NHS North Cumbria CCG Governing Body Agenda Item 4 October 2017 14 Assurance Framework Purpose of the Report The purpose of this report is to provide the Governing Body with an updated assurance framework. Outcome Required: Approve Ratify For Discussion For Information Assurance Framework Reference: 4, Leadership - The CCG needs to develop and implement robust governance and management arrangements to operate in a safe and sound manner. Recommendation(s): To approve and note the content of the Assurance Framework. Eecutive Summary: The Assurance Framework is a top down document that enables the Governing Body to identify the key risks to achieving it s strategic objectives and the work programmes required to mitigate those risks. This is complemented by the corporate risk register which is a tool for all departments to identify day to day operational risks and how those will be managed. However, where a departmental risk is so significant that it cannot be managed internally then it needs to be considered whether the risk is sufficient to warrant inclusion on the assurance framework given the potential likelihood and impact on the CCG overall. All risks are linked to one or more strategic objective and this is visible on each Committee report coversheet. Risk management information is provided to the Governing Body within its set agenda, via the reports. There is a clear link between Governing Body reports and the Assurance Framework (via the Assurance Framework reference bo on report coversheets).
Key Risks: The key risks are that the assurance framework is complete (i.e. avoids issues of significant strategic risk to the CCG) and that risks are ineffectively evaluated thus potentially resulting in disproportionate use of resources to address. Implications/Actions for Public and Patient Engagement: The purpose of the assurance framework is to identify key issues to enable the CCG to plan for effective engagement with patients and the public on these matters. Financial Impact on the CCG: The financial impact on the CCG is inherent in the identification of strategic risks. Strategic Objective(s) supported by this paper: Support quality improvement within eisting services including General Practice Commission a range of health services appropriate to Cumbria s Needs Develop our system leadership role and our effectiveness as a partner Improve our organisation and support our staff to ecel Impact assessment: (Including Health, Equality, Diversity and Human Rights) Please select (X) N/A Conflicts of Interest Describe any possible Conflicts of interest associated with this paper, and how they will be managed None identified Lead Director Charles Welbourn, Chief Finance Presented By Charles Welbourn, Chief Finance Contact Details charles.welbourn@northcumbriaccg.nhs.uk Date Report Written September 2017 2
Corporate Objectives Risks Principal Risks Controls Assurance Gaps in Control and/or Assurance Strategic aims we need to deliver 1. Better Health Improve the quality of eisting services, including General Practice 879, 989, 964, 1251, 1780, 1785, 1252, What may prevent delivery Risk that providers, including care homes, are unable to provide appropriate and clinically safe services to the population they serve What is in place to support delivery of the objective Working with NHS providers to and regulators to develop sustainable strategy and plans. Public consultation completed for services provided in North Cumbria University Hospitals NHS Trust. Evidence controls are working, managing risk and deliver Quality dashboard in place for providers and eternal reviews have taken place with specific action plans. Major engagement activity with stakeholders an ongoing process and part of the Coproduction work Ability to recruit to vital clinical roles Completion of the planned maternity service change, awaiting the outcome of the referral to the Secretary of State and subsequent referral to the Independent Reconfiguration Panel Action Plan Lead Risk Rating What we need to do and when Continue with overseas recruitment drive Full business case to be completed Accountable Very High (Red) Care Home Quality Group established Assurance visits to providers Nursing & Quality team joint working with Cumbria County Council Visits documented and revised Quality schedule in place Some internal capacity issues 1
Corporate Objectives Risks Principal Risks Controls Assurance Gaps in Control and/or Assurance Strategic aims we need to deliver 2. Better Care What may prevent delivery What is in place to support delivery of the objective Evidence controls are working, managing risk and deliver Action Plan Lead Risk Rating What we need to do and when Commission services that ensure the delivery of high quality and safe care for patients 980 There is a risk that the CCG is not delivering key NHS constitution targets Providers are required to develop actions plans to address shortfall in performance. Some areas (e.g. cancer) have seen improvements. On-going issues of performance recorded consistently: mechanisms need to be enhanced with providers. Longerterm plans need to reflect delivery of trajectories. In short-term with NCUHT establish replacement for regular joint performance review with NHSI Chief Operating Very High (Red) 1788 There is a risk that Child & Adolescent mental health services (CAMHS) are not of appropriate quality. Ongoing and regular monitoring of Tier 3 CAMHS services. Ongoing discussions with providers regarding mitigation of risks to eisting service model. Local Transformation Plan (LTP) in place enabling investment. Continued leadership input to the development of a whole system approach. Continued Formal reporting of progress on action plan to Quality & Outcomes Committee, CPFT contract meetings, LSCB and Children's Improvement Board reporting infrastructure, bi monthly commissioner provider meetings with an alternate bi monthly meeting of the LTP steering group. Assurance visits to Tier Work with partners to implement the LTP for emotional health & well being in Cumbria, including Development of a Community Eating Disorder service, and a CAMHS crisis service. Need to reduce incidence of self-harm, including hospital admissions that occur as a consequence. Emotional Wellbeing & Mental Health partnership group to monitor the implementation of the whole system approach Develop & introduce new pathways for ADHD and eating Disorders Director of Children & Families High (Amber) 2
support to the implementation of learning from Headstart in Cumbria. Development of a plan to address waiting times for CAMHS services 3 service. Continue transformation of tier 3 CAMHS to improve quality of service & improve access to Tier 4 CAMHS Continue to develop the Tier 2 Early Intervention service and Single Point of access. Developing models for Out of Hours crisis assessment. Implement waiting times initiatives in 16/17; Data cleanse and system efficiency Additional support for parents Additional therapeutic inputs Online alternatives put in place Automated reminder system 3
Corporate Objectives Risks Principal Risks Controls Assurance Gaps in Control and/or Assurance Strategic aims we need to deliver 3. Sustainability What may prevent delivery What is in place to support delivery of the objective Evidence controls are working, managing risk and deliver Action Plan Lead Risk Rating What we need to do and when Commission services that ensure the delivery of high quality and safe care for patients in a manner that is sustainable for the whole health economy. 964, 879 North Cumbria University Hospitals NHS Trust is unable to continue to provide clinical and financially sustainable services that are accessible to the local population. There are serious shortfalls in suitably qualified staff to support the current configuration of services, resulting in gaps in services (e.g. unscheduled community hospital bed Public Consultation on specified services has been completed The CCG Governing Body has made decisions on each of the areas consulted on The North Cumbria System Leadership Board is actively reviewing the sustainability of service delivery across the system, with in depth work on rele4vant services coordinated by Senior Responsible s, supported by a shared Programme Office The CNE NHS England Medical Director is leading a process to support 'distressed Implementation Reference Group will report to the CCG Governing Body after October 2017 Governing Body receives a report at each meeting on progress following the Consultation Performance and Quality issues are reviewed through the contracting process and reported to the appropriate Governing Body Committee STP, CGG operational plan and contract offers based upon PCBC: evidence of one plan for WNE Cumbria Evidence from partner organisations that have Completion of the planned maternity service change, awaiting the outcome of the referral to the Secretary of State and subsequent referral to the Independent Reconfiguration Panel Completion of the final Business Cases for each of the service changes agreed following the public consultation Plan needs to be refreshed to reflect outcomes of consultation process. Full business case for implementation of change required to articulate how plans will be implemented and secure funding for those elements not funded locally. Chief Operating Very High (Red) 4
closures) and reliance on epensive premium staffing (e.g. paediatric consultants). services' across the sub region, with direct input from the CCG and NCUHT Medical Directors A formal governance process for requesting mutual aid/partnership working/collaborative working/clinical networks with Newcastle Hospitals NHS FT will be established in October 2017 following agreement with Newcastle secured in August 2017 signed up to STP and PCBC, including formal approval from NHSE to commence consultation. 989 There is a risk that services for adults with mental health problems do not adequately address the needs of patients On-going contract & quality review of services combined with system-wide review of services. On-going quality reports and specific action plans and formal reporting to GB on progress. Specific strategy required for long-term regarding specialist (e.g. in-patient) mental health services, linking into wider-service offer. Mental Health strategy is supported by the STP work stream programmes identified to translate priority actions from Five Year Forward View. Chief Operating High (Amber) The local neurology service provided by CPFT may not be sustainable. This is currently managed through the contracting process with CPFT: identified in contract SDIP further work required Reviewed as part of performance & quality monitoring based upon stabilised position Long-term future still required Key action identified by both parties to be addressed in contracting round 2017/18 & Chief Operating Medium (Yellow) 5
2018/19 Corporate Objectives Risks Principal Risks Controls Assurance Gaps in Control and/or Assurance Strategic aims we need to deliver 4. Leadership What may prevent delivery What is in place to support delivery of the objective Evidence controls are working, managing risk and deliver Action Plan Lead Risk Rating What we need to do and when General practice across North Cumbria has significant workforce issues due to inability to recruit GPs and nurses. High levels of vacancies means general practice in some areas is at risk of being unable to deliver core services. Wide-ranging focus of North Cumbria approach fails to engage & support GP practices effectively Successful bid to NHSE for Overseas recruitment support. First wave of recruits arrive in Sept 2017 Bursary from Health education England for GP trainees. New models of delivery for services. Resolution to make boundary change approved by Full Council of Members Increased awareness of bursary availability to GP trainees in Cumbria Lack of ability to use primary care resources effectively Level 3 primary care commissioning sought to improve implementation of plan CCG working with NHSE to use capital process to best effect Director of Primary Care Very High (Red) Virtual Recruitment Hub developed to support GP recruitment Dedicated number of staff seconded to manage and develop this work The CCG needs to develop and implement robust governance and management arrangements to operate in a safe and sound 1778 There is a risk that the CCG does not achieve it s financial targets agreed with NHSE Annual budget & cost improvement plan signed off by Governing Body Plan considered in detail by F&P and CIP approach agreed by SLB Cost pressures continue around CHC & there are risks on full achievement of savings plans Continue to seek transitional funding per PCBC to support implementation of system changes Chief Finance High (Amber) 6
manner, including compliance with the formal directions from NHSE. Improvements to monthly financial reporting implemented in year 2016/17 following eternal review. The financial plan & contracting structure is based upon the wider Healthier Together plan with a financial risk share process agreed in principle with partners & supported by NHSE &NHSI Monthly reporting to F&P In addition to CCG reporting systemwide reporting adopted to ensure risks are identified & managed Improved links to cost improvement plan Further savings required Use risk share as mechanism to support implementation & delivery of schemes Continue to work with WNE system to identify further collective savings opportunities 7