GOVERNNG BOARD Date of Meeting 16 March 2016 Agenda tem No 6 Title Governing Board Assurance Framework Governing Board members reviewed the GBAF s and process at a development session on 10 February 2016. A number of issues were identified with the current process and concern noted that the GBAF process needs to be a more dynamic, timely and responsive process. Changes to the process will be incorporated into an update of the CCG Management Framework and presented to the June Audit Committee for approval. Audit Committee (2 March 2016) has subsequently approved the GBAF for presentation to the Governing Board. For the current version of the GBAF, additional fields have been added as follows, which require further development: 1. Date the register 2. tolerance for current residual Purpose of Paper As a result of the detailed review of each at the development session, the following changes are proposed: GB07 this has been spilt into two. The first relates to A budget cuts (ASC & PH) which remains on the GBAF. The second relates to the financial sustainability of health partners and is an open scoring 12 on the Finance Team register GB10 this has been separated into distinct parts reflecting the different constitutional rights & pledges at GB13 this has been incorporated into GB10 and is recommended for closure GB16 reworded and updated NB original incorrectly recorded as 6 on previous GBAF this has been rectified GB04 this was about cultural change in provider organisations and has been reworded to reflect the to the implementation of the Portsmouth Blueprint GB02 recommended for closure as GP member practice engagement is reflected in GB04 above GB03 this is reflected in the revised wording of GB07 and is recommended for closure GB05 recommended for closure from the GBAF. This remains an open on the Finance Team register
GB15 recommended for closure as the transfer of delegated primary care commissioning has been completed Recommendations/ Actions Requested Potential Conflicts of nterests for Board Members Author The Governing Board is asked to review and ratify the Governing Board Assurance Framework. None. Suzannah Rosenberg, Director of Quality and Commissioning Sponsoring Member nnes Richens, Chief Operating Officer Date of Paper 3 March 2016
NHS Portsmouth CCG Governing Board Assurance Framework Description of residual GB07 Finance 1 D,E,F F ocal Authority budget cuts impact the healthcare system THEN system pressures and the delivery of the Portsmouth Blueprint could be compromised Michelle Spandley 4 4 20 Feb16 Joint planning between PCC & CCG Health & Well Being Board Health & Care Executive Better Care Fund processes BCF S75 Agreement Joint leadership arrangements 4 4 16 GB10 A NHS Constitution rights & pledges 1 D,E,F ED 4 Hour Wait nnes F the CCG does not Richens meet the rights and pledges under the NHS Constitution THEN this may result in a detrimental impact on patient services and experience 4 4 16 Contract Performance Notice issued summit process in train ECP plan Admission/Discharge/Transfer workstream Daily System Sit Reps Contract monitoring groups including CQRM and ECRM CCG integrated performance reporting to CCG Board Accountability framework signed by all partners Diagnostics plan monitoring System wide programme performance via System Transformation and Resilience Group (STAR Board) mprovement trajectory required from PHT System wide learning event Feb 16 Follow up summit 5 5 25 PHT are subject to the NHS E summit process due to a deteriorating position & patient safety issued which is reflected in this highest. This is being managed on behalf of the compact CCGs by Julia Barton GB10 B Cancer F the CCG does not meet the rights and pledges under the NHS Constitution THEN this may result in a detrimental impact on patient services and experience 4 4 16 CPN issued 9/10/15 Cancer mprovement Plan CCG staff attend PHT waiting list assurance meetings Contract monitoring groups including CQRM and ECRM CCG integrated performance reporting to CCG Board Sign off the Cancer RAP 4 4 16 RTT F the CCG does not meet the rights and pledges under the NHS Constitution THEN this 4 4 16 CPN issued for RAP CCG staff attend PHT waiting list assurance meetings Contract monitoring groups including CQRM and ECRM Commissioners have agreed a process with Gastro for reviewing the waiting list and have included a digestive disorder project into the QPP 4 4 16
Description of residual may result in a detrimental impact on patient services and experience CCG integrated performance reporting to CCG Board for 2016/17 Commissioners are meeting with clinicians from troubled specialties to review pathways and encourage demand management where clinically appropriate Commissioners are working with community providers to provide a community based MDT triage service to assist with the spinal surgery backlog GB13 Quality 2 F F urgent care system capacity pressures continue THEN this could result in sub optimal care including Poor clinical outcomes Harm and patient safety s oss of privacy and dignity Poor patient and carer experiences Dr, Dapo Alalade 4 4 16 System accountability to deliver required actions to reduce are in place via Urgent Care Board and PHT CQRMs/ECRMs; Delivery of Quality in Admission, Discharge and Transfer CQUN Multi agency task & finish group established to agree and implement escalation frameworks and trigger points for quality and safety issues Development of quality & safety dashboard for urgent care will provide timely data on: Reduction in numbers of: Ambulance handover delays; Outliers from specialities; Patient moves; Patients queuing This will be an indicator of system pressures SRG/Urgent Care Board will monitor CQC action plan and escalate any quality and safety concerns to CQRM 4 4 16 COSE GB14 Quality 2 F Solent NHS Trust F recruitment & retention to community nursing vacancies does not improve THEN the quality of patient care delivered maybe compromised Dr, Dapo Alalade 4 4 16 Monthly meetings with providers for progress update Monitored at CQRM Contract performance Notice (CPN) issued RAP agreed. This includes weekly updates to the CCG Turnaround manager in post for 3 months from 2/10 Formal RAP review meetings CQRB updates Weekly reports Final report and action plan from Turnaround manager Gateway recovery indicator metric for 31/3 expects vacancy rate to be 10%; all Ss to be reported within national timeframes ndependent deep dive into root causes of staffing crisis to be completed 4 4 16 t is expected that recruitment & retention will continue to improve. There will be a formal review of the RAP mid April after which it s expected to be able to downgrade this Review date 18/4/16 GP feedback survey completed GB16 Quality C,F 1,2,3 PH GP OOHs. Failure to meet Dr, Dapo Alalade 4 4 16 Dec 15 Remedial Action Plan in place to address both performance & Bi-monthly RAP updates Organisation learning event with CCG quality leads & PH (Feb 4 4 16
Description of residual assessment and home visit timeframe targets has resulted in poor timed care and negative patient experience. F this continues or further deteriorates THEN this may result in harm to patients quality issues S panel in place Ongoing intelligence sharing calls with NHS E Programme of quality visits completed during January CQC inspection rated the service as good overall Joint CRM & CQRM meetings date cancelled due to nonavailability of PH staff) GB04 Transformation 1,3 C,D,G F providers do not achieve required cultural changes and service reform THEN the implementation of the Portsmouth Blueprint may be compromised nnes Richens 4 4 16 Engagement with staff at all levels, from ward to board Quarterly strategic reviews with Providers Contracts and robust performance management, Health & Care Executive System Transformation and Resilience Group (STAR Board) Health & Wellbeing Board Development of STPs 3 4 12 Board to Board programmes Primary Care Alliance Portsmouth Blueprint endorsed by all partners and the Health and Wellbeing Board. GB09 Estates 1,2 C,D,E,F F plans for the utilisation of Estates across commissioners and providers in the system is not aligned or coherent, THEN this would impact on the quality of service, patient experience and use of resources Michelle Spandley 4 3 12 System wide Estates work programme COMPACT Provider Board to Boards NHS Property Services liaison meetings ocal top 10 group chaired by CCG Community care estates business case System wide estates programme reports Development of system wide estates plan Full business case and delivery of programme Business case approved CCG Estate Strategy sign off 3 3 9 City Estate Forum GB02 Engagement 1,2,3,4 A,B F GP member practices do not engage with the CCG s Dr Jim Hogan 3 4 12 Continued engagement with member practices including weekly communications, Feedback from membership meetings & other forums, practice visits Develop revised talent management and succession planning strategy 2 4 8 COSE
Description of residual vision for the future THEN this may have a detrimental impact on the delivery of commissioning intentions commissioning evenings, TARGET, Practice visits, supported by Primary care engagement team Primary care CQUN CQUN monitoring Member practice surveys 360 degree feedback Targeted conversations about emerging model of care for the city Practice Managers Forum GB03 ocal Health Economy 3 C,D,E,F,G F we do not achieve nnes the transformation of Richens services THEN we may not be able to meet the rising demand for services 4 4 16 Exec level joint planning sessions with PCC, Solent & PHT BCFS75 agreement & plan Accountability to Health and Wellbeing board / System Transformation and Resilience Group (STAR Board) Health & Care Executive established Maximising opportunities of delegated commissioning Continued development of the Portsmouth GP Alliance Production of the Portsmouth Blueprint for health and care and endorsement of this from city partner boards and the Health and Wellbeing Board. 2 4 8 COSE GB05 Collabora -tive working 1 C,D,F,G F NHS England (Wessex) and CCG commissioning strategies are not aligned in relation to specialised commissioning THEN this may result in fragmentation of services and potential cost pressures nnes Richens 4 4 16 Agreed approach with local Area Teams mpact of commissioning decisions described effectively Analysis of commissioning intentions Collaborative contract monitoring NHSE(Wx) engagement with collaborative procurements Audit of commissioning intentions to check for gaps and overlaps NHSE (Wessex) / CCG operating plans NHSE (Wessex) two way assurance process Governing Board has taken on responsibility for primary care commissioning 2 3 6 COSE Taken on delegated responsibility GB08 CT 3 D,E F we do not achieve coherent and interoperable T solutions THEN we will not have effectively joined up health and social care services Michelle Spandley 5 3 15 Directing T strategy to support ntegrated Care agenda Establishing a PSEH nteroperability Programme Securing expert advice and leadership to the CCG T enabled change board PSEH nteroperability Programme Briefings Urgent care delivery board Performance of CSU SA/work programme T interoperability business case to be completed 2 3 6
Description of residual PSEHCC BCF workstream CCG T strategy implementation briefings TPP roll out programme for primary care and Solent CCG T Programme Manager in post to progress CSU Programme Director in post to progress GB15 Delegate d Commissi oning of Primary Care 1 A,F,G F there is not a robust Katie agreement between Hovenden CCG and the Area Team regarding handover of responsibilities THEN we will may not have the capacity and capability to manage the functions without adversely affecting engagement with member practices, delivery of primary care and CCG reputation 4 3 12 CCG and Area Team signed up to Transition plan and Agreement regarding collaborative working Monthly transition meetings with Area Team Training for primary care team and Governing Board members on aspects of primary care contracting. Primary Care Dashboard Primary Care Reference Group overseeing transition Development of Primary Care Balance Card nclusion of primary care quality issues within QSEG agenda Feedback from practices and the MC Agreement of joint plan with Area team regarding PMS reviews Development of plan for reinvestment of PMS freed up resources Scoping of additional staffing requirements to support management of all delegated functions once national HR guidance received and transition complete 2 3 6 COSE Priorities 1 We want everyone to be able to access the right health services, in the right place, as and when they need them. 2 We will ensure that when people receive health services they are treated with compassion, respect and dignity and that health services are safe, effective and excellent quality. 3 We want health and social care services to be joined up so that people only have to tell their story once. People should not have unnecessary assessments of their needs, or go to hospital when they can be safely cared for at home or stay in hospital longer than they need to. 4 With our partners, we will tackle the biggest causes of ill health and early death and promote wellbeing and positive mental health. s A enable our GP surgeries as members to engage and drive commissioning B engage with our patients and our public in our commissioning and our decision making C work with our partners to collaborate to deliver s in health outcomes D invest in improving and better health and wellbeing E manage our resources effectively F ensure that our services are safe and focused on maintaining and improving quality G develop the CCG as a mature organisation considered as credible and competent with the appropriate capacities and capabilities
Version control 02.03.16 GBAF v13.1 reviewed by the Audit Committee and approved for presentation to the Governing Board on 16.03.16 10.02.16 GBAF v13.1 reviewed at Governing Board development session and approved for presentation to the Audit Committee on 02.03.16 20.01.16 GBAF v12.1 ratified by Governing Board 09.12.15 GBAF v12.1 reviewed by the Audit Committee and approved for presentation to the Governing Board on 20.01.16 28.10.15 GBAF v12.1 reviewed by the Clinical Executive Committee and approved for presentation to the Audit Committee on 09.12.15 GBAF v12.1 - Review Meeting 15th October proposed the following - *New to be GBAF - GB16 re OOH contract (PH) (commissioning 20) *GB11 re Safeguarding to be removed from GBAF *GB10 NHS Constitution increase GBAF v11.2 ratified by Governing Board 23.09.15 22.07.15 GBAF reviewed by Clinical Executive Committee: * New GB14 - original and residual s amended to 16 * GB05 - description updated in relation to specialised commissioning * New added - delegated commissioning of primary care (GB15) GBAF updated - v11.1 reviewed by Audit Committee 09.09.15, approved for presentation to Governing Board 23.09.15 for ratification (v11.2) 07.07.15 GBAF reviewed by R/SR/JC: * New (GB14) - Solent Community Nursing team staffing * Reduction in current s for GB11, GB08 and GB05. * Board to consider whether GB05 should remain on GBAF. GBAF v11.0 - proposed updates to be reviewed by Clinical Executive Committee 22.07.15 01.07.15 v10.1 Approved by Audit Committee 27.05.15 for presentation to Governing Board 15.07.15 30.04.15 v10.0 Proposed updates to GBAF for recommendation to Audit Committee 27.05.15 (following Clinical Executive review) 18.03.15 v9.3 Ratified by Governing Board ( GB01 removed from 05.13.15 v9.2 Approved by Audit Committee 04.03.15 for presentation to Governing Board 18.03.15 11.02.15 v9.1 Approved by Exec 11.02.15 for recommendation to Audit Committee 04.03.15 04.02.15 v9.0 Proposed updates to GBAF from MS/SR 04.02.15. For review by Exec 11.02.15. Approved by Exec 11.02.15 for recommendation to Audit Committee 04.03.15