NHS THANET CLINICAL COMMISSIONING GROUP GOVERNING BODY HELD IN THE HARBOUR SANDS MEETING ROOM, 3 RD FLOOR, THANET DISTRICT COUNCIL TUESDAY 21 NOVEMBER 2017 AGENDA PART ONE (Public) - 13:00-13:10 Chair Dr Tony Martin ACTION BOARD SPONSOR TIMING 1. Opening Business 1.1 Apologies, Declarations of Interest, Quoracy To Note Chair 2. In-year review of Quality, Finance and Performance 2.1 Board Assurance Framework To Approve Chief Finance Officer Date of next Formal Governing Body meeting - 19 December 2017 Document Ref: Thanet CCG Board Agenda 21 November 2017 Version: 1.0 Chair : Tony Martin, Clinical Chair Date: 21 November 2017 Page 1 of 1
Report to: Governing Body Agenda 2.1 item: Date of Meeting: 21 November 2017 Title of Report: Thanet CCG Board Assurance Framework Author: Michelle Harris, Risk and Assurance Manager Board Sponsor: Jonathan Bates, Chief Financial Officer Status: Appendices: Board Assurance Front Sheet Board Assurance Framework Summary 1. Purpose of Paper To ask the Governing Body to review the Board Assurance Framework. 2. Introduction/Background The revised approach has been developed in discussion with the Governance and Risk Committee and takes account of the internal audit review which TIAA Ltd undertook on our behalf. 3. Recommendation The Governing Body is asked to approve the Board Assurance Framework. 4. Summary of Issues The revised Board Assurance Framework (BAF) is based on the critical performance areas for Thanet CCG, outlined in its Operational Plan. The BAF also includes primary care, for which each CCG has been given limited assurance, and financial balance, which is critical to the CCG s ongoing viability. The actions identified for success should correlate with the CCG s Operational Plan and key risks in the risk register are included. The front sheet gives both an initial RAG rating to each area, as well as a current RAG with a narrative of the current status. It is hoped the document will be updated every 3 months for presentation to the Governing Body. There is still considerable work to be done on the content of the BAF however, it is hoped the format will be allow this to be a less arduous task going forwards. 5. Risks The Board Assurance Framework is a key component of the CCG s system of internal control. 6. Appendices Author: Michelle Harris, Risk and Assurance Manager Version: Sponsor: Jonathan Bates, Chief Financial Officer Date: 21 November 2017 Agenda no: 2 Page 1 of 1
Strategic Objective 1A Key area for the CCG RAG 1 April 2017 Source of assurance Current status Current RAG Sustainability and Transformation Plan Amber East Kent Strategy Board report EK Strategy being developed; consultation likely to be deferred. Most projects amber 1B Local Care Models Green Integrated Executive Programme Board report 2 Achieving financial balance Amber Governing Body Report Immediate savings plan has been drawn up but significant savings to be made 3A Delivering RTT Red Integrated Quality and Not meeting RTT 18 week target November 2017 - This trajectory is getting worse 3B A&E targets Red Integrated Quality and Not meeting A&E target 3C Cancer targets Red Integrated Quality and NHSE rates as needing improvement. Not consistently meeting targets 3D Mental Health Amber Integrated Quality and KMPT not meeting EIP targets
3E Improving Access to Psychological Therapies (IAPT) Green Integrated Quality and Almost on target of 50% recovery rate 3F Dementia Amber Integrated Quality and NHSE rates as needing improvement but target nearly achieved 3G Diabetes Green Integrated Quality and NHSE rated CCG as needs improvement. All NICE treatment targets achieved. 87% participated in NDA 3H Maternity Red Integrated Quality and Historically very poor performance. 18.4% smoking at time of giving birth 4 Primary Care Quality Amber Clinical Cabinet Report Referral activity is high Prescribing costs being managed Improving November 2017 This is improving 5 Learning Disabilities Amber Integrated Quality and NHSE rates as needing improvement. Project at amber status November 2017 This is improving 6 Patient Experience, quality and safety Amber PPE report Engagement good
Key: Performance Projects Green: on target likely to deliver outcomes Amber: within 5% of target Red: anything less than 5% delivering only some of the outcomes not delivering desired outcomes
Thanet CCG Board Assurance Summary: We will improve the health outcomes of the people who live in the Thanet area 1.A We will develop and deliver the Sustainability and Transformation Plan Current RAG Develop the hospital care business case including stroke Develop the Local Care business case Develop the workforce Develop the finances for the STP Prepare the preconsultation business case Develop Integrated Commissioning Board March 2018 GB Lead: Hazel Carpenter/ Clinical Lead: Tony Martin/ Operational Lead: Oena Windibank and Jonathan Bates Senior staff attendance and K&M work stream meetings and work stream reports Organisational assurance Board Assurance Report to GB meeting STP Governance Framework East Kent Delivery Board established to report on local implementation of STP Public consultation on the Plan Listening events held NHSE oversight of process Timetables have slipped Costings of STP show significant gap Insufficient provider engagement with scale of change LC002 Risk that the scale of the work involved with the local care model is not reflected in the timescales LC003 Risk of providers not engaging with Local Care work PC009 If the Primary Care Strategy does not deliver as intended, we could fail to deliver the STP
1.B Local Care Models Current RAG Develop the case and plan for Thanet Local Care March 2018 GB Lead: Hazel Carpenter/ Clinical Lead; Tony Martin/ Operational Lead: Oena Windibank Clinically led EK wide Local Care planning groups are operational with strong plans Clinically led Primary Care Home teams established Local Operational group in place Organisation assurance Integrated Executive Programme Board established EK wide reporting structure is operational Project Management Office established and Director in place Bethesda build progressing and Estates Strategy developing Insufficient senior provider engagement with IEPB STP timetable has slipped slowing local progress Delays with Tiers of Care implementation LC002 Risk that the scale of the work involved with the local care model is not reflected in the timescales LC003 Risk of providers not engaging with Local Care work Listening events Esther engagement model operational STP maturity matrix assessment
2. We will meet our financial targets, particularly maintaining financial balance delivering the key savings projects Current RAG Controlling expenditure with providers Developing the whole system demand and capacity model Efficient cost-effective prescribing Focus on placements provider fees Continue redesign of pathways, using tiers of care March 2018 GB Lead: Jonathan Bates/ Clinical Lead: Tony Martin/ Operational Lead: Emma Emery Strong, well qualifies and experienced staff Weekly monitoring by exec team Organisational assurance Finance Report and Recovery Plan Report to each Quality Performance and Delivery Committee and reported to each Governing Body Meeting Report to Governance and Risk Committee NHSE oversight External review by Consultant for NHSE and CCG Internal and External Audit oversight Delays in some savings plans Lack of provider buy in and cooperation PC002 Insufficient resources to manage delegated commissioning CS002 Allocated budget for Psicon is being exceeded by activity in relation to ADHD referrals PS003 Due to No Cheaper Stock Offered the cost of CCGs prescribing budget could be exceeded
3. We will deliver the constitutional and access standards, and NHSE Clinical Priorities particularly: Current RAG A. RTT B. A&E and ambulance pathways C. 62 day wait for cancer D. Mental health access standards E. IAPT (access/ recovery and 6 week waits) F. Dementia (diagnosis rate) G. Diabetes H. Maternity Commissioning sufficient activity across all providers to deliver all targets, including for cancer, RTT, & mental health Redesign and implementation of pathways Implement BCF initiatives March 2018 GB Lead: Ailsa Ogilvie Clinical Lead: RTT: John Neden A&E: John Neden Cancer: John Neden Mental Health: Jihad Malasi Dementia: Jihad Malasi IAPT: Jihad Malasi Diabetes: John Neden Operational Lead: Ailsa Ogilvie/ Oena Windibank Bi-weekly Head of Department Review Monthly 1;1 reviews by COO with key staff Organisational assurance IQPR overseen by the Quality and Operational Leadership Team, with exceptions reported to Governing Body EK PMO and weekly EK executive meetings Weekly Thanet exec team meetings Delays in Tiers of Care Lack of provider buy in Inadequate delivery of improvement plans Gaps in provider workforce identified by CCG HO003 Risk that the A&E trajectory may not CA001 - Risk that EKHUFT will fail to achieve the 62 day Cancer Access standard that they have agreed with the CCG, Monitor and NHSE HO005 Risk that the revised trajectory for RTT will not be achieved
Implementation of collaborative projects at EK level Oversee providers Recovery Action Plans to ensure performance and quality Monthly contract management meetings and CPN meetings NHSE oversight Figures agreed with providers CS003 - Risk that the transfer of funds from NHS England to the CCG for paediatric Type 1 Diabetics does not meet the anticipated demand/current caseload within East Kent,
4. We will improve the quality and sustainability of primary care Current RAG Development of a clinical model for primary care for the local area Helping practices to improve and become more resilient including reviewing roles which the workforce can undertake Developing hubs able to provide local services, control referral activity and prescribing March 2018 Governing Body Lead: Tony Martin/ Sue Martin Clinical Lead: Primary Care Home Clinical Leads/ Operational Lead: Maria Howden/ Nicola Williams Primary Care Development and Commissioning teams in place Monthly Quality and Finance reports Organisational assurance Board Assurance Report IQPR including Primary Care to QOLT Exception reporting to PCCC PCCC held in pubic NHSE oversight Individual Patient Participation Groups Health Reference Group Practice reorganisation incomplete Some improvement required in Primary Care target achievement Pockets of vulnerability PC001 Multiple GP and Nurse vacancies PC002 - The Primary Care budget from NHSE was less than expected Developing IT to deliver shared patient records Establishment of Primary Care Commissioning Committee (PCCC) and Primary Care Operational Group (PCOG)
5. We will implement plans to transform care for people with learning disabilities Current RAG K&M Transformation Care Plan (TCP) developed and being implement Establishment of K&M Transformation Care Board and SRO March 2019 GB Lead: Hazel Carpenter/ Clinical Lead: Jihad Malasi/ Operational Lead: Ailsa Ogilvie Local staff actively working on delivering the programme Regular 1:1S by Thanet COO with K&M Operational Commissioning Lead K&M Transforming Care Team established Some slippage in delivery of the plan Inadequate resource at a K&M level Community infrastructure not yet in place Funding from NHSE not yet received K&M TCP Finance Board established and meeting regularly Dedicated Transforming Care team in place Put in place pooled funding arrangements Organisational assurance Strong K&M governance in place reporting by exception to Thanet committees Monthly work stream working to CLT Substantial NHSE oversight at a senior level Transforming Care Management Information reports to be put in place Development of community infrastructure and housing
6. We will improve patient experience, quality and safety Current RAG Develop and implement Patient Engagement Strategy for current and future services Develop and implement a Quality Strategy Develop toolkits for HCAI, Quality and Safeguarding Oversee Recovery Action Plans to drive improvements by providers in patient experience and safety Joint working to identify workforce issues March 2018 Governing Body Lead: Hazel Smith/Clive Hart/ Clinical Lead: Lay Nurse (currently vacant)/ Operational Lead: Ailsa Ogilvie/Maria Reynolds Regular 1:1 between COO and Head of Nursing, Quality and Safeguarding Quality issues discussed at weekly exec meetings and through EK Quality Round Table Quality Deep Dives and visits by team Organisational assurance General issues relating to Patient and Public engagement will be reported at each Governing Body meeting. The Assurance Report against each Clinical Objective includes Patient Engagement and Patient Experience. Quality and Safeguarding report to the GB Key provider contracts underpinned by monthly Clinical Quality Reference Groups LC004 Prime care not delivering on it s KPIs Review avoidable mortality rates NHSE oversight Patient Experience reporting/ surveys and complaints CQC visits External audits