korkor Ceasar (KA) (ZM) (SR) (KC) Minutes 1. Welcome and apologies DK DK welcomed all and noted the apologies received. 2. Declaration of interest register HD There were no declarations of interest raised at the meeting. 3. Minutes of last meeting Dee Parker was in attendance minutes to be amended. Minutes were approved as an accurate record of the meeting held 8 March Actions outstanding from previous meeting / Matters Arising The action tracker was reviewed and actions completed were closed. All outstanding actions were updated on the action log. JL sent apologies to the meeting but provided an update to the following actions 6.1:JL to confirm if flu vaccination figures within public health include pharmacy figures and report back to March Committee. Action 128

132 Action: SR/JL - A breakdown of practices for flu vaccination figures within public health to be circulated at Locality meeting. JL to confirm if flu vaccination figures within public health include pharmacy figures and report back at March committee. JL March 2017/April 2017 Response: Waltham Forest Public Health does not hold flu vaccination data and confirmed these are held by NHS England; the figures on performance for 16/17 will not be publicly available until May The uptake includes vaccinations delivered within the GP practice, pharmacies, and schools. The publicly available 15/16 flu uptake by practice was shared as a part of the Public Health Dashboard with the localities. In addition the data was sent by to the Chair on March 8 th Concerns relating to pharmacies with respect to patients being offered opportunistic vaccinations has been raised with NHSE. Chair s Report Briefing Whipps Cross (WX) Clinical Forum Minutes DK informed the committee of the meetings he attended last month. The Whipps Cross Clinical forum discussion related to abnormal radiology results and the lack of follow up received. John Peters will raise this with the Royal London Hospital to ascertain if a process can be arranged. A full debate took place around the Advice and Guidance Service. Governing Body The Stroke report was presented which received positive feedback and the chair made a special note of the great work undertaken within the Quality and Governance team. Local Medical Committee raised no performance issues. DK informed the group that he had an annual appraisal on 5 April and confirmed the following changes to his portfolio. The cessation as Clinical Lead for Independent Funding Requests (IFR s) and replaced with Lead for Safeguarding Adults and Children. DK also confirmed that he will be attending two Quality Assurance Visits going forward. In regards to Freedom of Information (FOI) request a clinical lead be identified to ensure ownership. 4. Medicines Optimisation AO 17/18 Quality Premium targets for antimicrobial stewardship elements. HA highlighted the requirements of the 2017/18 NHS Quality Premium (QP) scheme that rewards Clinical Commissioning Groups (CCGs) for improvements in the quality of the services they commission. With a Chair DK 129

133 specific focus on the Medicines Optimisation element, there are two parts that focus on the reduction of inappropriate prescribing of antibiotics (Part B and C). As in previous years, it is important that we retain a focus on the fundamentals of everyday commissioning. These include delivery of the NHS Constitution commitments on Referral to Treatment (RTT) Times, A&E, ambulance and cancer waiting times; adhering to quality regulatory standards, and delivering financial balance. The QP scheme will view CCG performance in the planning submissions round on the national and local priorities as well as on the fundamentals of commissioning to recognised standards. HA confirmed the composition of the QP as a two year scheme. The payment to CCGs in 2018/19 and 2019/20 reflects the quality of the health services commissioned by them in 2017/18 and 2018/19. The award will be based on measures that cover a combination of national and local priorities, and on delivery of the gateway tests, as described within the report. HD raised the query relating to Care Homes and GPs with the high rate of admissions into Accident and Emergency (A&E) is a piece of work being undertaken to resolve this issue? AO advised that the anti-microbial group involves Barts Health and confirmed the prescribing guidelines will be used in the main report and it is the expectation that Barts Health adhere to the guidelines. HD requested a discussion take place at the Medicines Optimisation Meeting today to seek assurance and support around the work being carried out by AW to take to clinical forum to avoid patients being over prescribed. SP advised there is a high prescribing rate for Urinary Tract Infections (UTI) which may need addressing through further education. HD agreed an action for a piece of work to be undertaken with Barts Health (BH) to seek assurance and this to be then an agenda item at Medicines Optimisations Meeting with presentation of the proposed management plan. Action 4.1 : AO/HS to compile a plan of action around education to reduce the high prescribing rate within UTIs. Report to be presented at the MO committee. 16/17 NELFT Medicines Safety Report HA presented the recent NELFT Medicines safety report for Waltham Forest. The report compares the number of incidents that occurred throughout the trust in this financial year compared to last 130

134 year, and highlights those incidents that caused harm and determines the severity of each incident. HA highlighted the majority of incidents related to medications not being administered or missed doses; arising as a result of issues with availability of information on therapy from the transfer of care. The majority of these incidents did not result in any harm to the patient with the exception of an adverse event to a vaccination and a needle stick injury both resulting in moderate harm. There were also issues with the incorrect handling of controlled drugs. NELFT have advised that there is a plan to re-educate staff in the handling of medicines and the Trust plans to roll out an insulin training package across all sites and disciplines. HA highlighted the main themes around the graphs shown within the report. KH highlighted there is no mention of acute wards within the report. HS stated they do provide a more detailed report on a quarterly basis where the report brought to the committee is a summary around the main issues but will include going forward. AW requested more clarity around moderate harms as highlighted within the report. If the process is not being followed is there an action plan in place? HS advised a very detailed step by step action plan is in place but was not presented within the report. HS has asked the Trust what actions are in place to address that moderate harms are occurring, this will be shown within the next report. A discussion took place around reflecting this into the Clinical Quality Review Meeting (CQRM) and the inaccuracy within the report. It was agreed this would be placed on the forward planner for CQRM going forward where a detailed deep dive will take place to seek assurance. AO/HS will attend CQRM on a quarterly basis to present. Action 4.2: AW To include Moderate Harms 16/17 Medicines Safety Report on forward planner for Whipps Cross CQRM 5. Quality Quality Assurance Visit for Ross Wyld HD informed the committee the purpose of the report is to inform the Performance and Quality Committee of the findings of the quality monitoring of the care home in which we place our patients. ZM provided a very comprehensive report within the committee papers where Waltham Forest Clinical Commissioning Group (WFCCG) have requested long term actions. HD highlighted the key findings of the report. 131

135 Ordering, Storage and disposal of medication Controlled Drugs (CD) General medicines management issues HD assured the Committee that all recommendations and risks which have been highlighted are being acted upon, that procedures have been put into place to ensure improvements in the management of controlled drugs and medicines and that these are reflective of current practice. It has been discussed that if recommendations are not meet a Contract Protection Notice (CPN) will be put into place. The committee approved the report where it was agreed to be brought back to the committee in July Patient Experience Report IDT highlighted the key issues as below: WF CCG Complaints Waltham Forest CCG received 2 complaints during February 2017: 1. Delay by the CCG to order a specialist wheelchair 2. Concerns a patient had with a nurse assessor. Healthwatch Waltham Forest Healthwatch Waltham Forest held Sustainability and Transformation Plan (STP) engagement events throughout the months of February and March Concerns were raised by members of the public around: 1. Transfer of patients out of hospital to receive care into a community setting 2. How Whipps Cross hospital s redevelopment fits into the plans 3. There was an emphasis that better public engagement is needed throughout the STP process. HD asked where Healthwatch learned of the issues and how this is being managed. IDT confirmed a report is being produced on 15 April which will be circulated by the communication team. IDT will ask for the report to be circulated within the team being published so any recommendations and changes can be made. Waltham Forest Parent Forum Members of WF CCG met with the Waltham Forest Parent Forum during January During this meeting concerns were raised by the forum around Education, Health and Care Plan s (EHC), phlebotomy 132

136 and Continuing Healthcare (CHC). Following this the CCG has met with the forum to discuss how we can work together going forward. GP Alerts WF CCG received 13 GP Alerts during February 2017 which is an increase on the number received during January It has been suggested by colleagues at Whipps Cross hospital for the CCG to create a new system similar to the GP Alerts system so that the provider can raise quality and safety concerns with GP practices. In relation to complaints HD advised that this and Continuing Health Care (CHC) is managed on the CCG s behalf by North East London Clinical Support Unit (NELCSU). It is important for GPs to understand the two way nature of the system. HD further advised in relation to Special Education Needs and Disability (SEND) this will report to the committee and Governing Body in May and wishes to assure the committee that a Project Board is up and running with CCG leading on borough improvement plan and is on track. IDT was open to questions from the committee. No questions raised. Action: IDT to request Communications team to circulate the Healthwatch report to the members of the Committee. Monthly Quarterly Report AW advised the purpose of the report is to inform the Committee of the quality provided to the patients of Waltham Forest at its Provider Organisations, indicating by exception where quality does not meet agreed targets. AW highlighted the key issues Positive areas of good practice for Whipps Cross Maternity Friends and Family Test response rate exceeded target. No grade 4 pressure ulcers reported. No MRSA cases reported. No Never Events reported. 30% Inpatient FFT response rate target achieved reaching 38%. Positive areas of good practice for NELFT Zero MRSA cases reported. Zero overdue SI reports. Zero Clostridium Difficile. 133

137 100% of complaints were responded to within the agreed timeframe. Compliance achieved with Safeguarding children level 1, 2 and 3. Areas for improvement for Whipps Cross 9 Serious Incidents overdue 60 days, this is a decrease on January s figures. 93% of Venous Thrombo Embolism (VTE) risk assessments were completed, not achieving the 95% target. 4 grade 3 pressure ulcers reported. 42% of complaints were responded to within the agreed timeframe, not achieving the 80% target. Continued low FFT response rate in ED achieving 3%. Compliance with Safeguarding Adults training Level 1 and 2, Safeguarding Children Level 2 and 3. Compliance with Basic Life Support training and Infection Control Training Clinical Staff Level 1 and 2. Areas for improvement for NELFT Compliance with Safeguarding training Adults (level 1 and 2). Compliance with Life Support and Infection Prevention and Control Training. HD requested clarity when NELFT were due to be compliant on Safeguarding Adults Training. AW advised end of March Up to date data has not yet been received but will be circulated amongst the CQRM papers. KH advised that a CPN cannot be issued until all data has been received, and a decision should be able to be made as of end April Accident and Emergency (A&E) AW confirmed Whipps Cross continue to improve FFT response rates in A&E with rates being as low as 1%. A remedial action plan is in place with the site stating they will be compliant with the Trust Target of 20% by August Volunteers are in place and a Director of Nursing has been appointed to help meet compliance. Pressure Ulcers Pressure ulcers at Whipps Cross (WX) is of concern although it is noted that there has been a reduction in the past two months. There was spike in reported numbers at the end of last year and AW met with 134

138 the Director of Nursing to request an action plan to ensure actions to drive improvements are in place and for more reporting on pressure ulcers to take place for this year. AW will keep the committee up to date of the progress. Care Homes During February 2017; 7 residential homes and 2 nursing homes were inspected. 2 reports have been published with 7 pending. The table demonstrates the CQC rating for each residential and nursing home against the 5 domains of care. Freedom of Interest Request (FOI) The Information Commissioner has announced that the thresholds that result in the Information Commissioner's Office (ICO) monitoring public authorities when responding to FOIs has been raised. All public authorities will now be considered for monitoring if less than 90% of their FOI responses are within the statutory timescale. Information Governance Toolkit Information Governance ensures necessary safeguards for, and appropriate use of, patient and personal information. The Information Governance Toolkit (tool kit) is an evidence based system, published through NHS Digital, which is used to demonstrate that an organisation has the necessary controls in place to ensure the safeguards are in place and are working. The CCG is required to make an annual submission of supporting evidence against the 28 requirements of the tool kit. HD raised the question in relation to non-compliance against KPI s. Whipps Cross have never been compliant with the Venous thromboembolism (VTE) KPI. A discussion needs to take place around management of Safeguarding Training for Adults and Infection Control to ensure compliance is met. This is highlighted within the expectation reports however, this will be raised at CQRM where a Contract Performance Notice will be put into place if recommendations are not met. A discussion took place around pressure ulcers and if all pressure ulcers reported are for Whipps Cross or from Care Homes/Homes. AW will pick up as an action and report back to the committee. Action 5.3: AW to advise if pressure ulcers figures are reported just from Whipps Cross or across Care Homes/Homes. 135

139 NHS Litigation Authority Update AW informed the committee of the proposed changes to NHS Litigation Authority as of April NHS Litigation Authority will become NHS Resolution and has published its five year strategy Delivery fair resolution and learning form harm Our Strategy to The service is to focus on prevention and improve safety. An extranet is in place where learning for claims is shared and each organisation will receive a quarterly report to show the litigation information which will be shared for discussions. In conclusion NHS Resolution will commence as of April 2017 and confirm that the strategy to 2022 incorporates feedback from customers. There is a commitment to refresh the strategy regularly ensuring that plans are directly linked to the NHS Five Year Forward View and the two year NHS business planning cycle. NHS Resolution will continue to carry out regular customer surveys and stakeholder engagement. Quality Review Ambulatory Care AW advised the purpose of the report is to inform the Performance and Quality Committee of the efficiency, effectiveness and quality of the service provided to the patients of Waltham Forest utilising the Ambulatory Care Service at Whipps Cross Hospital. At the A&E performance meeting held December 2016 a discussion was held regarding increasing the use of the ambulatory care pathway, it was noted there is a lack of clarity in understanding as to how primary care accesses the pathway and the need for clear definition of what the gateways are. The Director of Nursing Quality and Governance Helen Davenport agreed to arrange a quality assurance visit to the Ambulatory Care service which took place on Friday 24 March where HD, AW, KA attended. AW advised the following issues were discussed during the review of the pathway. Facilities Medicines Optimisation Radiology Access Diagnostic information Hot Clinics 136

140 Contact/Referral Issues Staffing HD highlighted the key issues around each area where the Quality Assurance Review Clinical Areas, where at the time of visit the unit had approximately 14 people in the waiting room and extra chairs had to be put in situ. It was noted that the Clinical Director was serving patients and family members with refreshments and informing patients of what was happening in the department. There was one agency nurse on duty in the ambulatory care area. There were a number of areas of concern which are noted within the report. In conclusion there was good medical leadership within the Ambulatory Care Pathway and a clear passion to improve the patient s journey and treatment. A number of areas were discussed to make improvements to the service and improve access and streamline pathways. The quality review highlighted that there was significant concern that the patients were not receiving the expected levels of quality safe care. There was a lack of nursing leadership within the CDU resulting in breaches to safe working practices and a lack of assurance of the delivery of safe and compassionate care to the patients. All immediate concerns were raised at the time with the nurse in charge and more in-depth feedback provided after the visit to the Director of Nursing at Whipps Cross. The report will be shared with the Director of Nursing Whipps Cross. It is the expectation that Whipps Cross will provide assurance that the issues highlighted at the Quality Assurance visits have been addressed. Assurance will be sought via the Clinical Quality Review Oversight and Assurance Meeting where recommendations were made and be shared with the team at Whipps Cross in order to support the maximisation of flow and efficiency through department. HD wished for this report to be taken to the Joint Executive Team meeting with the directors of the CCG and WX where a detailed discussion can take place for the issues to be resolved. This will further be discussed at CQRM in May. 5.5 Action HD To discuss Quality Review Ambulatory Care report at Joint Executive Meeting. 137

141 HD requested for a detailed piece of work to be undertaken regarding the coding. DP will discuss with EP to capture the correct pathways and understand the issues for a plan of action to be in place for May Action DP/EP to discuss and undertake an action plan to capture the correct pathways and consider the level of risk within ambulatory care. The report was approved. London Learning Disability Mortality Review Pilot HD advised the purpose of the report was that the Care Quality Commission examined how NHS trusts across the country identify, report, investigate and learn from the deaths of people using their services. The findings failed to identify any trust that demonstrated good practice across all aspects. The review found that there is no consistent national framework in place to support the NHS to investigate deaths that may be the result of problems in care. This can mean that opportunities to help future patients are lost, and families are not properly involved in investigations - or are left without clear answers. It was confirmed that the CCG has complied with NHS England s request for supply of information. Learning Disability KH presented the report detailing the current work being undertaken to improve services for people with a learning disability. The report also outlines the proposed learning disabilities dashboard for quarterly submission to the committee. KH highlighted the key issues. Transforming Care Partnership NHS England (NHSE), Department of Health (DH), Local Government Association (LGA), Association of Directors of Adult Social Services (ADASS), Care Quality Commission (CQC) and Health Education England (HEE) have committed to strengthen the Transforming Care delivery programme for people (Adults and Children) with learning disabilities. They have instigated the creation of 49 transforming care partnershipcommissioning collaborations between clustered CCGs, NHSE 138

142 specialised commissioners and local authorities. Waltham Forest CCG and the Local Authority has joined with: Tower Hamlets, City & Hackney and Newham CCGs and Local Authorities to develop a transforming care partnership. Compared to other areas the WELC partnership has relatively low numbers in Assessment and Treatment Unit and secure environments. In Waltham Forest there are currently less than five people in an Assessment and Treatment Unit, and 9 places commissioned by NHSE in secure settings. Commonly these are forensic placements made after individuals, (sometimes with Asperger s or autism spectrum disorders), come into contact with the justice system. KH advised that WFCCG are the only CCG who are 100% compliant. HD confirmed that a budget had not been set up around this where we need to consider internal CCG resource. HD/KH will decide a plan of management for extra resources within WFCCG for LD. 5.7 Action HD / KH to arrange a plan of management to put into place to provide extra resources for LD within CCG. Continuing Health Care KH advised this was originally a system which was managed by the Local Authority on our behalf. The CCG had significant concerns including that the in year spend increased by 2 million in one year. The service was brought in house in January 2017, and review identified a number of issues, including where 54 of the people that are funded only 50% have a care plan. Most patients care cost over per week. KH confirmed NELFT put into place an action plan so every patient has a care plan and this will be reviewed through the CQRM process. KH advised that NELFT have changed their Learning Disability nursing team and have been very responsive in the request. KH asked the committee to note that out of the 54 patients 34 are supported by providers. All but one Osbourne Road came out as inadequate where the LD service is undertaking a visit and a risk assessment is in place. KH advised the expectation is that the dashboard will be developed over time, but has been developed using current data available. A future area for reporting is the performance of the Specialist Learning Disability Service provided by NELFT. 139

143 Currently the dashboard provides information on: Number of Adults who are in patients who have a Learning Disability and / or autism. Funded by either the CCG or NHS England Number of Children or Young People who are in patients who have a Learning Disability and / or Autism Number of Blue Lights / Care and Treatment Reviews completed NHS Continuing Healthcare performance Learning Disability Health Checks KH reported good news regarding LD health checks that WFCCG reached 52% in 2016/17. The committee approved the report. HD requested this detail to be included as a Care Quality Commission (CQC) basis on our quarterly report. Inclusive of LD and Looked After Children (LAC) placements. 5.7 Action IDT/KH/AW Dashboard information to be inclusive of LD and LAC placements going forward. 6. Performance LB advised the purpose of this report is to inform the committee of the CCG s performance against the CCG Scorecard and other national performance and quality standards at the end of March 2016 (Month 12). The CCG is predicting that 16 out of 26 targets will be achieved at the end of the year (62%). The CCG is also predicting that 6 further indicators, a total of 22 (85%), are showing improvement from the previous year or baseline position. Since the previous report the committee is asked to note the following updates: Improvement in the Learning Disability Health Checks (5) from 40% to 52% (target: 45%) Personal Health Budget (9b) improved to 109 and is also expected to meet the target of 150 as patients who have been offered a PHB complete the paperwork process. End of Life reached 17 patients above target of 490 patients. 140

144 17/18 Scorecard LB advised the purpose of the report is to present the updated CCG Scorecard for 2017/18. All Scorecard leads have been asked to review their indicators and where necessary make changes in the indicator and/or set a revised target for 2017/18. The Performance and Quality Committee is asked to review and approve the proposal. HD queried what narrative can be used for LD. KH stated this will be broken down into individual plans and reports which will come to the committee to refine each definition. The committee approved the 17/18 scorecard. The final version of the Scorecard will be presented to the CCG Governing Body. 7.2 Planned Care SG SG provided an update on planned care. Information has been collated over the last few months and presented was an outline skeleton report and requested feedback from the committee as to the format. SG highlighted the key headings from the one page summary of planned care services, with an: Overview of current planned care contracts. Summary of current performance (snapshot of how services are performing against an individual performance/quality measure, e.g. patient experience) Current planned care activities Summary of current planned care projects/activities, e.g. procurements, service mobilisations Risks relating to planned care services Risks/issues that have arisen in relation to planned care services and mitigating actions being taken by the CCG/provider. HD highlighted issues around surgery and would this be included within the report. A discussion took place around areas covered under planned care and which should be reported on going forward within the report. It was agreed that a further discussion will take place at MDT for an overview on the areas covered within planned care. 7.2 Action LB/HD A discussion to take place at MDT with an overview of what areas are covered under planned care and where surgery would sit. 141

145 KH raised that all information across all sectors should be identical and suggested that the presentation slides used in the Finance and Activity report be used within performance of contracts. This was agreed. In conclusion it was agreed the final report will come back to the committee in June. 7.2 Action DC- Planned care to be an agenda item in June. 8. Cancer SG confirmed that there were two standards which breached target: 62 waits from urgent GP referral (6 breaches in total 2 breast, 1 gynaecology, 1 haematology, 2 urology) and 62 day wait from screening (1 breach lower GI). Three of the 62 day wait from urgent GP referral breaches were related to capacity, and the other three were administrative. The 62 day wait from screening breach was capacity related. All 62 day breaches are subject to a Root Cause Analysis, and will be referred to the Clinical Harm Review Group for further discussion if appropriate. The quarterly update on 100+ day breaches will be provided in the report submitted to the June Performance & Quality Committee. SG confirmed a media release will be issued in early April by the CCG s communications team to highlight that April is Bowel Cancer Awareness Month. The communication will be used to highlight the following key statistics about bowel cancer in Waltham Forest: 75 cases per 100,000 population in deaths from bowel cancer in 2014, up from 21 in 2010 Bowel screening uptake of under 49% in Waltham Forest, compared with national average of 57% The media release will also stress the importance of patients utilising their bowel screening kit when they receive it, and of seeing their GP if they have any symptoms of concern. HD raised a concern re breaches in cancer where this is a reported issue within administration areas. The figures do not specify if they are Waltham Forest patients where Whipps Cross need to be held to 142

146 9. AOB account for the information provided. HD requested confirmation why the patients have breached and would like assurance at the May meeting what issues are being taken for this to be resolved. 8. Action SG/DP To confirm why breaches are happening and what assurance the CCG are being given to ensure there is an action plan in place. Terms of Reference (TOR) The committee reviewed and agreed the TOR. AW will make amendments discussed and circulate revised ToR 9. Action AW ToR amendments to be made and circulated. Details of next meeting: Date: Wed 10 May Time: 10.00am 12.00pm Venue: Boardroom Kirkdale House 143

147 Item 6.3a Committee Minutes From Medicines Optimisation Committee Minutes - March 2017 Dr Ravi Gupta, Clinical Director for Medicines Optimisation - WFCCG Key highlights Antibiotic Quality Premium Antimicrobial Prescribing comparison for 2015/16 (up to month 8) against 2016/17 (up to month 8) was presented to the Committee and it was noted that WFCCG has made an improvement in both the general prescribing of antibiotics and in the prescribing of broad spectrum antibiotics. NHS England have also set targets for the reduction of inappropriate prescribing for Urinary Tract Infections (UTIs), which will be included in the CCG s scorecard. These targets also form Part B and C of the Quality Premium (QP). Discussions are underway across the STP with the quality leads to devise a plan to achieve Part A of the QP which relates to the reduction of e-coli bacteraemia in the local acute trusts. Non-Medical Prescriber (NMP) Prescribing in GP surgeries The overall management responsibility of a NMP lies with the GP practice employing the NMP. GP practices have been asked to provide evidence of skills and competencies of an NMP when requesting for a prescribing code on the behalf of the NMP. Waltham Forest CCG has recently received scopes of practices that have not provided evidence to demonstrate that the NMP has the skills and competency to prescribe and therefore were unable to issue a prescribing code. It was highlighted that in some instances where an NMP has not been issued a prescribing code, they have used an alternative code, such as a GP code. The Committee agreed to send out communication to GP surgeries GPs informing them that they must ensure all prescribers use the correct prescribing code and not the GP code. Medicines Matter Bulletin The February 2017 issue of the Medicines Matter Bulletin was approved by the Committee. The bulletin provides updates on current guidelines and information to support medicines optimisation and clinically effective prescribing. It also covers key issues identified over the past few months. Approved Prescribing Guidance and Medication The Committee approved the following documents: - The Committee approved the proposal to switch patients from Spiriva plus handihaler to Braltus plus Zonda inhaler. - The liothyronine guidelines have been revised and approved (update). 144

148 Minutes Meeting Date and Time: Venue: Chair: Medicines Optimisation Committee Wednesday 8 March 2016, 2.00pm 4.00pm Boardrooms B & C, Kirkdale House, 7 Kirkdale Road, E11 1HP Dr. Ravi Gupta Attendees: Name Title Dr. Ravi Gupta RG Waltham Forest CCG GP Clinical Director Ada Onyeagwara AO Assistant Director, Waltham Forest Medicines Optimisation Team Dr. Imran Kazi IK GP Prescribing Lead for Chingford Dr.Thaven Chetty TC GP Prescribing Lead for Leyton/Leytonstone Dr. Rishav Dhital RD GP Prescribing Lead for Walthamstow Natalie McCallam NMT Project Support Officer, Waltham Forest Medicines Optimisation Team Thomas Helen Davenport HD Director of Nursing, Quality and Governance Kay Saini KS Senior Prescribing Advisor, Waltham Forest Medicines Optimisation Team Anisha Sharma AS Prescribing Advisor, Waltham Forest Medicines Optimisation Team Hassan Serghini HS Senior Prescribing Advisor, Waltham Forest Medicines Optimisation Team Anisha Chandaria AC Senior Medicines Optimisation Pharmacist, Waltham Forest Medicines Optimisation Team Gurdeep Kenth GK Medicines Optimisation Pharmacist, Waltham Forest Medicines Optimisation Team Mayur Patel MP Local Pharmaceutical Committee representative for Waltham Forest Sultana Rahman SR Associate Director for Primary Care, Waltham Forest Sushma Lau SL Deputy Chief Pharmacist (MHS), NELFT NHS Foundation Trust Dr Hisham Swedan Apologies Name HSW Local Medical Committee representative for Waltham Forest Title Kamaljit Takhar KT Deputy Chief Pharmacist, NELFT NHS Foundation Trust Mohammed (Zahir) Rashid MZR Clinical Commissioning Pharmacist Barts Health NHS Trust (Newham University Hospital) Lynn Snowden LS Senior Commissioning Manager, Waltham Forest 1 145

149 17/03/01 Welcome and apologies The Chair welcomed members to the meeting and apologies were received as above. 17/03/02 Declarations of Interest and Register of Committee Interest KS will be delivering a presentation at an inhaler technique workshop on behalf of the LPC on 21 March The event is being sponsored by Pfizer, Chiesi, NAPP and AstraZeneca. The Medicines Optimisation Team have engaged in a joint working project with Teva to produce a poster on the management of inhaler devices for adult asthma. 17/03/03 Minutes and matters arising Review of February 2017 Minutes The MOC minutes were approved by the Committee as accurate. Review of Action Tracker MOC254 The LPC have received verbal clarification from the PSNC affirming that there is no provision for making claims for broken bulk on particular dressings as per the regulations from the drug tariff. It was highlighted that some community pharmacies have been refusing to issue prescriptions for dressings, where the quantity is for less than a full pack. NELFT have proposed setting up a central storage system for wound care dressings across the borough to address this matter, but until a process has been agreed for managing this, a solution will be needed in the short term. The Committee proposed that in the interim, where a GP practice is unable to obtain the specific dressings and quantity requested from a community pharmacy, the patient can be directed to an alternative pharmacy. The LPC agreed with this as a course of action. ACTION: LPC to discuss the alternative pharmacy agreement with local community pharmacy contractors, to ensure that prescriptions are redirected to a pharmacy who is willing to issue the number of dressings requested by the prescriber. MOC253 - WFCCG are awaiting a response from NELFT in relation to the feedback received from BHR CCGs about the wound care formulary. MOC252 NELFT will be adding tap water to the cleansing section of the wound care formulary and to the dressing request form. Once this has been completed, the updated documents will be brought to the MOC for ratification. MOC250 - NELFT have been tasked with designing a formal prescription request form for district nurses to use, to combat third party requests. This is currently ongoing, but no timescales have been confirmed. ACTION: NELFT to confirm the timescale for the design of the formal prescription request form at April s MOC meeting

150 MOC234 The CCG has received information from Newham CCG in relation to the review of prescribing of doxepin in their borough, which was found to be higher than in Waltham Forest. The MOT are contacting practices in Waltham Forest to ascertain how many patients are on doxepin and the indication for it use. Once this has been established, the information received from Newham CCG will be used as a template for local guidance. 17/03/04 Quality, Performance and Governance Risk Register R17- DIABETES Further clarification will be sought from the task and finish group regarding the timelines for the completion of the diabetes formulary. RAG Rating remains the same as last month: RAG: 6 (YELLOW) - (3 for Likelihood and 2 for consequence) R19 BIOSIMILARS Barts Health have submitted a proposal on the implementation of all biosimilars, which will be discussed at the Barts Health Clinical Commissioning Collaborative on 13 March. A gain share agreement has been agreed with Barts Health for the use of infliximab in rheumatology and a business case is being submitted to begin using the etanercept biosimilar. Four other biosimilars which will shortly be available for use will be reviewed by Barts Health during the next financial year (2017/18). An agreement has also been reached with the two other main providers, BHURT and Homerton, to provide a consistent approach to biosimilars across the economy. The implementation of biosimilars is also part of the Sustainability and Transformation Plan (STP) work plan. RAG remains the same as last month: RAG: 6 (YELLOW) - (2 for Likelihood and 3 for consequence) R20 SHARED CARE GUIDELINES Barts Health have been tasked to devise an action plan on how they will address the issue of out of date SCGs. This issue has been raised at the Waltham Forest Performance and Quality Meeting and at all formal contract meetings held with Barts Health. Other CCGs have also added SCGs to their risk register and Barts Health have been encouraged to add the issue to their own risk register. RAG Rating has increased 16 (AMBER) - (4 for Likelihood and 4 for consequence) North East London Antimicrobial Resistance Strategy Group (NEL AMRSG) update The AMRSG met recently to discuss the Antimicrobial resistance agenda. Recent Public Health campaigns have focused specifically on Sepsis and leaflets have been distributed to GP practices and community pharmacies. A number of practices have indicated that they have not received the leaflets, which will be followed up a Public Health representative who attended the meeting

151 Public Health England have updated their antimicrobial guidelines for Urinary Tract Infections (UTIs) to recommend nitrofurantoin for first line use instead of trimethoprim, due to high levels of antimicrobial resistance. Local guidelines have been updated to reflect this change and will be brought to MOC for approval. Barts Health have also been asked to comment on the changes made to the guidelines. This update is also important, as there is an NHS Quality Premium which measures antibiotics in UTIs and the prescribing of nitrofurantoin against trimethoprim. Antibiotic Quality Premium The Committee were provided with an Antimicrobial Prescribing comparison for 2015/16 (up to month 8) against 2016/17 (up to month 8). It was noted that WFCCG has made an improvement in both the general prescribing of antibiotics (-1.38%) and in the prescribing of broad spectrum antibiotics (-13.81%). NHS England have also set targets for the reduction of inappropriate prescribing for Urinary Tract Infections (UTIs), which will be included in the CCG s scorecard. These targets also form Part B and C of the Quality Premium. Part A of the Quality Premium relates to the reduction of e-coli bacteraemia in the local acute trusts. Initial discussions have been held with the acute trust microbiology teams to help address the rise of e-coli bacteraemia. Electronic Prescription Services 2 report The Committee were provided with a breakdown of EPS usage report in the borough at practice level. Every GP practice is live, but a number are not utilising the system regularly, so NEL CSU in collaboration with NHS Digital are working with these practices directly to increase usage. This issue is also being discussed at the EMIS User Group meetings, which is attended predominantly by practice managers. The Committee discussed some of the issues that may be arising with using EPS, which included: Reluctance from some patients in using the service Some elderly patients preferring to physically receive a prescription Pharmacies not immediately having details of prescriptions when requested by patients Historical issues with pharmacies not receiving prescriptions Difficulty changing patient behaviours Where a patient has a same day emergency appointment with a GP, EPS restricting which pharmacy they can attend to collect the prescription Drugs being absent from the EPS system It was highlighted that the Primary Care Team and IT Committee are looking at various patient communications to promote the use of EPS, to provide reassurance to patients and encourage uptake. ACTION: EPS usage to be added to the slides for the locality meetings and GP practices using EPS will be encouraged to give feedback and support to those practices with low usage

152 Liothyronine guidance The liothyronine switch guidance which was approved at February s MOC, was represented to the Committee following comments received from the WEL Medicines Optimisation Commissioning Committee (WEL MOCC), who suggested the following changes The document should highlight to Prescribers that liothyronine is normally requested by either a private consultant or particular patient groups Further clarity should be given on dose equivalence of Liothyronine A patient information leaflet is also being produced and will be presented to the MOC for comments. The Committee approved the revisions made to the guidance. Barts Health Safety Audits Barts Health gave a presentation to the WEL CCG Medicines leads on the plan to implement hot spot medicines safety audits at Barts Health NHS Trust. The aim of this process is to develop and implement a tool to assist the organisation with continuous standards compliance efforts and promote ongoing quality improvement. This includes: To evaluate the safe and secure storage of medications To evaluate safe medication practices To query staff on the critical issues affecting these unique areas To identify and address areas of deficiencies and patterns of non compliance A number of stakeholders will be involved and implementation of the audits at the Barts Health sites is planned to start from April Medication Related Incident BH This paper was presented to the Committee for information and provided an update on the monitoring of medication related incidents at Barts Health and highlighted how Barts Health intend to improve medication incident recording. Barts Health has historically been a relatively low reporter of patient safety incidents to the National Reporting and Learning System (NRLS) in terms of overall rates, numbers related to medication and resulting in harm compared to peer organisations, (higher reporting organisations have better and more effective safety cultures). The document presented provides assurance that Barts Health are taking steps to increase the number of reports received in relation to patient safety incidents. These incidents will then be reviewed at the Barts Health contract monitoring meeting on a quarterly basis. Waltham Forest CCG carried out a Quality Assurance visit to Barts Health in June 2016 and highlighted that an action plan was required to address the medicines issues. This resulted in safety audits being produced which both Barts Health and local CCG personnel are involved in. Waltham Forest CCG has also continued to work with Barts Health to monitor medicines safety issues and help drive improvement

153 Non Medical Prescriber (NMP) Prescribing Update Currently NMPs are contracted by NHS England, but overall management responsibility lies with the GP practice employing the NMP. Waltham Forest CCG has recently received scopes of practice that have not demonstrated that the NMP has the skills and competence to be prescribing. GP practices have been asked to provide further evidence, however, the CCG is unable to issue a prescribing code to the NMP. It was highlighted that where this is the case, NMPs have been using an alternative code, such as a GP code. This is a clear risk and will not be accepted by the CCG. Due to the risk involved, NMPs will be added to the MOC risk register. The Committee also recommended that an alert be sent to all GPs informing them that they must ensure all prescribers use the correct prescribing code. Risk assessments will also be carried out. Where the scope of practice is found to be insufficient, it will be made clear that the NMP is not authorised by the CCG, and will be unable to see patients or approve prescriptions.. This issue has also been taken to the Primary Care Commissioning Committee for discussion and is being reviewed by the LMC. ACTION: 1. NMP prescribing to be added to the risk register. 2. An alert will be sent to all GPs advising that with immediate effect all NMP practitioners should have the correct individual prescribing code. The message will also state that where a scope of practice is found to be insufficient, it will be made clear that the NMP is not authorised, and will be unable to see patients or approve prescriptions. Nursing Home Medicines Quality Report The Medicines Optimisation Team and Adult Safeguarding Team carried out a joint quality assurance visit to a nursing home on 21 February, as part of the enhanced care homes pilot. During the visit, the nursing home s medicines policy was reviewed along with other areas such as the medicines fridge, preparation area, controlled drugs process, medication requests and storage, process for medicines related incidents, training records and self-administration within the home. A few issues were highlighted with the nursing home, which included: The complete medicines policy was not readily available or accessible to staff The standard operating procedures for ordering, storage and disposal of medication was not readily available The controlled drugs policy was not readily available to staff A discrepancy involving a controlled drug was also highlighted to the Care Home Manager, who is investigating the matter. An action plan will be devised and reviewed by the MOT. It was also noted that contractually, the nursing home should be issued with a formal notice for non-compliance

154 ACTION: Nursing home to be issued with a formal notice for non-compliance. Medicines Bulletin The Medicines Optimisation bulletin was presented to the Committee for approval. The bulletin had been developed for GPs and practices and provides updates on current guidelines and information to support medicines optimisation and clinically effective prescribing. It also covers key issues identified over the past few months. The bulletin is issued bi-monthly via: The practice portal The practice bulletin from Waltham Forest CCG MOT s The ebnf link Locality updates This month s edition provides feedback on the 2016/17 Medicines Optimisation Scheme, information on queries, decisions made at Committee meetings and prescribing updates. The Committee approved the bulletin. SOP Answering queries The Medicines Optimisation Team have developed a Standard Operating Procedure (SOP) for answering queries received via the medicines helpline from GP practices, healthcare professionals, contractors and providers. An updated version of the SOP was presented to the Committee for information. Whilst the MOT provide information, it is ultimately the decision of the prescriber whether or not to prescribe a drug. It was noted that the MOT are unable to answer patient specific queries, where only generic national guidance advice can be given. If the query falls outside of national guidance or local agreements, it must be referred to NHS England. It was also highlighted that there is still an issue with GPs receiving inappropriate requests to prescribe from secondary care. To mitigate this, it was suggested that the inappropriate prescribing form should be relaunched to GPs, which would be used when a request is received from secondary care that falls outside of what has been locally agreed. The form would then be sent to Barts Health to address. ACTION: To relaunch the inappropriate prescribing form to GPs. 17/03/05 Finance and QIPP 16/17 M9 Budget position The prescribing budget position was presented to the MOC for information. For M9, it was highlighted that there was a significant underspend. Q4 Dashboard Review A thorough analysis of the month 9 dashboard identified a number of prescribing indicators where practices have not fully met the threshold. The report highlights areas of prescribing where there is potential to improve quality, address unwarranted variation across the CCG in care and make efficiency savings

155 It was noted that there has been little improvement in the indicators from M1 to M9, so lessons learnt are being addressed at an STP level. To address this issue at a local level, the following can be utilised: Ensure the GP Clinical Leads are kept informed Use the Thursday afternoon GP educational forums to highlight any issues GP Clinical Leads to speak to counterparts at meetings Braltus (tiotropium bromide) inhalation powder and Patient information Leaflet The proposal and patient leaflet was presented to the Committee for approval. Braltus is a more cost effective branded generic version of Spiriva plus handihaler (tiotropium bromide 10 micrograms) delivered via the Zonda inhaler. Braltus administered from the Zonda inhaler: Delivers the same dose of tiotropium as that delivered from the HandiHaler Is bioequivalent to tiotropium delivered from the HandiHaler The proposal is to: Switch patients who are on currently on Spiriva plus handihaler or tiotropium bromide 10 micrograms inhalation capsules to Braltus plus Zonda inhaler Initiate new patients on Braltus Zonda inhaler who require Tiotropium 10mcg capsules for COPD Use the opportunity to reassess inhaler technique although the difference between the two devices is negligible in terms of technique Whilst both inhalers are therapeutically equivalent and deliver exactly the same amount of drug, new regulations now require manufacturers to report the amount of drugs that reaches the lungs, so the Braltus Zonda inhaler will be labelled as 10mcg rather than 18mcg like the Spiriva plus handihaler. The Committee recommended that this information should be clearly highlighted at the top of the patient information leaflet. The Committee also questioned whether one or two prescription charges will be applied, when the inhaler device is prescribed with the associated capsules. The Committee approved the proposal to switch patients from Spiriva plus handihaler to Braltus plus Zonda inhaler. This branded generic product was considered in line with the agreed branded generic principles and provides a significant cost saving. The LPC will be given three months notice before the change takes place. ACTION: 1. MOT to amend the patient information leaflet to clearly highlight the change in labelling of the Braltus Zonda inhaler. 2. MOT to enquire whether there will be one or two prescription charges when both the Braltus Zonda inhaler and associated capsules are prescribed

156 MOS Incentive scheme update The Committee were informed that the launch of the 2017/18 Medicines Optimisation Scheme will take place on 27 April Lessons learned from last year s scheme have been taken and incorporated into the new scheme. For the launch, a summary of the audits has been prepared with an action plan, which will form the basis of the discussions. It was noted that page 2 of the summary required an amendment and should state: Patients with 10 or more medicines with either diabetes or asthma. Routine practice visits will not be carried out this coming year. Visits will be targeted at those practices that are in need of additional support. Other visits focusing on repeat dispensing, will take place. The Primary Care team are also carrying out practice visits, which will be focused on the dashboards and other issues. At February s MOC, it was suggested to consider making the incentive scheme a KPI, but following discussion it has been confirmed that this will not be feasible. Localising QOF could instead be a consideration in the longer term. ScriptSwitch An update on the use of ScriptSwitch by practices was presented to the MOC for information. CSS Prescribing report An update on the prescribing costs by the CSS was presented to the MOC for information. MEETINGS UPDATE 17/03/06 Barts Health Drugs and Therapeutics Committee (DTC) An overview of the medication/policy outcomes from the meeting was presented to the Committee for information. Spiolto Respimat Spiolto Respimat was originally submitted to WEL MOCC for a decision prior to the Barts Health DTC submission, but it was highlighted that the COPD guidance was out of date. WEL MOCC requested that the guidance be updated before approval could be given. However, the submission was taken to DTC, where Spiolto Respimat was approved for hospital initiation and primary care continuance. Currently, the COPD guidance does not highlight the step process required for a patient to move from Tiotropium Respimat to Spiolto Respimat or give guidance to GPs on choosing the most appropriate inhaler for a patient. WEL MOCC recognise that there is a clinical need for Spiolto Respimat, but are not happy with the implementation. ACTION: WEL MOCC to formally write to Barts Health DTC requesting an implementation plan for Spiolto Respimat including guidance to GPs on choosing the most appropriate inhaler for patients

157 17/03/07 WEL Medicines Optimisation and Commissioning Committee (WEL MOCC) An overview of the medication/policy outcomes from the meeting was presented to the Committee for information. It was highlighted that liothyronine has been prescribed for depression on occasions, but NELFT confirmed that this is not usually as a first line measure, and rarely occurs. The Committee agreed that the liothyronine prescribing guidance should be updated to include information regarding prescribing for depression. ACTION: NELFT to provide information to the MOT on prescribing liothyronine for depression. 17/03/08 NELFT Community Health Service Drugs and Therapeutics Committee An overview of the outcomes from the meeting was presented to the Committee for information Diabetic Foot Problem SOP The NELFT Podiatry team have developed a Standard Operating Procedure to support the team in managing their patients with an active diabetic foot. The Service Operating Procedure includes mechanisms to communicate to GPs if the podiatry team identifies an infected food. After reviewing the document, the Committee agreed that until the pathway for diabetic foot problem is clear, it cannot be agreed for use by Waltham Forest GPs. Medicines Safety Alerts A summary of the NELFT medicines safety alerts was presented to the Committee for information. All incidents are tracked and raised at the Medicines Safety Group. 17/03/09 NELFT Mental Health Service Therapeutics Committee An overview of the meeting was presented to the Committee for information. Highlights included: NELFT have set up an Antimicrobial Resistance Group A Prescribing Observatory for Mental Health (POMH) audit is being carried out on prescribing valproate for bipolar disorder. Melatonin was approved on a named patient basis only. Medication safety report A summary of the Q3 2016/17 NELFT Medicines Safety report for Waltham Forest CCG was presented to the Committee for information. 17/03/10 Integrated Respiratory Meeting The minutes from the meeting held in January 2017 were presented to the Committee for information

158 COPD project proposal Right Care has highlighted areas which require improvement in the management of COPD when compared to similar CCGs. The areas identified are in line with the findings of the National COPD Audit. This is a joint Primary Care and Secondary Care proposal to implement the learning from the national COPD audit locally. The proposal is to standardise the provision of care for patients with COPD by: A local audit undertaken in two practices within Waltham Forest CCG to help understand the current issues and identify possible solutions. Devise a standardised COPD review template which incorporates the key standards for the management of COPD. It is proposed that this will be tested across a small number of practices before embedding this in all practices across the CCG in an attempt to standardise the management of COPD in Primary Care. Review patients on high dose steroids who have not had a recent exacerbation. For this cohort of patients, to consider optimising treatment with other bronchodilator medications which are more cost effective and reduce the potential pneumonia risk from the use of high dose steroids. This will help to reduce the variation in prescribing spend when compared to comparative CCGs. Identify patients with more severe disease and optimise the use of nonpharmacological interventions. Improve coding and recording of COPD consultations, prescribing and referrals via education and training The Committee approved the concept of the project. Further work will be carried out on the proposal in relation to spirometry and the COPD SLA and contract. 17/03/11 Sustainability & Transformation Plan (STP) The STP workstreams have been developed and submitted to NHS England for April STANDING ITEMS 17/03/12 Queries Query Log (February 2017) A summary of queries received by the MOT were presented to the MOC for information, along with the query summary log. ACTION: MOT to add the summary of queries to the practice portal, so that it may be viewed by GP practices. 17/03/13 NICE Update A review of the recently issued NICE guidance relevant to primary care was presented to the Committee. 17/03/14 LPC Update No update was submitted by the LPC

159 17/03/15 LMC Update No update was submitted by the LMC. 17/03/16 AOB There was none. Wednesday 12 April :00pm - 4:00pm Boardroom B & C, Kirkdale House, 7 Kirkdale Road, Leytonstone, E11 1HP

160 Item 6.3b Committee Minutes From Medicines Optimisation Committee Minutes - April 2017 Dr Ravi Gupta, Clinical Director for Medicines Optimisation, WFCCG Key highlights NHS England directive for low value items on prescription NHS England will be leading a review of low value prescription items from April 2017 and introducing guidance for Clinical Commissioning Groups (CCGs) to manage the prescribing in these areas, with a view to substantially saving NHS expenditure in this area. Coagucheck position statement After a number of enquiries from practices on the formulary status of Coaguchek the Committee agreed that as policy has not been agreed locally to safely manage patients using the Coaguchek system, GPs should not prescribe Coaguchek strips requested by patients or haematology clinics. Medicines waste briefing The Committee was presented with an options appraisal for the management of medicines waste in the borough and agreed to work in collaboration with the LPC to improve process for the management of repeat prescriptions. Approved Prescribing Guidance and Medication The Committee approved the following documents: - Care Home Charter for Swallowing and Medicines - Non-medical prescriber policy Highlights [Medicines Optimisation Committee] [April 2017] 157

161 Minutes Meeting Date and Time: Venue: Chair: Medicines Optimisation Committee Wednesday 12 April 2017, 2.00pm 4.00pm Boardrooms B & C, Kirkdale House, 7 Kirkdale Road, E11 1HP Dr. Ravi Gupta Attendees: Name Title Dr. Ravi Gupta RG Waltham Forest CCG GP Clinical Director Ada Onyeagwara AO Assistant Director, Waltham Forest Medicines Optimisation Team Dr. Imran Kazi IK GP Prescribing Lead for Chingford Dr.Thaven Chetty TC GP Prescribing Lead for Leyton/Leytonstone Dr. Rishav Dhital RD GP Prescribing Lead for Walthamstow Natalie McCallam NMT Project Support Officer, Waltham Forest Medicines Optimisation Team Thomas Helen Davenport HD Director of Nursing, Quality and Governance Anisha Sharma AS Prescribing Advisor, Waltham Forest Medicines Optimisation Team Hassan Serghini HS Senior Prescribing Advisor, Waltham Forest Medicines Optimisation Team Anisha Chandaria AC Senior Medicines Optimisation Pharmacist, Waltham Forest Medicines Optimisation Team Gurdeep Kenth GK Medicines Optimisation Pharmacist, Waltham Forest Medicines Optimisation Team Mayur Patel MP Local Pharmaceutical Committee representative for Waltham Forest Kamaljit Takhar KT Deputy Chief Pharmacist, NELFT NHS Foundation Trust Dr Hisham Local Medical Committee representative for Waltham Forest HSW Swedan Karen Wise KW Podiatry Care Pathway Manager (West), NELFT NHS Foundation Trust Apologies Name Title Sultana Rahman SR Associate Director for Primary Care, Waltham Forest Kay Saini KS Senior Prescribing Advisor, Waltham Forest Medicines Optimisation Team Sushma Lau SL Deputy Chief Pharmacist (MHS), NELFT NHS Foundation Trust Mohammed (Zahir) MZR Clinical Commissioning Pharmacist Rashid Barts Health NHS Trust (Newham University Hospital) Lynn Snowden LS Senior Commissioning Manager, Waltham Forest 1 158

162 17/04/01 Welcome and apologies Dr Gupta welcomed members to the meeting and apologies were received as above. 17/04/02 Declarations of Interest and Register of Committee Interest No declarations were made. 17/04/03 Minutes and matters arising Review of March 2017 Minutes The MOC minutes were approved by the Committee as accurate. Review of Action Tracker MOC263 NELFT will follow up in relation to providing information to the MOT regarding the prescribing of liothyronine in depression. MOC254 It was agreed that the LPC will be notified if a community pharmacy declines to dispense the correct number of dressings on a prescription, and the pharmacy will be advised to refer requests to an alternative pharmacy. Broken bulk will also be discussed at the next LPC meeting, however this issue will be mitigated once the NELFT central storage system for wound care dressings is implemented at the end of May. This action is now closed. MOC253 - A draft copy of the wound care formulary has been received by the MOT, but a few minor amendments are still required. NELFT will forward a copy of the final version, with confirmation that the amendments have been made. MOC250 It was agreed that a formal prescription form for district nurses to use, to prevent third party requests will not be devised. Practitioners at NELFT will be reminded not to request to prescribe through relatives or third parties and GPs in the borough will be informed to not routinely accept requests for prescribing from third parties. If the issue still persists, the suggestion of a formal prescription form will be re-visited. This action is now closed. 17/04/04 Quality, Performance and Governance Risk Register R17- DIABETES An update will be provided to the WEL MOCC in April Waltham Forest CCG are leading on insulin and will be submitting a paper to the Diabetes Strategy Board in May 2017 for the formulary position of insulin degludec and how to manage the glargine biosimilar prescribing in Waltham Forest. The Clinical Lead for Diabetes has also been invited to attend July s MOC to discuss medicines optimisation and diabetes. RAG Rating remains the same as last month: RAG: 6 (YELLOW) - (3 for Likelihood and 2 for consequence) 2 159

163 R19 BIOSIMILARS Barts Health have submitted a proposal on the implementation of all biosimilars, which the CCG has responded to. An agreement has been made for the use of the etanercept biosimilar in rheumatology, but the risk share and financial agreement are still to be finalised. RAG Rating reduced: RAG: 4 (YELLOW) - (2 for Likelihood and 2 for consequence) R20 SHARED CARE GUIDELINES The issue with out of date SCGs has been raised at all contractual meetings held with Barts Health, who will be attending WEL MOCC in May with an action plan to address the issue. It was noted that the SCG for hydroxycarbamide has recently been updated. As the SCG issue has been raised at a number of forums but continues to be a risk, it may need to be escalated further. A meeting will be held to discuss the elements of the risk including clinical, operational, financial and also escalation. It will also be raised with the STP. It was highlighted that a practice in the borough had made the decision to reject all SCGs sent from secondary care, which will need to be investigated further. Whilst this is only one practice, if this stance is also taken by other practices, there will be an impact on patient care locally. The LMC representative indicated that the LMC would like further involvement and clarity regarding the process for agreeing SCGs, so it was proposed that an LMC representative could attend the WEL MOCC meetings where SCGs are being discussed and agreed. This proposal will be raised with WEL MOCC members. ACTION: 1. Meeting to be held to discuss the clinical, operational and financial risk of out of date SCGs and escalation options. 2. A copy of the process for SCGs to be forwarded to the LMC representative. 3. Process for SCGs (including how they are agreed and how the information is disseminated) to be added to the practice bulletin. 4. The suggestion of an LMC representative attending WEL MOCC meetings where decisions are being taken on SCGs to be raised. RAG Rating remains the same as last month 16 (AMBER) - (4 for Likelihood and 4 for consequence) R21 COVERT ADMINISTRATION IN CARE HOMES The Covert Medicines Policy has been drafted and is awaiting input and approval from the Local Authority. A two week deadline will be given for a response. The Safeguarding Team have also provided comment on the policy. RAG Rating 12 (AMBER) - (3 for Likelihood and 4 for consequence) 3 160

164 R22 NON MEDICAL PRESCRIBERS The NMP policy has recently been updated to incorporate the latest national and local guidance and is awaiting comments from the Safeguarding Team. The policy has been brought to MOC for approval and will be discussed later on the agenda. Practices will be informed that all NMPs should adhere to the NMP policy and will be reminded via the medicines bulletins and communications regarding the importance of using correct prescribing codes. RAG Rating 12 (AMBER) - (3 for Likelihood and 4 for consequence) R23 COAGUCHECK A position statement has been devised to inform GPs of the current arrangements for provision, and once agreed by MOC, will be disseminated via bulletins, locality meetings and newsletters. A discussion will also be required with Barts Health Haematology teams regarding development of the service. It has been suggested that this be part of the TST service redesign work for Long Term Conditions which includes haematology. RAG Rating 12 (AMBER) - (3 for Likelihood and 4 for consequence) R24 DOSSETTE BOXES It was highlighted that a number of pharmacies have been refusing to issue dossette boxes without 7-day prescriptions, irrespective of whether the patient meets the criteria set out in the Waltham Forest CCG position statement for 7-day prescribing. This breaches national guidance on supplying compliance aids to patients. Some of the issues are occurring due to requests being made by care agencies who cannot administer medication without a dossette box. This has been raised with the Local Authority and a meeting is being arranged to look at how dossette boxes and domiciliary care is managed. The LPC has also been informed of issue and dossette boxes has been added as an item for discussion at their next meeting. ACTION: A copy of the Royal Pharmaceutical Society s national best practice guidance for compliance aids will be sent to the LPC for discussion at the next LPC meeting. RAG Rating 12 (AMBER) - (4 for Likelihood and 3 for consequence) Diabetic Foot Problem Standard Operating Procedure The Podiatry Care Pathway Manager (West) at NELFT attended the meeting to provide clarification on the Diabetic Foot Problem pathway and GP letters presented at March s MOC. The new guidance has been produced in line with NICE NG19 guidance, and will be used predominantly by podiatrists. The document assists the Podiatrist with diagnosing the severity of an infection and where to refer the patient. Further work is required in primary 4 161

165 and secondary care to establish a pathway for prevention of diabetic foot. It was agreed that it would be beneficial for someone from the Podiatry Team to attend the locality meetings, to present information to GPs on diabetic foot. ACTIONS: 1. Waltham Forest CCG s antibiotics guidelines to be added to the diabetic foot problem SOP 2. Podiatry Care Pathway Manager to attend the three Waltham Forest locality meetings to present on diabetic foot problems. 3. Podiatry to be added to the agenda for July s MOC (which the Diabetes Lead for WFCCG, will be attending) 4. MOC to review the GP letters included in the diabetic foot guidelines, and submit comments to NELFT. NHS England directive for low value items on prescription NHS England will be leading a review of low value prescription items from April 2017 and introducing new guidance for Clinical Commissioning Groups (CCGs), with a view to substantially saving NHS expenditure in this area. It follows extensive work by NHS Clinical Commissioners which identified significant areas where potential savings can be made, up to potentially 400m per year. The three low category areas initially being considered are: 1. Products of low clinical effectiveness or where there is a lack of robust evidence of clinical effectiveness 2. Products which are clinically effective but where more cost effective products are available 3. Items which are clinically effective but due to the nature of the products, are deemed low priority for NHS funding. A consultation has already begun, to seek views on proposals to make changes to the availability of gluten-free foods that are prescribed on the NHS. This is due to close on 22 June This review will support the work the CCG has been carrying out to implement local guidance to reduce the prescribing of drugs of limited clinical value. Nursing Home Medicines QA report This report was presented to the Committee for discussion. A medicines related Quality Assurance visit was undertaken at a care home in March 2017 by the Medicines Optimisation Team. The manager and head of the care home also attended, to assist with answering questions and queries. The report highlighted key findings at the care home which included: No robust policy for managing medicines related incidents Some issues relating to covert and crushed medications Record keeping not complete No access to the full medicines policy Upon receipt of the QA report, the care home will be required to submit a detailed action plan, which will be reviewed by the Medicines Optimisation Team. A follow up visit to the care home will be planned if necessary

166 Non Medical Prescriber (NMP) Policy The NMP policy has been updated in line with new national guidance and includes detailed information to support cost effective prescribing for all NMPs working within Waltham Forest. Changes made include: Reviewing and updating the role and responsibilities for all involved in non-medical prescribing Incorporating a section on patient assessment and issuing and writing prescriptions Updating the segment on generic prescribing in line with local and national policy Adding MHRA guidance on the prescribing of anti-epileptics Including a new section in relation to the prescribing of medicines off license Including a new section on incidents, security and handling prescription forms and meeting representatives from the pharmaceutical industry The Committee approved the policy, which will also be taken the Primary Care Commissioning Committee (PCCC) for information. Care Home Charter for Swallowing and Medicines The Patients Association are launching a national pilot which identifies key pledges that both patients and health and care professionals will abide by whilst in care settings, focusing on patients who experience swallowing difficulties. A care home in Waltham Forest has been proposed to participate in the pilot, and this would involve the care home staff and entire MDT, including community pharmacists being given training on covert medication. An audit will then be carried out on the impact of the training on patients, hospital admittance avoidance and all issues relating to covert medication. ACTION: Care home charter to be hosted on the practice portal. Coaguchek position statement It was highlighted to the Committee that there have been a number of queries relating to the prescribing of Coaguchek strips for patients on warfarin who self-monitor their oral anticoagulant therapy. As a process or policy has not been agreed by Waltham Forest CCG, GPs should not prescribe Coaguchek strips requested by patients or haematology clinics. A position statement to reflect this guidance has been devised and brought to the Committee for approval. Bart s Health will also be informed of this position and the CCG will explore the future provision and commissioning a service to enable self-testing in the borough. The position statement was approved by the Committee. ACTION: Coaguchek position statement to be added to the practice portal and ScriptSwitch and highlighted in the practice bulletin

167 Regional MOC workshop report The report was presented to the Committee for information and outlined the outcomes of a workshop on NHS England proposals to introduce a Regional Medicines Optimisation Committee (RMOC). The event was attended by various medicines leads and commissioners across London. There is a plan to implement RMOCs across the UK but the specifics of how these will support local medicines optimisation committees is still to be outlined. The remit of the RMOCs has changed and will now focus on medicines optimisation. New drugs are still included on the work plan, but will be implemented at a later stage. Invites for people to apply as members have been sent out, although the RMOCs are seeking more clinical representation. The person specification will be circulated to MOC, once they become available. Medicines waste briefing The scope of the paper was limited to the management of repeat prescriptions; however work will be undertaken to help address other factors. Managing medicines waste has been a longstanding priority for NHS Waltham Forest CCG. In order to manage the issue of waste, a wide range of different stakeholders including pharmacists, prescribers and patients need to be targeted and engaged with the waste campaign initiative. Three options proposed to manage repeat prescriptions were: 1. Do nothing and continue with the current process for the management of repeat prescriptions 2. Waltham Forest CCG to issue a position statement for all GPs to stop prescriptions being generated at the request of community pharmacies and continue only to accept repeat prescriptions from patients. 3. LPC to work in collaboration with the CCG to identify possible solutions to improve systems and processes for ordering repeat prescriptions and subsequent implementation. The preferred option is to work in collaboration with the LPC to improve processes for the management of repeat prescriptions. The LPC representative agreed with this option and will raise at the next LPC meeting. Feedback and agreed timelines will be provided to the MOC by the end of May. Boots sore throat test A pilot study was undertaken by Boot pharmacies, with the data being analysed by their own head office. There is no evidence to suggest that this type of surface antigen test works or is successful in identifying bacterial sore throats. Surface antigen testing is not recommended by NICE (poor sensitivity and specificity to relevant bug). There is no evidence to suggest that these will ease workload on current services or whether this may even add to the pressure in some of the front line services There is no proper cost model to suggest that this service could financially benefit the NHS 7 164

168 The onward referral pathway is unclear and does not take into account the difficultly and rise in waiting time to get a GP appointment. This test will not currently be recommended for Waltham Forest until further evidence is available. CCG team nomination The Committee were notified that the Medicines Optimisation Team has received two nominations in the Waltham Forest CCG Staff Awards 2016/17. The categories the nominations were received in included Making a Difference and Project of the Year (for the respiratory project). Winners will be notified on 26 April /04/05 Finance and QIPP Right care/qipp opportunity report The report was presented to the Committee for information. Benchmarking and analysis has indicated that there are productivity opportunities in each CCG across WEL, but the extent to which these are addressed varies by CCG. Across WELC the variance between schemes identified in 2017/18 and the total productivity opportunity is 50.9m. The report also highlighted the success of Waltham Forest CCG in identifying a significant proportion of QIPP savings related to prescribing. 16/17 M10 Budget position The prescribing budget position was presented to the MOC for information. For M10, it was highlighted that there was a significant underspend, with a projection to underspend at the end of the year. The top 5 over performing practices were also discussed, and whilst support had been provided to these practices to optimise their medications and manage their budget, they still remained an issue. It was agreed that a salary conversion should be prepared, to highlight the amount of time and resource that has been spent supporting the practices to mitigate the over performance of their budgets. A visit will be made to the practice to illustrate this information and the risk involved. The committee noted MOT to prepare a conversion of salary, highlighting the time and resource spent on over performing practices, in comparison to other practices. 16/17 Jan QIPP Dashboard A dashboard update was presented to the MOC for information and is also available on the practice portal

169 17/18 Medicines Optimisation Scheme update and QIPP indicators (PrescQIPP) The 17/18 Medicines Optimisation Scheme, which was previously approved by the Committee, was re-presented for final approval. A number of changes have been made, which were highlighted to the Committee. It was suggested to the Committee that the eligibility criteria to participate in the scheme, which is based on budget performance, may discourage some practices to take part. This was therefore reviewed and amended in line with discussions as follows: Prescribing expenditure Stay within allocated budget 100% Stay within 5% of budget allocation 90% Stay within 10% of budget allocation 80% Greater than 10% overspent on allocation 70% Reduce % overspend on previous year by 70% 5% (2016/17 outturn) % Scheme payment available The updated Medicines Optimisation Scheme17/18 was approved by the Committee. Q3 Finance report The report was presented to the Committee for information. It was noted that whilst there is an underspend in the prescribing budget, the QIPP target has not yet been met. ScriptSwitch An update on the use of ScriptSwitch by practices was presented to the MOC for information. CSS Prescribing report An update on the prescribing costs by the CSS was presented to the MOC for information. MEETINGS UPDATE 17/04/06 WEL Medicines Optimisation and Commissioning Committee (WEL MOCC) An overview of the medication/policy outcomes from the meeting was presented to the Committee for information. 17/04/07 NELFT Quarterly Meeting The quarterly meeting was held in March, highlights include: The NELFT central storage system for wound care dressings (ONPOS) will be implemented by late May The dietetic leads for WFCCG have been invited to the next meeting to help clarify pathways, formulary choice and other dietetic support as required

170 17/04/08 Sustainability & Transformation Plan (STP) The key focus is reviewing how communication between the medicines optimisation worksteam and the rest of the STP is working, as this has not always been considered. STANDING ITEMS 17/04/09 Queries Query Log (March 2017) A summary of queries received by the MOT were presented to the MOC for information, along with the query summary log. 17/04/10 NICE Update A review of the recently issued NICE guidance relevant to primary care was presented to the Committee. 17/04/11 LPC Update Compliance aids/dossette boxes This was discussed earlier in the meeting. 17/04/12 LMC Update 17/04/13 AOB The MOT will send a communication to GPs regarding the use of canagliflozin. None. Wednesday 10 May :00pm - 4:00pm Boardroom B & C, Kirkdale House, 7 Kirkdale Road, Leytonstone, E11 1HP

171 Item 6.4 Committee Minutes From Planning and Innovation March 2017 Richard Griffin, Chair of the Committee - WFCCG Key highlights Fire Health Assessment Investment Proposal The committee were presented with an investment proposal from the London Fire Brigade which was sent to the CCG, outlining the risk analysis on the profile of Waltham Forest residents that are most at risk of having a fire and the Healthy London Partnerships presented a proposal to CCGs inviting them to apply for a pilot project in collaboration with the London Fire Brigade. The proposed way forward was agreed by the committee and approval subject to changes being made Bring back to P&I in June The Committee Annual Review The committee had been presented with the first annual review carried out of the Committee s activity and contribution to the commissioning system. The Committee were given an opportunity to reflect on and formally document its performance during the year. The focus of the report was on redesign and progress made since decisions were made by the committee. The Committee agreed to submit the report to the March Governing Body for approval Urgent Care Procurement The committee had been updated on the Whipps Cross Urgent Care Centre and explained that the feedback and questions from an engagement event held on 24 January 2017 led to an internal review of the specification. The Committee agreed to the approval subject to changes being made Smoking Cessation Consultation The local authority proposed a move to the new model for the consultation of the Smoking Cessation and this would be 3 tier-based and the tier 3 services will only be offered to those at the highest risk from the harms of smoking and for those who may require specialist service intervention. Subject to proposed changes being made Highlights [Planning & Innovation Committee] [March 2017] 168

172 PLANNING AND INNOVATION COMMITTEE Minutes of Meeting held on 8 March 2017 Boardrooms B&C Chair: Richard Griffin (RG) Attendees: Ken Aswani (KA) Jane Mehta (JM) Ravi Gupta (RG) Tonia Myers (TM) Gail Foord (GF) Abdul Sheikh (AS) Dinesh Kapoor (DK) In Attendance: Enrico Panizzo (EP) David Culley (DC) Joe McDonnell (JMc) Sharon Yepes Mora (SYM) Apologies: Anwar Khan (AK) Anne Walker (AW) Ian Clay (IC) Mayank Shah (MS) Syed Ali (SA) Item Action 1 Apologies Apologies were noted as above. 2 Declarations of Interest None 3 Minutes of the last meeting / Matters Arising The minutes of the last meeting were agreed as accurate. 169

173 4 Fire Health Assessment Investment Proposal DC DC presented the committee with an investment proposal from the London Fire Brigade which was sent to the CCG, outlining the risk analysis on the profile of Waltham Forest residents that are most at risk of having a fire and explained that the identified number of characteristics that increased the risk of fire and subsequent injury and the Healthy London Partnerships presented a proposal to CCGs inviting them to apply for a pilot project in collaboration with the London Fire Brigade. DC informed the committee that the CCG will not be contacting patients directly and each practice can be sent a health assistant and this will identify patients who are at risk of fire. It has been proposed that a meeting will be set up with the following parties: Waltham Forest CCG LBWF Metropolitan Housing Disabled Living Grants London Fire Brigade Comments TM wanted to encourage the use of coding Pathway to be sent to the GP Mental Health /Learning Disability Higher risk factors to be considered DC to send out HA loading template to practices with pathway ICM- pilot at this point, but scope for development. The proposed way forward was agreed by the committee and approval subject to changes being made Action: DC to send out HA load query to practices Bring back to next P&I meeting 170

174 5 The Committee Annual Review SYM SYM presented the first annual review carried out of the Committee s activity and contribution to the commissioning system. The Committee were given an opportunity to reflect on and formally document its performance during the year. The focus of the report was on redesign and progress made since decisions were made by the committee. The report was positively received by the committee and formally thanked SYM for compiling the report. JM suggested this would be a TST area for discussion and would take the report to the relevant TST group. The committee agreed to take the report to the next Governing Body meeting. Action: The Committee agreed to submit the report to the March Governing Body for approval 6 Urgent Care Procurement EP/GF EP updated the committee on the Whipps Cross Urgent Care Centre and explained that the feedback and questions from an engagement event held on 24 January 2017 led to an internal review of the specification. Currently the CCG is developing alternative options for home visiting and the preferred model is not known in detail and is dependent on further work with NELFT and SEPT following the transfer of this service from PELC to SEPT and will have an impact on the Urgent Care Centre specification. The current contract with SEPT for UCC expires on 31 September 2017 and the new NHS 111 service is due to commence 1 March 2018 and transfer of GP out of hours service from PELC to SEPT is provisionally planned for 1 April The Planning and Innovation Committee are asked to approve the recommended actions To stop the procurement process and work to a collaborative agreement and review the decision in 12 months, against the progress made. Clarify the lease arrangements and for a waiver to be completed for Finance and QIPP committee SEPT contract extension To continue discussions with BHR CCGs/NELFT 171

175 Create 24/7 service with strong links to the Urgent Care Centre Begin conversations with Barts about potential dialogue process and agree with Barts the optimal level of activity shift to support new specification Comments To plan for collaborative event with current providers to agree shared systems vision and develop systems plan to improve front end pathways and flow for patients KA NHS 111 service across CCGs, we would have to be responsive Rapid response model to service outside Liaising with Rapid Response and Accountable Care Systems Action: The Committee agreed to the approval subject to changes being made 7 Smoking Cessation Consultation JM JM from the local authority proposed a move to the new model for the consultation of the Smoking Cessation and this would be 3 tier-based and the tier 3 services will only be offered to those at the highest risk from the harms of smoking and for those who may require specialist service intervention, including pregnant women, mental illness, and longterm conditions, this criteria will also be able to directly access NRT at no cost. The Council has considered three possible options regarding the future of the Stop Smoking Service 1. Decommission the service 2. Recommission and re-designed service at a significantly reduced contract value to stay within overall budget 3. Make savings from within other non-statutory services commissioned by Public Health to continue to fund smoking cessation to the same level Option 2 is the Council s preferred option is a redesigned service which will continue to prioritise support for those at highest risk, while ensuring some advice and support for all. 172

176 Comments /Suggestions Seek the opinions/debate to MPs Public Health cuts An understanding the role in the GP duty of care Seek advice from Medicines Management whether NRT can be prescribed Enhanced support to be considered for the cardiovascular department Action: Subject to proposed changes being made 8 AOB All None Date of next meeting: Wednesday 12 April

177 Item 6.5 Committee Minutes From CCG Patient Reference Group (PRG) minutes - March 2017 Richard Griffin, Chair of the PRG - WFCCG Key highlights 1. Welcome / Apologies / Declaration of conflicts of interest Welcome to the new PPG locality representatives. PRG general recruitment is open until 4 April. Current members will be asked to identify the community they represent but not reapply for their place. PPG locality reps will meet to design the role. PPG local standard has been sent to GPs today for their input. 2. Cancer Survey Results Stephanie Good presented findings from National Cancer Patient Experience Survey alongside Clinical Lead, Dr Mary Crowe. Explained purpose of the survey and who completed it. WF are below average on all categories. Answers on Barts care are behind the national average. Points of interest for the PRG: One member knew someone who had cancer in 2015/16 and they say they have not received the survey. SG explained that the survey is issued when people s treatment ends. The group felt that this meant the experience was not real time and did not capture the experience of survivors. PRG felt this survey questions about GPs were meaningless. Particularly if you didn t see your GP because you were under the care of the hospital oncologist. Group discussed expectations and how having other conditions may affect their experience of cancer treatment. PRG wanted to know what will be done to raise the impact so that patient s response will be better than 42%. Dr MC responses: Will take back the feedback she heard from PRG. Cancer patient experience is more than chemo and radiotherapy. Patient experience is as important as other measures as if patient experience is good they have better results. Dr MC would look back at cancer care reviews and see what came out of the review that we could have done differently and what can we learn. Dr MC asked PRG about preferences on two week waits? Would you like to book an appointment today? PRG answered that they would rather have the appointment in your hand when they leave the GP so that it doesn t get lost or never booked. Actions 2.9 What happened to the Cancer participation structure? Do WXH clinical cancer board? Highlights/Summary [CCG Patient Reference Group] [March 2017] 174

178 4. CCG Governing Body update Update from chair Richard Griffin since the last meeting: Urgent Care planned to develop an urgent care centre at WXH but it was decided to not proceed. Care Homes education project update RG interested to know to what extent public are confident in NHS 111 advice. One member had expressed an interest to attend NHS 111 public session. They couldn t attend the one meeting organised and therefore was not included. Felt the one event and opportunity was very limited. [Update May 2017: Member has since joined the NHS 111 procurement panel] WXH have submitted a business case to develop the site. P&I meeting: Smoking Cessation Survey now live. ACTIONS 4.8 RW to find out who the new 111 provider is and what the service user engagement will be during the life of the contract. 5. Waltham Forest Principles of Engagement RW took flipchart notes of PRG member s opinions of the draft engagement principles. ACTION RW to share views with LBWF Strategic Boards Team via track changes on the document. Highlights/Summary [CCG Patient Reference Group] [March 2017] 175

179 Meeting CCG Patient Reference Group (PRG) minutes Date and time Venue Chair Attendees Wednesday 8 March 2016, 6-8pm Boardroom B&C, 7 Kirkdale House, Leytonstone E11 1HP Richard Griffin Guest speakers: Mary Crowe, CCG Clinical Lead for Cancer and EOL Stephanie Good, Senior Commissioning Manager CCG/Healthwatch standing attendees: Rebecca Waters, CCG Communications and Engagement Officer Althea Bart, Healthwatch Waltham Forest Patient Reference Group members: Adrian Dodd Sylvia Debreczeny Ana da Cunha Lewin Caroline White, CCG Lay Member Khadija Gitay Walthamstow PPG representative Pat Stephenson Walthamstow PPG representative George Wright Leyton/Leytonstone PPG representative Liz Philips - Leyton/Leytonstone PPG representative Debbie Barker - Chingford PPG representative Jim Sarginson Chingford PPG representative Apologies Julia Walsh, CCG Head of Communication and Community Participation Joan Fratter Dada Imarogbe Alex Kafetz Agenda items 1 Welcome / Apologies / Declaration of conflicts of interest Welcome to the new PPG reps. PRG general recruitment is open until 4 April. Current members will be asked to identify the community they represent but not reapply for their place. PPG locality reps will meet to design the role. Page 1 176

180 PPG local standard has been sent to GPs today for their input. 2 Cancer Survey Results SG presented findings from National Cancer Patient Experience Survey. Explained purpose of survey and who completed it. SG explained what is primary care and community care services were? JS asked why was the return for WF patients was less than national? 50% not responded. SG explained that there is no detail on the invitation or how it is chased up. It may be demographics, too many questions or English as a second language. The survey is sent by post from NHSE to people who are eligible. AC-G asked people who had cancer in 2015/16 and they have not received it. SG explained that the survey is issued when people s treatment ends. SG will find out if it is translated into different languages. The survey has been running 5 years and the questions have changed making it difficult to compare results. RG suggested that we have a further discussion about surveying and low responses at another time. Dr MC will take back the feedback she heard from PRG. Cancer patient experience is more than chemo and radiotherapy. Patient experience is as important as other measures as if patient experience is good they have better results. We know that Londoners have poor cancer patient experience. Especially those over 75 and from ethnic minorities. But this is not fully understood beyond communication issues. It is possible that smaller rural hospitals have a closer community and therefore closer knit experience. Dr MC discussed her thoughts on the outcomes of the survey relating to primary care. PRG felt questions were not asked at the right time, asking a very long time after completion of care is not relevant, questions about community staff should not be lumped together with nurses and GPs. Can t give credit to the right staff without the separation. PRG felt this survey was meaningless. Particularly if you didn t see your GP because you were under the care of the hospital oncologist. It seems WF are below average on all categories. Answers on Barts care are behind the national average. Group discussed expectations and how having other conditions may affect their experience of cancer treatment. How can people be proactive about their health care. Dr MC would like clinical lead Dr. Munesh Munir to look into Question 54 to understand why there is 20% behind national average. Group wondered if a patient would know what the interactions should be? RG asked what will the CCG do with the survey results? GW asked what other surveys are carried out in between the annual report? The data needs to be gathered in real time so that a change can be made. Page 2 177

181 2 Cancer Survey Results AC-G asked what will be done to raise the impact so that patient s response will be better than 42%? Dr MC looking into the questions in detail and looking at complaints and other experiences. LP asked Dr MC, as a GP, what do you think of it? What can you do about these experiences? Dr MC would look back at cancer care reviews and see what came out of the review that we could have done differently and what can we learn. As a GP lead it is my job to raise this with CCG and Barts meetings. PRG think there are too many questions and need to be asked during the treatment. The questions are a mix of quantative and qualitative. If the expected experience was separated out then I could answer if that was provided rather than long open questions expecting us to know we received everything as I should. Dr MC asked PRG about preferences on two week waits? Would you like to book an appointment today? Sometimes there is no slot so a referral is made later. How important is it to have an appointment immediately? If an appointment is not available the hospital should contact the patient to book an appointment. PRG answered they would rather have it in your hand when they leave the GP so that it doesn t get lost. RG how we follow on around gathering good patient experience and cancer. Are there any groups that help design the NHSE surveys? Actions 2.9 What happened to the Cancer participation structure? Do WXH clinical cancer board? 3 Notes/Actions from last meeting (Attached) 3.1 All agreed Actions None Page 3 178

182 4 CCG Governing Body update Update from RG since last meeting: Urgent Care constructing to delevop an urgent care centre at WXH. This was decided to not proceed as NHS 111 will be redesigned so that a clinician will talk to you to identify the right care and signpost you to immediate care and reduce A&E attendance. Care Homes education and seeing impact of weekend and weekday GPs on A&E demand. JS asked if paramedics reduce A&E attendance? RG yes some can make a certain level of decisions and they will be provided with more support on the phone to discuss decisions and provide them with expert advice. RG interested to know to what extent public are confident in NHS 111 advice. AC-G had expressed an interest to attend NHS 111 representation. AC-G couldn t attend the one meeting organised and therefore was not included. Felt the one event and opportunity was very limited. WXH have submitted a business case to develop the site. P&I meeting: Smoking Cessation Survey now live. The service will not be cut but the council wants to hear what type of support and where attention should be focused. Actions 4.8 RW to find out who the new 111 provider is and what the service user engagement will be during the life of the contract. 5 Waltham Forest Principles of Engagement Actions RW took flipchart notes of PRG member s opinions of the draft principles. Residents : Not sure about the use of the word residents. People who use WF services may also work here or be visitors. Should it say community or public? Empowerment: Instead of education could this say information / encouragement/ support? Diversity: PRG members felt that diversity is important but outright saying it is divisive. They would like the tone to be more belonging. Collaboration: This doesn t give direction on how to be collaborative. Public are wary of those that engage, have already decided what they want before asking. Clear and accessible information: The PRG thought we should agree which AIS we are all signed up to. I have added the NHS one to the tools below. RW to share views with LBWF Strategic Boards Team via track changes on the document. Page 4 179

183 6 AOB 6.1 Digital event date confirmed - 18 April 2017, 6 8:30pm, Leytonstone library. Actions 6.2 Parking for 5 PRG members requested. 6.3 RW to find out expenses process and avoid delays. Next meeting: Wednesday 12 April, 6-8pm. Boardroom B&C, Kirkdale House. Page 5 180

184 Item 6.6 Committee Minutes From Finance and QIPP Committee March 2017 Les Borrett, Director of Financial Strategy - WFCCG Key highlights The Committee received the month 11 (February) Finance report and noted that the CCG is projecting to deliver the 2016/17 planning surplus of 8.6 million and to maintain its corporate running costs to within the mandated cap. The Committee reviewed the QIPP performance report reflecting M10 SLAM data. The Committee received and approved the final 2017/18 budget paper. The Committee received and approved business case proposals to mainstream High Intensity User and Neuro Navigation schemes which had been tested through operational resilience funding. The Committee received and approved a proposal to extend the discharge to assess out of hospital pathway scheme for a further 12 months. The Committee received the business case to support sector wide re-procurement of the new integrated urgent care service (111). This was approved. The Committee received and approved a proposal to extend the Heathlands continuing healthcare contract for 12 months to March Highlights [Finance and QIPP Committee] [March 2017] 181

185 Meeting Date and time Finance and QIPP Committee 15 th March pm Board Room, Kirkdale House Chair Alan Wells (AW) Attendees: Apologies: Vineeta Manchanda (VM) Agenda Items and Summary Dr. Abdul Sheikh (AS), Enrico Panizzo (EP), Sharon Yepes-Mora (SYM), Ian Clay (IC), Kelvin Hankins, Nuzhat Anjum (NA) Les Borrett (LB),, Dr Syed Ali (SA), Ada Onyeagwara (AO), Jane Mehta (JM) Nicola Pearce-McGinn (NP-M) Gail Foord (GF), David Culley (DC), Paul Larrisey (PL), Nicola Pearce-McGinn (Minutes). 1&2 Notes of last meeting The minutes of the last meeting were agreed. Noted that all attendees should be listed. 3.0 Matters Arising There were no matters arising. 4.0 Finance Report month 11 LB presented the Month 11 Report to the Committee. It was reported that The CCG had achieved breakeven against plan year to date and is forecasted to deliver a total surplus of 8.6 million at year end after the application of reserves. He stated that they had reached a year end deal with Barts in January. There had been no movement in the associate acute trust forecast between January and February. LB noted the decision to pool WELC CCGs non recruitment headroom to support the deficit in BHR CCGs. AW queried whether the CCG had choice in the matter LB explained this was an STP risk share agreement and all CCGs had been instructed not to spend the 1%

186 5.0 QIPP Report Month 10 EP presented the key highlights from the report. Key Highlights Full year forecast savings are 9.5m against plan (100%) M9 YTD savings are 6.98m against an estimated plan of 7.6m Risks It was reported that Planned Care had a potential savings gap (low-med risk) Renal: Three pilot practices in place, impact is below expectations and being investigated MSK new contract implemented from 1st Oct, savings being delivered and reported from December. Ophthalmology mobilisation underway. Start date delayed from 1st Dec to 1st Jan /18 CCG Budget LB presented the draft budget for 17/18. He stated that this had been the 3 rd version that had been brought to the Committee, and this had been the final budget plan that will go the March Governing Body pending sign off from this Committee. He added that financial performance had been good this year and last, but stated that the next year would become more difficult, as the national tariff would be increasing which would put pressure on the budget. He stated that a plan to make some significant savings of 14m has been required which has not been done historically. This will prove challenging. The significant change from this report and the last is that there is a deterioration of 2m in our position, which is linked to the BHR control total. He stated that there had been a gap of 2m going into next year which increases the QIPP target.. He added that the CCG has delivered 10m worth of QIPP this year and confirmed that the QIPP target for next is 14m. LB stated that NHS England has asked Deloittes to bench mark across the 7 CCGs on the best QIPP schemes. He added that the results will be out by the end of the month and will inform how the CCG identified the extra QIPP needed. There was a discussion about a national piece of bench marking called Right Care. The STP had been looking at this. This had been linked into this piece of work with Deloittes. SYM had been leading on this. LB stated KH had been working on a tool to review the Commissioning portfolio. This will identify any areas of low priority or poor value where additional savings can be made. JM asked if Deloittes had been looking at Primary Care contracts. IC confirmed that this is not something that they had asked for but they had been looking at CHC and POLCV. JM felt a PMS review would be a good idea

187 SA queried the acute demand growth covering population increase of 1.22% and general demand growth of 0.81%, as he felt that there had been an influx in his locality. IC confirmed that this had been correct in 2016/17 as population growth had been difficult to forecast. The Committee agreed the budget be recommended to Governing Body for approval. Action: LB to present to Governing Body 7.0 Business case for High Intensity Users EP presented the paper. The High Intensity User pilot was commissioned by WF CCG as part of the operational resilience funding for 16/17. A Business case was approved by Finance and QIPP on 16/11/16 for continuation of the service pending successful evaluation of the pilot. This is a project that is funded with NELFT. The intention of this project was to identify people that attend A&E frequently, put in place some support to help these patients, and see what other services could help reduce their attendance at A&E. He added that the project had been supported across the system and other providers at the Urgent care working group had also been supporting it. EP updated the committee with the data on page 4 of his paper. He explained that the cohort of patients had been attending A&E on average 2 ½ times per month. After the intervention this had dropped quite dramatically. This would have an indicative savings for CCG of 80k against annual investment of 70k that does not include admissions. He stated that this had been good value for patients and this also had helped support A&E. It had made a small amount of saving to the current project. Recommendations are that this project is invested on a recurrent basis from April. It was agreed that it had made a big impact on WXH. AW felt there should be a more substantial section in the report highlighting the benefits for patients, which he felt would strengthen the case. LB stated that there had been a business case whilst AW had been off and this had details of full patient s benefits. This paper was an evaluation of the scheme. It was confirmed that these patient s had been linked back into mental health and drug and alcohol services. Action: Agreed. 8.0 Business case for Neuro Navigator DC presented the paper. He stated this had been an evaluation from the business case that had been presented to the Committee last September. He added that the recommendation was to continue to fund the project on a recurrent basis. He added that Neuro Navigator roles are being established across London and feedback from patients, providers and referring units indicate Neuro Navigators are helpful in ensuring patients receive the right care in the right place at the right time by: Diverting unnecessary referrals and effective signposting. Facilitating admissions/ discharges

188 Managing patients through the end to end cycle of care for this cohort from admission to transfer to rehab and discharge from rehab to Tier 3/continuing health care. Acting as a communications link between the different organisations within the pathway. The benefits expected from the pilot are as follows. Improved patient experience with reduction in DToCs for acquired and progressive neurological conditions. Reduction in people waiting inappropriately for Level 1/2A bed leading to DToC and into continuing healthcare as required. Promoting integrated working and ensuring people receive the right care in the right place for their neurological condition. Clearer local picture in relation to Level 1-3 neurological needs. Improved value for money (VFM). AW asked what had been the review process of this pilot does it report back in 2 years. LB confirmed that in next year s QIPP report the financial impact of this scheme will be reported on. He added that the challenge would be where the non-financial benefits are reported. He stated that SY-M had been doing a piece of work within P&I to capture this reporting and the impact in terms of quality. AW felt that it would be useful to have a report showing all the projects that had been approved at F&Q. He asked if this could be done at least once a year. The process that KH had been under taking for this year would pick this up reviewing all the service lines. This could be picked up on a yearly basis. Action: Funding was Agreed. SYM to review how quality impacts of QIPP schemes are reported to P&I. 9.0 Evaluation of Out Of Hospital Pathway scheme PL presented the scheme. He stated that the pilot had been going for 5 months. He added that this had been the evaluation of the pilot as of 3 weeks ago. The proposal was for further investment for 12 months in the discharge to access pathway. This would require an investment of 300k. He added that there had been a very small saving for the system of approximately 90k net. He confirmed the following benefits for patients. Improved patient access to, and outcomes of, rehabilitation and reablement and if required on going care assessments in a non-acute care environment. Improved patient flow, reduce acute length of stay and ensure patients receive care in the right place at the right time for Waltham Forest Residents. Low Re-admissions and step up facility to George Mason Lodge (GML) over 60 s. 95% of patients on the Supported Home Discharge Pathway reached their desired destination of home

189 LB asked for confirmation on the 300k if this was mainly staffing costs, PL confirmed this had been all staffing costs. He stated that they were still reviewing the staffing levels. Also confirmed that the paper had been shared with both NELFT and the LA. He added that if funding is agreed for a further 12 months, they would look for a more integrated pathway. It is suggested that they move the concept of discharge to access with this resource, to a front ended service with reablement and community therapy, supporting the patients out of Whipps Cross. JM asked if social services were still happy to second staff into the service. PL stated that he had met with John Higgins and they had gone through the paper. He stated the LA supported it but wanted to take this through to the next phase, along with the therapy and reablement piece. PL added that they had been doing a paper to go to the Better Care Together Board, which goes more into detail. Action: Funding Agreed 10 NHS 111 Business case EP went through the report. The purpose of this report is to present the business case for the new Integrated Urgent Care Service (NHS111 including the Clinical Assessment Service) and ask the CCG Finance and QIPP Committee to approve the additional investment that is required to proceed to procurement. WFCCG has been working with the seven North East London CCGs in response to the national Integrated Urgent Care (IUC) Commissioning Standards, which outline changes to the way calls are currently handled and proposed the introduction of what is termed the Clinical Assessment Service (CAS). He added that as part of the local model anyone with a care plan, under one year s old and anyone over the age of 75 would be eligible for early exit. This would mean that they would not go through the 111 assessment, which some people felt had not been tailored to their needs. This would be a standardised service across the 7 CCGs and should provide a better service than 111. This would also improve the triage for these patients and improve the outcomes and the volume of patients going through A&E. The Finance and QIPP Committee has been asked to approve the additional investment of 76k per annum, but up to 161k per annum, in order to meet the planned costs of the procurement. LB stated that the 160k is a gross investment and if A&E demand reduces, there should be a net saving. There was some discussions around the 111 current service, it was stated that the new service would be more efficient and more effective for patients. EP stated that the new specification should have a positive impact on patients. Patient engagement has been carried out as part of the development of the specification. A patient representative is currently part of the project group. The Committee noted that there has been a pause on the procurement for the Urgent Care Centre, in order to see the impact of this new service. Work is being done with the current providers to make some service changes, along with the extended hour s service. EP confirmed this new service will start in March Action: Agreed 5 186

190 12 A.O.B None AW wanted it noted that all business cases had been all very well presented

191 Item 6.7 Committee Minutes From IT Committee Minutes - April 2017 Dr Mayank Shah, Chair of the Committee - WFCCG Key highlights Patient Online Update The progress update as follows: Sign-up sessions are now being offered to practices below 10%. A Comms to encourage practices to release up to 80% has now been sent to all practices. The 50% utilisation target for Online Repeat Prescriptions has been removed from the project outcomes. The MyGP app is to be rolled out during this financial year. St James Medical Practice Ltd have now reached the 10% target. NHSE have agreed to count active patients. Uptake as of the end of March for the CCG had risen from 8% to 15%. With 11 practices that had still not hit the 10% practice target. There had been some issues with practices switching on their OCS. There had been some working around advising all practices to switch this on in order for patients to self-register. HN confirmed that there is still approx. 11 practices that have not switched this on. elpr (HIE) Progress Briefing paper Bill Jenks (BJ) presented update Oncology and clinical Oncology letters Now delivered electronically and in the elpr New HIE Project Manager selected and starting in early April Called Karen. NELFT Orion now live and discussions progressing about linking elpr into that. Orion and NELFT producing paper about the three options available to support elpr which can then be taken to Barts and Cerner to approve one of the options and produce a timeline for implementation. Hackney Council delaying joining C&H HIE as their solicitors are finalising work around the legal ramifications of sharing. Now looking to go live by Q1 2017/18. Newham Council - Decision has now been delayed with July date set for Go live no go live decision. Tower Hamlets Council Potentially moving systems with dates to be agreed. Work needs to be scoped on what can be done before that upgrade. Highlights [IT Committee] [April 2017] 188

192 Waltham Forest Council Moving to Mosaic with dates to be agreed. Work needs to be scoped on what can be done before that upgrade. Council now has its system hosted (which was the first move needed to be completed for the upgrade) and upgrade can now progress. Date to be agreed. CHS - Work beginning on what content will be shared and in what format using the EMIS native connection. Cerner and EMIS still waiting to sign off the contract but WEL pushing to have a look at piloting the test version. ETTF Funding - PID approved by NHS E and funding due to come over. BHR Meeting took place in November and INPS (Vision) to start work on elpr integration. Vision have a project similar to this in Lewisham CCG and are meeting with them on 19th December to start work. Some issues in BHR with regards to GP Systems which may delay elpr work but may ultimately make integration easier - Vision work to be a short project in Lewisham. Vision view of elpr needs Internet Explorer 11 and BHR have issues that Cyberlabs cannot work on IE 11 so exploration needed on this. West Essex now live for the elpr in 15 practices. Practices can see the Barts record and MIG working to get the link into Barts (should be completed by end of March. Then the next step is to get all the other practices signed up.some exploratory work commencing around Herts and West Essex STP to join this project. The STP is keen so exploratory work underway. Discovery The Discovery data service now has 41 practices feeding data into it and comms has now started with Waltham Forest and Newham to get them to sign the Data Processing Agreement and have data flow into the service. It was agreed that BJ to attend the next locality and LMC meetings, before practices sign up outlining the benefits. BJ will send out a comms on the benefits of the sign up. AP stated that the LMC had some concerns which BJ will address directly. RW stated that there had been a comms drawn up and waiting approval. CMC In February a large meeting was held with wide representation from the 3 CCGs of WEL and the CMC (Co-ordinate My Care) team. It was agreed that WEL should adopt the use of CMC and the CCGs are now looking at their own local implementation plans. WELC Sharing agreement The new Data Controller Console (DCC) from NHS England is now live. He stated that they will be using this for all future sharing agreements for practices and other providers to electronically sign off sharing agreements. They will be using this to re-sign the elpr sharing agreement with Barts as those agreements are now a couple of years old and then we will be looking to add in ELFT and the Homerton to this agreement to switch on bidirectional sharing with the practices. This will be using the new data sharing agreement format agreed and signed off at the WELC IG Committee. Highlights [IT Committee] [April 2017] 189

193 IT implementation progress report System Interoperability (Care Planning) The next steps are to arrange a pilot within some practices with a template, to report back at the next IT Committee to agree. He added that he would need to meet to discuss this at the next PI Committee. HN goes through his general updates. We continue to work towards set targets for Patient Online & e-referrals Support team continuing GP Practice visits to drive Patient Online Uptake at the end of March the CCG as an overall had improved from 8% to 15%. There are still reluctance from individual surgeries sign up sessions have been successful and we will continue to use this process Meeting arranged to plan our approach to achieving this year s Target of 20% per surgery BI Tool: Server built - in contact with CACI to arrange dates to start implementation and training the administrators GPIT procurement Preferred supplier notified on the 31 st March 2017 Meeting arranged for 10 th May 2017 to start discussions around mobilisation. EMIS Community (Will re-name to CCG/NELFT Care Planning) - Summary paper agenda item SharePoint: o A consultant has been engaged to assist with building business Case and initial governance/requirements planning o Following NHSE directives for services to satisfy ISO 1596 accreditation the CCG are investigating the option of Office365 Cloud based services Due to NHSE requirements the CCG has no option but to make a decision in regards to when we migrate to NHS.Net addresses ( Paper to be presented for decision at next IT Committee) NELFT Sites: Practices utilising NELFT telephony have been given new SLA s which are unreasonable CCG need to assist practices TQuest All tquest issues have been escalated to DK as the diagnostic lead. The committee asked if they could see data of which GP uses tquest within the surgeries. There are still 12 practices below the 50% target. NP-M stated that she had received the March data and the overall uptake had been 58%. The target now was to have all practices at 50%. Highlights [IT Committee] [April 2017] 190

194 CP-IS New requirements i.e. Federated Services and Out of hours services will also be required to be connected to the CP-IS which could pose an issue meeting to be arranged to discuss plan of action. Highlights [IT Committee] [April 2017] 191

195 IT Committee Date: Wednesday 19 th April 2017 Time: 15:00 17:00 Venue: Chair: Boardroom B/C, Kirkdale House, Leytonstone Dr Mayank Shah (MS) Attendees: Apologies: Les Borrett (LB) Dr Dinesh Kapoor (DK) Carl Edmonds (CE) Simon Wheat (SW) Adrian Dodd (AD) Harry Nyantakyi (HN) Rebecca Waters (RW) Shahnaz Begum (SB) Jessica Johnny (JJ) Dr Thaven Chetty (TC) Aysha Patel (AP) Bill Jenks (BJ) Ed Keating (EK) Nicola Pearce-McGinn (NP-M) Richard Griffin (RG),Amanda Ellis (AE),Joan Fratter (JF) Phil Koczan (PK) Agenda items 1. Welcome and apologies MS The chair welcomed attendees and apologies noted. 2. Updated declaration of interest forms MS No changes advised. 3. Notes from last IT committee & Matters Arising MS Minutes from the November meeting were agreed. Action log was updated. 192

196 4. Patient Online Update JJ JJ presented the paper as part of the pack. JJ stated and explained that this had been a national project and the National target for patient utilisation had been 10% and the LHP (London for Health Partnership) NHSE target is 20%. She stated the following: Sign-up sessions are now being offered to practices below 10%. A Comms to encourage practices to release up to 80% has now been sent to all practices. The 50% utilisation target for Online Repeat Prescriptions has been removed from the project outcomes. The MyGP app is to be rolled out during this financial year. St James Medical Practice Ltd have now reached the 10% target. NHSE are now deciding whether to count active patients. JJ stated that one of the major updates had been that they are able to count active patients as live which has improved the uptake. She added that they had a conference call with NHSE on an action plan to tackle the remaining practices which are still below the 10%. Practices are being advised to continue to pre-print in order to reach the 20% target. Additional help with sign up session within practices had proved very successful along with a public digital event held at the local library. Feedback from the event had been sign up sessions within the blood area of the hospital. Uptake as of the end of March for the CCG had been 15%. With 11 practices that had still not hit the 10% target. HN stated that this would be something that he would put on the June locality and Practice manager s forum meeting. Practices will be given support on how they can achieve these targets. HN added that he had been in the process of putting together a work plan with JJ, on how this can be increased to 20% for each practice. HN stated that they would continue to work with the Comms team and organising some signup events in the local libraries. There had been some issues with practices switching on their OCS. There had been some working around advising all practices to switch this on in order for patients to selfregister. HN confirmed that there is still approx 11 practices that have not switched this on. Actions Deadline Owner Please refer to action log for all actions 193 Page 2 of 7

197 5. WEL Update BJ BJ goes through the report as part of the papers. Bill highlighted the following: Oncology and clinical Oncology letters Now delivered electronically and in the elpr New HIE Project Manager selected and starting in early April Called Karen. NELFT Orion now live and discussions progressing about linking elpr into that. Orion and NELFT producing paper about the three options available to support elpr which can then be taken to Barts and Cerner to approve one of the options and produce a timeline for implementation. Hackney Council delaying joining C&H HIE as their solicitors are finalising work around the legal ramifications of sharing. Now looking to go live by Q1 2017/18 Newham Council - Decision has now been delayed with July date set for Go live no go live decision. Tower Hamlets Council Potentially moving systems with dates to be agreed. Work needs to be scoped on what can be done before that upgrade. Waltham Forest Council Moving to Mosaic with dates to be agreed. Work needs to be scoped on what can be done before that upgrade. Council now has its system hosted (which was the first move needed to be completed for the upgrade) and upgrade can now progress. Date to be agreed CHS - Work beginning on what content will be shared and in what format using the EMIS native connection. Cerner and EMIS still waiting to sign off the contract but WEL pushing to have a look at piloting the test version. ETTF Funding - PID approved by NHS E and funding due to come over BHR Meeting took place in November and INPS (Vision) to start work on elpr integration. Vision have a project similar to this in Lewisham CCG and are meeting with them on 19th December to start work. Some issues in BHR with regards to GP Systems which may delay elpr work but may ultimately make integration easier - Vision work to be a short project in Lewisham. Vision view of elpr needs Internet Explorer 11 and BHR have issues that Cyberlabs cannot work on IE 11 so exploration needed on this. West Essex now live for the elpr in 15 practices. Practices can see the Barts record and MIG working to get the link into Barts (should be completed by end of March. Then the next step is to get all the other practices signed up. Some exploratory work commencing around Herts and West Essex STP to join this project. The STP is keen so exploratory work underway. Copy to GP and Cyberlabs All three IT Groups in the three CCGs have agreed to switch off Copy to GP and Cyberlabs. Copy to GP will be switched off by the end of March 2017 and a date is yet to be set for the Cyberlab switch off. For patients on DMARDS GPs will need to check the elpr view when performing meds reviews as all path results will be there now rather than copied to the GP. For Cyberlabs the elpr team is reviewing the graphing functionality for GPs and also each CCG may have a different switch off date depending on their SLA with the Cyberlab provider. DK stated that he had received 3 pathology results and therefore copy to GP has not been turned off. BJ stated that the option has been removed for system and therefore this cannot happen. DK asked what function had been removed BJ confirmed that copy to GP was switched off at the end of March. BJ asked DK to send copies to BJ to investigate. LB asked in the comms to GPs had there been any mention of Dmerds in the elpr and asked why this comms had not gone out yet. RW confirmed that it had been awaiting 194 Page 3 of 7

198 approval from MS. DK asked if he could be involved in this comms. LB also asked to see the latest time series data on the elpr uptake with practices in order to address this. Discovery The Discovery data service now has 41 practices feeding data into it and comms has now started with Waltham Forest and Newham to get them to sign the Data Processing Agreement and have data flow into the service. It was agreed that BJ to attend the next locality and LMC meetings, before practices sign up outlining the benefits. BJ will send out a comms on the benefits of the sign up. AP stated that the LMC had some concerns which BJ will address directly. RW stated that there had been a comms drawn up and waiting approval. CMC In February a large meeting was held with wide representation from the 3 CCGs of WEL and the CMC (Co-ordinate My Care) team. It was agreed that WEL should adopt the use of CMC and the CCGs are now looking at their own local implementation plans. WELC Sharing agreement The new Data Controller Console (DCC) from NHS England is now live. He stated that they will be using this for all future sharing agreements for practices and other providers to electronically sign off sharing agreements. They will be using this to re-sign the elpr sharing agreement with Barts as those agreements are now a couple of years old and then we will be looking to add in ELFT and the Homerton to this agreement to switch on bi directional sharing with the practices. This will be using the new data sharing agreement format agreed and signed off at the WELC IG Committee. AP stated that primary care had been commissioning something locally within Waltham Forest. Asked if this needed to be put through the IG committee to be approved. BJ confirmed yes but it could be something done off line. Actions Deadline Owner Please refer to action log for all actions 6. System Interoperability Care Planning HN HN presents the report as part of the papers. The next steps are to arrange a pilot within some practices with a template, to report back at the next IT Committee to agree. He added that he would need to meet to discuss this at the next PI Committee. Actions Deadline Owner Please refer to action log for all actions 195 Page 4 of 7

199 8. Clinical Director s tquest update All All tquest issues have been escalated to DK as the diagnostic lead. The committee asked if they could see data of which GP uses tquest within the surgeries. There are still 12 practices below the 50% target. NP-M stated that she had received the March data and the overall uptake had been 58%.The target now was to have all practices at 50%. MS felt that it was helpful to have the list of all practices that had been below 20% - it was discussed that this had been something that NPM could pull together. 9. IT & Digital Implementation progress report HN goes through his progress report. We continue to work towards set targets for Patient Online & e-referrals Support team continuing GP Practice visits to drive Patient Online Uptake at the end of March the CCG as an overall had improved from 8% to 15%. There are still reluctance from individual surgeries sign up sessions have been successful and we will continue to use this process Meeting arranged to plan our approach to achieving this year s Target of 20% per surgery Delays in procuring devices for sign up sessions NHSE lack of communicating the national objectives to GP Practice Patient Online Assurance reporting submitted on deadline BI Tool: Server built - in contact with CACI to arrange dates to start implementation & training the administrators GPIT procurement Preferred supplier notified on the 31 st March 2017 Meeting arranged for 10 th May 2017 to start discussions around mobilisation. EMIS Community (Will re-name to CCG/NELFT Care Planning) - Summary paper agenda item SharePoint: o A consultant has been engaged to assist with building business Case and initial governance/requirements planning o Following NHSE directives for services to satisfy ISO 1596 accreditation the CCG are investigating the option of Office365 Cloud based services Due to NHSE requirements the CCG has no option but to make a decision in regards to when we migrate to NHS.Net addresses (Paper to be presented for decision at next IT Committee) NELFT Sites: Practices utilising NELFT telephony have been given new SLA s which are unreasonable CCG need to assist practices 196 Page 5 of 7

200 ETTF As stated above notification of initial successful bids under the EFFT was communicated in early December they are as follows: elpr Sharing of record (WEL) Telephony Bid in conjunction with Newham Issue raised with Newham regarding representation of figures submitted on behalf of Waltham Forest Newham were given notification of a 70K figure but submission indicated in bid is for only 31K. CP-IS New requirements i.e. Federated Services and Out of hours services will also be required to be connected to the CP-IS which could pose an issue meeting to be arranged to discuss plan of action. Actions: Please refer to the action log for all actions 10. IT & digital Communication Update RW updated the committee that there had been a London wide GP Services Online outdoor campaign. She stated that there is a pack that she would share with the committee on request. The branding looks the same the logo had changed to include, Healthy London Partnership confirmed that this would be changed for any future media. The CCG hosted its first public engagement event of 2017/18 held the night before on Digital Health Solutions including GP Services Online. This had proved positive with an approx 20 members of public attended. There had been a mixture of presentations and 4 patient access sign ups. The findings will be written up into a report and expected to be actioned at the Digital and business intelligence working group. TC updated the group on some feedback from a workshop on self-care people had wanted personalised information not a generic website. They also would like to interact online they wanted more than what was available positive feedback on Iplato. RW stated that the event involved positive partnership working with the Council, CCG, NHS England and digital unite. HN may contact the Council regarding public training to include health component, for those that are not yet digital. HN confirmed that they would be rolling out the My GP app. RW requested that a meeting is set up to fully manage the communications of the MyGP app roll out. RW confirmed that a full report will be circulated in due course. Actions: Please refer to the action log for all actions Deadline Owner 197 Page 6 of 7

201 11 AOB DK raised the issue around primary care hardware contract. HN updated the group that this had been something he had been looking into. All the NELFT sites that have this system have been notified. It was discussed that HN would need to send out a comms notifying NEFLT practices not to purchase new telephone system until HN has clarified the situation. MS advised the group that Joan Fratter patient rep has stood down due to family commitments. The Committee would like to thank JF for all her hard work and contributions. It was noted that RG will be looking to recruit a new patient rep for the committee. 198 Page 7 of 7

202 Item 6.8a Committee Minutes From Primary Care Commissioning Committee March 2017 Alan Wells, Chair of the Committee - WFCCG Key highlights Highlights of the March 2017 meeting are summarised below: 1. Quality Improvement STP The STP have asked the 7 CCGs to work together on QI in PC. There is potential for the STP to collate a primary care dashboard that would be relevant for all 7 CCGs and would be built on existing or developing dashboards. 2. GP CQC Ratings Outcomes Report The data presented was from the latest visits to practices using the 5 CQC domains and ratings of outstanding, good, requires improvement and inadequate. Any themes that come out of the CQC visits will be addressed, and contractual action will be taken. 3. Primary Care GP Resilience Quality Improvement Scheme The primary care team are working to create and deliver a programme of work to support sustainable future for General Practice in Waltham Forest. Key areas of the report were highlighted for the Committee outlining the aims of the programme and the CCG approach that will be taken. Funding of the NHSE resilience funding needs to be committed by the end of March, and additional CCG investment will be added which also needs to be committed. Approval for the programme was approved in principle, and a quarterly update would be provided for the Committee on progress. 4. Actions / Issues raised by the Primary Care Advisory Committee Childhood obesity further work is to be done on the letter to schools before the Committee discusses childhood obesity further. It was therefore referred back to the PCAC until this work is completed. Highlights [Primary Care Commissioning Committee] [March 2017] 199

203 PRIMARY CARE COMMISSIONING COMMITTEE Part 1 Minutes of Meeting held on 1 March 2017 Board Room B/C, Kirkdale House VOTING MEMBERS Initials Role Alan Wells AW Chair, Lay Member, WFCCG Caroline White CW Lay Member, WFCCG Terry Huff TH Chief Officer, WFCCG Azeem Nizamuddin AN Independent GP, WFCCG MEMBERS Ian Clay IC Deputy Director of Finance, WFCCG Aysha Patel AP Senior Commissioning Programme Manager, WFCCG Lorna Hutchinson LH Assistant Head of Primary Care, NHS England Sultana Rahman SR Associate Director Strategic Commissioning, WFCCG Abdul Sheikh AS Clinical Director, WFCCG Dinesh Kapoor DK Clinical Director, WFCCG Gabriel Ivbijaro GI LMC Tonia Myers TM Clinical Director, WFCCG Jane Mehta JM Director of Strategic Commissioning, WFCCG Anne Walker AWa Deputy Nurse Director, Quality & Clinical Governance - WFCCG Jacqueline Pluck JP Project Support Primary Care APOLOGIES Alison Goodlad AG Head of Primary Care for NEL, NHSE Vineeta Manchanda VM Lay Member/ Conflicts of Interest Guardian Althea Bart AB Manager, Healthwatch Waltham Forest ACTIONS LOG Who : Actions from last meeting When Complete AS An was sent to all GPs from the medicines optimisation team requesting a list of non-medical prescribers in their practices, and requesting the scope of practice. There are concerns in regard to the assurances in regard to work being carried out and issuing of prescribing codes. Practices were slow to respond. AS agreed to review information to assess whether LMC input is needed, provide general feedback and advice on a way forward. 5 April Open Item Summary / Actions Action 1 Welcome and Apologies AW The Chair welcomed members to the meeting. Apologies were noted as above. 2 Declaration of Interest ALL 1 200

204 DK declared an interest in item 5, because as a GP he would be included in the GP CQC ratings outcome report. 3 Approve Minutes of the previous PCCC Part 1 AW The minutes were agreed as a correct record. Matters Arising Baby checks SR confirmed that the 4 practices that were shown as not providing baby checks are doing so, and that it was because of a coding issue. Non-medical prescribing (NMP) accreditation This was discussed at the last meeting with an associated action. An was sent to all GPs from the medicines optimisation team requesting a list of nonmedical prescribers in their practices, and requesting the scope of practice. There are concerns in regard to the assurances in regard to work being carried out and issuing of prescribing codes. Practices were slow to respond. AS agreed to review information to assess whether LMC input is needed, provide general feedback and advise on a way forward. An update will be provided by AS. AS 4 Quality Improvement STP JM JM updated the committee on discussion at the STP meeting on quality improvement plans for each CCG. The STP have asked the 7 CCGs to work together on quality improvement in primary care. There is potential for the STP to collate a primary care dashboard that would be relevant for all 7 CCGs and would be built on existing or developing dashboards. A conversation took place on who would provide QI approaches and if there was scope to commission a joint QI intervention. Provider networks were discussed and how the STP could support them in providing training and development for them to provide primary care at scale, and how they can work alongside other providers. Primary care workforce and quality improvement was discussed, looking at age and gender profile of GPs, and plans that CCGs have in place for future workforce. 5 GP CQC Ratings Outcomes Report SR SR presented the CQC ratings outcomes report to the committee for information and discussion. The data presented was from the latest visits to practices using the 5 CQC domains and ratings of outstanding, good, requires improvement and inadequate. Any themes that come out of the CQC visits will be addressed, and contractual action will be taken. This information will be shared with relevant CCG colleagues and highlights will be incorporated in the quality improvement work, and quality report, and then presented to the Performance and Quality Committee and Governing Body meetings. Once the full set of reports are available the data will be analysed to see if there is learning for commissioners, practices and/or additional support required. The report was noted

205 6 Primary Care GP resilience quality Improvement Scheme SR SR informed the committee that the primary care team are working to create and deliver a programme of work to support sustainable future for General Practice in Waltham Forest. In order to do this they are reviewing all potential opportunities to maximise the developments within the GP Five Year Forward View and resultant NHSE led resilience and sustainability programmes. Key areas of the report were highlighted for the Committee outlining the aims of the programme and the CCG approach that will be taken. The Procurement Working Group has approved the planned approach and a task and finish group will be managing the delivery of the programme. Evaluation will be built into the programme. Funding of the NHSE resilience funding needs to be committed by the end of March, and additional CCG investment will be added which also needs to be committed. The Committee discussed how a bespoke programme would be required for practices according to the outcome of the CQC report for each practice. Approval for the programme was approved in principle, and a quarterly update would be provided for the Committee on progress. 7 Leyton Orient Caretaking Arrangement AP This item was withdrawn. 8 Actions/Issues raised by the PCAC AS Childhood obesity further work is to be done on the letter to schools before the Committee discusses childhood obesity further. It was therefore referred back to the PCAC until this work is completed. 9 AOB None. Date of the next meeting: 5 April pm 5.15pm 3 202

206 Item 6.8b Committee Minutes From Primary Care Commissioning Committee April 2017 Alan Wells, Chair of the Committee - WFCCG Key highlights Highlights of the April 2017 meeting are summarised below: 1. PMS Review LF tabled the PMS/GMS Review Commissioning Intentions 2017/18 Report and the Committee were given time to read it through as this was a late item. The impact assessment provided at appendix 1 was approved. The high level commissioning intentions set out in 3.1 were supported. The Committee agreed to an extraordinary meeting before the end of April in regard to the commissioning intentions and to support the timelines for the assurance process. It was agreed to hold this meeting on 26 April, immediately after the CCG away day. 2. Finance Report The Finance Report to the end of February and forecast to year end was presented to the Committee. There is a 0.1% projected underspend and the CCG is close to balancing the primary care budget. 3. Practice Visits 10 practices across the localities have been selected for visits by the end of April. Three visits had taken place so far and these have been very positive. 4. Estates update Old Church Practice had successfully been relocated to the Silverthorne site. A task and finish group was set up to facilitate the move. A paper is currently being produced on lessons learnt and this will be shared with the Committee in June. All practices were invited to apply for improvement grants in July 2016 and submission closed in October. The CCG have been successful with all 5 schemes that were submitted for phase 2 of the improvement grant process. Priority developments for Waltham Forest, St James Quarter and Score Coronation Square and Lea Bridge Road development were highlighted. 5. Latent TB Local Incentive Scheme The latent TB Local Incentive Scheme is funded from Public Health England and is for newly registered patients. 107k have been secured for next year to continue the programme. Highlights [Primary Care Commissioning Committee] [April 2017] 203

207 The report was noted and the continuation of the programme for 2018/19 was supported. 6. Actions/ Issues raised by the Primary Care Advisory Committee Complaints and how to manage difficult patients was discussed at the PCAC. It was agreed that a code of conduct could be developed as good practice to support better patient/doctor relationships. It was agreed at the PCAC that a draft code of conduct would be produced and forwarded to the PCCC, GPs at locality meetings and patient groups for comments. 7. AOB The Committee were reminded that the PCCC is a public meeting but no members of the public attend. The Committee were advised that the meetings will be publicised on the CCG website, in the local press, PPGs and via networks to encourage the public to attend. Highlights [Primary Care Commissioning Committee] [April 2017] 204

208 PRIMARY CARE COMMISSIONING COMMITTEE Part 1 Minutes of Meeting held on 5 April 2017 Board Room B/C, Kirkdale House VOTING MEMBERS Initials Role Alan Wells AW Chair, Lay Member, WFCCG Caroline White CW Lay Member, WFCCG Terry Huff TH Chief Officer, WFCCG Les Borrett LB Director of Strategic Finance, WFCCG Darren Newman DN Assistant Director for Commissioning, LBWF MEMBERS Aysha Patel AP Senior Commissioning Programme Manager, WFCCG Lorna Hutchinson LH Assistant Head of Primary Care, NHS England Alison Goodlad AG Head of Primary Care, NHS England Sultana Rahman SR Associate Director Strategic Commissioning, WFCCG Abdul Sheikh AS Clinical Director, WFCCG Dinesh Kapoor DK Clinical Director, WFCCG Joe Cox JC Consultant, PH Jane Mehta JM Director of Strategic Commissioning, WFCCG Althea Bart AB Manager, Healthwatch Waltham Forest Jacqueline Pluck JP Project Support Primary Care Vineeta Manchanda VM Lay Member/ Conflicts of Interest Guardian Alison Goodlad AG Head of Primary Care for NEL, NHSE Linda Finch LF Project Manager, WFCCG Aklasur Ahmed AA Commissioning Project Manager for Estates, WFCCG Paul Larrisey PL Deputy Nurse Director, CHC and Safeguarding Adults, WFCCG APOLOGIES Gabriel Ivbijaro GI LMC Azeem Nizamuddin AN Independent GP, WFCCG Tonia Myers TM Clinical Director, WFCCG Anne Walker AWa Deputy Nurse Director, Quality & Clinical Governance - WFCCG ACTIONS LOG Who : Actions from last meeting When Complete Item Summary / Actions Action 1 Welcome and Apologies AW The Chair welcomed members to the meeting. Apologies were noted as above. 2 Declaration of Interest ALL None. 3 Approve Minutes of the previous PCCC Part 1 AW The minutes of the last meeting were agreed

209 Actions from the previous meeting: Non-Medical Prescribing information from practices: This had been previously discussed and had subsequently been discussed at the CCG s Medicines Optimisation Committee. SR advised that it was agreed that the CCG needs to manage any risk involved from its role in the issuing of prescribing codes. The policy for non-medical prescribers is being updated and will be shared with practices. The document has been shared with AS for his input and comment. Extra Item PMS Review LF tabled the PMS/GMS Review Commissioning Intentions 2017/18 Report and the Committee were given time to read it through as this was a late item. The impact assessment provided at appendix 1 was approved. The high level commissioning intentions set out in 3.1 were supported. The Report was noted. The Committee agreed to an extraordinary meeting before the end of April in regard to the commissioning intentions and to support the timelines for the assurance process. It was agreed to hold this meeting on 26 April, immediately after the CCG away day. 4 Finance Report LB The Finance Report to the end of February and forecast to year end was presented to the Committee. LB explained that one of the PCCCs functions is to manage the delegated budget for primary care. There is a 0.1% projected underspend and the CCG is close to balancing the primary care budget. The Finance Report was noted. 5 Practice Visits SR SR reported that 10 practices across the localities have been selected for visits by the end of April. Three visits had taken place so far and these have been very positive. The intention is to visit the remaining practices and to undertake a review of the visits to help shape any future programme of visits. Updates will be provided to the Committee. 6 Estates Quarterly Update AA/CE AA updated the Committee that Old Church Practice had successfully been relocated to the Silverthorne site. A task and finish group was set up to facilitate the move. A paper is currently being produced on lessons learnt and this will be shared with the Committee in June. Improvement grants. All practices were invited to apply in July 2016 and submission closed in October. The CCG have been successful with all 5 schemes that were submitted for phase 2 of the improvement grant process. The CCG is working closely with practices to submit documents for due diligence. The deadline is 31 March for some practices and 2 June for others. AA highlighted the priority developments for Waltham Forest, St James Quarter and Score Coronation Square and Lea Bridge Road development. The Report was noted

210 7 Latent TB Local Incentive Scheme (LIS) SR SR highlighted key points from the latent TB Local Incentive Scheme, which is funded from Public Health England and is for newly registered patients. There have been some delays in getting the service running, and the funding was received late last year. 107k have been secured for next year to continue the programme. The report was noted and the continuation of the programme for 2018/19 was supported. 8 Actions/Issues raised by the PCAC AS AS informed the Committee that complaints and how to manage difficult patients was discussed at the PCAC. It was agreed that a code of conduct could be developed as good practice to support better patient/doctor relationships. It was agreed at the PCAC that a draft code of conduct would be produced for the PCCC, GPs at locality meetings and patient groups for comments. It was also agreed that LH would make enquiries about whether anything similar was planned on a national level or at a London wide level. 9 AOB JM reminded the Committee that this meeting is a public meeting but no members of the public attended. The Committee were advised that the meetings will be publicised on the CCG website, in the local press, PPGs and via networks to encourage the public to attend. Date of the next meeting: 3 May pm 5.15pm 3 207

211 Item 6.9 Committee Minutes From Locality Meetings Leyton/Leytonstone, Chingford and Walthamstow Shahnaz Begum, Miren Querejeta-Lopez and Linda Fontaine, Commissioning Managers - WFCCG Key highlights Please find attached the signed action log from Leyton/Leytonstone, Chingford and Walthamstow locality meetings March/April 2017 ACTION LOG: Leyton/Leytonstone (Sharhnaz) Dr Ken Aswani Agenda Item Actions from 1 st March Meeting CD Lead Due Date Owner Status 2 Cardiff Health Check Members responded that the tool is too long, are there any other template that can be used rather than Cardiff? LS By next meeting 4 Chlamydia Screening and C Card Scheme in Surgeries SB to send out relevant facts and costs to GPs and JK to provide GPs with all relevant resources SB Next meeting Completed Actions from 5 th April 2017 Meeting 5.1 Need clarification for the new Medicine Optimisation Quality Premium whether this is looking at patients diagnosed with COPD between April 2015 to March 2016 or April 16 17? Next meeting KS/SB Completed Update: KS confirmed that the COPD spirometry indicator should read patients diagnosed between (Feb 16 to Jan 17) Action Logs [Leyton/Leytonstone, Chingford and Walthamstow Locality Meetings] [March and April 2017] 208