NHS Stockport Clinical Commissioning Group Governing Body Part 1 A G E N D A

Chair: Enquiries to: Ms J Crombleholme Laura Latham 07827 239332 Laura.latham1@nhs.net NHS Stockport Clinical Commissioning Group Governing Body Part 1 A G E N D A The next meeting of the NHS Stockport Clinical Commissioning Group Governing Body will be held at Regent House, Stockport at 9am on 28 March 2018 Agenda item Report Action Indicative Timings Lead 1 Apologies Verbal To receive and note 9.00 J Crombleholme 2 Declarations of Interest Verbal To receive and note 3 Approval of the draft Minutes of the meeting held on 28 January 2018 Attached To receive and approve J Crombleholme 4 Actions Arising Attached To comment and note 9.05 J Crombleholme 5 Notification of Items for Any Other Business Verbal To note and consider 9.10 J Crombleholme 6 Patient Story Video 9.10 J Crombleholme 7 Corporate Performance Reports Written Reports To receive, assure and note. 9.25 a) Finance Report b) Performance Report 8 Stockport Together Highlight Report Written Reports M Chidgey G Mullins To consider 9.40 T Ryley 9 Locality Chairs Update Verbal To receive and note 9.55 Locality Chairs 10 Report of the Chair Verbal Report To receive and note 10.05 J Crombleholme 11 Report of the Chief Operating Officer to include the following: Written Report To discuss and note (To Follow) 10.10 G Mullins CQC System Visit Q4 Assurance Visit 001

12 Refresh and update of 2018/19 operational plan Written Report To approve outline plans (To Follow) 10.30 TR / MC 13 Reports from Committees Quality Report Finance and Performance Committee Primary Care Commissioning Committee Written reports To note the content of the reports and approve the recommendations of the Remuneration Committee 11.15 A Rolfe V Owen Smith J Crombleholme 15 Any Other Business Verbal 11.25 J Crombleholme Date, Time and Venue of Next meeting The next NHS Stockport Clinical Commissioning Group Governing Body meeting will be held on 30 May 2018 Potential agenda items should be notified to stoccg.gb@nhs.net by 1 May 2018. 002

NHS STOCKPORT CLINICAL COMMISSIONING GROUP MINUTES OF THE GOVERNING BODY MEETING HELD AT REGENT HOUSE, STOCKPORT ON WEDNESDAY 31 JANUARY 2018 PART 1 PRESENT Mrs J Crombleholme Mrs G Mullins Mr M Chidgey Mrs A Rolfe Dr J Higgins Dr D Kendall Ms C Morgan Mr J Greenough Dr V Owen Smith Dr R Gill Dr Lydia Hardern Dr A Johnson Dr S Woodworth Lay Member (Chair) Chief Operating Officer Chief Finance Officer Executive Nurse Locality Chair: Heatons and Tame Valley Secondary Care Consultant Lay Member for Primary Care Lay Member for Finance and Audit Clinical Director Public Health Chief Clinical Officer Locality Chair: Stepping Hill and Victoria Locality Chair: Marple and Werneth Interim Medical Director IN ATTENDANCE Mr T Ryley Dr D Jones Mrs L Latham Mrs S Carroll Cllr T McGee Director of Strategy and Performance Director of Service Reform Associate Director Corporate Governance Healthwatch Stockport Stockport Metropolitan Borough Council 68/17 APOLOGIES Apologies were received from Dr P Carne. 69/17 DECLARATIONS OF INTEREST Dr S Woodworth declared a pecuniary interest with regard to Item 16 Report of the Remuneration Committee on the basis that he was the interim post holder to which the remuneration would be negotiated. The Chair confirmed that he should leave the meeting and not take part in the discussion. Dr J Higgins, Dr R Gill, D L Hardern and D A Johnson declared an interest with regard to Item 9 Approval of Stockport Together plans. The nature of the interest being that they were partners in GP Practices in Stockport and the plans included investment in the GP Federation and also into General Practice. They also declared an interest with regard to Item 10 Mental Health Investment Plan. The nature of the interest being that they were partners in GP Practices in Stockport and the plans included investment into General Practice. Dr V Owen Smith declared that she was employed by Stockport Metropolitan Borough Council. Dr J Higgins declared an interest with regard to Item 9 Approval of Stockport Together Plans. The nature of the interest being that his practice was one of the designed sites for delivering Enhanced Case 1 003

Management. 70/17 APPROVAL OF THE DRAFT MINUTES OF THE GOVERNING BODY MEETING HELD ON 29 NOVEMBER 2018 The minutes of the meeting held on 29 November 2018 were approved as a correct record. 71/17 ACTIONS ARISING 29 11 2017 Patient Story Action completed and to be removed from the log. 29 11 2017 Chief Clinical Officers Report Action completed and to be removed from the log. 29 11 2017 Finance Report Action being progressed as part of the national planning guidance so to be removed from the log and reported to Governing Body as part of future plans. 72/17 ANY OTHER BUSINESS There were no items on this occasion. 73/17 PATIENT STORY The Governing Body heard from a patient who had accessed the GP Seven Day Service and also from a nurse working as part of the pilot site at Heaton Moor Medical Centre. The patient confirmed that accessing a Saturday morning appointment had proved very convenient for her and had meant that she d not needed to take leave from work. Sister Taylor from the Practice confirmed that the service was working well and awareness amongst patients had recently increased. She noted that IT issues had been rectified and that clinicians working at weekends had commented that clinics had operated smoothly and they d been able to deliver high quality care to patients. In particular she highlighted positive feedback from working age patients who found weekday appointments less easy to access. The Governing Body commented on the following elements of the story: Appointments were bookable in advance and on the day which was important. Important at weekends to have access to range of clinical skills within clinics and not just GPs. The importance to understand the impact on clinicians as part of Seven Day working in terms of work life balance. Importance of ensuring further roll out of the system was accessible for patients in terms of travel to GP Hub sites. The need to ensure real time data capture about the Seven Day Service which would be progressed through the GP Federation. Resolved: That Governing Body: 1. Note the Patient Story and express thanks to the patient and Sister Taylor for sharing their experiences. 74/17 CORPORATE PERFORMANCE REPORTS (a) Finance M Chidgey provided an overview of the CCG s financial position as at December 2017 and noting the forecast outturn position for 2017/18. He confirmed the CCG s CIP position, including some significant elements achieved which were non-recurrent. He highlighted the CCG s net risk of 0.64m which was outside the forecast and highlighted the impact of national price increases due to drugs in short supply. He drew Governing Body s attention to the recommendation relating to the CCG s relocation to Stopford House as was cross referenced to the Chief Operating Officer s report. 2 004

In response to discussion the following key elements were highlighted by Members: The technical accounting position for brought forward surpluses and the NHS England position. The significant work undertaken by the Medicines Optimisation Team in terms of CIP achievement and of GPs in prescribing medication which was effective firstly for patients in terms of treatment but also cost effective. Potential financial risk for NHS Stockport Foundation Trust of cancelled electives in 2017/18 as patient numbers would be likely to increase in 2018/19. The national impact of drugs in short supply which could not be planned for. Resolved: That Governing Body: Notes the year-to-date position is in line with plan. Notes that an outturn breakeven position is forecast to be delivered. Notes that net risks totalling 0.64m are not reflected within the forecast. Notes that the position includes provision in full of the 0.5% non-recurrent uncommitted reserve as required by NHS England business rules. Notes that the Mental Health financial performance target is forecast to be achieved. Note that a recurrent deficit of 3.10m is currently forecast to be carried forward into 18/19 and the risks associated with this. Approves the agreement of a 10 year lease for relocation of NHS Stockport CCG to 4th Floor Stopford House at an estimated total cost of 1.60m and note that this value was still subject to ongoing negotiations. (b) Performance M Chidgey provided an overview of current performance noting that a future schedule of reporting to Governing Body had been proposed within the report. In particular he highlighted the current position relating to Urgent Care Performance including the actions being taken by Commissioners in response which included partnership work in terms of pathways and resilient and safe services. New services being put into place to support improvements in Urgent Care performance were noted. The Governing Body also considered continued improvements in mental health performance and high performance in terms of the delivery of cancer standards. As part of discussion and questioning, the following elements were highlighted by the Governing Body: Modelling and understanding of any potential impact of the newly formed Manchester University Hospital Trust on performance in Stockport including patient choice. The reporting and investigation processes for validated 12 hour breaches at NHS Stockport Foundation Trust and the role of the CCG s Quality Committee in considering the outcome. G Mullins noted that the CCG had received a letter from Healthwatch on this matter and would respond in due course. A Rolfe confirmed that herself and the Director of Nursing from the Trust would be happy to meet with Healthwatch representatives to discuss issues highlighted in further detail. Concern about the impact on outcomes for those patients waiting longer than 12 hours was noted. The need to understand the ambulance performance position as aligned to existing measures to consider all contributory factors. R Gill confirmed that the CCG was actively working with Greater Manchester Health and Social Care Partnership and with the Trust and local partners to provide commissioner leadership and support as part of a Locality response to continued urgent care performance issues. He noted that improvements in patient safety had been demonstrated but that urgent care remained the priority for all partners in Stockport. Resolved: That Governing Body: (i) Notes the format and timing of performance reporting in transitioning to a quarterly integrated performance report. 3 005

(ii) (iii) Notes the performance issues highlighted to the Governing Body, in particular the continued levels of urgent care performance. Confirms that future reports will include data on ambulance performance. 75/17 STOCKPORT TOGETHER HIGHLIGHT REPORT T Ryley provided an update on the recent activity of the Stockport Together Transformation Programme and drew the Governing Body s attention to five principal risks of workforce, system leadership changes, digital funding, benefits realisation, and competing expectations. He noted that a significant amount of work was underway to develop and test new ways of working which would be embedded in contracts subject to Commissioner approval of the next steps. Governing Body noted that implementation and service mobilisation timescales were behind plan but that plans had been re-assessed following the approval out the Outline Business Cases in July 2017. The positive feedback from the LCO Peer Visit to Stockport was noted. In response to questioning, M Chidgey confirmed that the approach to planning and contracting would be based on an outcomes framework linked to a population segmentation approach and work will be undertaken with Providers to test an initial series of segments. Resolved: That Governing Body note the update report. 76/17 APPROVAL OF STOCKPORT TOGETHER PLANS J Crombleholme provided the context for the Governing Body s discussion noting that it was a significant milestone in the CCG and wider system s transformation plans. She explained that the approach to decision making would be based on considering the following key elements: The consultation process followed Information and evidence arising Risks Decision Public questions would be taken ahead of the decision in order for them to be actively considered by Governing Body Members. It was noted that recommendations arising from the discussion would be captured as part of the Board s formal decision. T Ryley provided an overview of the previous endorsement of Outline Business Cases in July 2017 and the reasons for transforming health and care in Stockport including the duty to address health inequalities, provide high quality integrated health and care services for the population of Stockport and reduce the financial gap. He noted that the public consultation had been accompanied by a series of Equality Impact Assessments (EIAs) which would continue to remain under review throughout proposed implementation. The output of the public consultation had been analysed independently and published as provided ahead of a Commissioner response. He noted that bed reductions had been highlighted as an area of concern but balanced against a wider context of improving the delivery of care for the population of Stockport. The actions and recommendations arising from the public consultation would be actively pursued as part of implementation and beyond. In discussing in detail the process followed as part of the public consultation the following elements were highlighted by the Governing Body: The importance of ensuring that the output of locality based consultation conversations was captured continually alongside review of EIAs and the provision of services within neighbourhoods to meet population needs whilst ensuring equality of service access for the population. Lack of evidence of patient choice within the consultation output and the reason for this in terms of statistical requirements. Language within the EIAs which refers to men working and should be amended to ensure equality and the importance of highlighting as part of continued review the digital divide. 4 006

Importance of ensuring staff training on embedding equality and diversity understanding across the system was provided and in particular ensuring service design responded appropriately to those groups with protected characteristics. T Ryley confirmed that as part of the consultation and preceding Listening Exercise a range of methods had been used to capture views and feedback from those residents living in areas less traditionally willing to engage. The importance of aligning all the actions from EIAs into a single plan was highlighted. Ongoing engagement with service users and their families would continue through to implementation, in particular focusing on actions arising from the EIAs. A representative from the Consultation Institute who had acted as independent analysts for the consultation output addressed the Governing Body to confirm the process for analysis which had been followed and confirmed the approach taken in working with the CCG including the responsiveness of the organisation in providing the evidence collated and in receiving openly the output arising. He confirmed that the Programme Director had commented only on issues of factual accuracy ahead of publishing the report and not on the independently analysed content. The Governing Body then moved on to consider the additional evidence arising from the consultation and highlighted the following issues: Requirement to consider children and families as part of the partnership strategy in Stockport. Future consideration of the tests which would be applied by Providers ahead of any bed closures Importance of ensuring that the approach to carers is embedded as part of communications approach to and delivery and implementation of new services. Continued development of public understanding of the role of neighbourhoods in delivering health and care services in Stockport. Public health spend as part of the Stockport Together approach. T Ryley confirmed that the analysts had separated out feedback from informed stakeholders and the wider population. Role of ensuring appropriate community and intermediate tier beds were available to support the delivery Governing Body discussed in detail the risks as at outlined to them and highlighted the following issues: The importance of ensuring the work reduces the risk of a growing gap in health inequalities in Stockport and future management of public health monies at a time of reducing spend remains in view. Future and continued focus on prevention. The risks posed to patients and the system in not sharing data and the importance of ensuring the 7 th Caldicott Principle outlining the duty to share is explicitly communicated across the system and commonly understood. The requirement for a comprehensive approach to system workforce planning given the scale of risk posed in this area and as aligned to the need for a Provider Organisational Development Plan to address known risks arising from culture and leadership matters. Future risks around access to adult social care services potentially arising from increases in rates for chargeable services need to be understood. Focus should remain at system and individual organisational level on mobilisation as aligned to benefits delivery. M Chidgey explained in response to questioning that individual organisational CIPs would need to be delivered. Effective management of implementation was highlighted as a risk, in particular relating to pace and embedding of change. A question was raised by a Member of the public regarding the decision to conclude the MCP procurement. G Mullins confirmed that focus for the system was in delivering the new models of care and the future aspiration to move to a single integrated provider ACO remained. Governing Body concluded the discussion by considering in detail the recommendations contained within the report and in particular the elements regarding statutory partners and wider determinants of health. It was noted that further work had been undertaken to embed mental health as part of the approach to neighbourhood design and delivery in response to previous Governing Body recommendations. 5 007

J Crombleholme provided a summary of the Governing Body s consideration and the full list of caveats and recommendations as outlined below. Resolved: That Governing Body: 1. Endorsed following detailed consideration and scrutiny the feedback from the public consultation, the updated Equality Impact Assessments (EIAs), the views of the Adult Social Care and Health Scrutiny Committee and the proposed response. 2. Agreed that the following elements be captured as part of the revised documentation, plans and thematic recommendations to be included in the approach to implementation: Public Involvement to include reference to carers, patients and citizens and a systematic approach to be progressed against agreed standards. Equality Impact Assessment Action (EIA) Plans to be combined into a single plan following a review of language to ensure consistency of terminology and understanding. Reference in the EIAs to be made to the digital divide and those with learning disabilities and LGBT groups. Consideration to be given to measures to be applied to the Equality Impact Assessment Actions Confirmation that the assurance will be received in future about the embedding of the approach to equality as part of implementation beyond the training staff will require as part of their roles. That reference to statutory partners including housing associations be made more explicit in addition to the Third Sector. That the future approach to health and care services for children be articulated as part of the wider implementation context. Commissioners to provide leadership and expertise to support the development of a robust and comprehensive approach to system workforce strategy and plans. Organisational Development Strategy to include references and understanding of organisational culture and the link to leadership. Designated capacity be put in place to lead the workforce and organisational development work. Reference to be included to Caldicott Principle 7 as part of the integration and sharing of data. The Health and Care Integration Board to consider how strategic and operational risks linked to implementation are managed in a changing and complex environment. Decision making by all partners regarding Financial and Operational Planning to consider system impact and potential implications for delivery of system transformation and performance improvements. Governing Body to receive detail about the tests to be applied prior to closure of any beds at NHS Stockport Foundation Trust ahead of any decisions being made by Providers. 3. Approved the recommendation at 4.5.2 to approve the approach described in the previously endorsed outline business cases and proceed to implementation subject to the recommendations set out in Section 5 of the report namely that: We review how, as commissioners and providers, we further engage and involve local people those who use health and social care services as well as those who do not. We accept that, in the past, consultation outreach has sometimes appeared start/stop. Going forward, we will act on comments made by consultees which suggest we should involve local people in a more consistent, regular, and sustained way. From January 2018, Commissioners will consider a method of engagement that involves collaborative working amongst stakeholders. It will build on comments received during this consultation about how we avoid complexity in our communications, promoting innovation and opportunity within our health and care system. Through more effective engagement techniques, we will specifically build-in checks and balances to ensure there is an equal and fair representation for people who often do not have their voices heard. We will review how we present financial information, and the need to provide greater clarity around how funding is directed (on what services), and how this compares to previous years. We would hope that greater familiarity of issues, through more regular and consistent 6 008

involvement, creates better understanding of those issues amongst patients and our wider stakeholder groups. We continue to work closely with the new Citizens Representation Panel to ensure closer working with our operational leads and move closer to a culture of shared leadership in decision making. We proactively build on the networks and contacts already achieved and established through this consultation. This will enable us to build greater involvement of local people in decision making about their health and social care services particularly those less able to access services, for example visually impaired, deaf and disabled people. Work with GPs and the new Neighbourhood model structures to establish local networks that create meaningful and early involvement of local people in decision making. We will establish channels of communication and engagement that will regularly update patients and the public on progress some of these channels will include Patient Participation Groups, collaborative working between patients and clinicians and greater use of digital media to support information flow to both patients and the public. 4. Approve the adoption of the series of recommendations regarding implementation in light of the consultation feedback as set out in Section 5.1.2 of the report and outlined above. 5. Approve the proposals to review progress as described in Section 6.1.2 of the report that the Health and Care Integrated Commissioning Board (HCICB) will consider in public a report on progress in addressing the recommendations as set out in Section 5 of the report and the Equality Impact Assessment Plans. This report would be presented in September 2018 and reviewed again in July 2019. 77/17 MENTAL HEALTH INVESTMENT PLAN M Chidgey provided an overview of the investment plan and expressed thanks to Dr N Hussain and G Evans who had led the work on behalf of the CCG. He drew attention to the detailed investment plan for the period 17/18 20/21 and noted that of the total 9.1m investment, 6.1m would be invested in national must dos and the remaining 3m into local priorities as aligned to system plans. The 4 themes within the plan were highlighted and the risks of not proceeding immediately were approximately 600k of schemes were considered by the Governing Body including the importance of setting the investment plan within the wider context of the Stockport Together Business Cases. The significance of the investment plan in working towards Parity of Esteem was noted. Governing Body members highlighted the importance of mental health investments being made on the basis of the neighbourhood model. J Greenough sought clarity about the basis for the development of the investment plan including the involvement of GPs and wider patient and stakeholder groups. *Dr L Harden left the meeting. Resolved: That Governing Body: (i) Notes the content of the Mental Health Investment Plan (ii) Approves the investment plan as a high priority for inclusion within the 2018/19 CCG plan. (iii)notes that the scope of this plan excludes both the CQC action plan and PCFT underlying financial position. 78/17 LOCALITY CHAIRS REPORT On behalf of Locality Chairs J Higgins presented the report which focused on work being actioned relating to member feedback on the crisis report, flu and long term condition management. V Owen Smith noted the high immunisation rates in Stockport which included being second nationally for Reception and Years 2 and 3 aged children. G Mullins noted that the member view of the changes to the crisis response service were being considered by commissioners. 7 009

Resolved: That the report be noted. 79/17 REPORT OF THE CHIEF OPERATING OFFICER G Mullins introduced the report and the following updates on key elements were provided: Working Well Project. Re-location of CCG Offices to Stopford House. Stockport Town Ambassador. With regard to the CCG office relocation, she informed Governing Body that the approach was aligned to the agreed strategy regarding strategic integrated commissioning and the terms of a lease for the floor space was being negotiated with the Council. T Ryley confirmed that scoping work had been undertaken regarding meeting room access and the financial case for moving would make a modest saving for the CCG and would ensure public sector monies remained in the public sector. Resolved: That Governing Body: 1. The CCG Governing Body are asked to note the report and confirm their endorsement of Stockport s engagement in the Working Well Early Help Programme. 2. Request that the Chief Operating report to the Governing Body any material changes to lease terms. 3. Delegate authority to the Chief Operating Officer to enter into a 10 year lease for the 4th Floor Stopford House subject to the final negotiated lease cost remaining value for money. 80/17 CHIEF CLINICAL OFFICERS REPORT R Gill introduced the report and D Jones provided a brief over view of the work being progressed relating to Healthier Together. In addition to the business case work being continued and refinement of the financial position, improved bowel cancer rates were noted and pathway work was noted to be progressing well with design characteristics now signed off. Resolved: That the report was noted. 81/17 SAFEGUARDING ANNUAL REPORT J Parker provided an overview of the report for the 2016/17 year. She highlighted in particular the work which had been undertaken to ensure the CCG met its statutory safeguarding requirements and ensures the compliance of its providers with CCG Safeguarding standards. She noted that the Quality Committee provided ongoing assurance regarding safeguarding activity and provided an overview of the issues highlighted regarding assurance from GP Practices as regards safeguarding standards. Areas of work which remained under progression were noted to be: Meeting the needs of Looked After Children, including those placed out of area. Additional capacity had been secured for safeguarding adults. Commitment to learning from safeguarding reviews Progress in embedding the PREVENT agenda. In response to questioning C Morgan expressed concern that the CCG had reported in 2016/17 that statutory duties had not been met and noted that she wished this to be formally recorded within the minutes. J Parker acknowledged the concern noting that work was being undertaken with small providers to ensure assurance regarding safeguarding was routinely provided to the CCG and a joint Quality Team between the CCG and Council had been established. She noted that the CCG would anticipate reporting full compliance in 2017/18 and the matter was being monitored by Quality Committee. Resolved: That the Governing Body: 8 010

Notes the Annual report Acknowledges that the CCG is not fully meeting its safeguarding responsibilities and accepts the level of assurance provided and the residual risk. Acknowledges the gaps / risks in the system and the actions in place to address them. Notes that C Morgan and J Greenough would meet with J Parker to review the work which had been undertaken in 2017/18 and would inform the Annual Report. 82/17 REPORTS FROM COMMITTEES (a) Finance and Performance V Owen Smith provided an overview of the recent work of the Committee including the focus on risks associated with delivery of CIP, performance against plan and financial cost pressures arising from NICE guidance and new medication. Resolved: That the report be noted. (b) Primary Care Commissioning Committee J Crombleholme provided an overview of the recent work of the Committee including the ongoing negotiation with the GP Federation regarding the contract for the delivery of 7 Day Services. Governing Body was informed of the Committee s approval of catch up scheme for pneumococcal vaccinations to be put in place for Winter 2017 in line with Urgent Care Plan and schemes to reduce Winter Pressures and approval of an application for an estates and technology transformation fund application for Bramhall Park Medical Practice. She noted that the Committee also approved the lifting of contract notices at Bredbury Medical Centre. Resolved: That the report be noted. (c) Remuneration Committee J Greenough provided an overview of the recent work of the Committee which included the discussions regarding the remuneration for the Medical Director position. Resolved: That Governing Body: Approves the range within which the Chief Clinical Officer can negotiate an agreed salary with the appointee to the Medical Role was 130,000-140,000. 9 011

NHS Stockport Clinical Commissioning Group 31 January 2018 Actions arising from Governing Body Part 1 Meetings NUMBER ACTION MINUTE DUE DATE OWNER AND UPDATE 1 Patient Story Note the Patient Story and express thanks to the patient and Sister Taylor for sharing their experiences. 73/17 February 2018 L Latham 2 Performance Report 74/17 March 2018 M Chidgey Confirms that future reports will include data on ambulance performance. 3 Safeguarding Annual Report Notes that C Morgan and J Greenough would meet with J Parker to review the work which had been undertaken in 2017/18 and would inform the Annual Report. 81/18 April 2018 C Morgan, J Greenough and J Parker 012

013

Finance Report for the period ending 28 th February 2018 Month 11 NHS Stockport Clinical Commissioning Group will allow people to access health services that empower them to live healthier, longer and more independent lives. NHS Stockport Clinical Commissioning Group 7th Floor Regent House Heaton Lane Stockport SK4 1BS Tel: 0161 426 9900 Fax: 0161 426 5999 Text Relay: 18001 + 0161 426 9900 Website: www.stockportccg.org 014

Executive Summary What decisions do you require of the Governing Body? (i) Note the year-to-date position is in line with plan. (ii) Note that an outturn breakeven position is forecast to be delivered. (iii) Note a NIL net risk position is now being reported. (iv) Note that the position includes provision in full of the 0.5% non-recurrent uncommitted reserve as required by NHS England business rules. (v) Note that the Mental Health financial performance target is forecast to be achieved. (vi) Note that a recurrent deficit of c 3.10m is currently forecast to be carried forward into 18/19 and the consequent impact on the CIP target for 2018/19. Please detail the key points of this report The YTD and forecast outturn positions are in line with the planned in year surplus of 1.32m. As a result of activity levels being above planned levels, non-delivery of recurrent CIP and an increase in the number of CHC placements a 3.10m forecast recurrent deficit will be carried forward into 2018/19. What are the likely impacts and/or implications? Non-delivery of NHS England business rules and performance targets would result in increased scrutiny and would impact on the CCG s assurance rating. How does this link to the Annual Business Plan? As per 2017/18 Financial Plan. What are the potential conflicts of interest? N/A Where has this report been previously discussed? This report is being presented for the first time. Clinical Executive Sponsor: Ranjit Gill Presented by: Mark Chidgey Meeting Date: 28 March 2018 Agenda item: 7 a Reason for being in Part 2 (if applicable) N/A 2 015

Report of the Chief Finance Officer 1.0 Introduction This report provides an overview of the CCG s performance against Statutory Financial Duties and Financial Performance Targets highlighting both the year to date and forecast positions for 2017/18. This report provides an update on:- The financial position as at 28th February 2018 The forecast outturn position for 2017/18 2.0 Statutory Financial Duties and Performance Targets As a CCG we are required to deliver statutory duties and financial performance targets that we have approved as a Governing Body. Table 1 below RAG rates our financial performance on both a Year to Date (YTD) and Forecast Outturn basis. Table 1: Statutory Duty and Performance Targets Area Revenue (Dashboard Table 1) Running Costs (Dashboard Table 1) Capital (Note: The CCG has not received a capital allocation in 2017/18) Statutory Duty Not to exceed revenue resource allocation Not to exceed running cost allocation Not to exceed capital resource allocation Performance YTD N/A Performance Forecast N/A 3 016

Area Performance Target Performance YTD Performance Forecast Revenue Underspend revenue resource allocation by 1.32m. Cash (Appendix 1 Table 9) Business Conduct (Appendix 1 Table 8) Operate within the maximum drawdown limit Comply with Better Payment Practices Code 0.5% Uncommitted Non- Recurrent Reserve Create an uncommitted 0.5% non-recurrent reserve CIP (Appendix 1 Table 6) Fully deliver planned CIP saving Mental Health Financial Performance Target Growth in Mental Health spend is at least equal to programme allocation growth Net Risk (Appendix 1 Table 7) All risk to be fully mitigated (NIL Net Risk) Integrated Assurance Framework (IAF) Finance Rating (Q4 anticipated) From 2017/18, NHS England moved to performance managing CCGs financial performance on an in-year basis. Because the NHS Stockport CCG 2016/17 planned surplus was below the national target level our financial performance in 2017/18 must compensate for this and we will be measured against delivering a 1.32m in-year surplus. The comparator for the majority of CCGs is breakeven. Previously members were notified that when reporting the CCG s statutory financial performance, prior year cumulative surpluses were to 4 017

be included. NHS England has now issued guidance which sets out that the reporting of CCG s statutory financial performance will align with the reporting of the CCG s in-year financial performance and exclude prior year cumulative surpluses. As required by the 2017/18 NHS Planning Guidance, the CCG has created a 0.5% (1.0% in 2016/17) uncommitted reserve. It is anticipated that the CCG will be required to release this reserve in M12 and as a result the reported surplus will increase by 2.00m to 3.32m. 3.0 Financial Position as at 28 th February 2018 Month 11 The financial position as at month 11 is summarised in Table 2 below with further detail provided in Appendix 1 to this report. Table 2: Summary of Financial Position at Month 11 Plan Actual (Favourable) (Surplus) / Deficit (Surplus) / Deficit / Adverse Variance 000s 000s 000s Month 11 YTD (1,208) (1,208) 0 Year End Forecast (1,318) (1,318) 0 The CCG has reported a YTD surplus of 1.21m and a forecast outturn surplus of 1.32m in line with plan. The forecast outturn includes CIP delivery of 17.64m (101.1%), against a plan of 17.45m of which 2.23m has been achieved by deploying the full CCG contingency against CIP delivery. 4.0 Programme Expenditure Acute Acute contract spend is 3.54m higher than year to date plan and forecast to overspend by 3.86m. This is due both to increases in activity which, whilst they are below national growth forecasts of c2.5%, are above the local planned growth forecasts of 0%. In addition to this volume increase there is also a significant element of the variance which relates to price changes driven by the impact of HRG4+. Community Health The forecast overspend of 0.30m in Community Health is due to an increase in community neuro-rehabilitation placements. Continuing Care The forecast overspend of 1.07m is primarily due to an increase in the number of placements which aligns with changes to CHC process to reduce pressure on the acute system, in particular to reduce the number of Delayed Transfers of Care (DTOC). In addition, 4 high cost children s 5 018

packages have been agreed which have a total cost of 0.38m per annum. Mental Health The Mental Health YTD over spend of 0.18m and forecast outturn over spend of 0.20m reflects funding costs associated with older people mental health services. The CCG is committed to implement all planned Mental Health schemes and investments in line with our local investment strategy. Where schemes planned for 17/18 have not yet been fully implemented then the full level of resources will be available in 18/19. Prescribing The prescribing budget has been set at 48.10m which is equal to the 2016/17 outturn and in therefore consistent with the Stockport Together economic case. The current prescribing forecast of 49.09m therefore reflects an over spend of 0.99m but includes significant unplanned charges for concessional pricing for drugs which are in short supply ( 2.32m) and Category M (generic drugs) price reduction benefits which, as part of a national financial risk reserve, are to be retained by NHS England ( 0.48m). Without these externally set charges the Prescribing budget would be contributing an additional 1.81m to CIP. Primary Care The forecast outturn includes an overspend of 0.34m which incorporates a cost pressure as a result of the 2016/17 QOF achievement being higher than anticipated as well as a higher QOF achievement estimate in 2017/18. The forecast outturn also includes an overspend of 0.24m due to an increase in claims for sickness and parental leave cover. These cost pressures have been offset by lower than planned increases in patient list sizes 0.30m, recovery of business rate overpayments and underspends within local enhanced services 0.19m. 5.0 Running Costs (Corporate) The YTD underspend of 0.62m and forecast outturn underspend of 0.57m reflect pay underspend due to staff vacancies ( 0.50m) and non-pay underspends ( 0.12m). 6.0 Cost Improvement Programme (CIP) Year to date 16.36m (93.7%) of the 17.45m CIP plan has been delivered, of which 2.23m has been achieved by deploying the CCG contingency in full against CIP delivery. It is forecast that 17.64m (101.1%) will be delivered by year end. 7.0 Recurrent (Underlying) Position Due to the planned level of Stockport Together benefits not being realised (i.e. activity levels being above planned levels), non-delivery of recurrent CIP and an increase in the number of CHC placements a 3.10m (Appendix 1 Table 1) forecast recurrent deficit will be carried forward into 2018/19. 6 019

This recurrent deficit places a significant additional pressure for the CCG achieving NHSE business rules in 2018/19. Failure to achieve the business rules would have a significant impact initially on the CCGs assessment rating but more fundamentally on the CCGs ability to implement the commissioning strategy, in particular where service change is dependent upon investment. 8.0 Recommendations These are set out on the front sheet of this report. Mark Chidgey Chief Finance Officer March 2018 Documentation Statutory and Local Policy Requirement Cover sheet completed Y Change in Financial Spend: Finance Section below completed Y Page numbers N Service Changes: Public Consultation Completed and Reported in Document n/a Paragraph numbers in place Y Service Changes: Approved Equality Impact Assessment Included as Appendix n/a 2 Page Executive summary in place (Docs 6 pages or more in length) n/a Patient Level Data Impacted: Privacy Impact Assessment included as Appendix n/a All text single space Arial 12. Headings Arial Bold 12 or above, no underlining Y Change in Service Supplier: Procurement & Tendering Rationale approved and Included n/a Any form of change: Risk Assessment Completed and included n/a Any impact on staff: Consultation and EIA undertaken and demonstrable in document n/a 7 020

RAG Rating Key: TABLE 1 G Potential risk of overspend: less than or equal to 0 TABLE 2 A Potential risk of overspend: between 0 and 250k Month 11 Financial Dashboard Appendix 1 Month 11 Financial Position - as at 28 February 2018 Revenue Resource Limit (RRL) Confirmed (415,151) (415,151) 0 0.0% (453,579) (453,579) 0 0.0% (445,422) (445,422) 0 Net Expenditure R Potential risk of overspend: Over 250k YTD (Mth 11) Forecast 17/18 Recurrent Recurrent Recurrent Variance Budget Commitment (Favourable) / RAG Budget Actual Var Var Budget Actual Var Var Adverse RATING 000s 000s 000s % 000s 000s 000s % 000s 000s 000s Total RRL (415,151) (415,151) 0 0.0% (453,579) (453,579) 0 0.0% (445,422) (445,422) 0 Acute 222,724 226,328 3,604 1.6% 242,954 246,811 3,857 1.6% 240,818 245,877 5,059 Mental Health 31,120 31,571 451 1.4% 34,221 34,421 200 0.6% 33,721 34,385 664 Community Health 35,187 35,490 303 0.9% 38,386 38,686 300 0.8% 38,386 38,695 309 Continuing Care 14,043 14,978 935 6.7% 15,320 16,385 1,065 7.0% 15,320 16,411 1,091 Primary Care 45,874 45,689 (185) (0.4%) 50,547 50,132 (415) (0.8%) 49,711 49,666 (45) Other 10,142 9,909 (233) (2.3%) 12,160 9,894 (2,266) (18.6%) 4,085 4,216 131 Sub Total Healthcare Contracts 359,090 363,965 4,875 1.4% 393,588 396,329 2,741 0.7% 382,041 389,250 7,209 Prescribing 44,094 44,975 881 2.0% 48,103 49,091 988 2.1% 48,103 48,103 0 Running Costs (Corporate) 5,568 5,003 (565) (10.1%) 6,086 5,461 (625) (10.3%) 6,086 6,086 0 Reserves (Ref: Reserves Summary) 5,191 0 (5,191) 0.0% 4,484 1,380 (3,104) (69.2%) 4,158 5,075 917 Total Net Expenditure and Reserves 413,943 413,943 0 0.0% 452,261 452,261 0 0.0% 58,347 59,264 917 TOTAL (SURPLUS) / DEFICIT (1,208) (1,208) 0 0.0% (1,318) (1,318) 0 0.0% (5,034) 3,092 8,126 Acute Contract Performance Major Acute Commissioning contracts & AQP/IS Annual Budget Budget Year to Date Actual YTD Variance - Overspend / (Underspend) Forecast Outturn Forecast Forecast Variance - Overspend / (Underspend) '000 '000 '000 '000 '000 '000 Stockport Foundation Trust 151,426 138,807 138,934 127 151,447 21 Manchester University NHS Foundation Trust 23,840 19,863 20,903 1,040 25,015 1,175 University Hospitals of South Manchester FT 13,765 13,765 14,355 590 14,351 586 Central Manchester University Hospitals FT 10,071 10,071 10,009 (62) 10,009 (62) Salford Royal FT 6,976 6,394 6,832 438 7,500 524 The Christie NHS Foundation Trust 3,546 3,250 3,354 104 3,658 112 East Cheshire NHS Trust 2,118 1,942 2,158 216 2,357 239 Tameside & Glossop Integrated Care FT 1,275 1,169 1,114 (55) 1,216 (59) AQPs/IS 13,786 12,637 13,350 713 14,567 781 Other 16,151 14,826 15,319 493 16,691 540 Total Acute 242,954 222,724 226,328 3,604 246,811 3,857 TABLE 3 TABLE 4 TABLE 5 Month 11 - as at 28 February 2018 Forecast Reserves Summary Reserves Commitments Forecast Bals Held Mth 11 Year End Amounts Held in CCG Reserves 000s 000s 000s Investments 7,596 3,134 (4,462) Contingency 0 0 0 In-Year Allocations 684 413 (271) Savings & Efficiency (3,796) (2,167) 1,629 Total Reserves 4,484 1,380 (3,104) TABLE 6 Statutory Surplus Forecast 000s 2017-18 Allocation (453,579) Less: 2017-18 Expenditure 452,261 In-Year Surplus (1,318) Add: Brought forward 2016-17 Surplus Allocation 0 Forecast Statutory (Surplus) / Deficit (1,318) Top Five Increases in Prescribing Spend by Drug Type Jan 16 - Dec 16 ( 000s) Jan 17 - Dec 17 ( 000s) Change ( 000s) Change in Change in No. Spend (%) Items (%) Cardiovascular System 6,528 7,262 734 11.2% -0.4% Appliances 1,526 1,659 133 8.7% 15.3% Stoma Appliances 1,657 1,771 114 6.9% 5.4% Nutrition And Blood 2,893 2,958 65 2.3% 3.2% Immunological Products & Vaccines 603 639 36 6.0% 7.2% TABLE 7 - not required for month 11 TABLE 8 Public Sector Payment Policy (PSPP) - Measure of Compliance TABLE 9 Cashflow Summary - Month 11 000s Cash Limit for the Year 451,177 Cash drawn down YTD 410,144 Remaining cash 41,033 Actual cash drawn down (%) 90.9% Expected cash drawn down (%) 91.7% 8 The Public Sector Payment Policy target requires CCG's to February YTD aim to pay 95% of all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. Number 000s Non-NHS Payables Total Non-NHS Trade Invoices Paid in the Year 11,888 100,701 Total Non-NHS Trade Invoices Paid Within Target 11,528 99,910 Percentage of Non-NHS Trade Invoices Paid Within Target 96.97 99.21 NHS Payables Total NHS Trade Invoices Paid in the Year 2,712 261,282 Total NHS Trade Invoices Paid Within Target 2,606 260,107 Percentage of NHS Trade Invoices Paid Within Target 96.09 99.55 Total NHS and Non NHS Payables Total NHS Trade Invoices Paid in the Year 14,600 361,983 Total NHS Trade Invoices Paid Within Target 14,134 360,017 Percentage of NHS Trade Invoices Paid Within Target 96.81 99.46 We will continue to monitor our performance against the 95% 'Public Sector Payment Policy' (PSPP) target of invoices paid within 30 days of invoice. Performance is measured based on both numbers of invoices and value. 021

022

Performance Update Report March 2018 NHS Stockport Clinical Commissioning Group will allow people to access health services that empower them to live healthier, longer and more independent lives. NHS Stockport Clinical Commissioning Group 7th Floor Regent House Heaton Lane Stockport Tel: 0161 426 9900 Fax: 0161 426 5999 SK4 Text 1BS Relay: 18001 + 0161 426 9900 Website: www.stockportccg.org 023

Executive Summary What decisions do you require of the Governing Body? Governing Body is asked to: (i) Note the format and timing of performance reporting in transitioning to a quarterly integrated performance report. (ii) Note the performance issues highlighted to the Governing Body, in particular the continued levels of urgent care performance. Please detail the key points of this report Urgent Care performance remains the key performance area for improvement. What are the likely impacts and/or implications? These are identified in the report. How does this link to the Annual Business Plan? The CCG s Annual Business Plan is based upon achievement of national standards. What are the potential conflicts of interest? There are no potential conflicts of interest Where has this report been previously discussed? n/a Clinical Executive Sponsor: Dr Ranjit Gill Presented by: Mark Chidgey Meeting Date: 28 March 2018 Agenda item: 7 b Reason for being in Part 2 (if applicable) Compliance Checklist: Documentation Cover sheet completed Y / N Statutory and Local Policy Requirement Change in Financial Spend: Finance Section below completed To follow Page numbers Y / N Service Changes: Public Consultation Completed and Reported in Document n/a Paragraph numbers in place Y / N Service Changes: Approved Equality Impact Assessment Included as Appendix n/a 2 Page Executive summary in place (Docs 6 pages or more in length) n/a Patient Level Data Impacted: Privacy Impact Assessment included as Appendix Y / N All text single space Arial 12. Headings Arial Bold 12 or above, no underlining Y / N Change in Service Supplier: Procurement & Tendering Rationale approved and Included Any form of change: Risk Assessment Completed and included Y / Na n/a 024

Any impact on staff: Consultation and EIA undertaken and demonstrable in document Y / N 025

Issues highlighted to Governing Body 4 hour and 12 hour Urgent Care performance Performance against the 4 Hour ED waiting time standard has continued to be significantly challenged. The graphs below show performance for the year, and this highlights the continued under-performance against the standard. When we compare our performance to Greater Manchester, our levels of performance are below those of other systems. Whilst demand is 2.1% higher than last year, we can see that this is within normal/expected levels of variation. Control chart methodology shows that there has not seen a step change in the demand our population places on A&E departments. Whilst performance is clearly a challenge, there is a small positive improvement in performance evident from March 2017 from 80% to 83%. The winter months have seen below average performance this year, as was the case last year. If our Urgent Care plans are effective, we would now hope to see a further improvement in performance over the summer months, this will need to be both sustained and increased. A&E Attendances (adjusted for calendar days) (Stockport CCG patients, all providers) April 2016 to January 2018 10000 9000 8000 7000 6000 5000 4000 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 A&E Attendances Average UCL LCL 026

We see a very similar pattern when we look at Stepping Hill as a whole. Whilst attendances this year are 2.5% up on last year, this all falls within expected and natural variation. A significant element of the 2.5% increase we see is due to below average levels of demand over the winter last year returning to average levels this year. Again, we see an improvement in performance at Stepping Hill as of March 17 from average performance of 77% to 80%. The run of improved performance from Dec 16 to May 17 is most likely a combination of seasonality and the implementation of the system wide Urgent Care plan. 10000 A&E Attendances (adjusted for calendar days) (Stockport Foundation Trust, all commissioners) Apr 2016 to Feb 2018 9000 8000 7000 6000 5000 4000 Below average winter demand last year Returning to average this year 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 A&E Attendances Average UCL LCL 100.0% A&E 4 hour performance (Stockport Foundation Trust, all commissioners) Apr 2016 to Feb 2018 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 2016-04 2016-05 2016-06 2016-07 2016-08 2016-09 2016-10 2016-11 2016-12 2017-01 2017-02 2017-03 2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 Average UCL LCL Target 4hr A&E Performance 027

Within Q3, the acuity of patients presenting across the holiday period increased significantly over December with a number of flu patients attending requiring isolation, putting a greater pressure on patient flow through the hospital. During December and January an additional 30 medical beds were opened at SFT to provide additional capacity but placing additional pressure on workforce capacity to staff all areas safely. Additional capacity was commissioned by the CCG over the winter period and into January from Mastercall to support admission avoidance through the following schemes: 7 day access ATT/GP Pathfinder capacity IV Capacity Supportive actions have continued to take place to promote performance improvement at Stockport Foundation Trust in January and February. Performance on the 4 Hour target continues to be a challenge with unvalidated performance predicted to be 73.8% in February. Cumulative annual performance of 80.0% for the period April 2017 to February 2018 compares to 77.2% for the period April 2016 to February 2017. 4 hour performance at all providers is slightly higher at 82% year to date. There were 52 patients who experienced a 12 hour trolley waits at Stockport Foundation Trust in January 18, raising the year to date figure to 64 patients. It is known that patients have been experiencing long waits prior to the recruitment of extra medical staff. The recruitment of the medical staff and the subsequent assessment of patients with clear treatment plans and decisions to admit has made the long waits safer but this situation is not acceptable. There is an expectation that further improvements will be made to reduce the incidence of the 12 hour waits. The Quality and Safety Team are working closely with SFT to ensure that there are thorough investigations of each of the circumstances and subsequent learning. A key theme of learning is the timing of bed availability throughout the day, which requires improved flow through the hospital. Delayed Transfers Of Care There has been good progress in reducing the number of patients classified as DToC, although a point prevalence in medicine in February suggests Medically Optimised Awaiting Transfer (MOAT) patients to be as high as 90; equivalent to 55% of the specialty medicine bed base. A four week Multi Agency Discharge Event (MADE) commenced at the end of January to reduce delays and increase discharges. Implementation of the SAFER programme continues to be the approach for reducing delays from admission to discharge, by aiming to deliver timely appropriate care at the right time in the right place. The implementation is not consistent and a robust standardised approach is needed for the benefits of this programme to be realised. Longer term sustainability of performance will only be delivered by full delivery of the Urgent Care Improvement Plan and the service model changes outlined in the Stockport Together Business Cases. 028

Ambulance Ambulance response times remain a challenge with performance across all categories consistently below the national standard, particularly over the winter months. Response times to Category 2 (emergency) calls are particularly challenging with performance at ~40 minutes in Jan 18 against a standard of 18 minutes. There has been issue with patients experiencing delays in waiting for an ambulance response. The Executive Nurse has corresponded with the Chief Executive of North West Ambulance Service to advise that the delays are impacting in patient safety. The Executive Nurse has also escalated the issue to Blackpool CCG who are the lead commissioner and GMHSCP for wider discussion with the rest of GM CCGs at the GM Quality Board. Referral to Treatment Time for Planned Care (RTT) Maintaining RTT performance at SFT is at significant risk, primarily as a consequence of clinical resources being prioritised away from elective activity to support the urgent care pathway over the winter period. This is in line with national policy. A capacity and demand review has taken place to assess risks to performance and agree a planned response to improving performance. The impact of the above on the number of patients waiting longer than 18 weeks at SFT is that this has increased from:- 268 in November to 472 as at the end of Feb 18 (admitted patients) 1,322 in November to 1,811 at the end of Feb 2018 (non-admitted patients) To achieve the 92% standard the combined number of patients waiting longer than 18 weeks should be no greater than 1,675. 52 Week Waits There were 2 reportable 52 week waits in January Diagnostic performance standard and cancelled operations Although within range for January, both diagnostic and cancelled operations standards have failed year to date. The diagnostic performance is a result of patients waiting at Manchester University Hospitals NHS Trust (formerly UHSM and CMFT) Clostridium difficile The 2017/18 Health Economy Target is no more than 86 cases, SFT have been allocated no more than 17 Lapses in Care (LIC) with 69 allocated as non acute cases. SFT cases investigated to determine LIC identified 3 LIC cases for 17/18 (April = 1, May = 2). Due to 9 cases in Dec (trajectory for month is 7), the health economy is currently 9 cases over our total trajectory for the year to date (trajectory of 64, actual of 73) In comparison to 2016/17 for the same period (77 cases), the health economy has reduced the incidence of CDT by 4 cases 029

MRSA We have had one acute MRSA bacteremia reported this year, a transfer in from Manchester FT, and as a result the bacteremia has been assigned to SNHSFT. We have had two community MRSA bacteremia reported, one attributed to the Christie Hospital because the patient had not been receiving community services and the other was a Tameside patient. The CCG is currently negotiating with both providers regarding the acceptance of responsibility. Mixed Sex Accommodation (MSA) The CQC, in its inspection of Pennine Care in 2016 reported that they were in breach of MSA regulations, these have been correctly reported from August 2017 Pennine Care Trust Board has received an options paper to move to single sex wards for both adults and older people to ensure patient safety and maintain dignity, and also to ensure compliance with CQC regulations. A full consultation exercise will need to be undertaken. CPA 7 day Follow up This target is measured quarterly with performance across Q3 at 95.6%. October underperformance: One patient not followed up within 7 days, Trust report every attempt was made to follow-up the service user, this continues. December underperformance: One patient not followed up within 7 days due to patient having influenza. 030

E.B.5 Code A&E Waits Performance at M10 NHS Constitution Indicator Patients should be admitted, transferred or discharged within 4hours of their arrival at an A&E department 2016/2017 2017/2018 National Standard Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan 95% 79.76% 80.75% 87.10% 87.57% 87.29% 85.79% 85.61% 85.04% 83.50% 82.92% 81.68% 80.72% 82.26% E.B.S.5 No waits from decision to admit to admission (trolley waits) over 12 hours 0 0 0 0 0 0 0 4 0 0 0 8 52 64 Ambulance (Performance at Ambulance Trust Level) ARP.01 Category 1 (life-threatening) calls - 90th centile appropriate response time 00:15:00 #N/A #N/A #N/A #N/A #N/A #N/A 00:15:59 00:16:21 0:15:36 00:16:14 00:18:37 00:16:44 2017/18 YTD to January 18 ARP.02 Category 1 (life-threatening) calls mean time taken for a response to arrive 00:07:00 #N/A #N/A #N/A #N/A #N/A #N/A 00:10:07 00:09:50 00:09:29 00:09:44 00:11:17 00:09:51 ARP.03 Category 2 (emergency) calls 90th centile appropriate response time 00:40:00 #N/A #N/A #N/A #N/A #N/A #N/A 00:55:54 00:56:11 00:57:41 01:10:18 01:43:58 01:31:33 ARP.04 Category 2 (emergency) calls mean time taken for an appropriate response to arrive 00:18:00 #N/A #N/A #N/A #N/A #N/A #N/A 00:24:20 00:25:04 00:25:55 00:30:34 00:44:49 00:39:59 ARP.05 Category 3 (urgent) calls 90th centile appropriate response time 02:00:00 #N/A #N/A #N/A #N/A #N/A #N/A 01:37:27 01:58:21 02:01:58 02:02:02 02:54:47 03:14:16 ARP.06 Category 4 (non-urgent assess, treat, transport calls only) 90th centile appropriate response time E.B.15.i Category A calls resulting in an emergency response arriving within 8minutes Red 1 E.B.15.ii Category A calls resulting in an emergency response arriving within 8minutes Red 2 E.B.16 Category A calls resulting in an ambulance arriving at the scene within 19 minutes Referral To Treatment Waiting E.B.3 Patients on incomplete non-emergency pathways waiting no more than 18 weeks from referral 03:00:00 #N/A #N/A #N/A #N/A #N/A #N/A 02:34:21 02:40:28 02:28:47 02:36:00 03:33:35 03:16:31 75% 64.71% 65.64% 70.08% 65.92% 62.50% 64.67% #N/A #N/A #N/A #N/A #N/A #N/A 65.75% 75% 60.96% 63.44% 68.94% 64.43% 64.67% 64.17% #N/A #N/A #N/A #N/A #N/A #N/A 65.51% 95% 88.38% 90.23% 92.54% 90.08% 89.39% 89.80% #N/A #N/A #N/A #N/A #N/A #N/A 90.43% 92% 92.76% 92.99% 92.47% 92.89% 92.52% 92.41% 91.97% 91.61% 91.83% 92.18% 91.63% 91.31% 92.08% E.B.S.4 Zero tolerance of over 52 week waiters 0 1 0 3 4 1 0 2 1 2 3 3 2 21 Diagnostic test waiting times Patients waiting for a diagnostic test should have been waiting no more than 6 E.B.4 weeks from referral Cancelled Operations 99% 99.19% 99.56% 99.15% 99.20% 98.84% 98.58% 97.97% 98.41% 99.07% 99.25% 98.93% 99.25% 98.87% E.B.S.6 Urgent operations cancelled a second time 0 0 0 0 0 0 0 0 0 0 0 0 0 0 E.B.S.2 Number of patients not treated within 28 days of last minute elective cancellation. (Quarterly Measure) Cancer Waits E.B.6 Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP E.B.7 Maximum two-week wait for first outpatient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected) E.B.8 Maximum one month (31-day) wait from diagnosis to first definitive treatment for all cancers 0 #N/A 4 #N/A #N/A 6 #N/A #N/A 2 #N/A #N/A 1 #N/A 9 93% 97.22% 97.88% 97.17% 97.95% 97.05% 97.95% 98.83% 97.57% 97.20% 97.65% 95.99% 96.47% 97.40% 93% 95.03% 94.80% 93.62% 96.84% 94.85% 98.57% 97.44% 94.92% 98.37% 97.89% 96.95% 99.23% 96.86% 96% 96.32% 100.00% 99.15% 100.00% 98.45% 99.17% 98.54% 98.26% 99.25% 100.00% 98.33% 100.00% 99.14% E.B.9 Maximum 31-day wait for subsequent treatment where that treatment is surgery 94% 96.77% 96.43% 95.83% 100.00% 100.00% 100.00% 100.00% 93.55% 100.00% 100.00% 100.00% 100.00% 98.91% E.B.10 Maximum 31-day wait for subsequent treatment where that treatment is an anticancer drug regimen 98% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% E.B.11 Maximum 31-day wait for subsequent treatment where the treatment is a course of radiotherapy 94% 100.00% 100.00% 100.00% 100.00% 97.30% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 99.74% E.B.12 Maximum two month (62-day) wait from urgent GP referral to first definitive treatment for cancer 85% 92.75% 89.04% 91.67% 77.05% 82.00% 90.91% 89.71% 87.50% 91.89% 84.29% 89.47% 84.48% 87.01% E.B.13 Maximum 62-day wait from referral from an NHS screening service to first definitive treatment for all cancers 90% 83.33% 83.33% 100.00% 82.35% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 96.81% E.B.14 Maximum 62-day wait for first definitive treatment following a consultant's decision to upgrade the priority of the patient No National Standard 86.96% 92.59% 84.21% 85.00% 95.83% 69.23% 82.61% 90.91% 88.46% 80.00% 79.17% 84.62% 84.47% Healthcare Acquired Infections E.A.S.4 HCAI measure (MRSA) 0 0 0 0 0 0 0 1 0 0 0 1 1 3 E.A.S.5 HCAI measure (Clostridium difficile infections) 0 9 9 13 5 8 10 10 7 6 4 9 7 79 Mixed Sex Accommodation Breaches E.B.S.1 Mixed Sex Accommodation Breaches 0 0 0 0 5 3 5 6 10 9 6 13 6 63 031

032

Stockport Together Programme Director s Report NHS Stockport Clinical Commissioning Group will allow people to access health services that empower them to live healthier, longer and more independent lives. NHS Stockport Clinical Commissioning Group 7th Floor Tel: 0161 426 9900 Fax: 0161 426 5999 Text Relay: 18001 + 0161 426 9900 Regent House Heaton Lane Website: www.stockportccg.org 1 033

Executive Summary What decisions do you require of the Governing Body? No decisions are required of the Governing Body This report is for consideration and note Please detail the key points of this report The report draws the Governing Body s attention to three areas: - The progress made in service delivery, IM&T and structural change including consultation in 2017-18 - The most significant issues facing the partnership in delivery of the model currently and progress in addressing these - The next steps with a focus on the first quarter of 2018-19 What are the likely impacts and/or implications? - Considerable contract work to embed changes from a commissioning perspective - Slower than anticipated benefits realisation resulting in lower than originally planned activity changes as set out in the CCG operational plan How does this link to the Annual Business Plan? The Annual Business Plan includes delivery of improvements in the areas described and sets out the associated shifts in activity. What are the potential conflicts of interest? None Where has this report been previously discussed? Stockport Together Programme Board Clinical Executive Sponsor: Gaynor Mullins Presented by: Tim Ryley Meeting Date: 28 th March 2018 Agenda item: 8 2 034

Stockport Together Governing Body Report 1. Introduction The Stockport Together programme is coming to the end of the second year of its 5 year plan and the second year of the 3 year Greater Manchester Partnership Investment Agreement. The programme is designed to address many of the deep rooted causes behind the financial and performance challenges facing Health & Social Care in Stockport. The programme has a number of dimensions including structural change, a large scale and recurrent investment in new integrated services, and a new integrated outcome based approach to commissioning. Full realisation of our ambition also requires significant cultural change among leadership and staff across the system. This report updates the Governing Body on: - Progress made in this financial year - The main issues being addressed by the programme - The next steps in Quarter 1 of 2018-19. 2. Progress in 2017-18 During 2017-18 we have made significant progress in a number of areas: Service Delivery, IM&T, Structural change 2.a. Service Delivery The following services have gone live as a consequence of the plan during this financial year: Stockport Falls Service Steady in Stockport Psychological Medicines Service Care Home Quality Team Crisis Response Active Recovery Integrated Discharge Team Enhanced Case Management Work is still underway to ensure these are fully optimised as we bring together staff and process across the system. In a number of other areas service delivery is being rolled-out and it is anticipated will be completed in the first quarter of 2018-19, including GP 7 day services GP Home Visiting services Enhanced Medicines Management Direct Access Physiotherapy The one area where considerable further work will be required in 2018-19 is Outpatients. 035 3

2.b IM&T All GP Practices and the NHS Community Services are now on EMIS (EMIS is a sophisticated patient record system). EMIS remote access (RC) is in A&E to provide access to patient information to hospital clinicians and is being utilised to roll-out GP 7 day access and home visiting services. The Stockport Health & Social Care record (SHSCR) version 3 has been implemented ensuring live feeds and thus real time data is now potentially available to all professionals working together to care for individuals. The GM Partnership has now adopted the same system across Greater Manchester and this will enable information sharing at a patient level under the right information governance arrangements across all GM health & social care providers. Further work is required in 2018-19 to deliver on all these opportunities. 2.c Structure At a system level we have the neighbourhood leadership established including GPs from the CCG Governing Body who have transferred to Viaduct Care. The permanent SNC management team is now in place with Caroline Drysdale s arrival and the Alliance Agreement is now formally signed by all providers. We have undertaken a thorough public consultation exercise leading to approval of business cases by the joint commissioners allowing for changes to be made recurrent through contracts. 3. Issues The scale and complexity of the changes underway are significant. There are a number of issues currently being managed jointly by the Stockport Together Chief Executive s Group. Issue Escalated 1. Pace of introducing Enhanced Case Management 2. Pace of introducing GP 7 day & Home Visiting Service 3. Commissioning the Collaborative Progress Update The integration of social workers, community nursing and others utilising risk stratification and MDT s is the largest single project within the programme to date and is also identified as the primary individual driver of non-elective benefit. Since November 2017 significant progress has been made - 150 staff have been trained to be enhanced case managers with another 122 booked in for March; 345 individuals have active Goal of Care plans with a further 1648 identified; 7 out of 8 neighbourhoods have the service. There have been delays in getting the Viaduct Care Contract in place. The Contract has now been agreed. Viaduct Care underwritten by the CCG has gone at risk and 2 hubs are already on line and all are on-track for May. Home visiting will go live in April 18. There has been concern about the impact on benefits of this work area being behind due to challenges of starting a new 4 036

General Practice Model organisation from scratch and associated contract delays. As noted above the contract is now agreed as organisational structures in place. In addition 5 CCG staff are now supporting Viaduct Care. It should be noted that other than prescribing Viaduct Care projects are not significant direct drivers of financial benefit delivery. The good news is that prescribing improvements whilst not yet at full mobilisation have already delivered next year s benefit of 1.5m. Viaduct Care have been recruiting ahead of contract for the full range of services and it is expected that all services will be mobilised in the first quarter of 18-19 with 7 day and home visiting earlier. 4. Development of system level Workforce & OD strategies 5. Formal Staff Engagement 7. Accessing Digital Funds 8. Benefit Realisation Plan There is a Workforce Strategy & Plan in place for Stockport Neighbourhood Care and workforce is now being tracked in an integrated way. However, there is not a yet a sufficiently robust workforce strategy for the wider system. The CCG Governing Body have noted as a condition of business case approval that a plan is put in place ahead of the CQC visit to address this and an individual of suitable calibre is appointed. This will also need to address wider OD. A draft proposal is being worked up. Work continues with staff side representatives to address concerns and a further series of staff engagement events is being undertaken. The challenges we are facing are indicative of the level of change we are now embedding as normal business. In a number of areas full mobilisation is now being compromised by IM&T systems and lack of mobile technology. This is in part (though not exclusively) due to delays in securing the digital fund component of the Investment Agreement. Over a three year period we had planned for 3.1m; to date the figure received is closer to 1.4m. To mitigate this where possible we have deployed other resources but mobile working in particular has been delayed. We are working with GMHCP with the intention of securing the remaining funding in 18-19. The system in the Economic Business Case (and other cases) agreed a set of benefit realisation measures in 2017 and monitors these through routine systems. However, as we move into full mobilisation (and the need to realise benefits through cash releasing activity) it was agreed that this needed to be further developed. A piece of work has been undertaken and during March will be going through partnership governance starting with providers to ensure input and accuracy and will go to the Chief Executives Group in April. It is focussed on three tiers. Bottom Tier answers the question, is this service mobilised?. The next tier (2) answers the question, is the service optimised and working as envisaged?, and Tier 1 then asks whether the collective impact of optimised services is 5 037

delivering benefits both on the target cohorts and also on the wider system. Wherever possible all benefits are tracked at both neighbourhood and system level. 4. Next Steps During 2018-19 the emphasis will be on optimising the services already mobilised, completing mobilisation of those under development and in particular focussing on ensuring that service transformation supports urgent care delivery and making the planned changes to outpatients. In the first quarter of next year the emphasis will be on: Optimisation of existing new service models Completing mobilisation of collaborative general practice Ensuring changes are being managed effectively through joint commissioning arrangements Adjusting the service model in light of learning from the CQC visit to Stockport Renegotiation of the GM Investment Agreement Taking forward integration of commissioning to create a single strategic commissioning function (SCF) 038 6

Quality Report Report of the Quality Committee March 2018 NHS Stockport Clinical Commissioning Group will allow people to access health services that empower them to live healthier, longer and more independent lives. NHS Stockport Clinical Commissioning Group 7th Floor Regent House Heaton Lane Stockport SK4 1BS Tel: 0161 426 9900 Fax: 0161 426 5999 Text Relay: 18001 + 0161 426 9900 Website: www.stockportccg.org 039