GOVERNING BODY. Corporate Objective addressed by this paper (please select one or more with an X):

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1 Enclosure: D Agenda item: 8 Title of paper: Managing Director s Report Date of meeting: 5 September 2018 GOVERNING BODY Presented by: Neil Kennett-Brown Prepared by: Neil Kennett-Brown Title: Chief Officer & contact: andrewbland@nhs.net Title: Managing Director & contact: neil.kennett-brown@nhs.net Corporate Objective addressed by this paper (please select one or more with an X): 1. To commission safe, sustainable, efficient and affordable services to meet the health and wellbeing needs of the population of Greenwich and reduce health inequalities; 2. To ensure the CCG s position recovers to meet its financial duties and performance standards; 3. To nurture and support primary care to be resilient and thrive; 4. To strengthen productive relationships with partners and the public to work as a health and care system; 5. To actively engage with our communities to improve their eperience of healthcare; 6. To play an active and influential role in shaping SE London and London wide commissioning. Purpose of the report: To brief the Governing Body on matters the Managing Director wishes to bring to their attention not covered by agenda items. Issues arising: None. Summary of actions, if any, following this meeting: None. Previous committee involvement: (insert details of any other committees that have considered this matter) None. Recommendations to the Governing Body: For information.

2 (Please provide details below where Yes is indicated ) Impact on Governing Body Assurance Framework () Yes No N/A X Impact on Environment () Yes No N/A X Legal Implications () Yes No N/A X Resource and or financial implications () Yes No N/A X Equality impact assessment () Yes No N/A X Privacy impact assessment () Yes No N/A X Impact on current NHS Outcomes Framework areas () Yes No N/A X Patient and Public Involvement () Yes No N/A X Communications and Engagement () Yes No N/A X Impact on CCG Constitution () Yes No N/A Attachments: i. Managing Director s report 2

3 Managing Director s Report Governing Body Meeting September Introduction The country eperienced record heat levels in many parts, and I am pleased to report that the health and social care system worked well together during this challenging period, to support those who were most vulnerable. Understandably at this time of year many people take a holiday, and I was privileged to spend three inspiring and challenging weeks in Africa with my family, visiting Uganda and Tanzania, where I had done some voluntary work over 25 years ago. One of our visits was to a local village health clinic, and was struck by the very basic conditions and limited resources affecting so many people in Africa, and the significant challenges faced with malnutrition and high levels of mortality, and the amazing work of many charities and NGOs. For eample Neema Crafts, where we spent a week, who s purpose is to transform the lives of people with disabilities in Tanzania, through handicrafts, training and employment. The voluntary sector continues to play a significant role in health and social care improvement and innovation, and I am delighted that we are continuing to work closely with many organisations. I recently went to the Greenwich Recovery College annual celebration event. It was wonderful to hear about their work helping people with mental health problems to recover and lead full and meaningful lives, one of whom is now returning to nursing, and working locally. 2. Good News! In fact, the good news is so fantastic that it merits repeating: a few weeks ago, NHS England published the CCG Improvement and Assessment Framework (IAF) ratings for 2017/18 and Greenwich secured a rating of Good, a marked improvement from our Inadequate rating in 2016/17. This means that NHS Greenwich CCG is two levels higher within a year, and the special measures status has been lifted. This significant improvement is testament to the continued hard work and commitment by all, in particular the senior management team and Governing Body members for their strong leadership of the CCG and their work to engage and collaborate with member practices and partners. NHS Greenwich CCG now has a full permanent senior team in place, helping the CCG to maintain this success. This strong recovery could not have been achieved without the ongoing support of the CCG's partners in relation to improvement schemes to help recover the CCG's financial position - a significant cause of the inadequate rating for 16/17. The CCG is particularly grateful to member GP practices, Royal Borough of Greenwich, Oleas NHS Foundation Trust, Lewisham and Greenwich NHS Trust, Greenwich Health, GP Federation, community and voluntary partners and the people of Greenwich for their insight and involvement. The support of the wider south east London system has been critical to this success and especially the capacity and capability that they provide, with an improved acute

4 commissioning function and the alignment of financial planning under the shared leadership of Andrew Bland, the CCG's Accountable Officer. The CCG's comprehensive Organisational Recovery Plan has helped to create focus across the organisation on the key improvement areas of performance, quality, finance, strategy, engagement, staff development and governance, to name a few. The CCG will continue to focus on maintaining and building upon this improvement, and providing the best possible health outcomes for the population of Greenwich, and will do that through implementing the CCG's clinical commissioning strategy in collaboration with all its partners and the public. The CCG recognises the need to continue to improve, particularly around leadership which was rated amber for 17/18, an improvement from red in 16/17. It will focus on: Strengthened partnership working on integrating care across health and social care on our shared strategy which will be launched in September A sustained push on improvements by all staff including the full permanent senior team, with support and oversight from the Governing Body. A comprehensive engagement approach with member GP practices to ensure strong clinical leadership in the CCG s decision-making. 3. Overall progress update: There has been much achieved in the last few months, across the CCG. Particular highlights have been: Final engagement on the clinically led Greenwich Strategy, which is now for approval by our Governing Body today. Ensuring that we have our QIPP plans in place for 18/19 and that these are fully delivered. We are working very closely with Beley and Lewisham CCGs on collaborative unplanned and planned care initiatives with Lewisham and Greenwich Trust, so that our improvement plans are aligned. A Beley, Greenwich and Lewisham (BGL) Planned Care Board has been set up to oversee a collaborative work programme and plans are in place for a BGL Unplanned Care Board. Eamples of collaborative workstreams being established are Outpatient Referral Management and Referral Optimisation, Care Homes and High Intensity Users. These all build on work already done locally but will provide a stronger platform and help to share the workload with other CCGs. All workstreams will have a lead CCG and a clinical lead, who will link with leads from other CCGs to ensure pathway and service changes meet local needs. Implementation of our new constitution, following full endorsement from our member practices (83%). From September onwards our new committees will be up and running, and today s Governing Body will be reviewing and approving the their terms of reference. This has helped take forward the recommendations from the Good Governance Institute s review of our governance arrangements, which we have reported on previously. Further work on the 18/19 Emergency Department improvement plan for the Beley, Greenwich and Lewisham system, working with Lewisham and Greenwich Trust. We continue to work very closely with our partners on this plan. I remain focused on leading the improvement to discharge processes

5 at the QEH site, working on the Transfer of Care Collaborative. We are now very actively working on our planning for winter, with our partners across South East London. We had a well-attended staff awards ceremony on the 12 th July, and it was good to recognise the many individuals and teams, both from Greenwich practices and within the CCG, who have made a real impact in the last year. Si south east London CCGs have awarded a new NHS 111 contract for an Integrated Urgent Care (IUC) service to London Ambulance Service NHS Trust. The contract has been awarded by Beley, Bromley, Greenwich, Lambeth, Lewisham and Southwark CCGs. The service will be mobilised later this financial year. 4. Strengthening membership engagement Member practices, as part of both syndicates and local care networks, have been instrumental in spurring the CCG onwards and upwards. Since member practices voted to approve the new constitution in May, we have agreed a number of measures to ensure the member practices hold a central role within the CCG. We have increased the number of GP members on the Governing Body from 7 to 9 GPs; and I am delighted that they are now all in post, following selection and election by our member practices. All on the selection panel commented on their enthusiasm, motivation and skills and as a group I think they will be a real asset to the GB going forward. Our Governing Body GPs are as follows: Dr Vivienne Chai Network Syndicate Lead Dr Anuj Chaturvedi Ecel Syndicate Lead Dr Adebisi Olunloyo Eltham Syndicate Lead Dr Janakan Ratnarajan Blackheath and Charlton Syndicate Lead Dr Ranil Perera Dr Sabah Salman Dr Vijay Sivapalan Dr Krishna Subbarayan Dr Jaisun Vivekanandaraja During the summer we have run a comprehensive induction programme for our new Governing Body GPs, running on si consecutive Wednesdays, and have heard very positive feedback on it. This programme has been overseen by Dr Ellen Wright, our outgoing Chair. Later this year we will have a Council of Members, with a clinical representative from each practice and an independent GP Chair. Under the Council of members, practices will be able to challenge and advise the CCG on issues ranging from commissioning intentions to financial budgets. 5. Long Term Plan for the NHS On 18th June the Prime Minister set out a funding settlement for the NHS in England for the net five years. In return, the NHS has been asked to set out a long term plan for the future of the NHS by Autumn, setting out our ambitions for improvement over

6 the net decade, and our collective plans to meet them over the five years of the funding settlement. As articulated by the Prime Minister and Simon Stevens, the development of the long term plan will need to be based on the advice and eperience of clinical eperts and other stakeholders, including representatives of patients and the public. Engagement with these groups will therefore be a key feature of our work at all points of the plan s development, and will primarily be based around three components: In addition to engagement on the content of the long term plan, they will also be developing the thinking around the role that an NHS Assembly, made up of representatives of NHS staff and patients, should play in overseeing the delivery of the plan s ambitions going forward. Working groups are now being established, bringing together local and national system leaders, partners and stakeholders, to shape the final plan. SEL Commissioning Alliance are actively ensuring that we contribute to this, and Greenwich CCG has put forward a number of clinical leaders to participate in the working groups. The Prime Minister has asked the NHS to prepare its long term plan in time for the 2018 Autumn Budget; we anticipate that this will be mid-november. The indicative timeline for engagement with stakeholders and development of policies is set out below:

7 Greenwich CCG will be actively participating in this, and welcome the reiteration of priorities on mental health and cancer, which are reflected in our local strategy. We understand that the green paper for Social Care has been delayed until the autumn, which will be very important to help resolve the funding challenge affecting the health and social care system. We will endeavour to keep the Governing Body updated on these developments over the net few months. 6. Telehealth Care System The benefits to patients, staff and GPs of the Telehealth Care System were recently demonstrated at Meadows House Care Home, Kidbrooke. The system collates the results of vital observations monitored by staff and calculates the National Early Warning Score (NEWS). The digital pad also enables photos to be taken. Meadows House GP, Dr Wahba, was able to view images taken by staff of two patients they were concerned about. He was able to diagnose their conditions and prescribe treatment remotely which he then followed up with his routine visit. He praised Meadows House staff and the telecare system which avoided a delay in the start of treatment and reduced the number of visits. Greenwich CCG has installed the Telehealth Care System in the 12 care homes for older people in Greenwich over the past few months. 7. Dementia inclusive Greenwich The Dementia Friendly Communities programme aims to meet the targets outlined by the Prime Minister's Challenge on Dementia 2020 to create communities around the UK which make daily living and activities easier and more accessible to people living with dementia. The Royal Borough of Greenwich (RBG) has been formally awarded Dementia Friendly Community status. RBG is listed here as Dementia inclusive Greenwich. Congratulations and thanks to everyone who has made this possible. 8. Thank you I wanted to end my report with a big thank you to Dr Ellen Wright, our Chair, who finished her term on the 31 st August I am particularly thankful for her personal support and wisdom in helping me settle into my new role when I started last autumn. Over the summer Ellen has overseen and supported the smooth transition and induction period for our si new Governing Body GPs. Ellen has led the organisation through some very challenging times, and has been so helpful in supporting us as we recovered and brought the CCG to a much more positive position, and hands over to our new Chair.