NHS Newham CCG Board Part I. 14 June :30pm 3:30pm. Committee Rooms, Unex Tower, 5 Station Street, Stratford, London, E15 1DA

NHS Newham CCG Board Part I 14 June 2017 1:30pm 3:30pm Committee Rooms, Unex Tower, 5 Station Street, Stratford, London, E15 1DA 1

NCCG Board Part I 14 June 2017 1:30pm 3:30pm Committee Rooms, Unex Tower, 5 Station Street, Stratford, E15 1DA Agenda No. Time Item Page Action Required Owner 1. Welcome 1.1 1:30 1:45 p.m 1.2 1:30 1:45 pm 1.3 1:30 1:45 pm 1.4 1:30 1:45 pm 1.5 1:45 2:00 pm Welcome, Introductions, Apologies and Declarations of Interest Verbal Chair Minutes of the meeting held on 12 3 Approval Chair April 2017 Action Log 11 Discussion Chair Chair s Actions 12 Information Chair Chief Officer s Report 17 Information S Gilvin 2. Patient and Public Engagement 2.1 2:00 2:10 pm Questions Verbal Discussion Chair 3. Strategic Items for Approval or Discussion 3.1 2.10 2:30 pm 3.2 2:30 2:45 pm 3.3 2:45 2:55 pm 3.4 2:55 3:05 pm 3.5 3:05 3:30 pm 4. Any Other Business 5. Date of Next Meetings Board Assurance Framework 21 Approval S Sanghera Quality Report 30 Discussion C Vyas Performance Report 41 Discussion S Douglas Finance and QIPP Report 47 Discussion C Whitton Newham University Hospital CQC Inspection Report 51 Discussion C Vyas 13 September 2017 13:30pm 15:30pm Committee Rooms, Unex Tower 11 October 2017 13:30pm 15:30pm Committee Rooms, Unex Tower 13 December 2017 13:30pm 15:30pm Committee Rooms, Unex Tower 14 February 2017 13:30pm 15:30pm Committee Rooms, Unex Tower www.newhamccg.nhs.uk

Newham Clinical Commissioning Group (NCCG) Minutes of the Part I meeting of the Board held on Wednesday 12 th April 2017.13.30pm- 15.15pm Committee Rooms, Unex Tower, Stratford Present: Elected Voting Members Dr Prakash Chandra Dr Muhammad Naqvi Dr Bapu Sathyajith Dr Clare Davison Dr Catherine Gaynor Dr Rima Vaid Appointed Voting Members Wayne Farah Andrea Lippett Fiona Smith Hazel Trotter Steve Gilvin Meradin Peachey Grainne Siggins Appointed Non-Voting Members: Dr Ashwin Shah In attendance: Selina Douglas Satbinder Sanghera Jason Clarke Apologies Dr Ambady Gopinathan Chad Whitton Chetan Vyas Dr Nasim Joarder Chair Elected GP Representative Newham CCG Joint Deputy Chair Elected GP Representative Newham CCG (Left at 2:35 during agenda item 3.3) Elected GP Representative Newham CCG Elected GP Representative Newham CCG Elected GP Representative Newham CCG Elected GP Representative Newham CCG Vice-Chair, Lay Member Patient & Public Engagement Newham CCG Lay Member Remuneration Newham CCG Registered Nurse Newham CCG Practice Manager Representative Newham CCG Chief Officer Newham CCG Director Public Health LBN Newham CCG Director of Adult Social Services LBN Newham CCG Co-opted Member Newham CCG Deputy Chief Officer Newham CCG Director of Partnerships and Governance Newham CCG Interim Board Secretary Newham CCG Elected GP Representative Newham CCG Chief Finance Officer Newham CCG Director of Quality & Development Newham CCG Elected GP Representative Newham CCG 3

1 Administration and Updates 1.1 Welcome, Introduction, Apologies for Absence & Declarations of Interest 1.1 1.2 1.3 The Chair welcomed all to the meeting. Apologies were given for: Dr Ambady Gopinathan Elected GP Representative Newham CCG Chad Whitton Chief Finance Officer Newham CCG Chetan Vyas Director of Quality & Development Newham CCG Dr Nasim Joarder Elected GP Representative Newham CCG There were no declarations of interest. 1.2 Minutes of the Part I meeting 8 th February 2017 1.2.1 Selina Rodrigues, Healthwatch Newham, noted that she was in attendance at the meeting in February. 1.3 Part I Action Log With this amendment the minutes were approved as an accurate record of the meeting. 1.3. CCG 153 BAF Proposal made to Chair of the QPF Committee. ToR will be reviewed at the meeting in April. The outcome of the meeting will give direction to any new BAF risks that need to be added for 2017/18. CCG 154 BAF Action covered in Item 3.1 - BAF Report. Closed 1.4 Chairs Actions 1.4.1 There were no Chair s actions to report. 1.5 Chief Officer s Report 1.5.1 S Gilvin introduced a report for information updating the Board on: Five Year Forward View Next Steps Development of an Accountable Care Systems in Newham. The NHS Newham CCG Operating Plan 2017-19 North London Sustainability and Transformation Plan System Delivery Board Sustainability Reporting 1.5.2 The key points raised were as follows: The urgent and emergency care return to the 95% standard by March 2018, with 90% achievement against the standard by September 2017. The Board noted that the current cancer testing programme would be in place in 2017/18 and asked whether we could learn from previous lessons in order to increase the uptake. 4

Newham CCG was rated as Good by NHS England for both its collective and individual duties with regards to the statutory obligations to involve patients and the public. Barts Health, ELFT and other providers were aligning Operating Plans and QIPP plans, and there was currently a gap being worked through. The System Delivery Board supports the framework within the STP. The Report was noted. 2 Patient and Public Engagement 2.1 Questions 2.1.1 A representative from Newham - Save Our NHS raised two questions: i) STP - With the P in STP recently changing from Plan to Partnership, and 2 Local Authorities noting concerns and a change to the MOU, are there merger talks underway? Response: The Five Year Forward View Next Steps document is clear that the STP is not an accountable statutory body, and does not possess the powers to be a decision making body. The Board was keen to stress that there is nothing in the partnership agreement about delegating powers, and that any such powers would have to be formally delegated by the Newham CCG Board. There are no current plans to do so. ii) Accountable Care System With a population in excess of 300,000 residents, have we thought about how to explain what this means to, and for, our population and the need for robust patient and public engagement? Response: The Board recognise that the Accountable Care System is not an easy concept to communicate, but was keen to highlight that it built on our integrated care programme. Dr Ashwin Shah, Co-opted Member, is the NHS Newham CCG clinical lead for the programme. The Board indicated that there would continue to be collaborative work between organisations to deliver integrated care. The Board highlighted the need to put patients at the centre and that the CCG s approach to PPE was flexible, as demonstrated through recent programmes of engagement such as in relation to the MSK commissioning, Building Healthy Communities programme, the Primary Care Strategy and Primary Care Estates Strategy. 3 Strategic Items for Approval 3.1 Board Assurance Framework (BAF) S Sanghera introduced a report noting the year end position of the BAF. The report also discussed the proposals for the 17/18 Board assurance and alignment to the CCG s revised committee and governance structure. S Sanghera noted that there were 3 risks where the risk rating had not moved during 2016/17. They were: 5

STP Primary Care Commissioning Care Closer to Home S Sanghera noted that at the Board development session later in April 2017, the Board would consider the BAF risks for 17/18, linked to the revised corporate priorities. The alignment of the BAF risks to the revised committee structure would ensure that the committees were in a positon to assure the Board via a robust deep dive process. Decision: The Board agreed the current end of year risk ratings for the BAF. 3.2 NCCG Quality Report F Smith introduced the Quality report to the Board which asked the Board to note the actions taken in relation to the red and amber rated quality indicators in the exception report. The following key, were noted to the Board: Barts Health - 53% of amber alerts actioned within 10 days, which is below the 100% target. Barts Health - Safeguarding Adults Level 2 training below the target of 85%, with a score of 85%. The Board heard that this figure had improved since the report was written. Barts Health Friends and family test The Trust asked for support from the CCG to seek and establish best practice. The Board was informed that the data in the report was up to January and showed a general move in the right direction. Barts Health The Trust reported a back log in complaints and SIs. The CCG had provided the Trust with resource to support our collaborative working approach. ELFT Clinical sharing of information with GPs slightly under the 90% target with 88.40%. ELFT Adult Community DNA rates above the threshold of 10% with 13.70%. ELFT Safeguarding training. Level 1 training is 84% against the 85% target and level 3 training is at 65%, below the 85% target. The Board raised the following comments: Decision: The Board sought assurances on whether complaints concerns raised were solo or linked to SIs received. The Board was informed that the complaints were more general, and not necessarily linked to SIs. The Board also queried when progress against the Friends and Family Test would be visible. The actions and assurances within the Quality Report were noted. 6

3.3 Finance and QIPP Report Month 11 L Wei presented the M11 finance report. L Wei noted that the report was a summary update on the 16/17 position. The Board were also asked to approve the 2017/18 Operating Plan and draft budget. L Wei noted that the CCG was currently on track to deliver the planned surplus for 2016-17 of 6.5m, with an expenditure of 479m. QIPP delivery was projected to be on track. L Wei informed the Board that the first draft of the Annual Report had been circulated to Board members, the Audit Committee and NHS England. The Board heard that the latest version of the Operating Plan Financial Template was submitted on 30 March 2017. L Wei noted that there were two key challenges facing the CCG in 2017/18: An increased surplus requirement of 7.5m An increased QIPP target of 16.1m The Board were informed that there were plans in place to address the increased surplus of 7.5m, and the Board and Executive Committee would receive regular reports and provide scrutiny to support the active review of costs. Despite the financial challenges, the L Wei noted that the CCG would continue to support collaboration through the Transforming Services Together and East London Health Partnership programmes and seek to develop a strong primary care strategy. The Board noted the following points: The CCG and the Borough were working together closely to reduce activity out of hospital through initiatives such as rapid response. The Board welcomed the commitment from the Borough to support these initiatives and highlighted the importance of actively managing acute care demand. Members noted that CCG s financial position had been made more difficult by the need to find an increased surplus in order to support other deficits within the local health economy. The Board highlighted the need to ensure that there was adequate communications and engagement with patients to explain the changes as they arose, as the focus moved to managing demand more effectively in the community at a lower tariff. The Board sought to be guided by clinical colleagues and PPGs around the most effective ways to undertake this engagement. Healthwatch Newham are meeting with NUH to work on a communications plan, noting the importance of effective referral management and the need for robust communication and engagement to drive behaviour change. The Board queried the confidence on delivery against the QIPP targets, noting that some schemes looked easier to achieve that others. The Board were informed that the QIPP targets were being closely monitored. 7

The Board noted the importance of timescales and timeliness of reporting of QIPP plans, emphasising the need for local engagement. Decision: The Board noted the M11 finance report and draft budget for 2017/18t. 3.4 Developing an Accountable Care System Dr Ashwin Shah introduced a paper to the Board on the approach to developing an Accountable Care System. The paper asked the Board to discuss and approve the approach to ACS, the care model and the next steps for establishing the ACS in Newham Dr Shah noted that a Board development session had been held to understand the challenges. Dr Shah highlighted the need for engagement to support patient centred care and that the Board would be fully engaged and kept informed of developments. S Douglas outlined the two population based care models, recommended within the Five Year Forward View; The Multi-speciality Community Provider model (MCP) and The Primary Care Acute Care System model (PACS) S Douglas noted that the first meeting of the commissioners had taken place earlier in the day and an initial workshop with providers will be held on 17 May 2017. The CCG was keen to ensure a rapid pace of development be maintained. S Douglas highlighted that the first step was to agree the vision and general approach. The Board raised the following comments: Had the link to the BAF risk around the primary care strategy and GP federation been considered? It was noted that the approach was not without risk, but the move to build on the work of the clusters would ensure a solid foundation The strength of the collaborative provider partnership and resources of those providers would be critical. Robust clinical leadership was noted as a key driver. In addition the need for trust between the providers to build and develop those key working relationships was emphasised. The Board noted that phase 2 would see the pace of development quicken, and considerations regarding the language and terminology would need to be made. STP was noted as a term that was not patient and public friendly. The need to be explicit regarding the patient focus and developing the accountability framework was accepted. The importance of building in and considering the CCG s out of hospital approach. Decision: The Board approved the proposed vision and principles for a Newham based ACS 8

The Board approved the MCP as the proposed model for the Newham ACS. The Board approved the governance arrangements and next steps for the ACS in Newham 3.5 Newham CCG Priorities for 2017/18 S Douglas presented a paper asking the Board to approve the revised vision and priorities for 2017/18. The Board noted the following: The draft priorities had been discussed at an away day in February 2017. The importance of applying the person on the street test to the phrasing of the priorities That there should be a challenge process to items being presented to the Board. If there is not a link to the CCG s key priorities, then the relevance of an item would be challenged. A concern that the word equality had been lost from the CCG s vision. Action: Revise wording to ensure that equality can be included. Decision: The Board approved the revised vision, subject to the inclusion of the term equality. The Board approved the priorities and identified key enablers. 3.6 Health London Partnership Quarterly Update S Gilvin introduced a report to the Board on the Healthy London Partnership (HLP) Update. S Gilvin noted that the overall programme budget for 2017 had been reduced by around 24%, with an allocation for NHS Newham CCG of 537.5k in 2017/18. Meradin Peachey noted 3 areas where the work of the HLP had had added value in Newham. These were: Support for homelessness Child asthma deaths The Great Weight debate Wayne Farah noted that the Board would like to seek clarity from regarding the explicit outcomes that could be expected as part of the project as a result of the 537k allocation. Decision: Note the review undertaken in order to identify the HLP operating model in 17/18 Note the key achievements of the HLP programme Approval of the key priorities and HLP portfolio budget of 14,447. 9

4 Items for Information 4.1 Appointments to Board Outcomes of South 1 and South 2 elections and Appointments to Committees for Board Members and Clinical Leads S Sanghera presented a paper to the Board for information, noting that following an election process the CCG had one nomination each for South 1 and South 2 so consequently both candidates were elected unopposed to the Board as follows: South 1 Dr Nasim Joarder (St Lukes) South 2 Dr Catherine Gaynor (Tollgate) Decision: The new appointments to the Board were noted. 10

Newhan CCG Board Action Log Part I - 14/6/17 ITEM 1.3 - highlighed items represent a recommendation to remove from register Action reference Meeting date Minute reference Action Owner Update CCG155 12/04/2017 3.5 Revise the wording of the Newham CCG vision to include the word, or reference, to equality. S Douglas The vision has been revised, as requested, to ensure that the CCG's commitment to equality is accurately reflected. 111

Chair s Action Meeting Name a) NHS Newham CCG s Constitution gives the Chair of a meeting of its governing structure the authority to take a decision normally reserved for that body by virtue of the following paragraphs within its Constitution: 5.1.3 The provisions of these standing orders shall apply where relevant to the operation of the Practice Member Council, Board, the board s committees and sub-committees and all committees and sub-committees unless stated otherwise in the committee or subcommittee s terms of reference 4.6. Chair's ruling 4.6.1 The decision of the Chair of the Board on questions of order, relevancy and regularity and their interpretation of the Constitution, standing orders, scheme of reservation and delegation and prime financial policies at the meeting, shall be final 4.9. Emergency powers and urgent decisions 4.9.1 The powers which the Board has reserved to itself within these Standing Orders may in emergency or for an urgent decision to be exercised by the Chief Officer and the Chair after having consulted at least two non-executive members. The exercise of such powers by the Chief Officer and Chair shall be reported to the next formal meeting of the Board in public session for formal ratification And that as a matter of interpretation it is deemed that the phrase where relevant to the operation of committees and sub-committees is appropriate in relation to paragraphs 4.6 and 4.9 b) These paragraphs relate to; The Executive Committee The Audit Committee The Remuneration Committee The Quality Committee The Primary Care Commissioning Committee c) The terms of reference of the following committees (approved by the Executive Committee), which are not part of the Constitution, gives the Chair of these meetings the authority to take a decision normally reserved for that meeting with guidance on the requirement to report back on the action taken to the next meeting; The Integrated Care Committee The Acute Commissioning Committee The Community Commissioning Committee The Mental Health Commissioning Committee The Children and Maternity Commissioning Committee The Urgent Care Working Group The Information Management and Technology Committee The Finance Committee The Medicines Management Committee 12

1. Decision taken normally within the terms of reference of the Committee Award of the contract for GP IT following a North Central and East London wide procurement. 2. Reason decision cannot await consideration at next meeting The evaluation paper was not available in time to be considered at the CCG Board and provide approval within the time period for awarding the contract and enabling mobilisation in time for the end of the current contract. The decision was taken to take Chair s action after the paper, and the associated procurement, was subject to extensive review with the Executive Committee 3. Date of next meeting where decision will be reported to the Committee A paper and the Chair s action will be taken to Part I Newham CCG Board meeting on 14 June 2017 Signed Date: 8 June 2017 Chair of the committee 13

Board 14 th June 2017 Title: GPIT Agenda item 1.4 Author: Chad Whitton, Chief Finance Officer Newham CCG Presented by: Chad Whitton, Chief Finance Officer Newham CCG Contact for further information: Chad Whitton, Chief Finance Officer Newham CCG This Paper is for: Decision Action required: The Board is asked to Note the award of the GP IT contract under Chair s action as reviewed and recommended by the CCG s Executive Committee. 14

Executive summary: In May 2015 NHS England informed CCGs that, in order to secure value for money for GP IT services and minimise the risk of fragmentation, where GP IT is currently sourced from a NELCSU CCGs are required to re-procure the service through the Lead Provider Framework (LPF) to a standard national minimum specification. The CCG engaged with WEL, BHR and NCL colleagues in a mandated re-procurement of GP IT services through the national Lead Provider Framework. These services were previously provided by NELCSU primarily to practices. A revised specification was agreed, based on national requirements and the NCCG team organised and led the WEL CCG engagement in this North Central and East London-wide process. The contract is for four years from 1 st August 2017 with an extension of one year and an annual value of 665,510 (total potential value 3,327,550.) The Executive Committee considered details of the bid process and the outcome based on a detailed evaluation report. The outcome of the process was an Executive Committee recommendation to award the contract to NELCSU as the provider with the best bid. Because of the urgency and timing for all parties involved in the tender to approve the award of contract so that the necessary mobilisation could be undertaken and the date of the next appropriate Board Meeting, Chair s action was taken to provide the necessary approval. Given the size and importance of the contract the Board is asked to ratify the Chair s action. Supporting papers: None How does this fit with Newham CCG Strategy: Values: Working with our partners to improve Health Outcomes. Aims: Reducing Quality Variation Where has the paper been already presented? A detailed evaluation report outlining the basis and outcome of the procurement has been reviewed by the Executive Committee. Risk: Failure to provide confirmation may require a review of the Chair s action and risks leaving Newham CCG with no provider to deliver GPIT services from 1 st August 2017 Equality Impact: This paper supports the delivery of patient care to diverse groups, by ensuring a GPIT service that underpins the delivery of a safe and effective patient care in primary care. Stakeholder engagement: Significant stakeholder engagement was undertaken as part of the procurement process and this is detailed in the attached papers. 15

Financial Implications The proposed contract remains within the financial allocation identified for this area over its duration. 16

Board 14 th June 2017 Title: Chief Officer s Report Agenda item: 1.5 Author: Presented by: Contact for further information: Steve Gilvin Chief Officer Newham CCG Steve Gilvin Chief Officer Newham CCG Steve Gilvin Chief Officer Newham CCG Date paper finalised: 7 th June 2017 Action requested: Executive summary: Note the report The report provides an update on work undertaken by the CCG team since the last Board meeting including: Development of Accountable Care System in Newham Annual Accounts 2016/17 CCG Assurance framework 16/17 Impact of the ransomware attack on NHS services in Newham North East London STP update Primary Care Contracting team How does this fit with Newham CCG Strategy: Where has the paper been already presented? Impact on risk: The above areas of work relate to key objectives of the CCG in relation to quality and safety of commissioned services, public engagement, primary care development, and improving outcomes for our population. N/A Key risks relating to these areas of work are contained within the Board Assurance Framework. 1 17

Item 1.5 Newham CCG Board Meeting: 14 th June 2017 Chief Officer Report 1. Development of an Accountable Care System for Newham The CCG Board approved a vision and a strategic approach to developing an Accountable Care System for Newham at the April Board meeting. The CCG approved the following vision as the foundation for the system: ACS Vision: An integrated community, health and social care model of provision will be in place for the population of Newham underpinned by the following principles A population based commissioning approach based on outcomes in which all stakeholders have joint accountability with Newham CCG as the system leader; A single overarching common shared outcome framework for all providers that is visible to service users; One pooled risk-adjusted capitated budget that will be shared across all providers in health and social care based on an integrated care model; and Prevention and self-management will be a fundamental component of improving health outcomes. The key aims of the CCG in developing an ACS are to implement a place-based model of care with General Practice at the heart of what we do, to build on the Integrated Care programme in place in Newham and to deliver value for money. The Board agreed that four local organisations will be key in developing the provider partnership to support the development of the ACS and a workshop was held in May to begin the process of developing this partnership. Regular meetings of the partnership are being established together with a programme plan, resourcing plan and provisional timetable to ensure that the ACS is developed at pace. The Building Healthy Communities programme and the Urgent and Emergency Care procurement will be the key commissioning vehicles for developing and delivering the more integrated care system that forms the basis of Accountable Care. 2. Annual Accounts 2016/17 The CCG has submitted its annual accounts for 2016-17 having received an unqualified audit opinion and following approval at the Audit Committee and special Board meeting held on 25 th May 2017. The CCG achieved the planned surplus and all of the required financial targets for 2016-17. The CCG received a revenue resource limit of 481.19 million from NHS England. This was made up of recurrent funding allocation of 476.10 million. This allocation equated to 1,400.70 per registered person in Newham for patient care (excluding admin costs). 2 18

The Operating Plan for 2016-17 included achieving a surplus of 6.5 million for the financial year, which the CCG achieved, delivering a surplus of 6.52 million. This shows an overachievement surplus of 0.52 million. The full accounts will be published along with the Annual Report for the CCG s Annual General Meeting planned for September. 3. CCG Assurance Framework 2016-17 The CCG has been advised that NHS England will be releasing the next CCG Improvement and Assessment Framework dashboard for 2016/17 before the end of June. The data will then be made available on MyNHS by around in July. This data will be used to inform and finalise the year end and clinical priority area assessments for 2016/17. The CCg has made enquiries as to when the Board would be advised of the final assessment of the CCG for 2016-17 against this framework and I hope to be able to update the Board verbally at the meeting. 4. Impact of the Ransomware Attack on NHS Services in Newham The publicised ransomware attack that took place on 12th May had a significant impact in Newham. One of our local providers, Barts Health NHS Trust, was amongst the most affected NHS organisations. This meant that Newham University Hospital and associated services such as the Urgent Care Centre and the GP Out of Hours service which depend on the hospital s computer network were unable to operate electronic systems. This meant clinicians had to move to paper notes and paper-based requests for diagnostic tests. GP practices were asked not to send blood samples for pathology testing or patients for radiology unless they were urgent cases for a 10 day period until 22 nd May and the CCG is thankful for the support of GPs and their staff throughout this period. The Trust is now recovering the position and the CCG is reviewing with the Trust the impact of the event on patients including those whose appointments may have been cancelled to understand when the Trust will be able to have rescheduled all affected patients. GP surgeries were not directly affected which demonstrated the robustness of the GP IT solutions in place through the EMIS Web system. The Trust and the CCG are meeting on 16 th June to review the incident and the root cause of the problem to ensure a plan is implemented to prevent future recurrence of such events although investment will be required as part of the solution and securing such investment remains problematic. 5. North East London Sustainability and Transformation Plan Update The East London Health and Care Partnership (the STP for North East London) is a partnership of NHS commissioning and provider organisations working together with local authorities in East London to plan and deliver services that are clinically and financially sustainable and that meet the needs of our population. The partnership as agreed an interim Partnership Agreement which each organisation has been asked to approve. This agreement was circulated for comment following the last Board meeting and has now been adopted by the Partnership as a working agreement. 3 19

The CCG is now working with colleagues CCGs in North East London on review commissioning functions and to see whether there is scope for more commissioning functions to be undertaken at scale at a STP level allowing the CCG teams to focus on the commissioning of borough-based Accountable Care Systems. This work will be reported to the Board in detail during July. 6. NHS England s Primary Care Contracting team NHS England has agreed to devolve the management of the NHS England Primary Care Contracting teams to be managed by lead CCGs in each STP footprint. This is with effect from 1 st April 2017. Newham CCG has agreed to be the host CCG for North East London and the team moved into Unex Tower on 8 th May. An induction day has been held and we are working to support the team in developing a constructive relationship with each CCG alongside a more detailed knowledge of each CCG s primary care strategy. The intention is to make these roles more rewarding as well as improving relationships with General Practice through the shift. Steve Gilvin Chief Officer 8 th June 2017 4 20

NCCG Board 14 June 2017 Committee Rooms, 4 th Floor, Unex Tower Title Board Assurance Framework Agenda item 3.1 Author Jason Clarke, Risk and Information Governance Manager, NCCG Presented by Satbinder Sanghera, Director of Partnerships and Governance, NCCG Contact for further information Satbinder Sanghera, Director of Partnerships and Governance, NCCG This paper is for Decision Action required The Board is asked to agree the following: Agree the revised Board Assurance Framework for 2017-18 in line with the CCG s identified priorities and challenges. Agree the revised BAF wording for BAF.07. Agree the addition of the newly proposed risks. Note the next steps listed in section 3. Executive summary The report asks the Board to agree the proposed BAF risks for 2017-18, which have been revised in accordance with the CCG s priorities which were approved at the Board in April 2017. Supporting papers Appendix A Board Assurance Framework Report 21

How does this fit with NHS Newham CCG strategy? Explain which single value and single aim the report best fits delete others as appropriate. Values Effective and collaborative communication Transparency with our decision-making and leadership Commitment to continuous learning and development Accountability and responsibility Working with our partners to improve health outcomes Aims Improving health outcomes through developing models of integrated care and focusing on prevention Reducing inequalities and improving accessibility Reducing quality variation Where has the paper been already presented? No previous presentation to any meeting. Risk Inadequate governance arrangements, and/or a failure to operate a robust risk management system would expose the organisation to the risk that the CCG would be unable to manage and mitigate identified risks or barriers to achieving its stated priorities. Equality impact The CCG has a strong and unequivocal commitment to promoting equality for all our communities. We believe that Newham CCG should be an exemplar of good practice and able to demonstrate consistently that we are innovative and at the forefront of pushing boundaries for greater equality. We think that our approach to patient and public engagement provides a blueprint for our work because our PPE work has now begun to be mainstreamed across all commissioning activity. We consider equalities to be integrally linked to quality and our PPE approach and over the next year we will be looking to how we can mainstream within quality and PPE, our equalities objectives. The CCG expects that the next stage of our PPE work will focus on a more flexible approach intrinsically linked to commissioning activities and that equalities will be central to that, likewise the work on quality processes and indicators and improvement will encompass equalities considerations. The CCG has reviewed the EDS2 (Equality Delivery System) that sets out the CCG s Equality Objectives, undertake an equalities analysis of policies and services and set out the work that we will be undertaking with patient, stakeholders and providers. The Board has started the process to agree a revised Equalities Strategy will commit the CCG to SMART actions underlined with the approach identified above that will aim to ensure that equalities is embedded within the organisation. A key action will be to communicate to all commissioning committees their responsibility in relation to equalities impact assessments and targets and to monitor their compliance. Stakeholder engagement None. 22

Financial Implications CCG faces reputational and financial risks if risks identified in this paper are not sufficiently mitigated. Plans outlined in this paper address these issues however inherent financial risk remains. 23

1. Introduction and background 1.1 1.1.1 Introduction The BAF is the primary mechanism by which the Board of NHS Newham CCG is appraised and updated on material risks which may affect the CCG s ability to deliver its strategic objectives as set out in the Operating Plan. 2. Key considerations 2.1 2017-18 CCG objectives 2.1.1 At the NCCG April Board meeting, the following 3 CCG priorities were agreed: 1. To lead the development of a Newham-based health and care system which will bring together services in way that delivers high quality services and the best outcomes for the people of Newham. 2. To develop General Practice services that are modern, accessible and robust enough to care for the local population now and into the future. 3. To change Urgent Care Pathway to deliver a more integrated service model in response to feedback from patients. 2.1.2 In addition, three key enablers were identified as requirements to ensure that Newham s health care economy continues to be sustainable: 1. To support the local workforce to adapt to meet the needs of Newham patients now and into the future. 2. To develop strong and future proofed hospitals in East London. 3. To deliver financial sustainability within a backdrop of increasing demand. 24

2.2 2017-2018 BAF risks 2.2.1 Following the revision of the CCG s vision, priorities and key enablers at the April Board meeting, the following BAF risks were proposed for Newham CCG s Board for discussion at the May 2017 Board Development session: BAF risk Lead committee Strategic priority Enabler Dependencies Original Risk Target Risk BAF.01 Failure to meet NHS Constitutional standards. Quality, Performance and Finance Committee 1 2 BAF.02, BAF.04, BAF.07 20 10 BAF.02 Failure to effectively meet the CCG s financial targets and savings plans in 2017/18. Executive Committee 1, 2, 3 1, 2, 3 BAF.01, BAF.03, BAF.05, BAF.07 20 10 BAF.03 Failure to effectively integrate health and social care by progressing Building Healthy Communities programme and the development of an ACS. Commissioning Committee 1, 2, 3 1, 2 BAF.02, BAF.06 16 8 BAF.04 Failure to effectively monitor the quality, performance and activity of commissioned services for all health care providers, with a focus on ensuring the delivery of better clinical outcomes. Quality, Performance and Finance Committee 1,2 2 BAF.01 N/A N/A BAF.05 Failure to effectively develop a primary care strategy that is adequately resourced to serve Newham residents and secure a sustainable and viable GP Federation. Primary Care Commissioning Committee 2 1, 2 BAF.02, BAF.03, BAF.04, BAF.07 20 10 BAF.06 Failure to equip staff, the Board and clinical leaders with the skills, knowledge and expertise to Executive Committee 1, 2 1 BAF.03 12 8 25

enable the delivery of the CCG s priorities and commissioning agenda. BAF.07 Failure to effectively develop and implement the redesigned urgent care pathway and understand the interdependencies with the NHS 111 procurement Commissioning Committee 3 2, 3 BAF.01 BAF.02, BAF.05 16 8 2.2.2 2.2.3 At the Board development session the links to the Board s committees, CCG priorities and key enablers were discussed. It was requested that in addition, the dependencies and linkages to other BAF risks should be presented to the Board. This would enable to Board to note at a glance where a risk increase or decrease, may have an impact on other risks. Proposed risk and target risk scores have also been added for the Board to consider. Progress since the Board Development session: Since the Board development session, the proposed risks have been presented to CCG staff at our staff meeting, and conversations have been held with risk owners. The following amendments have been requested, and are being presented to the Board for approval: 2.2.4 Include a risk around the STP. The recent Five Year Forward View refresh set out the central role for STP partnerships in addressing the three challenges facing the NHS set out in the Forward View improving health outcomes, tackling quality and financial. It is therefore important that the risk around the failure to successfully implement and shape the STP within East London is monitored by the Board. The proposed wording for the risk is as follows: Failure to implement the key programmes within the Sustainability and Transformation Plan and therefore failure to achieve the system control total. 2.2.5 BAF risk 04 be separated: The 2016-17 BAF contained the following risks linked to the performance, activity and quality of our commissioned services: BAF.03 Failure to effectively monitor performance and activity levels of acute and nonacute providers BAF.04 Failure to effectively monitor the quality of commissioned services of all healthcare providers. 2.2.6 The original proposed risk for 2017-18 sought to integrate the risks in line with the integration of Quality, Performance and Finance as a new Committee of the NCCG Board. The QPF Committee believe that the QPF related risks should still be individualised on the BAF as the 26

Committee is currently in an embryonic stage and has not yet established an integrated approach to monitoring quality, performance and finance. 2.2.7 Revise the wording of BAF.07: The wording has been amended to ensure that it reflects the desire to secure integration between the 111 and Clinical Assessment Service procurement and the Urgent Treatment Centre procurement as follows: Failure to implement an integrated urgent care pathway through the 111 and UTC procurements. 2.2.8 Risks no longer on the BAF: The following risks have been removed from the BAF in 2017-18. 2.2.9 BAF.08 - Failure to deliver stated TST benefits including quality and financial efficiency (2016-17 end of year rating: 20): Rationale: The TST benefits and targets are included within the STP strategy. 2.2.10 BAF.10 - Failure to implement the improvements agreed in corporate governance structure (2016-17 end of year rating: 8) Rationale: We have reviewed the governance arrangements, and have agreed and implemented the proposed changes. Whilst we will continue to monitor the robustness of the governance mechanisms within the CCG, this is no longer considered to be a key strategic risk. 27

3. Next Steps 28

3.1.1 3.1.2 3.1.3 To ensure that we are continually developing the CCG s risk management approach, work is currently taking place in the following areas, and the following actions will be undertaken prior to the next report to the Board in September 2017: Review of internal controls/mitigations: In order to adequately assure the Board that the risks in the BAF Report are being effectively managed the reports to the Board in September 2017, December 2017 and April 2018 will have a focus on the robustness of the risk descriptions, internal controls, mitigating actions and timeframes for completion. This will address a number of the recommendations noted by the auditors. Board Assurance Framework Audit: The CCG s internal auditors concluded a deep dive report into two 2016-17 BAF risks. The final report was reported to the CCG s Audit Committee in April 2017. Within the report the auditors note that the CCG has a well-developed Board Assurance Framework which has been embedded within the risk management and governance structure of the CCG, which informs decision making at various levels of the organisation. An action plan has been developed to address the recommendations identified within the report and a follow up audit has been built into the CCG s internal audit plan for 2017-18. To provide further assurance to the Board, that the management of the BAF is robust and fit for purpose, it is proposed that we undertake the following deep dives during 2017-18 : October 2017: BAF.03 Failure to effectively integrate health & social care by progressing BHC and ACS and BAF.05 Failure to effectively develop a primary care strategy that is adequately resourced to serve Newham residents and secure a sustainable and viable GP Federation. December 2017: BAF.06 Failure to equip staff, the Board, Clinical leaders with the skills, knowledge and expertise to enable the delivery of the CCG s priorities and commissioning agenda and BAF.07 Failure to effectively develop and implement the re-designed urgent care pathway and understand the interdependencies with the NHS 111 procurement February 2018: BAF.01 Failure to meet NHS Constitutional Standards and BAF.02 Failure to effectively meet the CCG s financial targets and savings plans in 2017/18. At the meeting in September, the Board will be provided with the criteria by which to assess the risk appetite and tolerance within the deep dive assessment framework. This will allow the Board to make an accurate judgement of the risk being carried within the CCG, and assess what additional mitigating actions, if any, need to be taken in order to ensure that the risks can be appropriately managed. 3.1.4 3.1.5 Revise local and committee risk registers: To support the revised governance re-structure which was implemented in April 2017, the risk registers within the Board sub-committee structure are currently undertaking a review. A clear escalation process will be developed to ensure that where appropriate, the necessary Committee risks are escalated to the Board. Chair s meeting: A meeting has been established for Chairs of the following CCG Committees, the first of which will take place on 27 June 2017: NCCG Audit Committee NCCG Board NCCG Commissioning Committee NCCG Executive Committee NCCG Primary Care Commissioning Committee NCCG Quality, Performance and Finance Committee This will be a meeting for Committee Chairs to horizon scan, review Committee forward plans and discuss potential risks to the delivery of our strategic objectives and priorities. The frequency of the meeting will be discussed at the meeting in June. 29

Board 14 June 2017 Title: Quality Report Agenda item 3.2 Author: Saem Ahmed, Newham CCG, Head of Quality and Development Presented by: Fiona Smith, Newham CCG, Chair of Quality, Performance and Finance Committee Contact for further information: Chetan Vyas, Newham CCG, Director of Quality and Development, Chetan.Vyas@newhamccg.nhs.uk, 0203 688 2316 This Paper is for: Monitor Action required: The Board are asked to: NOTE the actions taken by Newham CCG or CSU on behalf of Newham CCG in relation to the Red and Amber RAG rated Quality Indicators reported on an exception basis. NOTE the assurances provided in relation to the other Quality matters reported on. 30

Executive summary: The June 2017 Newham CCG Quality Report provides an update against the reported Quality Indicators for the 3 Providers from which Newham CCG commissions health services in addition to providing an update on other quality related matters. Barts Health Green rated areas Amber Alerts acknowledged within target of 3 working days at 100% No MRSA cases against a zero tolerance No C.diff reported under currently under the 82 annual threshold Safeguarding Childrens Training Level 1 above the 85% target with 95.5% Safeguarding Childrens Training Level 2 above the 85% target with 86.4% Safeguarding Adults Level 1 above the 85% target with 94.6% VTE Assessment at 99.50% above the 95% target FFT Inpatient Response Rate at 15.89% above the 15% target 93.42% FFT Inpatient % recommended the service 96.80% FFT A&E % recommended the service 85.48% FFT Maternity % recommended the service 90.51% FFT Outpatient % recommended the service Amber rates areas Safeguarding Childrens Training Level 3 above the 85% target with 80.4% 14.32% FFT Maternity Response Rate above the target of 15% Red rated areas 14 Mixed Sex Accommodation Breaches reported, however zero on the Newham site. 75% Amber Alerts actioned within target of 10 working days, below the 100% target, further information provided within the report Safeguarding Adults Training Level 2 below the 85% target with 73.90%, further information provided within the report A&E response rate at 2.30% below the 15% target, further information provided within the report All amber and red issues are being discussed with Barts Health and assurances are sought on improvement plans and trajectories through the Newham site CQRM meetings and Trust KPI review meetings. East London Foundation Trust Mental Health Green rated areas Zero MRSA reported in June against a threshold of zero Zero C.DIFF reported in June against a threshold of zero Reduction of medication errors through medicine on admission to hospital is above the target of 95% with 98.90% Clinical sharing of information with GP slightly above the 90% target with 91.90% Discharge notification sent to GP within 48 working hours of patient discharge is above the target of 95% with 97.00% Smoking status of patients recorded electronically above the 80% target with 96.60% Page 2 of 4 31

Child and Adolescent Mental Health Service DNA rates (CAMHS) below the threshold of 15% with 6.90% Zero Mixed Sex Accommodation breaches reported Older Community DNA rate is below the threshold of 10% with performance at 6.80% Amber rated areas Adult Community DNA rates above the threshold of 10% with 11.70%, further details of actions taken provided on the report Red rated areas Adult inpatient re-admissions within 28 days at 11.30% which is above the threshold of 7.5%, further details provided on the report All amber and red issues are being discussed with East London Foundation Trust and assurances are sought on improvement plans and trajectories through the East London Foundation Trust Clinical Quality Review Meetings East London Foundation Trust Community Health Green rated areas Safeguarding Childrens compliance Level 1 at 91% above the 85% target No MRSA reported No c.diff cases reported VTE Assessments at 100% achieving the target 100% on Duty of Candour against a target of 100% 100% of Cardiac Rehab patients surveyed were satisfied with the service against a target of 85% 100% of adults in Cardiac Rehab achieving independence three months after entering care/rehab rate per 10,000 (%) against a target of 60% 100% of patients in Foot Health Service who have completed treatment (closed) were satisfied with the service against a target of 80% 92% of Children in Occupational Therapy Services who have shown improvement on agreed Therapy Outcome Measures following direct intervention against a target of 80% 100% of Children in Physiotherapy Services who have shown improvement on agreed Therapy Outcome Measures following direct intervention against a target of 80% Red rated areas Safeguarding Children compliance Level 2 at 77% below the 85% target, further information provided within the report Safeguarding Children compliance Level 3 at 65% below the 85% target, further information provided within the report Page 3 of 4 Other Quality Matters The most recent Newham CQR/ Oversight and Assurance Meeting took place on 20 April 2017 and details are within the report The most recent ELFT Community Health Services CQRM took place on 1 June 2017 and details are within the report The most ELFT Mental Health Services CQRM took place on 8 June 2017 and details are within the report Care Quality Commission (CQC) Re-inspection of Newham University Hospital Trust 32

Supporting papers: Quality Board Report supporting this paper How does this fit with Newham CCG Strategy: Values: Collective clinical leadership Effective & collaborative communication Patient/Public voice throughout our decision making Transparency with our decision-making and leadership Accountability and responsibility Caring culture and behaviour Working with our partners to improve health outcomes Aims: Improving health outcomes through developing models of integrated care and focusing on prevention Reducing inequalities and improving accessibility Reducing quality variation Ensuring equity of Health and Wellbeing outcomes Where has the paper been already presented? Presented at the May 2017 Quality, Performance and Finance Committee. Risk: The risks in relation to Barts Health and East London Foundation Trust are around non-delivery and these are reported on in the appended report. Newham CCG Board Assurance Framework reference BAF.06. Equality Impact: This document relates to all Newham residents in the 9 protected characteristics that are covered by the Equality Act 2010 and our Equality Duties. Stakeholder engagement: Integrated Care Impact No consultation has taken place nor is it required for this report. A number of quality indicators will have an impact on Integrated Care and the report has been shared with the programme team. Financial Implications No financial implications for this paper. For information only. Page 4 of 4 33

Quality Board Report June 2017 34