A meeting of the Governing Body of NHS Bromley Clinical Commissioning Group 26 November 2015

Transcription

1 South East London Sector A meeting of the Governing Body of NHS Bromley Clinical Commissioning Group 26 November 2015 ENCLOSURE 6 HEALTHY LONDON PARTNERSHIP SUMMARY: The enclosed is a paper from the interim London Transformation Group (LTG) as part of the Healthy London Partnership (LHP), which asks all CCGs to discuss the proposals set out in the paper. KEY ISSUES: The Better Health for London report by the London Health Commission identified the goal of transforming London into the world s healthiest major global city. In order to deliver this, London CCGs and NHS England (London) agreed to a pan London transformation plan under the umbrella of the Healthy London Partnership. Significant stakeholder engagement took place in the creation of the plan. This was then filtered down into 13 programmes to address transformation priority areas and agreed by London CCGs. The long term aims of the Healthy London Partnership were considered by the Interim London Transformation Group on the 29 July 2015 and by the Chief Officers and Chairs on the 17 September It was agreed that the enclosed paper would be sent to CCGs and they would consider by November 2015 the following proposals at their Governing Body: Progress to date in the Healthy London Partnership Proposal for ongoing commitment to Healthy London Partnership, the proposed planning process and timetable for 2016/17 and the planning assumptions The proposed ongoing governance arrangements. Any future proposals developed by the Healthy London Partnership will be brought to the Governing Body for approval. COMMITTEE INVOLVEMENT: The Interim London Transformation Group have agreed that this paper should be sent to all GGCs Clinical Chair: Dr Andrew Parson 1 Chief Officer: Dr Angela Bhan

2 RECOMMENDATIONS: The Governing Body is asked to:- Note the progress to date of the Healthy London Partnership. Agree to support longer term commitment to the Healthy London Partnership for 2016/17. Agree the proposed planning process and financial planning for 2016/17 and 2017/18 Agree proposed ongoing governance arrangements. DIRECTORS CONTACT: Name: Angela Bhan AUTHOR CONTACT: Name: Saimah Tahir Clinical Chair: Dr Andrew Parson 2 Chief Officer: Dr Angela Bhan

3 Healthy London Partnership Healthy London Partnership beyond 15/16 Executive Summary This is a paper from the London Transformation Group. Healthy London Partnership has now been in operation since May 2015 and as programmes progress in line with the agreed plans by CCGs and NHS England (London), the London Transformation Group has asked that longer term commitment for 2016/17 and 2017/18 and planning be considered by accountable organisations. The Interim London Transformation Group on 29 July 2015 agreed that a paper be considered by CCGs and NHS England (London) in October/November 2015 outlining: Progress to date in the Healthy London Partnership Proposals for ongoing commitment to Healthy London Partnership, the proposed planning process and timetables for 2016/17 and the planning assumption The proposed ongoing governance arrangements CCG governing bodies and NHS England (London) are asked to consider the proposals set out in this paper. This paper is the final draft proposed to CCG and NHS England (London) for consideration by CCG Chief Officers and Chairs. Payments and Funding Group, Chief Finance Officers and London Transformation Group have reviewed and endorsed this paper. Please see information about the review round below. It should be noted that SPGs and CCGs are able to localise or align this paper to their own strategies as appropriate and also consider the paper without taking to full governing body meetings in line with local governance arrangements. Information about the review round Date Forum Outcome 07 Sept 2015 Chief Finance Officers Group Endorsed the paper and proposed a two year commitment to P&F Group 07 Sept 2015 Payments and Funding Group Signed off the paper and recommended a two year commitment for LTG to consider 08 Sept 2015 London Transformation Group Signed off the paper and approved the recommendation around a two year commitment Healthy London Partnership Transforming London s health and care together 1

4 17 Sept 2015 CCG Chief Officers and Chairs meeting The paper was approved including recommendation for two year commitment for 2016/17 and 2017/18 Oct/Nov 2015 Final paper considered by CCG governing bodies (or committees where appropriate) and NHS England (London) 2

5 1. Introduction and background When the London Health Commission launched its report Better Health for London in October 2014 it had one overarching and simple goal: transform London into the world s healthiest major global city. The ten accompanying aspirations for London defined where progress, particularly long-term progress, needed to be made with agreed action to achieve these aspirations agreed across CCGs, NHS England (London), GLA, London Councils and PHE. Both the NHS Five Year Forward View and Better Health for London recognised the extensive work involved in bringing about sustainable and real change in the health and care system and particularly the time required in order to embed that change. It was against the back drop of these two major strategy documents that London s CCGs and NHS England (London) agreed to jointly support the development of pan-london transformation programmes under the auspices of Healthy London Partnership to support London wide and local transformation. Significant engagement with a large number of stakeholders across the health and care system took place to develop plans and ensure that the 13 programmes were addressing priority transformation areas and needs; programmes are shown in the figure below. Joint CCG and NHS England (London) senior responsible officers (SROs) for each programme, supported by a small programme team, then developed plans to align activity to local transformation and determine the resources required for 2015/16. These plans then formed the basis of a paper taken to CCG Governing Bodies or appropriate during Spring 2015, which asked Governing Bodies to: Agree the thirteen priority programmes Agree interim London-wide programme governance arrangements, recognising that further proposals would be brought back to CCGs with regard to final governance arrangements 3

6 Agree the proposed maximum CCG transformation funding contribution of 0.15% of allocations for 2015/16, in addition to the NHS England contribution Agree the next steps for programme and resource development. Longer term commitment to Healthy London Partnership (HLP) was considered by the Interim London Transformation Group on 29 July 2015 and by CCG Chief Officers and Chairs on 17 September 2015 as well as ongoing governance arrangements and it was agreed that a paper be considered by CCGs and NHS England (London) in October/November 2015 outlining: Progress to date in the Healthy London Partnership Proposals for ongoing commitment to Healthy London Partnership, the proposed planning process and timetables for 2016/17 and the planning assumption The proposed ongoing governance arrangements. CCG governing bodies and NHS England (London) are asked to consider the proposals set out in this paper. 2. Progress to date Since the launch of the Collaborative Transformation Programme Prospectus in March 2015 the Healthy London Partnership has established itself in line with the agreed operating model and mobilising the thirteen collaborative programmes. In mobilising the programmes, extensive engagement with CCGs and SPGs has taken place to ensure alignment of programmes across the commissioning system. Feedback was clear that pan-london activity should build on local work and demonstrate value; HLP programme leads therefore tested scope, deliverables and timelines with their respective CCG and SPG leads and revised where necessary. Robust governance arrangements have been put in place across programmes with wide representation across the health and social care system. The Payments and Funding Group has been established to set up and manage the financial flows and governance around the transformation fund and the Interim London Transformation Group established to provide strategic direction and to oversee programme delivery. The benefit of working collaboratively has already been evident through relationships with other pan-london organisations and stakeholders such as maintaining strong links and visibility of NHS transformation priorities with the Greater London Authority, Public Health England, London Councils and the London Health Board chaired by the Mayor. This has enabled influence over national and regional policy direction, such as, the Estates programme influencing national policy on the allocation of the Primary Care Infrastructure Fund. The benefit of working collaboratively has also been evident through securing a number of other financial contributions to programmes totalling around 1.3m. A full progress report is shared with CCGs quarterly detailing progress which supplements the monthly progress reports for Interim London Transformation Group that are shared widely and the enews that provides updates to stakeholders every fortnight. The quarterly progress report to date has been included as Appendix 3, the next report is being published at the One year on event in October. Progress highlights include: 4

7 London s hospital charities are working collaboratively with Healthy London Partnership to explore opportunities to implement evidence-based interventions to improve workplace health. Agreement to conduct a pilot of community health promotion and improvement involving one of London s great assets London s professional football clubs to promote health in novel settings and via new channels with London United providing over 100k funding in addition to staff, technical and communications resources. The Cancer programme has received 0.75 million of funding from Cancer Research UK to support our transformation work in London. 30,000 of additional funding from Public Health England (PHE) has been secured to run six expert working groups to inform the commissioning model for Health Services for Homeless People. Five Urgent and Emergency Care networks across London have been agreed to oversee the planning and delivery of the transformation of the U&EC system in London and 160k network development funding secured. Match funding of 300K from NHS England and NHS 111 National Futures Board to support the 111 Cloud Patient Relationship Manager (system to enhance personalisation and resilience and provide access to crisis care records) project. Consistent standards for cancer care of children and young people in London have been agreed and a community pharmacy public health campaign is underway to raise awareness of asthma in children and young people. To support implementation of the primary care strategic commissioning framework an event was held for providers to support overcoming the challenges of working together at scale and sharing innovations. Feedback was positive and discussions from the event will be used to shape further provider support activities going forward, with the next in the series of events lined up on access to be delivered in September. The value that will be delivered to local CCGs as a result of adopting a pan-london approach against key deliverables is mapped in Appendix 1 and further details progress or completion of deliverables. Appendix 2 then demonstrates how Healthy London Partnership deliverables support local transformation delivery; what this change will mean for patients, the workforce and the system; and the benefits this will achieve. 3. Commitment beyond 15/16 Investment in the transformation fund to support our agreed HLP transformation activities - those activities that have been agreed would benefit from scale and/or consistency at a London level - reflect that the vast majority of the activity associated with transformation investment would be undertaken at CCG and SPG level. A much smaller amount was proposed for pan-london work in support of local activities and priorities. In establishing the portfolio of programmes recruitment to NHS fixed term and secondment positions identified in the programme plans has been undertaken with some success and this has been supplemented with interim resources secured through agencies and consultancy. The operating model agreed was to have a blended team of NHS employees together with interim 5

8 staff working collaboratively to maximise flexibility and manage liability risks and with longer term commitment make better use of resources; in line with the operating model, on 29 July 2015 the Interim London Transformation Group approved the Healthy London Partnership proceeding with substantive recruitment to improve value and in recognition that liability risks were outweighed by the costs of alternative interim staffing solutions and these potential liability costs would be minimal due to redeployment opportunities across the commissioning system. At the same time the Interim London Transformation Group highlighted the need to seek commitment from CCGs and NHS England (London) for 2 years beyond 2015/16 in recognition that many programmes were established as longer term three to five year programmes and need to keep pace; however, as programmes progress, their planning horizon is currently limited to March For example, the primary care programme want to launch a programme of support for providers up to and beyond March 2016 to support delivery of the vision set out in the Primary Care Strategic Commissioning Framework. The team have also been supporting CCGs as they move to new co-commissioning arrangements; a new wave of this will occur in April 2016 and therefore it would be beneficial if the team were able to provide support in the months following that transition. The Integrated Urgent Care and NHS 111 programme is another example of where the current planning horizon needs to extend beyond March A business case was recently supported to develop a 111 Patient Relationship Manager which will enable the retrieval of previously agreed crisis care information, care plans (including end of life plans) and Special Patient Notes from multiple provider systems to front line clinicians in real time. The pilot is planned to mobilise in October 2015 with each London 111 provider and the cloud integration provider contracted from September 2015 to April 2016 to support the new system. Commitment beyond March 2016 will ensure a full evaluation of patient, service and system impact is undertaken to inform all future procurement specifications for the new Integrated Urgent Care Service (NHS 111, GPOOH and UCCs). 3.1 Proposed planning process and timetable for 2016/17 Healthy London Partnership was agreed to be a rolling annual agreement subject to review as part of the annual business planning round. As such, Healthy London Partnership will undertake a robust planning process, reviewing priorities and programmes, agreeing programme deliverables beyond 2015/16, and indicating the required resources beyond for 2016/17. A financial planning assumption based on a maximum of 0.15% for 2016/17 and 2017/18 (in line with that for 2015/16) is proposed for CCGs and for NHS England (London) the planning assumption for 2016/17 and 2017/18 based on a maximum of 1.3m is proposed. The planning process for 2015/16, led by CCG Chief Officers, followed a six step process to define the future transformation requirements for London and extensive engagement took place during developments. The principles agreed this year will be applied again for 2016/17 and 2017/18 planning to ensure only activities that would add value to be developed once for London and facilitate local transformation are agreed; programme governance infrastructure now in place will be asked to consider and agree proposed plans. An annual review in the autumn of 2016 is assumed for year 2017/18. Engagement with CCG and SPG leads will continue throughout the process and align with their own planning processes and timetables. The planning process will also be broadened to incorporate Strategic Clinical Network and Academic Health Science Network planning to ensure 6

9 alignment is maximised to deliver against agreed London priorities and to minimise duplication across the system. The outline timetable for key milestones in the planning process is as follows: Key milestones in the programme planning process SROs for current programmes draft plans for 16/17 and discuss with Programme Boards Date During Sept - Oct 15 Principles and approach agreed by London Transformation Group 8 th Sept 15 Share reflections, agree principles and identify additional candidate programmes at SRO meeting Agree principles, identify additional candidate programmes & owners at CCG Chief officers meeting 17 th Sept th Sept 15 Commence initial scoping of new candidate programmes During Oct 15 Agree long list of programmes and agree prioritisation approach at London Transformation Group 22 nd Oct 15 Review programme plans at CCG Chief officers meeting 19 th Nov 15 Prioritised programmes signed off by London Transformation Group 10 th Dec 15 Programme plans submitted to CCG governing bodies and NHS England From end of Dec The output of the planning process will demonstrate how further progress will be made in supporting the achievement of London s clear vision and the robust, collaborative plan for whole system transformation across the NHS and beyond. It is proposed that a paper detailing proposed activity for 2016/17 is taken to CCG governing bodies in January and February 2016 for agreement, following endorsement by ILTG. CCG Governing Bodies and NHS England (London) are asked to agree the proposed planning process and timetable for 2016/17 and agree the recommended financial planning assumption 4. Ongoing governance arrangements As agreed by CCG governing bodies in March 2015 the Interim London Transformation Group was given the remit to make recommendations to accountable organisations (CCGs and NHS England) on final ongoing governance arrangements. For each collaborative transformation programme a programme board has now been established, co-chaired by the joint programme SROs CCG Chief Officer and NHS England (London) Director. Informing programme boards are clinical and working groups, where appropriate. Principles for programme governance were established by the Interim London Transformation Group to support SROs and ensure adequate engagement across the system 7

10 and as such representation on programme governance includes patients, local government, Trust Development Authority, Monitor, Health Education England, Public Health England, and Greater London Authority. At a programme portfolio level the Payments and Funding Group has been established to ensure robust pan-london governance of the CCG and NHS England transformation fund, provide technical oversight to the management of the fund and hold programme SROs to account for delivery of programmes within the agreed financial envelope. Membership ensures geographical CCG and NHS England (London) representation including Chief Finance Officers and an audit/lay member. The Interim London Transformation Group was established with representation from NHS commissioners and with the remit outlined on page three as agreed with CCG Governing Bodies in March 2015; the group has now considered its ongoing role and membership. The ongoing role of the London Transformation Group is proposed as follows: Make recommendations to accountable organisations on collaborative transformation priorities and proposed resources Ensure strategic alignment between Strategic Clinical Networks, Academic Health Science Networks and collaborative transformation programmes Provide strategic direction to programmes Hold programme SROs to account for delivery of agreed programmes Take decisions on recommendations from the London Payments and Funding Group regarding transformation programme funding and priorities within the financial resources agreed by accountable organisations When considering membership the group agreed that to enable effective decision-making membership should remain as accountable bodies and funders only with the addition of a patient and public representative member. The group recognised that whilst meetings should be kept to a minimum there was a need to ensure robust governance and engagement and reflected there was a need to provide an opportunity for wider involvement of a range of stakeholders across health and social care to reflect the multi-agency approach required to enable whole system change; it was therefore agreed to establish an improvement collaborative forum to support discussions with partners including local government, NHS Improvement (previously Monitor and the Trust Development Authority), Health Education England, Public Health England, Academic Health Science Networks and Greater London Authority. In addition, a clinical oversight group is proposed to be established to complement governance for the portfolio of collaborative transformation programmes. This group would ensure the integrity of clinical commissioning is maintained and provide clinical advice and support to the Healthy London Partnership and all programmes ensuring clinically sustainable and coherent whole system transformation is delivered. Proposed ongoing governance arrangements are shown in the figure below. 8

11 Full terms of reference for each group are included as Appendix 4. CCG Governing Bodies are asked to agree the proposed ongoing governance arrangements 5. Summary of ask CCG Governing Bodies and NHS England (London) are asked to: Note the progress to date of the Healthy London Partnership Agree to support longer term commitment to the Healthy London Partnership for 2016/17 and 2017/18 Agree the proposed planning process and the financial planning assumption for 2016/17 and 2017/18 Agree proposed ongoing governance arrangements 9

12 Appendix 1. Deliverables tracker There are four main types of value that will be delivered to local CCGs as a result of adopting a pan-london approach. A sample of the 13 HLP Programmes deliverables is mapped against these in the tables that follow. Create access to learning, innovation and best practice from across the system All Healthy London Partnership programmes are consulting with a wide range of clinicians, stakeholders, academic subject experts and using evidencebased research in order to gather and disseminate local, national and international best practice. This will be made available to support local delivery through involvement in the governance of the HLP programmes and programmes investing in engagement with local health economies. In addition many programmes are putting in place and facilitating system wide events, innovation groups and innovation forums (e.g. through the MyHealthLondon website, the Primary Care Innovation Group & Network) that provide local clinicians with access to a repository of information and a network of colleagues who can provide support. Developing standards and providing developmental support to the implementation of new models of care HLP programmes are reviewing evidence examining how health care can best be delivered to ensure the most successful outcomes for patients. To do this they are revising and devising enhanced models of care, care pathways and standards, and defining best-practice in provision. The outputs of this work will provide commissioners with guidance on the models, pathways and standards that can raise the bar of provider quality across London and provide a consistent high quality patient offer. Pan- London standards can also act as benchmarks for providers. In addition many programmes are investing in organisational development support where significant organisational change is required to deliver new models of care. Investment in these programmes pan-london is a more cost effective way of providing development support. Influence national or regional policy The Healthy London Partnership Programme emerged in response to two major strategy documents the NHS Five Year Forward View and the Better Health for London report published by the London Health Commission, with the backing of the Mayor of London. This high-profile support and the ability to work with stakeholders across London, such as Local Authorities, Public Health and other regional bodies will continue to be critical, given the ambitious and far-reaching change required to deliver transformation at this scale. With direct links into bodies such as the London Health Board and NHS England nationally led programmes, the HLP can use its broad base of support across London CCGs and partners to influence national or regional policy direction in a way that favours London. An example is the Estates programme influencing national policy on the allocation of the Primary Care Infrastructure Fund. Deliver economies of scale pan-london The 13 programmes of the Healthy London Partnership represent teams designated entirely to addressing their priority area on behalf of all 32 London CCGs and the NHS England (London Region). Transformational change at a local level by CCGs or local health economies will be essential to deliver the outputs and benefits that achieve the ambitions of the HLP. There will, however, be deliverables that all or many CCGs will require to support their local implementation, where there are efficiency benefits of delivering once for London. Through local engagement and involvement in local delivery pan-london deliverables will often build on existing best practice. An example would be the development of a technical prototype for delivering a personalised 111 service which could be rolled-out more widely after the concept is proven. Healthy London Partnership Transforming London s health and care together 10

13 Programme A radical upgrade in prevention and public health Deliverables Develop and distil best practice to improve workplace health and wellbeing and monitoring health for health & care employees. Added value of pan- London approach Impact assessment and evaluation of interventions on alcohol, smoking and obesity, including evidence from global cities. Informing the London Plan to encourage healthy eating and active travel / support pan-london public campaigns. Forecast date Dec - 15 TBC Mar - 16 Description of progress On track Plans in place for a workplace Health Charter event in Oct in partnership with the GLA and BMA. Approach being defined to develop indicators for monitoring outcomes on improved workplace health. This deliverable targets London s workforce, supporting them to become healthier. This will be delivered through a national report on the top ten priority areas with high ROI and works towards reducing unhealthy habits in the population. Campaign project underway with London football clubs to target 40+ men and use of a fitness app. The deliverable supports Londoner s to improve their physical health. All Londoners to be able to access the best cancer care in the world Develop a structured approach to support detection and diagnosis of earlier stage cancer in primary care. Develop a cancer accreditation scheme across London. Develop pan London early diagnosis pathways, e.g. for vague abdominal symptoms. Complete Mar - 16 Jul - 16 Specifications have been developed for Early Diagnosis of Cancer and are being shared with Commissioners via the Transforming Primary Care Programme Implementation Board. They will drive the co-ordinated delivery of care to improve patient outcomes. On track. This scheme will tackle areas of largest variation in patient outcomes. Working collaboratively with NHS England and the Integrated Cancer Systems to implement pathway changes in Prostate and Lower GI to support achievement of cancer waiting time standards and to assure trust delivery plans for trusts to achieve these standards. Progress in these areas will improve productivity of London s cancer services as well as facilitate cancer care to be delivered in a more co-ordinated way. Giving London s children the Define a new model of care for CYP healthcare in London based on CYP needs with strong clinical support describing how care will be integrated systematically across health settings. Dec - 15 Work undertaken to define case for change and model of care for CYP in mental health crisis. This deliverable drives work towards an integrated care system for CYP and mental 11

14 best start in life Reduce variation in services by defining standards for acute in-patient care, asthma, community care, child and adolescent mental health services, and transition to adult services. Pilot the use of new media for communicating with CYP to inform them on how to access the health system. Nov 16 Mar 16 health patients. Standards for acute in-patient care and asthma complete. Standards for community care and child & adolescent mental health services and transition to adult services due Nov 16. These standards target the outcome of reducing the variation in outcomes for patients. Not yet started. This deliverable will meet different patients needs around their treatment and engagement. Transforming care for Londoners experiencing mental illness Establish an expert group to scope the key interventions needed to reduce the life expectancy gap and interdependencies with other agencies. Make recommendations on implementation of intervention programmes on the basis of evidence (following development of an evidence base for key interventions). Co-develop model of care and designation process for crisis care services. Jun 15 Jan 16 Feb 16 Working group scoped and development underway. This work supports the outcome of delivering care in a co-ordinated way and reducing the variation in outcomes for patients. Ongoing. This deliverable drives the outcome of ensuring that different patient needs are well understood. On track: crisis care concordat plans for UEC analysed and submitted to Programme Board. The model of care and designation process will work towards ensuring that care is delivered in the right place, at the right time and in a coordinated way. Joining up to transform the lives of the homeless Conduct assessment to highlight challenges in current system of commissioning for Homeless Health Services. Commission and implement evaluated pan-london model of commissioning (following pilot). Develop and pilot prototype model for data sharing for Homeless service users (following review of existing practice and shortcomings). Complete Apr 16 Completed in April 15. This deliverable drives an improved understanding of the needs of patients from the homeless population. Approach superseded. The Lead Commissioner will begin working with the Programme Board from July to design the model, so the focus of the pilot is on the Lead Commissioner function rather than the model. The model will evolve with the commissioning cycle. When fully developed the model will support the outcome of improving access to healthcare services for patients from the homeless population. Lead Commissioners will lead on this deliverable, working with stakeholders from Data EWG and Interoperability Programme, no longer a pan-london deliverable. This work lends itself 12

15 to an improved understanding of the needs from London s homeless population. Transforming London s urgent and emergency care system Improve and expand the NHS 111 system to direct patients to the most appropriate care setting to receive the right care, first time, and support integration. Develop pan-london specifications for U&EC networks, system and facilities, ensuring consistency across London. Develop consistent pan-london whole system outcome measures. Aug - 15 Sept - 15 Dec 15 NHS 111 Patient Relationship Manager is on track with objective of implementing a personalised 111 response. Following successful Alpha phase, the business Case for Beta phase development approved by ILTG on 29/06/15. Integrated 111 re-procurement timelines currently paused by three months to enable NHS England national team colleagues to develop revised commissioning requirements and clinical model. This deliverable will allow patients to flow more easily through the healthcare system ensuring access to crisis care records are known to healthcare professionals. Network specification signed off by U&EC Board 24 June 2015 and public engagement underway to inform system and facilities specifications. This deliverable will enable U&EC services to be consistent and reduce confusion amongst public and professionals. The national team are now developing whole system outcome measures, the U&EC programme will inform national developments. This joint work will deliver a reduction in the variation in outcomes for patients. Transforming London s primary care Identify common barriers to local planning and facilitating solutions across London or influencing national / London partners. Create a provider development support package and tool for emerging scale practices. Mar 20 Mar 17 Significant progress made with first draft pan- London plan for implementation of Transforming Primary Care Specifications discussed at July Implementation Board. Support being provided by programme team to local development of plans with aim to baseline plans for all SPG areas by Oct 15. This deliverable targets improving the productivity of services. Draft provider development support package discussed at August Strategic Oversight Group following engagement with providers and commissioners across London. Launch event scheduled for 4th Nov 15. The implementation of the support package and tools targets a reduction the variation in outcomes for patients. 13

16 Launch an online portal to celebrate progress across London, share ideas, get advice and find information on new innovations and best practice. Mar 17 Innovation network and forums established. Further development required to create an electronic portal. These resources and networks will support the improvement of capabilities among health care professionals to meet the needs of patient groups. Creating world class specialised care services Establish contracting arrangements for specialised services for 2016/17. Provide benchmarking data to CCGs routinely and bespoke on request. Scope and implement a small number of cocommissioning pathways e.g. neuro-rehab, morbid obesity, CAMHS, renal. Sep 15 Ongoing Apr 16 Co-commissioning of specialised services formally established, London-wide joint oversight group established in shadow form. This deliverable forms part of the journey towards centralising specialist care in centres of excellence. Analysis and application of this data will equip health care professionals with information to meet the needs of their patient groups. On track through above co-commissioning arrangements. This deliverable targets improvement in the flow of patients through the healthcare system. Connecting Londoners and health and care providers to allow for real time access to records and information Work with local health economies to define interoperability standards for information exchange across diverse platforms. Provide commissioning guidance to support local commissioning of interoperability. Develop prototype solutions to join up patient records in discrete environments e.g. managing patients in crisis. Ongoing Mar 16 Mar 16 Work ongoing with programmes and SPG areas to define requirements for interoperability. Safe and secure information exchange targets improving the productivity of services and equipping healthcare professionals to personalise care to the specific needs of patients. This deliverable supports improvement in the productivity of services. Scope of prototype builds being developed through engagement in standards development. Joined up patient records support the outcome of delivering care in a co-ordinated way. Ensuring Londoners are engaged and involved in their own health and the health of their Review and audit local Personal Health Budget approaches to date to develop a benchmarking paper outlining the varied effectiveness. Define success measures for Personal Health Budgets based on citizen and carer outcomes and experience, and value for money. Dec-15 Dec-15 There have been some delays in collecting the benchmarking data from all SPG leads. This deliverable supports the investment in out of hospital activity, in areas that maximise effectiveness and value. In progress programme plans to commission dedicated work on this to demonstrate likely value from the programme. Working towards 14

17 city Relaunch myhealthlondon providing a single online platform and additional Public Health budget functionality and information. Dec 15 success measures will drive improvement in the productivity of services. In progress - the asset has been transferred to CCGs with immediate glitches fixed by Verve. A single online platform will enable Londoners to do more to look after themselves and access their data. Aligning funding and incentives to promote transformation of care new payment mechanism pilots. Support the development of a transformation fund to support pan-london transformation activities. Develop evidence base, guidance and support materials for commissioning population based care and associated payment mechanisms. Support the measurement and evaluation impact of Complete Aug 15 Ongoing The transformation fund supports the delivery of all programmes. Implementing the tools from this deliverable supports the goal of delivering care in the right place, right time. Support for pilots of new U&EC payment models underway. Developing London s workforce to enable transformation of care Establish a London Workforce Advisory Board with membership drawn from experts in HRDs, CCGs and HEE. Consult stakeholders to understand pan-london workforce issues. For each pan-london workforce issue, present a preferred solution with rationale to the LWAB, adjust following expert feedback and implement. Apr 15 - overdue Ongoing Apr 16 A revised approach has been agreed by programme SROs to establishing programme governance, starting with a pan-london Delivery Group. The first meeting has taken place. Meetings have been held with other HLP Programme areas and SPG leads. The workforce transformation strategic framework will identify key strategic areas of focus for the system with both a 1-2 year and 3-5 year perspective. The establishment of appropriate governance, consultation on issues and implementation of solutions target the outcome of ensuring that Health and Social Care is an attractive place to work. Transforming London s estate to deliver high quality care Develop comprehensive asset database of all the different NHS estate in London and make public what estate exists, the quality of the estate and how effectively it is being used. Link NHS estate database to London Land Commission/GLA process to establish a register of all public land and assets. Develop joint guidance to provide to commissioners around estate quality standards. Jun 15 Partially complete Complete Sep 15 Version 5 of the database has been developed and shared with CCG Chief Officers. A joined-up NHS estate database supports the improved utilisation of public sector estate. A joined-up NHS estate database supports the improved utilisation of public sector estate. This deliverable targets commissioners to ensure that services are delivered in clinically appropriate facilities. 15

18 Appendix 2. Benefits Healthy London Partnership Transforming London s health and care together 16

19 Appendix 3 Healthy London Partnership - Progress report July, 2015 I am pleased to share the first Healthy London Partnership report, which highlights some of the progress each of the thirteen transformation programmes has achieved in the short time since the launch of the Healthy London Partnership. My thanks go to those who have committed their time and input into the various away days and meetings which have informed the proposals for how we support you to realise whole system change, deliver value and sustainability, and support London s overarching goal to be the world s healthiest major global city. These proposals were scoped in response to the Better Health for London report and the NHS Five Year Forward View, and are now being delivered in the form of the collaborative transformation programmes under the governance of the Interim London Transformation Group (ILTG). The programmes build on existing transformation efforts and already successful collaborations. This report summarises the progress each programme has made, including programme budgets and identified SPG and CCG engagement leads for each programme. The intention is to keep these progress reports informative yet concise. Please do send me your feedback by ing england.healthylondon@nhs.net so that we can ensure this report is useful and engaging. Shaun Danielli Director, Healthy London Partnership 17

20 Introduction Healthy London Partnership has been operational since 1 May The core team is hosted by the Health Innovation Network in South London and the team operates to ensure robust delivery of programmes, strong collaboration across the system and effective engagement networked with local communications teams has been detailed in the operating model. This operating model was endorsed by the Interim London Transformation Group in April 2015 following development with programme SROs, CCG colleagues and other key partners to ensure the team meets expectations. Since the launch of the Programme Prospectus in March 2015 the Healthy London Partnership has been establishing itself in line with the operating model and mobilising the thirteen collaborative programmes. In mobilising the programmes, extensive engagement with SPGs has taken place to ensure alignment of programmes across the commissioning system. Feedback was clear that pan-london activity should build on local work and demonstrate value; HLP programme leads have since tested scope, deliverables and timelines with their respective CCG and SPG leads and revised where necessary. A stakeholder map of SPG and CCG programme lead representatives across London has now been developed and this will facilitate ongoing communications and engagement to ensure programmes maintain alignment. The programme team has been following up on any remaining gaps to ensure comprehensive coverage. Highlights London s hospital charities are keen to explore opportunities with Healthy London Partnership for evidence-based interventions to improve workplace health. We are working with the charities to explore what they can do as a collective to improve the health and wellbeing of NHS staff, aiming to reduce staff absences and improve recruitment and retention. We have also reached agreement to conduct a pilot of community health promotion and improvement involving one of London s great assets London s professional football clubs to promote health in novel settings and via new channels. London football clubs are contributing the majority of the funding ( 108,000) in addition to staff, technical and communication resources to carry out this pilot in London, leveraging their unique brands and relationships with London s. The Cancer programme has received 0.75 million of funding from Cancer Research UK to support work in London. A commitment has been secured to run six expert working groups to inform the commissioning model for Health Services for Homeless People, the team has been working with Pathway to allocate 30,000 of additional funding from Public Health England (PHE), which will be used towards ensuring service user representation is integrated into the programme through the Expert Working Groups membership. Positive discussions have taken place with London s three Collaboration for Leadership in Applied Health Research and Care (CLAHRCs), They have agreed to provide post-doctorate resource to support Healthy London Partnership to undertake evaluative work of Transformation programmes in London. Five Urgent and Emergency Care networks across London have been agreed to oversee the planning and delivery of the transformation of the U&EC system in London. Further detail in each programme is given in appendix 1 and programme budgets in appendix 2. 18

21 Communications and engagement update To support effective communications and engagement across the system a communications network has been established across local communications teams, NHS England (London) communications team and the Healthy London Partnership. The purpose of the communications network is to ensure Healthy London Partnership communications are linked and complementary to local communications and messages. The group will also discuss plans for forthcoming announcements and media activity to ensure there is no cross over or duplication and to maximise stakeholder engagement at local, sub-regional and regional level. HLP communications is also working with CCG engagement leads to ensure a similar joined up approach is taken with patient and public engagement. Upcoming Events Improving Personalisation and Citizen Participation Launch Event 26 June The Personalisation and Participation programme acknowledges that effective engagement - at both the individual and the collective level - are key to good health and care delivery. By listening to Londoners and ensuring that their views are influencing and shaping outcomes, the programme aims to improve levels of individual engagement through the wider access of Personal Health Budgets and Integrated Personal Commissioning. It will also explore how the myhealthlondon website can provide an online platform for collective engagement. Graham Mackenzie and Jane Barnacle, as joint SROs for the programme, formally wrote out to London s wider system leadership on 8 May to inform them about this important work and promote awareness of a pan-london launch event on 26 June. The event programme and registration details will be released shortly. For further information contact shaun.crowe@nhs.net London Clinical Senate 9 July The Clinical Senate on 9th July will be dedicated to Urgent & Emergency Care (U&EC). A key goal of the National U&EC Review for 2015/16 is the establishment of networks across the country. The geographical footprints for London s networks have been agreed and commissioners and providers will now be aware of these. We want to update the Forum on the Urgent and Emergency Care Networks, launch the network specification for London and outline how the Networks will be established and how they fit with the broader commissioning system. The event at the Senate will also inform the development of the specifications for facilities within the Networks and seek patient and clinical engagement and buy in to the whole system transformation vision for the future U&EC system, particularly the development of the out of hospital urgent care system and seek views on the quality outcomes that a future urgent and emergency care system should seek to deliver and how these could be measured. For further information please contact england.londonclinicalsenate@nhs.net. Transforming Primary Care - Into Action 15 July This event is planned to support providers overcome challenges relating to innovation and working at scale. The event is intended to inspire and energise the primary care workforce across London and discuss how innovation can be used to solve the challenges faced daily. The event will bring together federation leads to share experience and learnings, hear discussions about different ways and experiences of working at scale and share examples of practice innovations that improve outcomes for patients and staff. The event will also provide an opportunity for networking with colleagues facing similar challenges related to working at scale and the implementation of the Primary Care Strategic Commissioning Framework. Invitations have been issued but places are still available. Please contact england.londonprimarycaretransformation@nhs.net if you would like further information. 19

22 Appendix 3.1. Programme Progress Urgent and Emergency Care (U&EC) Programme The footprint of U&EC networks to oversee the planning and delivery of the transformation of the U&EC system in London has now been agreed. Following the development of an options appraisal and engagement across the system a representative panel met to score each option; the option for five geographical areas was determined to be the optimal configuration. This decision was ratified by the U&EC Board (on 1 April) and further endorsed by Chief Officers and ILTG. The development of the network specification for London is now under development; the specification builds on national guidance and brings together the many programmes of work across London in relation to urgent and emergency care. The network specification will be published in early July. U&EC facility specifications are also under development and we are seeking broad engagement across the system to support this. The Clinical Senate on 9th July will be dedicated to U&EC to inform the development of the facility specifications and seek patient and clinical engagement and buy in to the whole system transformation vision for the future U&EC system, particularly the development of the out of hospital urgent care system. In support of the U&EC programme, Community Services have worked with over 1000 service users and health and care staff to develop a shared vision for the foundation of excellent community services in the form of a declaration which is summarised in this poster, which we d like you to share with colleagues and your networks. Please visit and give us your feedback. Children and Young People (CYP) Programme A launch event was held on 6 May for commissioners and clinicians at which a number of priority areas were discussed including Child and Adolescent Mental Health Services (CAMHS) and CYP high dependency services. Current variation in CYP services will be reduced through establishing standards against which services can be commissioned, supported by a commissioning development programme for CYP commissioners across the system. A set of standards for asthma care is currently being finalised, and a community pharmacy public health campaign to raise awareness of asthma in CYP will run from the end of June. To support the asthma work, a Darzi Fellow for asthma has recently been appointed to work in conjunction with the Whittington Hospital and UCLP. Fragmentation of both provision and commissioning of healthcare services for children will be addressed by developing population based CYP networks at SPG level bringing together providers, commissioners and public health to undertake needs assessment and delivery of healthcare at the population level. A set of surgical standards to work across a network-based model has been finalised and will be piloted across south west London through their CYP population network. Learning from this pilot will be shared widely. 20

23 Health Services for Homeless People programme Following extensive stakeholder engagement across health, local government and third sector organisations, a Case for Action has now been published. Examples of existing good practice within the health services for homeless people, and the issues and challenges which lead to the fragmentation and inequity of services are outlined in the Case for Action. Commissioning outcomes and principles for the pan-london commissioning model were tested with the Mayor s Rough Sleeping Group (GLA) on 20 May. A commitment has been secured to run 6 Expert Working Groups to further inform the commissioning model design; these workshops will cover Mental Health, Data, Primary Care, Secondary Care, Intermediate Care and Health in the Justice System. The appointment of the lead commissioner is also underway with expressions of interest requested by 12 June. The lead commissioner will work at scale across organisations and boundaries to ensure commissioning outcomes are achieved, which may include commissioning some services at a pan-london level. Prevention The prevention programme is working in partnership with Public Health England, local authorities and the Greater London Authority to embed health and wellbeing in health and care systems, improve workplace health and promote health and tackle other city-level health challenges through partnership working and taking innovative action. The potential scope of any prevention programme is considerable. To date, a series of scoping meetings have been held with commissioners, PHE, and the GLA. A survey of local prevention activities and current barriers to implementation was undertaken in May to ensure that the programme supports local efforts. Responses to this survey have been considerable, with over two thirds of London s geographical areas represented by a local authority, CCG or combined response to date. The efforts of the health and care system need to be amplified by other partners in order to achieve a step-change in prevention for London. The prevention programme is developing detailed proposals for partnership working with Transport for London (TfL), London hospital charities and London s football clubs. The programme team is working with TfL to explore opportunities to encourage active travel by timely messaging on the transport system, in addition to broader opportunities for health promotion through advertising. Detailed proposals for partnership working with Transport for London, London hospital charities and the pilots with London s football clubs are being developed. Cancer programme The Cancer Waits programme and Endoscopy strategy have now been agreed and signed off by the Cancer Commissioning Board, and the roll out of the 2 week referral has been launched (NCL). A structured support programme for people living with and beyond cancer aligned with optimal long term conditions management has also commenced. The cancer programme has also received 0.75 million of funding from Cancer Research UK (CRUK) to support its work. 21

24 Primary Care programme The Pan London team have recently held planning discussions with all SPGs in order to support creation of delivery plans to meet the Strategic Commissioning Framework and transform primary care to be more accessible, coordinated and proactive, and to ensure high quality care can be delivered for all Londoners. A baseline survey was issued in May to gather information regarding emerging and established federations throughout London, this information is currently being analysed in order to support better understanding of progress towards at scale models, and to identify areas of developmental support needed for providers. An event is also being planned to support providers overcome challenges relating to innovation and working at scale, on the 15th July. Invitations have been issued but places are still available. Please contact england.londonprimarycaretransformation@nhs.net if you would like further information. Mental Health Programme The Mental Health Transformation Board has now been established and its inaugural meeting took place on 29 May, the Board has broad representation to support the programme to make a fundamental shift from a focus on treatment to one of prevention; helping Londoners stay emotionally, mentally and physically well at all ages, as well as the aspiration to eliminate the inequality in life expectancy of those with severe and enduring mental illness (SEMI). Clinical leads have been appointed for the Early Intervention in Psychosis (EIP) and perinatal workstreams, and the Primary Care project group has now been formed. The London Crisis Care Commissioning Standards developed in response to the Crisis Care Concordat also form an integral part of the U&EC programme and the network and facility specifications currently under development. Interoperability programme The Inter-operability programme has designed and commissioned engagement surveys which will be delivered via the South London Health Innovation Network to establish the resource request to support data exchange and linkages between organisations to respond to the challenges and targets set out by the National Information Board Framework. These challenges include providing paperless, real-time information exchange across geographical boundaries. Positive discovery meetings with e referral and Patient Online (POL) Services have taken place and engagement with the National Digital Primary Care team is planned. POL is a programme of work which is providing patients with access to their GP record, access to electronic appointment booking in primary care and the ability to order repeat prescriptions. Workforce Programme Discussions are underway between the SROs for the programme and Health Education England to agree an approach to workforce and further define the scope of the programme. The programme will have oversight and strategic direction of London s heath service workforce transformation; developing a modern workforce in order to support delivery of innovative new care models. To this end the programme continues to engage other programmes to gain an 22

25 understanding of the scale of transformation and the inter-dependencies across the whole workforce. Personalisation and Participation Programme London CCGs recognise the need to fulfil their statutory requirements for personalisation and participation to ensure Londoners feel involved in their health and care system including when making decisions about their own care. The programme acknowledges that effective engagement - at both the individual and the collective level - are key to good health and care delivery and aims to support CCGs in meeting the statutory requirement. By listening to Londoners and ensuring that their views are influencing and shaping outcomes, the programme aims to improve levels of individual engagement through the wider access of Personal Health Budgets and Integrated Personal Commissioning. It will also explore how myhealthlondon can provide an online platform for collective engagement. Graham Mackenzie and Jane Barnacle, as joint SROs for the programme, formally wrote out to London s wider system leadership on 8 May to inform them about this important work and promote awareness of a pan-london launch event on 26 June. The event programme and registration details will be released shortly. For further information contact shaun.crowe@nhs.net Specialised Commissioning Programme The Specialised Services Collaborative Commissioning Oversight Group has now been established and CCG nominations have been sought. An initial deep dive review of neuro-rehabilitation demand and capacity has commenced. Through the reviews the disjointed nature of care pathways caused by the differing commissioning responsibilities for services will be explored, and a more collaborative approach to specialised commissioning will be established, making it easier for commissioners to work together to better align pathways, and service models across the system. Estates programme The programme has now held meetings with CFOs in each SPG to discuss programme scope and to begin to develop the asset database and Strategic Planning and Capital Boards which will be developed to ensure that estates planning and a comprehensive asset database are part of service planning and link to robust clinical strategy. The second version of the London database has been issued to SPGs; this includes the finalised financial details for NHS Property Services and CHP. In addition, a letter has been written to London Land Commission to position the Health estates programme. A business case for resourcing the detailed asset database is being worked up and will be presented at the next steering group in June. Payments and funding programme In addition to setting up the financial flows and governance around the transformation fund the Payments and Funding group will support the creation of the right environment for commissioning and the right incentives for providers, including funding and payment mechanisms and personal health and care budgets towards person-centred care. Guidance on potential new payment models for U&EC is expected from Monitor and NHS England imminently; the guidance gives great flexibility to local development and the Payments 23

26 and Funding Group are considering hurdle criteria and guidance to support new models in London. U&EC Networks will be invited to express an interest in piloting new payment models in 16/17 with evaluation and learning as an output to inform further development. 24

27 Appendix 3.2. Programme budgets Programme resources are based on programme charters developing through engagement. The programme spend will be monitored monthly by the Payments & Funding Group. Programme CCG lead SRO Total programme budget Urgent & Emergency Care Conor Burke 1,135,076 Children and Young People Martin Wilkinson 667,268 Mental Health Jane Milligan 1,148,443 Cancer Paul Haigh 2,073,270 Homeless Health Services Matthew Bazeley 298,803 Prevention Sarah Price 702,394 Primary Care Andrew Bland 2,682,984 BI & Interoperability Terry Huff 2,428,713 Personalisation & Participation Graham MacKenzie 785,015 Specialised Commissioning Cynthia Cardozo 0 (costed under programme support) Estates Peter Kohn 472,381 Payments & Funding Alison Blair 723,981 Workforce Angela Bhan 191,745 Portfolio (Support costs) Shaun Danielli 865,163 Portfolio (Non pay on costs) Shaun Danielli 1,350,000 25

28 Appendix 3.3. Programme Leads Programme Programme Lead Programme Lead Contact details Transformation Shaun Danielli Urgent & Emergency Care (and 111) Patrice Donnelly (UEC) / Eileen Sutton (111) patrice.donnelly1@nhs.net / eileensutton@nhs.net Children & Young People Tracy Parr tracyparr@nhs.net Mental health Andrew Turnbull andrew.turnbull@nhs.net Cancer Teresa Moss teresamoss@nhs.net Prevention Jemma Gilbert jemma.gilbert2@nhs.net Health Services for Homeless People Delvir Mehet Delvir.mehet@nhs.net Specialised Commissioning Will Huxter will.huxter@nhs.net Primary care Paul Roche Liz Wise paul.roche@nhs.net liz.wise1@nhs.net Estates Stuart Saw s.saw@nhs.net Workforce Helen Bullers Paul Roche helen.bullers@nhs.net paul.roche@nhs.net Interoperability Mike Part mike.part1@nhs.net Payments & Funding Stuart Saw s.saw@nhs.net Personalisation & Participation Shaun Crowe shaun.crowe@nhs.net 26

29 Appendix 4. DRAFT Terms of Reference DRAFT terms of reference are included for the following proposed groups: Appendix 4.1 London Transformation Group Appendix 4.2 Clinical Oversight Group Appendix 4.3 Improvement Leadership Collaborative 27

30 Appendix 4.1 London Transformation Group DRAFT Terms of Reference Introduction: When the London Health Commission launched its report Better Health for London in October 2014 it had one overarching and simple goal: transform London into the world s healthiest major global city. The ten accompanying aspirations for London defined where progress, particularly long-term progress, needed to be made with agreed action to achieve these aspirations agreed across CCGs, NHS England (London), GLA, London Councils and PHE. Both the NHS Five Year Forward View and Better Health for London recognised the extensive work involved in bringing about sustainable and real change in the health and care system and particularly the time required in order to embed that change. It was against the back drop of these two major strategy documents that London s CCGs and NHS England (London) agreed to jointly support the development of pan-london transformation programmes under the auspices of Healthy London Partnership to support London wide and local transformation. Significant engagement with a large number of stakeholders across the health and care system took place to develop plans and ensure that the 13 programmes were addressing priority transformation areas and needs The Interim London Transformation Group was convened in May 2015 with a specific remit that included agreeing ongoing governance arrangements and mobilising the transformation programmes. The Interim London Transformation Group have completed their specific deliverables and ongoing governance arrangements have now been agreed. The Terms of Reference below outline the revised role and membership of the London Transformation Group. Purpose: The overall purpose of the London Transformation Group (LTG) is to: Oversee the Healthy London Partnership programme development and delivery; Provide strategic direction on the Healthy London Partnership programme, incorporating the views from other governance functions that feed into the LTG; Ensure strategic alignment between London s collaborative transformation programmes. Objectives: More specifically the London Transformation Group objectives include: Holding programme SROs to account for delivery of agreed programmes and benefits and providing advice and support to any urgent decisions regarding programmes; Providing strategic direction to the thirteen Healthy London Partnership programmes and ensuring programmes are effectively delivering their strategic intent; 28

31 Making recommendations to accountable organisations on collaborative transformation priorities and proposed resources; Ensuring effective sharing of learning across the programmes and other London transformation programmes; Taking the decisions on recommendations from the London Payments and Funding Group regarding transformation programme funding and priorities within the agreed financial resources from accountable organisations. Membership: Membership will continue to remain as accountable bodies and funders with the addition of a patient and public representative member. Membership of the LTG will include the following representatives: Geographical area Representative members NWL Ruth O Hare (GP chair, Central London CCG) Trevor Begg (Lay Member, Hillingdon CCG) Rob Larkman (CO, Brent, Harrow, Hillingdon CCGs) NCL Sarah Price (Chief Officer, Haringey CCG) Dr Debbie Frost, Chair, Barnet CCG/Chair, NCL Collaboration NEL Conor Burke (CO - Barking, Redbridge, Dagenham) Paul Haigh (CO Hackney CCG) or Dr Clare Highton (Chair, City and Hackney CCG) Terry Huff, Waltham Forest CCG SEL Dr Marc Rowland (Chair, Lewisham CCG) Dr Jonty Heaversedge (Chair, Southwark CCG) Sarah Blow (Chief Officer, Bexley CCG) SWL Graham Mackenzie (CO, Wandsworth CCG) Dr Naz Jivani (Chair, Kingston CCG): Co-chair NHS England (London Region) Office of CCGs Anne Rainsberry, Regional Director: Co-chair David Slegg, Director of Finance Helen Bullers, Director of HR and OD Simon Weldon, Chief Operating Officer Andy Mitchell, Medical Director Caroline Alexander, Director of Nursing Jane Barnacle, Director of Patients and Information Andrew Eyres (Chief Officer, Lambeth CCG and Chair, Chief Officers Group) HLP Shaun Danielli, HLP Programme Director Patient & Public representative TBC Each member of the LTG is responsible for representing the opinions of the accountable organisations they represent and ensure two way engagement with CCGs and NHS England 29

32 colleagues. The London Transformation Group is accountable to CCG governing bodies and NHS England, the overall governance structure is shown below: Conduct of meetings Quorum is 50% plus at least one member from both CCGs and NHS England. Meetings will occur on a monthly basis; these are currently scheduled up until early September October, November, December, January, February, March, 2016 Each member is expected to attend all of the scheduled meetings. Evaluation Terms of reference will be reviewed in March