NHS Southwark Clinical Commissioning Group Board Assurance Framework December 2017

Transcription

1 TP-12 TP-02 TP-08 QN-15 18/12/2017 QN-11 NHS Southwark Clinical Board Assurance Framework December 2017 CCG CORPORATE OBJECTIVES Involvement Delivery and 1. Act to comprehensively assure and improve the quality and safety of all commissioned services. 2. Work towards the delivery of NHS Constitution standards for the residents of Southwark, taking remedial action with providers where there is variance from agreed standards or recovery trajectories. 3. Support the on-going development and delivery of the South East London Sustainability and Plan. 4. Implement year two of the CCG s Five Year Forward View to establish a population based approach to commissioning. This includes the further development of GP federations and Local Care Networks and the CCG 5. Ensure patients and local people are involved in decisions related to the design, and commissioning of local services. Local people should be empowered in relation to their health and care. 6. Ensure the effective involvement of member practices and other partners in commissioning decisions. 7. Maintain effective governance within the organisation and across partnerships. Act to secure the financial stability of the local health economy, deliver Value for Money (VfM) and all other statutory responsibilities. 8. Have in place an organisation and workforce capable of delivering the CCG s objectives and fully embed the new Partnership Team with Southwark Local Authority. / Risk of not meeting the London Transforming Care performance target is a reputational risk to the CCG Kate Moriarty- Baker Mathew Griffiths Quality & Safety Sub arrangements: CCG and LA Transforming Care Steering in place and is meeting all reporting requirements. Joint forward planning reviews with the local authority undertaken. SEL Transforming Care Partnership in place. Progress made on further development of SEL TCP with key workstreams identified. TCP redesigned Strategic Board has its first meeting in September A common approach to identifying people at risk to prevent admissions has been developed across the TCP. The CCG's governance and internal escalation process provided to NHS England as assurance. Twoweekly updates provided to SMT and IGP alternately. Care and Treatment Reviews (CTRs) and Care, Education and Treatment Reviews (CETRs): CCG proactive in ensuring pre-admission CTRs for clients at risk of admission and post-admission CTRs, as well as CETRs for children and young people, take place within timescales. CCG has robust processes in place to review the care management and discharge planning for all clients fitting the Transforming Care criteria. All clients have care plans and a programme of further review. Additional clinical resource in place to support CTRs and discharge planning. s for notification: SLaM has committed to notifying the CCG within 24 hours of an admission in line with SEL TCP standards, but has struggled to meet this requirement. SLaM have an action plan and an operational lead to address this. CCG is seeking further assurances through senior leadership of this process. The ability of SLaM to work to this timescale will impact on the achievability of the CCG's ten-day target for CTRs. Transforming Care is on a monthly basis at IG&P meetings. TCP programme-level monitoring. Potential pressure on CCG trajectories through NHSE specialised commissioning patients being stepped down to CCG beds. Risk that CCG will not meet its trajectory for reduction in bed usage. Concerns around local authority approach to Ordinary Residence disputes escalated to NHSE National Programme for TCP - awaiting update on way forward Joint CCG-Local Authority review of registers for LD clients with MH and/or autism in assessment and treatment in order to identify those at risk of crisis in the community and to track for inpatient discharges, including CAMHS - MG - The current inpatient cohort is being weekly - MG -. Governing Body presentation on Transforming Care Programme in September The CCG is currently meeting its trajectory. Risk that pressure to achieve monetary and performance targets at main providers will negatively impact on the quality of services Kate Moriarty- Jacquie Foster Baker Quality & Safety Sub : sub-committee meetings in new format well-attended by GB clinical leads and lay members. Each quarter focusses on system-wide learning, quality assurance and quality improvement. CCG sub- receives monthly feedback from the CQRGs. Minutes of the QSC sub-committee and CQRG feedback summaries are sent to the IGP committee. Regular updates are provided to the Governing Body on quality issues related to achievement of constitutional standards. Monthly quality report to IGP and quality updates to Governing Body. Assurance provided to Governing Body on learning from Serious Incidents. Staff and Governing Body involvement: CCG staff meeting (16 Jan) on the CCG's approach to quality and individual and team responsibilities to ensure quality of commissioned services. Robust quality monitoring systems and processes: Clinical Quality Review (CQRG) meetings a key mechanism by which the CCG gains assurance on quality of service - CCG team attends all main provider CQRG meetings, serious incident and other relevant meetings. CQC Action plans for KCH, SLaM, LAS and GSTT tracked by the CCG for assurance at each CQRG. Southwark CCG attends the South London Quality Surveillance (QSG) meetings, chaired by NHS England, where local, regional and national quality priorities and risks are discussed. All serious incidents, Quality Alerts and Never Events are and monitored by the CCG Quality team. Local programme of clinical site visits to Southwark providers continued in Visit to SLaM Home Treatment Team took place May 17 - the team was assured. Learning from Subcommittee to be disseminated to practices. Safeguarding Executive munites CQRG minutes for KCH, GSTT, LAS and SLaM. Copies of new SAR Policy Serious Incident s and Quality and minutes IGP minutes sub- minutes SLaM CQRG Chair is vacant resulting in less robust meeting Awaiting formal notification of 2016 CQC inspection at KCH. Monthly monitoring of quality and safety via CQRGs with KCH, GSTT, SLaM, LAS and at IGP - Carry out programme of clinical site visits - March 2018, KMB. CCG leading review of SLaM CQRG. Second 4 Borough workshop in January 2018 CCG-led quality stocktake of KCH contract in May A Commissioner led review of SLaM CQRG began in October 2017 and as a result a Programme Manager has been appointed to support the meeting. Also conducted review of the SI committee at SLaM which has led to strengthening of review processes and learning and the introduction of a Trust-wide meeting. GB minutes Failure to implement Multi-speciality Community Providers type of contracting arrangements will make it harder to provide joined-up care that is preventative, high quality and efficient Risk that operational and financial instability of local GP Federation impacts on service delivery of EPCS and other neighbourhood/population based initiatives. Strategy Local Care Network Provider Implementation of outcomes-based contracts forms part of the FYFV strategy document for Southwark Development s are informing the development of commissioning intentions for 2017/ /19 which will include a focus on population-based commissioning for children and young people, adults and serious mental illness. Additional enhanced oversight by a joint CCG and council group - Planning, co-chaired by CCG lay member for governance. Joint approach to segmentation agreed with Southwark Council and Development. Segmentation used in CDGs to inform commisioning intentions. A PID has been produced in context of wider transformation programme. Three year programme of non-recurrent transformation investment in GP Federation business plans is due to end in March Planning for 18/19 investment is underway as part of the CCG's business planning cycle; however, it is expected that the CCG will not be in a position to invest at the same levels as under the business plan. CCG/Federation dialogue on future sustainability through joint Board to Boards in Q2-Q3 2017/18 focused on identification of other income streams, including future contracting arrangements. Q2 board to board meeting focussed on financial stability for federations. Open book accounting for population-based contracts and non-recurrent CCG transformation investment to support joint planning. CCG has secured additional GP Access Investment (under GP Forward View) to support continued investment in Extended Primary Care Service, and Population Health Management contract has been extended for an additional two years through to the end of 2019/20. Programme of Joint Board to Board meetings established. Funding arrangements and expectations confirmed with federations. intentions developed setting out clear expectation about contract changes to bring together contractual resource for LTC segment. Development group quarterly reports to CSC Published framework guidance on MCPs STP Community based care delivery board oversight FYFV Strategy for Southwark Joint Contract and Service Development meetings for Extended Primary Care Service and Population Health Management Open book accounting process Quarterly board to board meetings between CCG and Federations CCG operating plan/business planning process Further actions to be planned. Planning for further actions to be undertaken - MK - Jan 18 Q3 meetings considering future contracting arrangements - Jan MK CCG non-recurrent funding availability for 18/19 not yet confirmed through business Facilitate partnership discussions between federations planning process. and other local providers to enable more sustainable/ affordable corporate support/ infrastructure - AB/MK - Dec 17 Risk of slow progress in the delivery of the CCG's Five Year Forward View strategy and operational plan due to staff unable to make a connection between their roles and the overarching priorities set out in the operational plan. Senior Management Team Leadership team setting out plan for internal communications with internal and external stakeholders, with a particular focus on directors and their teams Update session on LCNs provided to Heads of team. SMT actions complete. SMT updates Follow up SMT discussion resulting in a short action plan - MK, on-going Series of GB discussions over summer 2017 to take forward the operational plan. This will support a series of directorate level discussions over the same period - MK

2 FM-04 FM-02 FM-01 TP-16 TP-15 / Involvement CCG does not manage to engage fully and sufficiently with a small cohort of GP member practices, thus impacting on fulfilment of CCG's constitutional requirements. Rosemary Watts Strategy Council of Members: Regular meetings discuss CCG business incl. operating plan and budgetary framework, CCG constitution changes, CCG's forward plan and commissioning intentions. New Chair and Deputy chair identified and leading September CoM meeting. Attendance at meetings achieving quorum requirements. 360 Stakeholder Survey 2017: 80% (33) practices responded with satisfactory responses. The results were discussed at the May locality meetings and the June CSC and August GB lunch time meeting. Locality meetings: 10 times a year. Enable practices to raise their issues and take part in key discussions relating to CCG business. Analysis of attendance during 2016/17 was discussed at June CSC meeting so clinical leads can pick up issues of participation with their groups of practices. Engagement Enablers: - Membership Support Scheme: from April 2016 with payments on a quarterly basis with payments for criteria to encourage participation in CCG affairs such as logging on to Members and Staff Zone, attendance at locality meetings and submission of at least 1 quality alert in the quarter. - GP Bulletin and Members and Staff Zone: Bulletin well received and published weekly with a range of information for practices e.g. care pathways, medicines optimisation, workforce development, etc. Promoted at the August Practice Nurse Forum where all nurses present knew how to access the MSZ. It was also promoted at the September Practice Managers' Forum. Engagement agenda within the Quality ate: PLTs, Practice Nurse Forum, GP Forum for salaried GPs Locality meeting minutes and locality reports to CSC Council of Members minutes 360 stakeholder survey results 2017 Report Reports on take up of Membership Support Scheme GP bulletin QSC minutes Continued engagement with practices - RW - Involvement Risk that CCG does not fully comply with its duties under equalities legislation leaving commissioning and procurement decisions at risk of challenge. Rosemary Watts Equality Leadership reporting to CSC and / or IG&P : refreshed and bi-monthly Equality Leadership (ELG) established with refreshed membership and chair. Lay member for Patient and Public Involvement includes Equalities; Clinical Lead for Engagement, Equalities and Early Action identified. Governing Body training completed 7 September. Equality training for staff took place on 17 July Compliance: EDS2 summary report sent to NHS England, EDS2 report and action plan published on the CCG website end March EDS2 areas for have been identified: Talking Therapies in Southwark, EPCS and Continuing Health Care and the NELCSU E&D lead is working with the identified leads around evidence gathering. A November workshop as part of the EDS2 external assurance process is taking place on 28 November. Evidence templates on the chosen areas are being completed for review. Stakeholder event held in December which looked at evidence templates for assurance. Equality Objectives Compliance Report 2017 Equality Leadership minutes IG&P minutes Jan 2017, Evidence templates development and assurance : Equality work programme has been developed and is a standing agenda item on the ELG. Failure to deliver financial targets and financial sustainability compounded by increasing pressure from acute providers financial challenges and 1% non-recurrent reserve frozen nationally Julian Westcott and Robust monitoring and oversight of CCG financial position: Monthly reporting to IG&P, Governing Body (bi-monthly) and to SMT. CCG financial plan approved by CoM and GB. CCG has in place strong internal systems to regularly monitor progress, including monthly reports to IG&P, in depth reviews of finance at the CCG Governing Body and regular updates to SMT. CCG Audit committee reviews the completeness and accuracy of information provided to the GB and is responsible for systems of financial reporting to the Governing Body, including those of budgetary control. Annual systematic internal audit review of financial management takes place as well as regular external monitoring through the NHSE quarterly assurance process. There is an annual financial reporting process which the CCG adheres to and this includes scrutiny sign off of annual accounts by external auditors. CCG Budget Framework approved by CCG Governing Body and Council of Members. Significant risks for the coming year. Risk share arrangements: Partnership working is well-established with monthly CFO meetings in both SEL and across London to address generic financial pressures and opportunities. Acute contracts: GST and KCH contracts signed which limit risks to the CCG. Ongoing work at STP level including all SEL commissioners, NHS provider organisations and Councils to ensure sustainability of the health and social care systems in south east London as reported above. NHSE has indicated 1% reserve to remain frozen. Primary Care budgets: Southwark has a 1.406m (after using 432k from 1% NR reserve) shortfall to be met from overall budget. Agreed to use 216k Primary Care Contingency budget to further mitigate this shortfall. This would leave the shortfall at 1,190k. There is work to identify recurrent solutions to this issue. IGP and GB minutes for assurance CoM assurance - CoM minutes NHS England Assurance CCG Financial Plan and Budgetary Framework Monthly finance reports to IG&P and Governing Body May IGP received updates on financial risks Increasing financial pressures within Council as a result of reduced funding may be adversely affect CCG due to the effect of actions taken within the Council. CCG finance team monitoring issue of financial pressures within Council affecting the CCG - MH - CCG in the process of agreeing final mental health figures - JW/MH - Jan 18 CCG is mitigating primary care gap by the use of reserves - MH Failure to achieve full delivery of QIPP Programme in 2017/18 leads to risk delivery of the CCG financial plan. Julian Westcott and Risk-share on QIPP delivery in place with trusts, which limits CCG risk significantly. Further reserves have been identified to mitigate in-year slippage on QIPP delivery. Effective monitoring of QIPP delivery with risk management. The CCG completes close in-year monitoring through SMT and IG&P to enable early identification of risks, variances and oversight of mitigating action implementation. Specific delivery risks captured in ate Risk Registers. Monthly Reports to IG&P and Governing Body. Monthly minutes of IG&P and Governing Body. Additional stretch target from CEP process of 2.8m. IG&P scrutiny of QIPP targets and GB oversight - MH - monthly Discussions on with governing body on achieving targets - MH previous score 2x4=8 Contracts are now signed; most of CCG's QIPP plans embedded in contracts. CCG is on track to deliver 100% of our QIPP target ( 12.4m). Regional performance monitoring reports to NHSE Formal SLA monitoring process in place, which take place on a monthly basis. Management monitoring of KPIs previous score 2x4=8 CSU : Risk that North East London Support Unit (NEL CSU) does not deliver high quality support to Southwark CCG impacting on discharge of CCG functions. Julian Westcott and CSU services: Completed contract extensions for all CSU provided services (except ICT) to 2018 and agreed new pricing from October 2016 to June 2018 Discussion with NHSE regarding when to issue ITT in 2017, for starts in mid 2018, for Contracting and Business Intelligence. CFO working with the CSU for service improvements. Lambeth and Southwark CCG reps regularly meet with CSU around CCG and GPIT on assurance and this work is being led on our behalf by Jo Steranka. CSU has agreed to a credit of 40K to reflect non-delivery in relation to GP facilitators. IG toolkit audit - significant assurance Quarterly FOI reports and KPIs are satisfactory. Bi-annual SAR reports on CSU being carried out, and results of these reported to Audit committee Issues related to GP practice IT systems support provided by NELCSU Continue monthly monitoring of KPIs and the SLA for services provided by the NELCSU, MH - CCG setting up IT recovery board with CSU and Lambeth CCG to gain assurance on actions related to GP IT systems and support - MH/ JS - Jan 18 2

3 IC-30 21/12/2017 IC-13 FM-07 FM-06 / OHSEL programme governance structure in place, full team in place - Clinical Advisory, Community-based Care (CbC) Working, Capital Finance and Estates. Community based Care workshops are also on-going. Engagement with patients and clinicians is on-going. Continued oversight maintained by CCG Governing Body, Strategy, and Audit committee. Our Healthier South East London (OHSEL) Strategy Programme:Risk that current planning and strategic approach is not sufficiently robust to manage pressures and deliver sustainable financial position in the context of lower levels of growth in the period to 2020/21 Andrew Bland/ and Governing Body Sustainability and Plan: The CCG Five Year Strategy and SEL Five Year Sustainability and Plan (STP) was published in Oct CCG s two year Operating Plan submitted. Work on Sustainability Plan (STP) progressing well, governance structures revised. SE London CCGs and providers have ownership of STP to deliver transformation across boroughs. CCG working with the OHSEL programme to assess the impact of the STP plans to support local delivery. Contracts with KCH, GSTT and SLaM signed. The finance and activity impact of commissioning intentions at CCG and SEL level and has been built into provider contracts. CCG is risk assessing QIPP schemes for 2017/19 including phasing and impact and developing further options for consideration where deliverable. Lambeth and Southwark QIPP working group is meeting to agree acute related implementation plans. Implementation plans are being finalised. Provider Collaborative Productivity workstream underway to support delivery of efficiency savings across SEL. Programme delivery plans are in place to achieve our 2017/18 commissioning intentions and these have been built into our signed contracts. Capped Expenditure Process (CEP): All organisations in SEL are in discussion about how to reduce the risks inherent in their plans and ensure that overall we deliver the control totals for SEL. Discussions are continuing with NHSE and NHSI on further financial plans that have been submitted on 5 June. CCGs are reviewing options for extending QIPP e.g. Treatment Access Policy (TAP), Continuing Health Care. SEL Collaborative QIPP Schemes have been agreed. SROs appointed, project plan in place with governance through the SEL DOC/ CFO groups. GB oversight of STP through Chief Officer's updates Finance and risk reporting to Governing Body at every meeting and IGP reports every month and Financial Framework approved by Council of members M8 financial position further worsened for Bexley CCG ( 7m) affecting the SELwide control total. Risk that other SEL CCGs may not be in a position to contribute to the recovery of the SEL control total Series of deep dives on clinical, estates and digital programmes underway - MH Regular discussions with all CFOs, ICDT, SEL AO to agree mitigations and maximise delivery of control total - MH CCGs required to hold 0.5% NR fund to mitigate health strategies. CCGs have been required to deliver SEL wide control total which has been reflected in the Operating Plan. Failure to implement a new service model in the Dulwich area would delay implementation of CCG's SELwide OHSEL strategic plans and result in additional costs to the CCG such as double running costs and double moves, additional work at business case stage to manage this risk and costly management solutions. Rebecca Scott and structure in place and operating effectively. Dulwich Programme Board meeting monthly, regular updates provided to SMT, and and CCG Governing Body. Programme Board has HealthWatch representation and patient reps from the CCG's Engagement and Patient Experience. Progress on work plan is progressing as scheduled. Dulwich Hospital site identified as location for health centre 'hub'. Subsequently confirmed as a new build through the PID and Site Options Appraisal. Continued close working with CHP, NHSPS and LIFTCo partner on agreeing process and timetable. Project Initiation Document and Site Options Appraisal signed off by NHS England. Close working with NHS Property Services: Close monitoring of progress of the project. Maintaining close working relationships with NHS Property Services. On-going liaison with Project Appraisal Unit (PAU) to brief them on issues in advance of the submission of the business case. Procurement. DH decided that the development will be procured via a Land Retained Agreement through the LIFT programme. LSL LIFTCo appointed, CHP appointed architects project proposal sent to LIFTCo. Design work: Design of the building progressed following a series of workshops involving patients and clinicians. Business case: Stage 1 approved in March 17. Stage 2 Business case submitted on 8 December SMT and Dulwich Project Board monitoring. GB oversight. Overview and Scrutiny oversight. Consultation Institute have assured consultation process and confirmed it follows best practice NHS England approval of PID; and site options appraisal DH approval of procurement method Approval of Stage 2 business case. Awaiting response from NHSE as Stage 2 business case is presented at London and national level NHSE committees in Jan and Feb 18 On-going liaison with NHS PS and PAU CHP (as landlord) - MH/RS Financial closure anticipated for end March RS/MH High numbers of staff vacancies is a risk to sustaining good quality community nursing service impacting on the delivery of care to patients and ability to manage patients in the community reducing the impact on Trust admissions (Also on Lambeth BAF) and Effective governance: CCG works with Lambeth CCG (lead commissioners for GSTT community nursing provider) on performance monitoring through core contract and CQRG meetings. Quality Alert system in place to monitor quality issues. CQRG and contract monitoring: Quality and recruitment of community nursing services (vacancy rate Jan 17 for DN: 25% service 27%) is managed through existing actions including rotating acute service staff through service from both GST and KCH. Carenotes and Single Point of Access (SPA): caused process issues which GSTT has investigated and addressed by implementing actions following a process mapping exercise to understand high call volumes and address how patients can continue to access the service; additional call handling capacity; escalation processes to be shared with GPs for access issues; close monitoring of SPA; cross directorate working to share call volume. Service escalation process for the community nursing service has been drafted and distributed. Community nursing lead and team attended June Locality meeting with constructive outcome. Leads will attend these meetings quarterly. GSTT reported at November Contract Board that 20 posts were in the process of being recruited to across Southwark.The highest level of vacancies remain in Dulwich and Peckham Team (reduced from 34% in July to 29.55% in September). Bermondsey vacancy rate is 18% and Walworth 7% (the lowest across the service). Recruitment. Teams providing cross cover where required. Service average new accepted referrals per month is CQRG and core contract meeting minutes including review of provider recruitment and retention plan monitored at least quarterly. Buurzborg model pilot in the Walworth area in August 2017 Provider Daily Surge reports monitored by CCG Impact on service improvement following recruitment Assurance that Carenotes and SPA working as per specification Utilisation of escalation process Regular short progress updates to be made to GP practices through the locality meetings JY on-going Monitor implementation of actions through the GST Contract meetings to improve service quality including recruitment - JY on-going CCG in the process of agreeing patient outcome measures with GSTT for the District Nursing service which will be overseen by a clinical quality working group during. Q1-Q3 17/18 - JY CCG to raise assurance issue through Contract Board and CQRG meetings at least quarterly- JY - On-going Effective governance: AMH transformation plans approved by Governing Body. Primary Care Development Models being developed via the Serious Mental Illness Development. A monthly service design and delivery group with providers, service users and clinicians to oversee service delivery and on-going service improvement to ensure timely service delivery and to identify and manage risks. Non-delivery of the Adult Mental Health (AMH) Model will place at risk (1) the required independent living and primary care support infrastructure that is needed to reduce inpatient acute beds at SLaM (2017/18 QiPP); and (2) transfer of care support and processes that will enable primary care to deliver the Mental Health agenda. Development s/ CSC Quality assurance: Impact Assessments have been carried out for various areas of the new model of Care. Mental Health Team working closely with the of Quality & Nursing and the 4 borough CQRG group to ensure that there is continuity of care and quality standards are maintained. Implementation: Some schemes fully implemented and schemes around improving community and crisis response such as enhanced Home Treatment (24 hour access) fully implemented since October New service model for primary care liaison and transfers agreed in consultation with GP lead for Mental Health. Following June 17 CSC meeting, proposal under consideration for LIT to support discharge to primary care with fully developed health only model. New delivery model signed off and SLaM staff consultation process has commenced. Robust contracting process: Progress of implementing the AMH model us review at the weekly 4 borough (L/S/L/C) meetings and at the monthly Southwark contract Meeting. Published AMH model Serious Mental Illness Development minutes Adults and Children and Young Peoples' Development s minutes Non-delivery of discharge facilitation function. Commissioners to work with SLaM to develop their community teams so that they can provide greater focus to goal setting, medication management and care planning for people ready for discharge from secondary care - RB - Jan 2018 onwards Joint Mental Health and Wellbeing strategy engagement closed on 11 September. To be presented to Cabinet and GB in January - RB - Jan 18 Strategy - Joint Mental Health and Wellbeing Strategy to be presented to CAB in November, Cabinet and Governing Body in January for sign-off. Successful public engagement undertaken with wide range of feedback from Southwark commuities which will be included in final iteration of document. Well received at two Overview and Scrutiny s during engagement period and detailed feedback received from Health Watch with review meeting taking place on 26th October. 3

4 IC-34 IC-07 IC-06 IC-31 / Risk that the provider does not deliver achievement of IAPT 50% recovery rate in year as well as by end March This will impact on CCG IAF outcome and reputational impact as a result of CCG failing to achieve national constitutional target. and IAPT targets monitoring: At core SLAM contract monitoring meeting and monthly at IGP. Continued close monitoring of service performance because of concerns about required KPI's and targets not being met. This includes monitoring of IAPT data submissions to NHSE and monthly meetings with the provider to discuss performance and service issues. The 50% recovery rate was achieved in March 2017 at 51%, although the rate has been fluctuating since that time. The recovery rate stands at 37.3% for November SLaM has recently changed how recovery is coded within the service which will improve recovery rate totals from January 2018 onwards. Data Reporting: The reasons for the discrepancy between national and locally reported published data had been resolved previously but the issue recurred in July and August One of the agreed actions from the recent NHSI Intensive Support Team (IST) diagnostic review of the service was that there should be centralised data reporting from Business Intelligence at SLaM. Plans for this have now been finalised and from January 2018 data reporting methods will be aligned with NHS Digital, so there will be no discrepancy between national and local data reporting in future IST Review and Recovery Plan: The IST review identified a number of areas which need to be addressed to improve the service offer and ensure that required targets can be consistently achieved. A detailed action plan has now been completed which includes IST report recommendations, and this is on a monthly basis during contract monitoring meetings. The action plan states that compliance with the 50% recovery target will be achieved by February Proposals to review the Southwark IAPT model have been agreed by CSC in relation to its ability to deliver the required recovery rate within the current structure - the Southwark IAPT service supports people with complex needs in Step 4 which is not offered in all IAPT services. SLaM are currently reviewing complex psychological treatment pathways and this review will consider the best way to deliver high intensity step 4 treatments. reports to IGP and IGP minutes SLAM contract monitoring meeting minutes Paper to CSC regarding revised model November recovery rate is 37.3% Capacity in the model to deliver recovery and access Ability of current model to deliver recovery rate and other targets Following national IST review recommendations, SLaM are reviewing complex psychological treatment pathways. The review will include a focus on Step 4 treatments and their impact upon achievement of IAPT recovery rate and other targets. The service review will report through CCG governance structures and return to the CSC for further discussion about the potential impact of changes to the local IAPT model - March 2018 Risk that providers do not deliver contractually agreed trajectories for Referral to Treatment target, specifically delivery of recovery plan by March Effect would be longer waiting times for patients, and reputational impact as a consequence of failing to meet NHS Constitutional Standards. / / ICDT and Recovery Plan monitoring: RTT recovery plans included in KCH and GSTT contracts for 2017/18 and are being discussed with KCH, NHSI and NHSE through the Oversight fortnightly. Further focus created through CCG & the Contracting and Delivery Team (ICDT) to increase understanding of gaps in assurance - ICDT members are attending internal trust-wide performance improvement meetings. Formal feedback received by KCH following the NHSI investigation into RTT, a condition of this outcome was KCH needed to have a fully integrated recovery plan for RTT. Support to the trust from NHSI has been given with an RTT Improvement working at the trust 2 days/week. Data Validation: Post MBI report, KCH have developed and implemented a data validation programme for areas identified by the MBI report, which the CCG monitors through the ICDT. Outsourcing: GSTT commenced ENT outsourcing to Concordia in January 2017, and Orthopaedics is expected to begin outsourcing to BMI once contracts have been agreed. The ICDT is working with KCH to identify further opportunities to outsource activity. Insourcing: ICDT working with KCH to increase outpatient and day case capacity. Services currently being insourced are outpatient appointments and day cases for Ophthalmology, Dermatology, and General Surgery. Planned Care Workstream The Team worked with local stakeholders to develop an incentivised GP peer review scheme, which was approved by IGP and rolled out in October. A number of GP practices have signed up to participate and the impact of the scheme will be monitored on a quarterly basis. Southwark, Lambeth and Bromley CCGs rolled out Consultant Connect on 16th October, a telephone advice and guidance service that will allow GPs to seek advice from a local specialty consultant in real time. Numerous communications have been circulated to GPs and practices publicising the service. Dedicated referral optimisation workstream has been established to help maximise gains across the system and ensure a common approach. A single point of referral (SPoR) business case for Ophthalmology and Dermatology has been approved by IGP and procurement is progressing. Ophthalmology SPoR contract awarded on 7 November - contract mobilisation under way. NHS Improvement enhanced performance management framework Contract monitoring meetings Monthly performance reports to IG&P and GB Oversight minutes and actions Planned Care Programme Board which reviews progress on referral optimisation work ICDT attend provider internal performance meetings. On-going requirement to validate >18 week waiters Recovery plans complex and multifactorial. Financial stability and sustainability of KCH Demand increases above population growth Insufficient capacity to implement plan Planned capacity is being diverted to cope with urgent and emergency care pressures. Impact of suspension of the Community Dermatology service on acute demand. Proposals for additional resource to support referral optimisation from NHSE provisionally approved with implementation plan currently being developed - ICDT/DS - Jan 18 Working with NHSE to explore further outsourcing opportunities - on-going- ICDT/DS Dermatology procurement completed and signed off by GB, we are currently in standstill period of contract award - on-going - DS/ team Risk that providers do not deliver contractually agreed trajectories for A&E NHS constitutional standards, specifically delivery of recovery plan to meet A&E 4 hour waiting time targets by March Effect would be longer waiting times for patients, possible clinical risk to patient safety and reputational impact as a consequence of failing to meet NHS Constitutional Standards / Kerry Lipsitz and ICDT and Contractual agreements: Trajectories for delivery of NHS constitution standards agreed with providers in 2017/18 and supplied to NHSE and NHSI. Trajectories reflect distance from national target and set improvement expectations across the coming year, whilst also reflecting the delivery of estates and transformation programmes at both GSTT and KCH. Additional non-elective activity commissioned as part of the contracting round. Resilience allocations authorised to support providers across the system to reduce pressure at ED with oversight by the A&E Delivery Board. A&E Recovery Plan: Both GSTT and KCH have extensive recovery plans which detail, by month, the improvements expected and detailed action plans to ensure delivery. These plans are scrutinised on a weekly basis through 'Here and Now' groups and Emergency Care Boards. management: Comprehensive approach to performance management with partner organisations including NHSE and NHSI and through the Oversight, acute contract monitoring and overseen by CCG IG&P and Governing Body. Detailed reports, plans and briefings shared with Governing Body members and included in monthly performance reports. CO attends NHSI's monthly escalation meetings with Lambeth CCG and Bromley CCG Chief Officers and NHSE for assurance on recovery plan. Lambeth and Southwark and SE London Discharge to Assess and Trusted Assessor workstreams - new for 17/18 these workstreams aim to reduce the volume of patients having assessments for CHC, community or social care in hospital in order to maximise rehab potential and to reduce bed occupancy and delayed transfers of care at acute providers. Workstreams established with impact expected from October onwards. Winter Monies and Plans - Through Lambeth and Southwark A&E Delivery Board, winter monies have been allocated to all system partners to improve resilience for the winter period. Providers and commissioners agreed that monies would be top sliced to ensure there is adequate funding available to support Discharge to Assess and Trusted Assessors workstreams which aim to significantly reduce the number of patients waiting in hospital for assessments. Winter plans submitted to NHSE; escalation meetings on-going with NHSE/NHSI and Secretary of State to be held. NHS England enhanced performance management framework with weekly oversight CCG hold weekly Thursday and Friday call with KCH and Surge Hub for weekend planning and assurance. KCH & GSTT reporting on progress with programme and ECIP recommendations IGP and GB performance reports. KCH & GSTT CQRG and contract monitoring meetings. Oversight minutes and actions A&E Delivery board minutes Estates plans for both GSTT and KCH are subject to slippage with negative impact. Workforce issues delay the opening of estates or cause operational difficulties Recovery plans for both GSTT and KCH are highly complex thus are subject to delay or revision CCG involved in process improvement to improve flow and capacity through patient choice protocols and patient discharge - KMB, on-going Co-ordinating actions and supporting trusts to reduce DTOCs and delays in discharging patients who are medically fit - KMB - on-going Work on-going with both Trusts to review recovery plans and examine options for further mitigations. - KL/AB/SC - on-going Work being undertaken on MH breaches by SLaM, KCH and CCG - Work on-going with The Hurley and KCH around filling gaps in GP rotas and issuing honorary contracts to improve shift cover - Set up new winter scheme with The Corner Surgery for KCH to redirect non-urgent patients with primary care needs away from the department - Risk that providers do not deliver contractually agreed trajectories for 62 day target for urgent cancer referrals / / ICDT and review: Cancer 62 day South East London Leadership meetings in place to address SEL wide issues - SRO is Lambeth Chief Officer. structure in place across the three trusts to oversee shared breaches, pathway delays and delayed transfers. SEL Cancer Network established and led by the Accountable Cancer Network - developing and implementing tumour level pathways across SEL. SEL wide cancer recovery plan - The 2017/18 plan includes transformation bid actions, diagnostic bid actions and new actions from internal trust plans. Plan was and updated for the October NHSE review meeting. SEL has now signed up to the updated return to trajectory by March Cancer diagnostic fund - SEL made 4 successful bids around additional training and point of care testing - implementation and monitoring will be undertaken through the Accountable Cancer Network and the 62 days review group. fund - SEL transformation funding has been agreed - Q1 funding has been issued, however we are still awaiting release of Q2 funding. Following the transformation fund bid there have been two further opportunities for SEL to bid for additional diagnostic funding. Funding was secured in the first bid with funds released in September. Funding has now been secured from a second bid with funds released in November. SEL has agreed to locally fund additional diagnostic outsourcing with 1m in total being provided by the three SEL trusts and Lambeth and Southwark CCGs. Additonal outsourcing began for CT and MRI at LGT and KCH in late November/early December The system is negotiations with private providers for endoscopy outsourcing which is expected to begin January Macmillan GP - Recruited to support the GP clinical lead in Southwark improve quality and efficiency of cancer care. Shared pathway review groups - Bilateral meetings were held between GSTT/ LGT and GSTT/KCH. The meeting the new agreed final shared pathways. Following review, a number of shared care actions were produced which are being taken forward through a weekly task and finish group. Assurance meetings with NHSE SEL Leadership minutes for oversight role IGP reporting SEL wide Cancer Recovery Plan Primary care led Cancer Locality meetings - oversees quality and primary care actions Impact of unplanned admissions on planned cancer procedures. Avoidable breaches are occurring. Patients on inter trust pathways referred late. Patient choice delays Late referrals from outside SEL Diagnostic capacity - Long term Implementation of the improvement plan with the oversight at the SEL Leadership - ICDT - on-going Improve uptake of new 2 week wait referral forms and supporting information - national audit. Forms have been updated to include reference to e-rs - Perf/ National team - on-going We are working with CCGs to ensure full utilisation of e-rs for cancer 2 week wait referrals. We are communicating this to GPs through the planned care newsletter, GP bulletin and practice visits - Mar team Diagnostic Capacity Review - The Accountable Cancer Network (ACN) is producing a SEL wide diagnostic review paper focusing on imaging and endoscopy. This paper will review demand and capacity and outline medium to long term options. Upon completion we will take forward the recommendations of the review- on-going - ICDT

5 IC-49 21/12/2017 IC-45 IC- 43 IC /12/2017 Risk that adverse CQC inspection outcomes for general practices in Southwark will negatively impact on quality of care provided to the registered populations. / Primary Care The outcome of the CQC inspection process has resulted in: 9 practices being rated as being inadequate and going into special measures of which - 2 practices have now closed - 3 practices are under caretaking arrangements - 1 with significant clinical risks being investigated. - 1 has had their rating improved and are no longer in special measures as a result of support from the CCG, NHSE, GP federation and GPFV-funded support - 1 practice remains in special measures, but has received support from the CCG, NHS England, GP federation and GPFV-funded support. - 2 recently rated as inadequate: Forest Hill practice previously rated as requires improvement, and Trafalgar Surgery following their first visit - all have received contractual action 5 are rated as requires improvement: - all of these practices have been followed up with support from the CCG teams and LMC, where requested - 1 of these have received contractual action, 1 of these notifications are outstanding To recognise the additional workload of 2 recent list dispersals in the same area of North Southwark, the CCG has identified and provided additional funding for practices taking on a significant number of patients in a short period for the additional admin and clinical health check work. This is in addition to the funding practices receive for taking on new registered patients from the national contract formula allocation. minutes Primary Care minutes Sustainability of improvements made after intensive support in 6 months and onwards Full report on specific risks in 1 caretaking practice awaited in partnership with NHS England. Primary Care team reviews status of practices and improvement actions on a weekly basis - JY on-going Primary Care receive updates on progress against contractual actions and CQC status changes - bimonthly JY CCG to monitor GPFV resilience plan against agreed funding - JY monthly Securing high quality GP service sites has also been a challenge as a result of practice changes where these have been owned by the contract holder and continues to be a high priority for the CCG in the short and long term. This is linked to the estates strategy. CCG, with input for GP federations, have endorsed 6 prioritised practices for resilience funding using London set criteria. The CCG is continues to work with these practices and has agreed their resiliance plan and funding which will be paid against a signed Memoradum of Understanding between each practice and the CCG. LAS recruitment: Target staffing; however this is an on-going challenge due to turnover. Risk that London Ambulance Service (LAS) does not achieve performance trajectories for response rates or hospital handover for Southwark residents by March 2018 and does not deliver improvements required based on CQC inspection outcomes. Kerry Lipsitz and Centralised commissioning arrangements. Led by North West London Alliance on behalf of London CCGs to enable a single commissioner voice. London-wide Strategic Board in place chaired by the CO of Brent CCG. Joint approach with NHS England. London Chief Officers' meeting that Southwark CCG leads for SEL has agreed an STP approach to LAS commissioning. Emergency Pathway Board at KCH: attended by CCG representatives where hospital handovers are discussed. New working practices implemented & will be continually monitored to ensure performance improvement is maintained. of action plans: LAS CQC action plan at each CQRG meeting; CCG representatives incl. Southwark attend these meetings to seek assurance. CQC reinspection on 30/6/17: Significant improvements made in the 5 inspected areas and the service moved up a rating to 'requires improvement' overall. Quality improvement: Quality Report at each CQRG. Southwark CCG participated in a Quality Working to design and negotiate LAS CQUINs and the 17/18 Quality Schedule, it is expected that this group will continue for 18/19. Focus is upon non-conveyance to incentivise hear and treat, see and treat rather than automatic transfers to hospital. Focus on demand management schemes at London level. Ambulance Response Programme (ARP) - From November 2017, the service will implement this pilot providing LAS extra time on a call to better understand the condition of a patient before dispatch. This will also modify performance targets that the LAS work to. Demand Management - SEL wide Demand Management formed to identify and implement opportunities to reduce demand on the LAS and implement: Hear and treat - LAS will be working to increase hear and treat activity by 2%. Technology - LAS will be improving access to technology, e.g. provision of tablets for LAS ground crews to help them identify potential alternative pathways. Alternative care pathways (ACPs) - The service is looking at increasing the use of ACPs across London. London Strategic Board oversight. NHSE tripartite oversight review at IGP CQRG minutes NW London commissioning team performance review processes SEL wide LAS demand management group Quality Working minutes London wide significant quality and financial pressures High staff turnover On-going increase in demand, if above 9% targets are unlikely to be achieved. Alternative Care Pathways usage does not improve. Description of specific risks on King's handover times and demand management A&E delivery boards working with SEL wide LAS demand management group to implement demand management actions to ensure 9% growth target is met. We will be focusing on these key areas; ACPs, HCPs, high frequency users, care homes, IUC, hospital handovers - on-going - KL KCH developing improvement plans around improving ambulance handover times to improvement performance - on-going Risk that workforce, workload, financial and infrastructure pressures threaten sustainability of GP practices in Southwark thus impacting on the delivery of GP primary care services including access, quality of care and patient experience. This will result in reduced quality outcomes for Southwark general practices which will continue to remain the lowest in south east London and London wide benchmarks. Primary Care CCG monitors GP practice quality through Quality Assurance Framework incl. monitoring against SEL and similar boroughs in London (statistical neighbours). CCG supported federations submit provider resilience plan for practices to access funding and support to improve and sustain local General Practice as per the General Practice Forward View. The CCG support provided as below: Workforce: Investment and guidance, Enabling training practices to be set up; Supporting recruitment processes; Development of pre-reg nurse placements and mentoring; Supporting different ways of working i.e. primary care pharmacist. Workforce access, specifically nursing, is included in prim. care commissioning intentions. Supporting federations to develop nurse leadership to lead and retain workforce. Supporting the establishment of Local care networks (partnership working). Starting to develop a primary and community care service for wound management to maximise resources. Care redesign: Supporting practice mergers (e.g. Nexus); GP Federations established, infrastructure funding for at scale working, leadership development; Extended Primary Care Services commissioning and development; Estates and Technology Fund (ETTF) bids to test apps which support patients with self care and alternative access; Local Care Networks establishment and support, of which GP Federations are part of. Practice Infrastructure: ETTF applications to fund estates development and premises improvement; Testing new consultation methods (telephone/econsultation/skype); Funding virtual Community of Interest Network (CoIN) for practice mergers; practice Wi-Fi. Securing support for key worker homes to attract workers into the area. Workload: Supporting practices access transformation funds to increase investment in general practice and support sustainability & transformation; Developing locality resilience plans with GP federation including immediate and long term support; Local Care Record (LCR) implementation by CCG enables direct access to patient results and information within the GP practices. Primary Care oversight and minutes Local delivery of London Strategic/CBC Framework to delivery accessible, coordinated and proactive care in progress STP funding and delivery Potential access to support for practice mergers Impact of practices working at scale Practices investing in good quality workforce that is sustainable CCG working with federations to develop different work force models including practice based pharmacists MK on-going CCG working with federations to develop training practices, nurse mentors and placements for pre reg nurse KMB on-going Roll out of GP Forward View (GPFV) resilience funding. Focus on ensuring the resilience funding plan is delivered JY on-going : CCG's GP practice commissioning incentives aim to simplify the primary care incentive and payment structure enabling practices' stronger focus on lower number of incentives in line with our published FYFV. This will be focused on improved access, prevention and coordinated care. Completed successful negotiation of the PMS premium in May Final contract offer distributed to practices in June. Premium offer made to APMS and GMS practices seeks to reduce unwarranted variation and incentivising continuous quality improvement through sustainable GP practices for the benefit of the local population. Risk that budget reductions in adult social care impact disproportionately on key hospital discharge, reablement and intermediate care services, adding additional pressures to acute bed capacity. Council facing year-on year cuts. and : Partnership arrangements in place to promote joint working and designed to help to ensure there is a transparent discussion about funding decisions that have a whole system impact, enabling joint plans to be made to mitigate the impact of budget reductions wherever possible. This includes the Adults Development, the Joint Strategy, the Partnership Team and the Health and Wellbeing Board. Better Care Fund (BCF): Key social services substantially funded through the BCF. arrangements in place to ensure that the delivery of services is in accordance with plan, incl. quarterly monitoring by Health and Social Care Partnership Board (HSCPB) and monthly monitoring of key BCF measures, in particular Delayed Transfers of Care (DToC). Any proposal by the council to reduce services funded by the Better Care Fund would need the CCG to agree changes to the Section 75 agreement. BCF includes the additional funding announced in the spring budget for social care in the form of the Improved BCF grant which provides an extra 7.2m for Southwark which will be applied to home care and nursing home care cost pressures and reduces the need for budget reductions by that amount. The CCG will be seeking to work with the council to ensure this has maximum impact in order to mitigate the social care savings risk. DToC monthly reporting and other BCF and ibcf metrics. DToC targets comfortably met, including for the key September 2017 milestone target on which good performance reduces the risk of future ibcf reductions. Finance discussions: Areas of joint working to mitigate potential impact of cuts identified by CCG for discussion with council. Concerns raised at senior leadership meeting with council and high level joint working group set up to consider the "Southwark ", and the Planning (IDPG). Specific discussions being formally held on high risk savings areas, for example Community Equipment Stores (ICES) on which an agreement has been reached. JCSC in November had further discussion on finances. Further follow on work to look at understanding impact and possible mitigation, and improving joint approach in future to reduce unilateral budget decisions in areas of joint concern. Winter pressure funding allocated and complements BCF funding to maintain discharge performance and deliver the High Impact Change model. Joint governance arrangements including Adults Development, the Joint Strategy, the joint Partnership Team and the Health and Wellbeing Board terms of reference. Section 75 agreement agreed. H&SCPB BCF monitoring reports and minutes BCF and ibcf approved DToC targets met to October. BCF Evaluation panel in December provided assurance investments is in the right services for 2018/19 and identified scope for further improvements in the way services work together. No clear plan on implementation and mitigation of all aspects of budget shortfall. Progress needs to be made in ensuring joint discussions on key budget reductions happen at an appropriate stage in the budget process of each organisation. Lack of clarity about 2019/20 and beyond when the BCF is due to end and public health grant funding arrangements change. Ensuring full implementation and monitoring of BCF plan including the High Impact Change plan and proposed investment of ibcf to support social care - GB - Budget discussions - CG High level Planning (IDPG) including lead council members to explore whole system strategy including savings - MK - Work on planning for 2019/20 risks to be undertaken through BCF Planning, and Health and Social Care Partnership Board - GB - Jun 18 5