AGENDA The Governing Body will be available to meet with ......2020/01/29 · Governing Body GP Member Godfrey Reynolds Member of the Local Medical Committee P Direct Ongoing 29/10/2019

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Meeting of the West Suffolk CCG Governing Body to be held from 0915–1230 hrs on Wednesday 29 January 2020 in

the Edmund Room, St Edmundsbury Cathedral, Bury St Edmunds, Suffolk, IP33 1LS

AGENDA

The Governing Body will be available to meet with members of the public from 0900 – 0915

GENERAL BUSINESS

1. Apologies for Absence Dr Christopher Browning

2. Declarations of InterestTo declare any interests specific to agenda itemsDeclarations made by members of the Governing Body are listed in theCCG’s Register of Interests. The Register is available via contact withthe CCG’s Corporate Governance Officer or at the CCG website.

All

3. Minutes of the previous West Suffolk CCG Governing Bodymeeting.To approve as a correct record Minutes of the West Suffolk CCGGoverning Body meeting held on 27 November 2019

Dr Christopher Browning

4. Matters Arising and Action Log Dr Christopher Browning

5. General UpdateTo receive a verbal report from the Chief Executive

Ed Garratt

PATIENT AND PUBLIC ENGAGEMENT

6. Patient Story

7. West Suffolk Alliance UpdateTo receive and note a report from the Director of Integration

Kate Vaughton Report No:

WSCCG 20-01

8. Patient and Public Involvement – Vision for 2020To receive and note a report and presentation from the Lay Memberfor Patient and Public Involvement

Lynda Tuck Report No:

WSCCG 20-02

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STRATEGY AND SERVICE DEVELOPMENT 9. Procurement Update: Summary of Activity 2019/20

To receive and note a report from the Director of Finance Jane Payling

Report No: WSCCG 20-03

10. Ipswich and East Suffolk and West Suffolk Mental Health Update

To receive and note a report from the Director of Transformation and Strategy

Richard Watson Report No:

WSCCG 20-04 11. Business case for Child and Young Person (CYP) (0-18) Crisis

Outreach Team for Mental Health To receive and approve a report from the Director of Nursing

Lisa Nobes Report No:

WSCCG 20-05 12. East of England Leadership Compact

To receive and endorse a report from the Director of Corporate Services and System Infrastructure

Amanda Lyes Report No:

WSCCG 20-06 FINANCE, PERFORMANCE AND SCRUTINY 13. Integrated Performance Report - Are the CCGs finances,

performance and quality on track? To receive and note a report from Directors. • Integrated Performance Report Supporting Information

Directors Report No:

WSCCG 20-07

WSCCG 20-07a 14. Governing Body Assurance Framework

To receive and approve a report from the Director of Corporate Services and System Infrastructure


WSCCG 20-08 GOVERNANCE AND CORPORATE BUSINESS 15. Freedom of Information

To receive and note a report from the Director of Corporate Services and System Infrastructure


WSCCG 20-09 16. Minutes of Meetings:

To receive a report seeking the endorsement of minutes and decisions from the following West Suffolk CCG Sub Committees. a) Financial Performance Committee

The unconfirmed minutes of a meeting held on 18 December 2019

b) West Suffolk CCG Primary Care Commissioning Committee The unconfirmed minutes of a meeting held on 27 November 2019

c) Commissioning Governance Committee Decision from ‘virtual’ meeting held on 12 November 2019

Committee Chairs Report No:

WSCCG 20-10

17. Terms of Reference for Community Engagement Group

To receive and approve revised terms of reference for the Community Engagement Group

Lisa Nobes/ Kate Vaughton

Report No: WSCCG 20-11

18. Date and Time of future Governing Body meetings

0915 - 1200 Wednesday 25 March 2020, Conference Room, West Suffolk House, Western Way, Bury St Edmunds, Suffolk

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19. Questions from the public – Maximum 15 minutes Please note questions should relate to the items under discussion and must be a question rather than statement. Where individuals deviate from this requirement they will be asked to stop and will not be invited to take any further part in the meeting.

Exclusion of the Press and Public

The Governing Body is recommended to exclude representatives of the press, and other members of the

public, from the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest; Section 1(2), Public Bodies (Admission to

Meetings) Act 1960.

Financial Interests

Non Financial Professional

Interests

Non Financial Personal Interests

From To

Governing Body GP Member Zohra Armitage GP and GP Streaming work for Suffolk GP Federation P Direct Ongoing 09/10/2019 No further action required YesHusband is a consultant urologist at Cambridge University Hospital P Indirect Ongoing 09/10/2019 No further action required YesDirector of company providing urological services to Swan Surgery, BSE P Direct Ongoing 09/10/2019 To be declared when appropriate Yes

Lay Member for Governance and Vice Chair CCG Geoff Dobson Former Director of Resource Management with Suffolk County Council P Indirect Ongoing 02/10/2019 No further action required YesFamily Member being seen by Norfolk and Suffolk NHS Foundation Trust P Indirect 2018 Ongoing 02/10/2019 No further action required Yes

CCG Chair Christopher Browning PMS Provider, Practice Partner Long Melford P Direct 2001 Ongoing 10/04/2019 To be declared at relevant meetings YesOut of Hours doctor for Care UK and Suffolk GP Federation P Direct 2010 Ongoing 10/04/2019 To be declared at relevant meetings YesWife is Consultant at West Suffolk Hospital P Indirect 2004 Ongoing 10/04/2019 To be declared at relevant meetings Yes

Lay Member Steve Chicken Owner and MD of Galliform Ltd, consultancy and training company. No NHS activity P Direct 2009 Ongoing 03/10/2019 No further action required YesLay Member for Ipswich and East Suffolk CCG P Direct 2016 Ongoing 03/10/2019 To be declared when appropriate YesWife is President and Director of East of England Co-op P Indirect 2018 Ongoing 03/10/2019 To be declared when appropriate Yes

Chief Officer Ed Garratt Accountable Officer for Ipswich and East Suffolk CCG P Direct Mar-16 Ongoing 28/10/2019 No further action required YesAccountable Officer for North East Essex CCG P Direct Jan-19 Ongoing 28/10/2019 No further action required YesExecutive Lead - Suffolk and North East Essex Integrated Care System P Direct Apr-19 Ongoing 28/10/2019 No further action required Yes

Enhanced Associate GP Andrew Hassan Nil 06/11/2019 YesDirector of Corporate Services and System Infrastructure Amanda Lyes Director of Corporate Services and System Infrastructure for Ipswich and East Suffolk and North East Essex CCGs P Direct Ongoing 27/08/2019 None Yes

Member of Bulmer Parish Council P Direct 2018 Ongoing 27/08/2019 None YesDirector of Nursing Lisa Nobes Chief Nursing Officer for Ipswich and East Suffolk CCG and North East Essex CCG P Direct Ongoing 24/10/2019 None YesDirector of Finance Jane Payling Chief Finance Officer for West Suffolk CCG

PDirect 25/09/2017 Ongoing 02/09/2019 Arrangements in place for the joint management team of the

CCGsYes

Director of Finance for North East Essex CCGP

Direct 01/07/2019 Ongoing 02/09/2019 Arrangements in place for the joint management team of the CCGs

Yes

Trustee of Cambridge Theatre Trust P Direct Oct-18 Ongoing 02/09/2019 To declare when appropriate YesGoverning Body GP Member Godfrey Reynolds Member of the Local Medical Committee P Direct Ongoing 29/10/2019 None Yes

Chair of Mildenhall Sick and Poor Fund P Direct 1989 Ongoing 29/10/2019 None YesConsultant in Public Health Medicine Jep Ronoh Husband is a salaried GP at Hardwicke House Surgery and does locum work for Out of hours provider, Suffolk GP Fed and

other GP Surgeries P Direct Ongoing07/11/2019 To declare when appropriate Yes

Governing Body GP Member Bahram Talebpour Medical Director of Sudbury Primary Care Network P Direct Ongoing 01/10/2019 No further action required YesGP Partner P Direct Ongoing 01/10/2019 No further action required Yes

Chair of Community Engagement Partnership David Taylor Chairman of Hargrave Parish Council P Direct Apr-17 Ongoing 08/11/2019 No further action required YesLay Member for Patient and Public Involvement Linda Tuck Nil 01/10/2019 YesChief Operating Officer Kate Vaughton Director of Integration for West Suffolk NHS Foundation Trust, non-voting member of Board P Direct Ongoing 03/10/2019 To declare when appropriate YesGoverning Body GP Member Firas Watfeh Local Medical Committee member P Direct 01/08/2015 Ongoing 29/10/2019 No further action required Yes

Works for Care UK Out of Hours P Direct 01/04/2013 Ongoing 29/10/2019 To be declared at relevant meetings YesGP Partner at Haverhill Family Practice P Direct 04/07/1905 Ongoing 29/10/2019 No further action required YesPCN Clinical Director P Direct 04/07/1905 Ongoing 29/10/2019 Yes

Director of Transformation and Strategy Richard Watson Director of Strategy and Transformation for Ipswich and East Suffolk, North East Essex CCGs and West Suffolk CCGs P Direct Jun-16 Ongoing 28/10/2019 None YesHusband is employee of Hadleigh Group Practice P Direct Ongoing 28/10/2019 None Yes

Governing Body GP Member Victoria Wilson Shares in compnay for ophthalmology related work P Direct Ongoing 30/10/2019 To be declared when appropriateMaternity work for maternity voices partnership, West Suffolk Hospital P Direct Ongoing 30/10/2019 No further action required

Governing Body GP Member Andrew Yagar Nil 02/10/2019 YesGoverning Body GP Member Vacant GP PostGoverning Body PM Member Vacant PostGoverning Body PM Member Vacant PostSecondary Care Doctor Vacant Post

West Suffolk CCG Governing Body and Sub Committee Members

Title First Name Last Name Declared Interest Type of Interest Direct or Indirect

Date of Interest Date of Receipt

Action Taken to Mitigate Consent to Publish

Minutes of a meeting of the West Suffolk CCG Governing Body held in public on

Wednesday 27 November 2019 in the Conference Room, West Suffolk House, Western Way, Bury St Edmunds, Suffolk

PRESENT: Dr Christopher Browning CCG Chair Dr Zohra Armitage GP Member Geoff Dobson Lay Member for Governance Ed Garratt Chief Executive Amanda Lyes Director of Corporate Services and System Infrastructure Lisa Nobes Director of Nursing Jane Payling Director of Finance Dr Bahram Talebpour GP Member Kate Vaughton Chief Operating Officer Dr Firas Watfeh GP Member Richard Watson Director of Strategy and Transformation Andrew Yager GP Member IN ATTENDANCE

Dr Andrew Hassan Enhanced Associate GP Jo Mael Corporate and Governance Officer

19/102 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and introduced a minute silence for those members of the East of England Ambulance Service NHS Trust that had recently taken their own lives. Apologies for absence were noted from: Steve Chicken Lay Member Dr Godfrey Reynolds GP Member Dr Jep Ronoh Consultant in Public Health Medicine David Taylor Chair of Community Engagement Group Lynda Tuck Lay Member: Patient and Public Involvement The Chair reminded those present that as we were currently in ‘purdah’, the period in the run-up to an election when there was a restriction in place on publicising political issues, response to some questions might be affected.

19/103 DECLARATIONS OF INTEREST

Dr Zohra Armitage, Dr Christopher Browning, Dr Bahram Talebpour and Dr Firas

Watfeh declared an interest in agenda item 10 (Integrated Front Door Model at West Suffolk NHS Foundation Trust) insofar as it related to the Suffolk GP

Federation and the GP Streaming service, but remained in the meeting for the discussion.

19/104 MINUTES OF PREVIOUS MEETING

The minutes of the meeting held on 25 September 2019 were approved as a

correct record.

19/105 MATTERS ARISING AND ACTION LOG

There were no matters arising and the action log was reviewed and updated.

19/106 GENERAL UPDATE

The Chief Executive reported; • That the Integrated Care System’s Long Term Plan would be published after

the General Election. • Recent Indices of Deprivation data indicated a small improvement in West

Suffolk and rural East Suffolk, with a deterioration in Ipswich. • The outcome of a Care Quality Commission recent inspection at West Suffolk

NHS Foundation Trust was awaited, early indication was that there was pressure within maternity services.

• Staff consultation associated to a proposed restructure had now concluded and recruitment to posts had commenced.

The Governing Body noted the update.

19/107 PATIENT STORY

In the absence of a patient story representative the Director of Integration read out

the experiences of a Dementia Together service user. The experience was from a middle aged person caring for an 80 year old mother with dementia. The pressures of caring for someone with dementia had left the carer feeling suicidal from anxiety and social isolation, feelings which had not been shared initially. Following contact with Social Services a multi-disciplinary team meeting had been convened and crisis support provided. Dementia Together had provided a listening service and had been able to access records to ensure that assistance was provided more speedily from various organisations. As a result the carer was no longer feeling so isolated. The Governing Body noted the report.

19/108 WEST ALLIANCE UPDATE

The Governing Body was in receipt of a report which provided an update on the

progress and development of the West Suffolk Alliance and partnership working in our system. Points highlighted included; • An event for Lay and Elected members had been scheduled to take place in

January 2020, which would incorporate consideration as to how Lay membership might be aligned with development of the Alliance.

• Primary Care Network development continued and social prescribing was being progressed.

The Governing Body noted the content of the report.

19/109 COMMUNITY ENGAGEMENT GROUP (CEG)

The Director of Integration presented the minutes of the Group’s last meeting, which

had been held on 31 October 2019. The CEG had received an update on mental health, together with developments within localities and the need to link relevant CEG members into teams. At that point, and in relation to development of the 111/2 service, members of the audience raised concern in relation to services becoming too fragmented and confusing for patients. It was explained that the 111/2 service was due to launch in May 2020 but would not launch until staff were in place. Although site discussions currently continued with the County Council home treatment teams were being established. Although additional funding had been acquired to develop a 24/7 psychiatric liaison service, recruitment to the service remained a challenge. The lack of resilience within the service was highlighted and the need to not only consider highly qualified individuals for posts, but to include those that had good empathy and listening skills, was emphasized. The Governing Body noted the update.

19/110 WEST SUFFOLK CCG AND IPSWICH AND EAST SUFFOLK CCG 2020-21

COMMISSIONING INTENTIONS

Each year, Clinical Commissioning Groups were required to produce commissioning intentions which described to local providers how the CCG intended to shape its local healthcare services; described what services the CCG wanted to buy, and set out the health outcomes the CCG wished to achieve for its local population. West Suffolk CCG and Ipswich and East Suffolk CCG had developed a joint commissioning intentions letter for 2020/2021 which was appended to the report. The letter had been shared with all main providers and added to the CCG’s websites. It was intended that for 2021-2022, the three CCGs in the Integrated Care System would publish a joint commissioning intentions letter. The Governing Body noted the report.

19/111 INTEGRATED FRONT DOOR MODEL AT WEST SUFFOLK NHS FOUNDATION

TRUST

The Governing Body was in receipt of a report which sought approval of the proposed new front door model at West Suffolk NHS Foundation Trust due to commence on the 1 November 2019. A number of meetings had taken place with representatives from ESNEFT, the GP Federation and CCG to agree the detail of the model including who would provide the service. Key points were set out within Section 2 of the report which included a proposal to extend the current contract until 31 March 2021 at a cost £662,525 for 17 months. This is a reduction in the current models costs by approximately £8,000 a month.

It was explained that via a virtual meeting held from 12-15 November 2019, the CCG’s Commissioning Governance Committee had approved the contract extension, subject to, the Committee receiving an evaluation of the new model during the summer of 2020. Evaluation of the service was queried and it was explained that a joint review by GPs, the hospital, CCG and GP Federation was to take place. Key performance indicators had been developed and were being monitored.

The Governing Body subsequently endorsed the decision made by the Commissioning Governance Committee to extend the current GP streaming contract by 17 months subject to, the Committee receiving an evaluation of the new model during the summer of 2020. .

19/112 PROCUREMENT UPDATE

The Director of Finance introduced a report which updated the Governing Body on

procurements completed since the last procurement, together with those currently in progress and planned. Key points highlighted included; Pathology Services - the CCG currently commissioned Pathology Services with NHS West Suffolk CCG and NHS North East Essex CCG through a contract with North Essex and East Suffolk Pathology Services (NEESPS). A review of the options open to the CCGs was still in progress and the outcome of the review would be presented to Clinical Executive and Governing Body at the earliest opportunity.

Mental Health - the transformation work continues with mental health services and it was expected that a full due diligence process would be undertaken during June and July 2020.

IVF Services - the procurement for Specialist Fertility Services successfully completed on the 12 November 2019. The tender received five submissions and each were evaluated with the outcomes presented to a recent private Governing Body meeting. One provider withdrew its submission prior to the award process and, as such, four standstill letters were released. Each standstill letter contained areas / issues which the provider would need to address either prior to contract start or as part of a service development improvement plan. Contracts were due to start on the 1 December 2019, and service users that met the thresholds for the services would be offered the choice of all four providers. Procurement Review - work was progressing on establishment of a Procurement Board, Terms of Reference had been drafted and were out for comment. Once agreed they would be sent to Clinical Executive and Governing Body to decide upon the role and responsibilities of the Board. The Governing Body noted the content of the report.

19/113 GP+ CONTRACT EXTENSION

The Governing Body was in receipt of a report which sought ratification of the

proposal to extend (by agreement) the existing contract with Suffolk GP Federation for the GP+ service. The West Suffolk contract was worth £1,020,591 per annum. - NHS England provided the CCG with funding for the service. NHS England had announced that funding for the GP+ service would be transferred from the CCG to Primary Care Networks (PCNs) from 1 April 2021. As a result it

was suggested that there was no value in going out to the market for, what would be, a very short contract term.

Further considerations included the fact that NHS England had announced a review of extended access (GP+) along with out of hour’s services. That review was due to be published imminently and would inform any revisions required in the extended access scheme (GP+) which would make development of a specification and going out to the market problematic.

The Governing Body subsequently approved the extension of the GP+ contract with Suffolk GP Federation until the 31 March 2021

19/114 INTEGRATED CARE SYSTEM (ICS) WORKFORCE UPDATE

Further to a previous update, it was reported that a Director of Workforce was now

in post and work had begun to outline the medium term plan over the next five years through the strategic plan process.

Many of the workforce solutions would cross cut most, or all five themes of the Interim People Plan, and all those themes were closely linked with the digital and estates elements of the strategic plan. An integrated approach to workforce would be adopted, working closely with performance and finance teams to ensure workforce plans were realistic and met the needs of the local population.

The ambition for the population was to have an integrated workforce that delivered care at the right time; in the right way; in the right place; by the right person. Key challenges identified within the report were;

• Recruitment and retention of the workforce, including a shift from agency

dependency to permanent workforce. • Health and wellbeing of the workforce led by good leadership. • Ensuring supply timelines of learners /students and a consistent quality of

education. • Supporting clinical accountability and confidence in upskilling and developing

new roles. • The need for a joined up approach and capacity to support learning in practice. • Meeting the level of system transformation and resources required to achieve

the aims of the Five Year System Strategic Plan. The report went on to outline the current workforce profile, workforce planning and future actions. In light of previous discussion, the Chief Executive emphasized the need to review mental health link worker capacity going forward, together with the need to invest in the caring element rather than seeking academic qualifications.

The Governing Body noted the report.

19/115 MY CARE RECORD

The Director of Corporate Services and System Infrastructure introduced a report

which provided an update on the progress of My Care Record. ‘My Care Record’ was a branding created and owned by West Essex CCG, which aimed to facilitate access by the right professional to relevant information to help them make the best decisions for an individual’s care.

Having obtained agreement from West Essex and Herts to roll out the concept of My Care Record across our own STP footprint, delivery of the project was dependent upon the collaboration of stakeholders across the Suffolk and North East provider organisations and all GPs under three strands: Information Governance, Communications and Existing Technology. Since commencement of the delivery project, we had created: • a single Information Sharing Agreement in collaboration with all providers

across the integrated care system including practices in our region. • communications plans and materials, including updates to the existing website,

resources for all organisations, printed and electronic to support a full fair processing campaign satisfying GDPR requirements, starting on the 14 October 2019.

• review and analysis of current sharing via technology to be included under the My Care Record brand.

The report went on to detail progress to date, patient and public engagement and next steps which included; • That by the middle of January 2020 it was intended that all individuals’ GP

records would be shared unless an individual had objected. • That compliance checking was underway to ensure all organisations were

complying with full fair processing – updated privacy notices and signposting to the My Care Record website alongside the printed materials in public areas

• There were six STP/ICS areas within the East of England. West Essex and Hertfordshire CCG and Suffolk and North East Essex CCGs had implemented the framework of My Care Record to reflect the sharing of individual information for health and care; the remaining four areas within the East of England had also agreed to take the framework for communicating with the public on sharing within the existing legal framework thereby giving a consistent approach across the region.

• Creation of a regional team to support business as usual activities and support other areas deploying My Care Record as a communications and Information Governance framework to support their own sharing technologies.

It was emphasized that whilst patient choice remained, My Care Record helped clinicians to make improved decisions in respect of an individual’s care. It was felt that My Care Record had been received well in practices although due to its title being similar to its predecessor the Summary Care Record there remained some confusion for patients. The Governing Body noted the report.

19/116 INTEGRATED PERFORMANCE REPORT

The Governing Body was in receipt of the new formatted Integrated Performance

Report, which provided members with a summary of provider performance against national targets, contractual targets, clinical quality and patient safety issues, and financial performance. The report also included work being carried out by the transformation, and primary care teams. Key issues highlighted included; East Suffolk and North Essex NHS Foundation Trust (ESNEFT) – uncompleted serious incident reports were a key issue and a recovery plan had been received. A new framework would commence in 2020. Infection control was a concern and

a system wide meeting to review and consider the situation had been scheduled. Cancer, referral to treatment and A&E performance levels were not being met. All cancer breaches were being reviewed by a panel and an action plan in respect of A&E performance was in place although recruitment remained a key challenge. Winter plans had been developed and included the identification of additional bed capacity. The Trust had highlighted a risk in achieving its control total at year end and both Ipswich and East and North East Essex CCG were working with the Trust to better understand its position. West Suffolk NHS Foundation Trust – although the outcome of a recent Care Quality Commission inspection was awaited there was an awareness that maternity services process issues might be raised. Work was taking place to develop an action plan. There had been two incidents of MRSA and assurance with regard to Local Safety Standards for Invasive Procedures (LocSSIPs) was being sought as a result of a serious incident. Cancer, and referral to treatment performance levels were not being met; the Trust was currently a pilot site in respect of A&E performance. There was work by the Trust to address 52 week breaches. The Trust had highlighted a risk in achieving its control total and was aiming for a break-even position. Having queried whether there was a need to formalise work to bring performance back in line it was explained that issues could be taken forward via Executive to Executive and Contract meetings. Norfolk and Suffolk NHS Foundation Trust (NSFT) – there were signs of improvement with reduced waiting times for children’s services. There was good progress in respect of national quality requirements although there remained significant ongoing concern in respect of local standards. Recovery plans were in place for adult triage and treatment. The IAPT and well-being services were making good progress and there had been good progress in respect of recruitment to the crisis service. Areas of key focus going forward were eating disorders and peri-natal services. The Trust was reporting that finances were on-track. The Chief Executive reported that, at a Special Educational Needs and Disability (SEND) meeting held with the Department of Education on 26 November 2019, signs of improvement had been reported although autism waiting lists remained a key challenge. It was felt that improvements were due to a change of culture within the organisation which was also embracing locality working. Primary Care – a recent GP education event had had an emphasis on safeguarding. Nursing, medical secretary and practice managers were also established. Market Cross surgery had been re-confirmed as ‘outstanding’ by the Care Quality Commission and Christmas Maltings and Clements had moved to ‘requires improvement’. Work by practice staff was acknowledged. GP capacity and resilience in Haverhill had improved and a new GP had been recruited to Christmas Maltings and Clements practice. Steeple Bumpstead had now become a branch surgery of Christmas Maltings and Clements practice and the CCG was providing support. Prescribing remained over budget year to date due to costs associated with CATE M and No Cheaper Stock Obtainable (NCSO) drugs. Community Services – Health assessments for children in care had been highlighted as a concern by the Corporate Parenting Board and it was suggested that thought be given to incorporating investigation as part of the Community Paediatric Review the report from which was expected by the end of the financial

year. Despite significant investment, performance of the Speech and Language Therapy service was deteriorating and an investigation was underway. The Director of Strategy and Transformation agreed to report the outcome of the investigation to the CCG’s Executive. East of England Ambulance Service NHS Trust – recruitment and retention remained the key challenge going forward. The situation was being monitored on a monthly basis to consider what might be offered as a system. The Trust had established a helpline and was providing support to staff following the recent staff suicides. Winter plans were in place which included incentives, new rotas and employment of additional resource. There had been a 50% reduction in serious incidents. The service was exploring the recruitment of nurses. Finances had been flagged as a risk due to additional staffing costs. Integrated Urgent Care – recruitment was going well and relationships between the out of hours and 111 service were improving. Ezec – performance levels continued to be a cause for concern and vehicles were to be ring-fenced for use by acute Trusts for the discharge of patients. CCG Finances The CCG was on track to deliver its planned surplus of £1.2m at year-end. Identified risks were prescribing and mitigation was in place. Continuing healthcare critical care packages had been identified as a risk and the CCG’s Financial Performance Committee would be receiving a report to its next meeting. The Governing Body noted the report.

19/117 GOVERNING BODY ASSURANCE FRAMEWORK

The Director of Corporate Services and System Infrastructure presented the current

version of the Governing Body Assurance Framework (GBAF) together with a summary of Chief Officer local risk registers. Amendments and additions to the GBAF were detailed within Section 2 of the report, with key aspects of departmental risk registers being listed in Section 3. The Governing Body noted and approved the GBAF as presented.

19/118 2019 EMERGENCY PLANNING RESILIENCE AND RESPONSE (EPRR) CORE

STANDARDS AUDIT

The Governing Body was in receipt of a report which informed on the outcome of the 2019 EPRR Audit. On 9 July 2019 NHS England had written to Accountable Emergency Officers outlining the expectations for the 2019/20 Emergency Preparedness, Resilience and Response [EPRR] assurance process. There were 43 EPRR Core standards applicable to CCGs, the 2019/20 assurance audit also contained a deep dive of 16 standards looking at the CCG’s response to severe weather and long term adaptation. The deep dive standards did not contribute to the overall rating the CCG received. For 2019/20 the CCG had assessed itself as ‘Substantial compliant’ [green] in all the core standard areas, and was required to publish that fact in the annual report. The one standard where the CCG was partially compliant related to infectious

disease planning for which it had an action plan in place to reach full compliance by December 2019.

A deep dive in to the CCG’s severe weather planning showed that it had a number of plans and procedures to manage and mitigate the impacts of severe weather on the CCG’s activities. It was decided that it would be beneficial to bring those together into one severe weather plan which was why the CCG had chosen to show itself as partially compliant. In respect to longer term climate change adaptation that would be considered by the risk forum in future with input from facilities.

The assurance audit was peer reviewed and moderated by the EPRR team from NHS England and although fully compliant a number of areas where improvements could be made to enhance resilience had been identified. Those areas were set out within the action plan appended to the report. The Governing Body noted the content of the report.

19/119 DECLARATION OF INTERESTS

The Governing Body was in receipt of a report which provided a public record of

relevant and material interests declared by members of the Ipswich and East Suffolk CCG Governing Body, its sub-committees, decision making staff and member practices. Declarations were sought on an annual basis in October with an update by exception in April of each year and the register published on the CCG’s website. The updated register was attached to the report at Appendix 1. The Governing Body was asked to review the current register and provide support. where possible, in obtaining outstanding declarations. The Governing Body noted the report.

19/120 APPROVAL OF CONSTITUTION AMENDMENTS AND SEPARATION OF

DETAILED FINANCIAL POLICIES

In view of the closer working relationship between the Suffolk CCGs and North East Essex CCG it was necessary to amend the existing CCG Constitutions to reflect that and the new combined senior management arrangements. It was not necessary to have the CCG’s Detailed Financial Policies (DFP’s) as part of the Constitution (excepting the delegated scheme of financial authority which was Appendix A of Appendix E) and it was therefore proposed that they be separated Following Governing Body approval, the amended Constitution would be presented to NHS England for final approval. As the changes were only administrative, it was anticipated that approval by NHS England would be a straightforward process. The same changes were being applied to the West Suffolk and North East Essex CCG Constitutions. Work on a new combined Constitution based on a recently published NHS England template would commence in due course. The Director of Corporate Services and System Infrastructure advised that the map on page 102 of the Constitution required revision to include Botesdale.

Subject to the inclusion of Botesdale on the map as mentioned above, the Governing Body approved the Constitution amendments as presented for submission to NHS England.

19/121 JOINT CCG COLLABORATIVE GROUP REVISED TERMS OF REFERENCE

At a meeting held on 8 October 2019, the Joint CCG Collaborative Group had

proposed to revise its terms of reference to include North East Essex CCG. Those revised terms of reference were now being presented to the Governing Body for approval. The Governing Body subsequently approved the Joint CCG Collaborative Group terms of reference as presented.

19/122 MINUTES OF MEETINGS

The Governing Body received the following minutes and decisions from meetings;

a) Audit Committee

The unconfirmed minutes of a meeting held on 1 October 2019

b) Remuneration and HR Committee The unconfirmed minutes of a meeting held on 9 October 2019

c) Financial Performance Committee The unconfirmed minutes of a meeting held on 18 September 2019

d) Clinical Scrutiny Committee The unconfirmed minutes of a meeting held on 30 October 2019.

e) West Suffolk CCG Primary Care Commissioning Committee

The unconfirmed minutes of a meeting held on 25 September 2019 f) CCG Joint Collaborative Group The unconfirmed minutes of a meeting held on 8 October 2019 The Governing Body endorsed the minutes as presented.

19/123 DATE AND TIME OF FUTURE GOVERNING BODY MEETINGS

0915 - 1200 Wednesday 29 January 2019, Conference Room, West Suffolk House, Western Way, Bury St Edmunds, Suffolk

19/124 QUESTIONS FROM MEMBERS OF THE PUBLIC

The following questions were received from members of the public:

1) It was questioned whether the 111/2 service would be going ahead.

It was explained that development of the service was a national ‘must do’ and therefore it would go ahead. Although May 2020 was the anticipated start date for the service that was subject to recruitment and the need for a comprehensive ‘all age’ service to be established. The current issue was siting of the service and bids were currently being finalised. It was agreed that regular updates would be provided to the Community Engagement Group.

2) Concern was raised at the lack of communication associated to flu and

pneumonia vaccine availability/shortages.

_____________________________ _______________________ Chair (Dr Christopher Browning) Date

The need for pro-active public communication in future was recognised.

3) It was questioned whether conflict management training might be provided for staff at Christmas Maltings and Clements practice following concerns raised as a result of it having launched Steeple Bumpstead as a branch surgery.

It was explained that the CCG had worked closely with the practice, Suffolk GP Federation and West Essex CCG to provide support. Practice staff were commended for their dedication during a difficult period.

4) Being aware that St John’s Ambulance had introduced a mobile minor injury

unit in Ipswich over the winter period, it was queried whether the same had been considered for Bury St Edmunds or Haverhill.

The Director of Strategy and Transformation advised that he was unaware of the initiative but happy to explore. Other comments included;

• My Care Record had been well received. • Work on Atrial Fibrillation was successful. • Paramedics in GP surgeries was considered of benefit.

WEST SUFFOLK CCG Governing Body

ACTION LOG: 27 November 2019 (updated) MINUTE DETAILS ACTION BY WHOM TIMESCALE/UPDATE Meeting of 25 September 2019 19/094 Integrated

Performance Report Quality Having queried whether more information in respect of the progress of West Suffolk NHS Foundation Trust might be provided within the report, to include more up to date maternity information, and progress in respect of improvement to discharge summaries, the Deputy Chief Nursing Officer agreed to incorporate more information in the next report.

Nichole Day January 2020 The IPR pack has been updated by Helen Bowles to include most current data. Michael Wigg contacted Dr Browning re key issues in relation to discharge summaries. Gradual improvement observed.

Meeting of 27 November 2019 19/116 Integrated

Performance Report Community Services - despite significant investment, performance of the Speech and Language Therapy service was deteriorating and an investigation was underway. The Director of Strategy and Transformation agreed to report the outcome of the investigation to the CCG’s Executive.

Richard Watson

19/124 Questions from the Public

Development of the 111/2 service - it was agreed that regular updates would be provided to the Community Engagement Group.

Richard Watson

Page 1 of 9

GOVERNING BODY Agenda Item No. 07

Reference No. WSCCG 20-01

Date. 29 January 2020 Title

West Suffolk Alliance Update

Lead Director

Kate Vaughton, Director of Integration

Author(s)

Jo Cowley, Senior Alliance Development Lead, WSCCG Dawn Godbold, Associate Director, Integration and Partnership, WSFT Sandie Robinson, Associate Director of Transformation, WSCCG Lesley Standring, Head of Operational Improvement, WSFT

Purpose

To provide an update to the Governing Body on the West Alliance

Applicable CCG Priorities 1. Develop clinical leadership x 2. Demonstrate excellence in patient experience & patient engagement x 3. Improve the health & care of older people x 4. Improve access to mental health services x 5. Improve health & wellbeing through partnership working x 6. Deliver financial sustainability through quality improvement x Action required by Governing Body: Note the progress being made on individual initiatives and collaborative working across the system. This paper provides an update on the progress being made with integration in the West Suffolk system including specific transformation projects. This is a combined paper on Alliance development and transformation.

1. Background

1.1. This paper provides a quarterly update for the Board about activity to transform services and outcomes for people within the west Suffolk alliance area. A number of different teams contribute to the report, from across the CCG and from the hospital and services in the community.

2. Primary Care Network (PCNs) 2.1. In November 2019 we welcomed a new Clinical Director into the Forest PCN, Dr Evelin

Hanikat. Evelin is a GP partner working at Forest Surgery in Brandon, and has particular interest in dermatology and women’s health.

2.2. On the 23 December 2019 NHS England and NHS Improvement published a set of draft

service specifications for PCNs, with a deadline for comments of the 19 January 2020. These five specifications will dictate the work of PCNs during 2020 and beyond. They are written in a way that supports integration with other alliance partners, for instance community health services. Concerns have been raised about the amount of additional work indicated through the service specifications, which national and local bodies are responding to.

2.3. In West Suffolk, individual GPs and PCNs are submitting their own comments. In addition,

the CCG will be considering the impact of the specifications, whilst being aware that some detail may change following consultation,

2.4. Monthly meetings between the PCN clinical directors and the CCG are in place to share information, align the new activity going forward and agree how best to implement changes to for example reimbursed roles.

3. Integrated Neighbourhood Teams (INT) 3.1. The INT is a key element of the community health and care model and is in various stages of

maturity across each of the localities. Where co-location exists we have found the INT tends to mature faster with Mildenhall and Newmarket leading the way in forming single teams, shared leadership and sharing information. The INT maturity matrix is nearing completion and has been designed as a simple “checklist” to enable an INT to self-evaluate their development. The matrix is built around four core elements (empowered INT, people telling their story once, responsive and proactive care, and promoting self-care and independence) and has five steps of progression, moving from ‘not yet established’ to ‘exemplary’. Each core element is divided into headings that outline the main development areas that are reflected across all localities.

3.2. Using this tool, the Newmarket INT has tested the matrix and self-assessed themselves as

an “established” team and are now forming a plan to move themselves forward along the various elements of the matrix towards exemplar. Some areas of the matrix will be outside the INTs control and will require Alliance leaders to support delivery (i.e. shared record/reporting). An outcomes framework is being developed to support the INT to evidence their achievements. The final version of the Maturity Matrix is expected to be signed off at the February West Suffolk Alliance Steering Group.

3.3. As part of the ongoing work to strengthen integrated working, and to populate the locality

delivery plan a workshop style discussion was held with the community health and social care teams in Mildenhall and Brandon to:

• Establish how well they feel they are progressing with integration between the two teams

• Identify what ‘wrinkles’ exist and what solutions may be possible • Identify their ‘burning issues’ and agree any actions/escalation • Identify their top 3 priorities for the locality to go into the locality delivery plan

3.4. The conversation was lively and demonstrated that a strong relationship exists between the

two teams, supported jointly by the respective health and care team managers who helped to facilitate the discussions.

3.5. The three priorities agreed by both teams to go into the locality delivery plan were: • Improved shared access to equipment – this will remove duplication, save clinical

time and reduce the length of time the process takes, meaning a more efficient service for people

• Improve the integration/joint working between themselves and the local mental health teams

• Improve the joint working that happens between the two teams at Brandon to the level/scale of the joint working that happens at Mildenhall – members of the group that work across both the Mildenhall and Brandon areas recognised that ‘it feels more integrated at Mildenhall’

3.6. The delivery plan will now be updated to reflect this, and the learning and the priorities from

the event will be shared at the next locality delivery group. Having visibility of these locally determined priorities through the delivery plan will ensure that there is alliance group focus and attention, particularly where there are system issues that require resolving.

4. One Clinical Community 4.1. The One Clinical Community Leadership Programme is now approaching its third module,

which will be focussing on Building a new culture for the Alliance and includes a field trip to Adnams to learn how Adnams as an organisation encourages innovation and hear some of the leadership journeys of key senior players in the organisation.

4.2. The locality teams, have chosen the focus of the their projects concentrating on the function

of the INT relating to case finding and MDTs, with some looking at high intensity users across the system.

5. Locality Engagement Plan 5.1. The alliance communications and engagement group has been working on a plan that sets

out how the alliance will work in partnership with communities to improve wellbeing. The plan will ensure that the public voice and feedback is gathered through community events, and that feedback is evaluated consistently and shared back with the public. It will also be an opportunity to share knowledge gathered in the place-based needs assessments and bring in the public voice to help guide local priorities or actions, working with communities to facilitate their ideas on how to improve health and wellbeing in their areas.

5.2. The first events will be held in the Brandon, Lakenheath and Mildenhall, and the Sudbury localities.

5.3. This is part of the wider work that the Locality Leads are developing with partners in each of our six localities. For instance in Sudbury the locality group is working with the Dementia Action Alliance to make Sudbury and surrounding rural areas a Dementia Friendly Community.

6. Transformation Projects Update 6.1. Integrated Community Paediatric Services Review: The purpose of this review has been

to understand how the service can best meet the needs of children and young people in Ipswich and East and West Suffolk. Phase 1 was completed with a report being discussed at the Children and Young People’s Board in November 2019. The report highlighted a number of operational issues for the provider to address and some areas to which a system wide

approach is needed. The Board agreed that a number of key priority services would be the focus for Phase 2. The services identified are:

• Medical • Nursing • Occupational Therapy and Physiotherapy

6.1.1. This is in addition to the existing work that is currently being undertaken around SLCN and

Neurodevelopmental pathways.

6.1.2. Phase 2 will centre on the redesign and development of each service delivery model and will include the interface with other services and predicted future demand. The first steering group meeting to determine the scope and terms of reference for this phase of the project is on 23 January 2020.

6.2. The Rapid Intervention Vehicle – The service has been extended to working 12 hours a

day, 7 days a week on 15 December 2019. It continues to respond to over 100 calls a month with an 80% non-conveyance rate.

6.3. Virtual Ward – Test and learn went live on 6 January 2020 supporting people for step up

admission avoidance and step down from hospital. The service works closely with the Community Matrons, Early Intervention Team and the medically optimised team in the hospital and can support up to 8 people. The ward brings health and care closer together in providing an integrated offer of support to people who would otherwise be admitted into a community physical bed. The evaluation will be produced at the end of the test later in May 2020.

6.4. The activity on virtual word is part of the programme to ensure people are given the most appropriate treatment in the right environment. The discharge to optimise and assess pathway one work is also part of this programme. The following example is a recent case study of the impact of this way of working.

Case study – Discharge to Optimise and Assess Mr N is an 80 year old gentleman who lives alone. Mr N was admitted to hospital for a short time and when he became medically optimised, he was identified as suitable for discharge on pathway 1. Mr N still had shortness of breaths and leg oedema, but he was most concerned about a new indwelling urinary catheter. On his day of discharge an occupational therapist (OT) and a Homefirst risk assessor assessed Mr N at his home, along with Support to go home (SGHT) reablement workers and agreed that Mr N should be visited four times a day. On the assessment visit, all the appropriate equipment was brought by the assessors, as well as removing mats in his home. With support and encouragement Mr N soon got comfortable with his indwelling urinary catheter, so when Homefirst reablement, took over from SGHT they had already reduced the calls to twice a day, which were further reduced a week later to once a day. By the following week, Mr N was completely re-abled. Before Pathway 1, Mr N would most likely have waited in hospital until Homefirst were able to provide the care, which at four times a day, would have usually meant long delay, resulting in Mr N possibly deconditioning and becoming institutionalised. Also the OT visit would not have been on day one of discharge, instead 2 reablement workers would have attended, resulting in the necessary changes not being made and a longer period of reablement.

6.5. An ICS wide outpatients workshop is being planned for the 18 February 2020 in the

afternoon aimed at challenging local thinking on what a 21st century outpatient model should look like and develop a high level plan to progress the changes required. A West Suffolk

team of transformation, clinical and operational leads will represent the system at the workshop and drive forward local implementation of the transformational change.

6.6. The evaluation of the Frailty Test and Learn in Mildenhall has been well received and is

now being adopted by all 6 localities as a model linking into the development of the projects being set up by the One Clinical Community leadership teams.

Case study – Frailty Test and Learn Mr A is a Market Cross patient who was referred by his GP to the community matron as part of the test and learn project. Mr A has a previous medical history of a right total hip replacement, Ischaemic Heart Disease (IHD) and chronic obstructive pulmonary disease (COPD). A previous fall and subsequent fracture resulted in restricted mobility of leg and ankle causing a limp and need to walk with aids. Mr A is often breathless due to COPD and IHD. Mr A reported he had been referred to hospital by his dentist for suspected osteonecrosis of the jaw, but was continuing to take Alendronic Acid and, as he did not understand the significance of this, he had not informed his GP of the referral. Mr A’s wife has dementia and no longer recognises him. She has moved into nursing home, where he visits 3 to 4 a week. He is very much devoted to her still but found the separation emotionally very difficult. Mr A was sceptical that he needed assessment by a community matron but consented to the visit and assessment. A Comprehensive Geriatric Assessment, a falls assessment and a medication review were completed with Mr A his home. The community matron felt that Mr A had become socially isolated and was low in mood. He had lost confidence and was finding trips to see his wife difficult and costly. He was not eating well, although able to cook for himself and was finding some activities a struggle, including getting in and out of bed. Mr A’s greatest concern was that he could not bend down to clean his oven. Community matrons actions from the assessment included:- • A referred to community Occupational Therapy for bed transfers assessment and for a

perching stool in kitchen • Mr A’s GP advised to stop prescription of Alendronic Acid until review by Maxofacial team. • Mr A was provided with information and application form to cash in his bus pass for taxi

vouchers to help him independently visit his wife • Mr A also given Information of a voluntary agency which would locate a local oven cleaner. • Referral to Orchard Day Centre – Mr A has attended for psychological support and to learn

strategies to cope with breathlessness on exertion and anxiety. • Mr A was put in touch with a social care specialist dementia worker involved with the local

nursing home who has provided some support regarding managing his feelings about his wife’s decline and admission .

The community matron has provided one follow-up visit to ensure Mr A is happy with interventions and has found he has engaged well with services offered. He will now be discharged from matron caseload but given contact details so he can re-refer if he needs.

6.7. High Intensity Users (HIU) – The HIU multi-disciplinary team meetings (MDTs) are now

taking place monthly. 2 patient specific MDTs have taken place which have included Primary care, police, Care UK 111, ED, social care, NSFT with good outcomes for very complex patients. HIU coordinator in the process of discussing with GPs about the next step plan and how the MDTs move out to the localities.

6.8. IV antibiotics in the community – A test and learn working with Brandon Park nursing home is in the planning stages. Patients on IV antibiotics who do not require the services of

an acute hospital can be transferred to Brandon Park. They will continue to be monitored by the acute Out Patient Antibiotic Team.

6.9. Community Teams Productivity – The hospital transformation team led a session supported by Emergency Care Intensive Support Team. They introduced red to green principles for managing caseloads for district nurses initially. Next steps are for a member of the team to shadow the district nurses and map out current and future states to understand the gaps and need for change.

6.10. Discharge Planning – From February 2020, a hospital discharge planning nurse will be

linked to each locality which will provide the community teams with a point of contact. It is envisaged that the discharge planning nurse will spend time in the locality to build relationships and to get a clear understand what each has to offer.

7. Alliance governance and meetings update

7.1. Lay member event – Over 20 NHS lay members and local authority elected members are

meeting on the 22 January 2020 to find out more about alliance working and to discuss how they can be involved and add value through their lay and elected member roles. Sue Cook, Executive Director for People at the County Council, will give the key note speech and she will be joined by front line managers to provide examples of practical integration on the ground that has made a difference to outcomes for people in West Suffolk.

Objectives for the session are: 1. To enhance relationships across the lay community, including non-executive and

elected members, as part of establishing a broader lay network within the west Suffolk alliance;

2. To share learning and perspectives about the current and future development of the alliance;

3. To work together to support the development of a future framework for lay and elected member involvement in the west Suffolk alliance;

4. To make recommendations on the next steps. 7.2. System Executive Group (SEG) – The SEG meeting on the 8 January 2020 discussed the

outputs from the November workshop and how to put these into action: 7.3. System wrinkles – In terms of issues that impact on all teams there are themes that come

up in multiple discussions in different forums on what is working well and what has got in the way. The common themes were that integrated working would flourish much more rapidly if we could make progress areas such as: generic skills, co-location and shared technology, flexible use of resources.

7.4. Most of these are underway but either do not have deadlines or seem to be moving very

slowly. The proposal is to use the steering Group and SEG as enablers – supporting the staff involved to unblock issues and move the plans forward. SEG agreed that this would be a good approach and would be used to shape part of their agenda going forward.

7.5. Health Inequalities in West Suffolk – Stuart Keeble, Suffolk’s Director of Public Health lead

the discussion about adopting a framework to tackle persistent differences in life expectancy between the most and least deprived groups, for both men and women.

7.6. He shared a graphic that showed that the determinants of health and many and varied.

7.7. Stuart proposed that take a new approach at a place level- with Civic, community and service

level interventions as the basis of place-based planning. Part of the service response would be to use the levers we have as public sector organisations through purchasing, employment and local leadership. SEG agreed that this would be a useful framework. Detailed actions will be set out in the alliance delivery plan.

7.8. SEG also heard from Andrea Pittock, Head of Grant Programmes at the Suffolk Community

Foundation who updated the group on the Realising Ambitions programme. Her update is attached as Appendix 1, showing the groups funded and the next steps for the programme.

7.9. The group also reviewed the timeline for the delivery plan and noted that it would be coming

back to the March 2020 SEG meeting for approval. 7.10. Alliance Steering Group (SG) – The SG met on the 19 December 2019. Two main items on

the agenda were the suicide prevention and the development of the delivery plan. The group heard from Chris Pyburn in the Public Health team, about the funding and priorities around suicide prevention. The SG encouraged him to make links with the locality groups where there is a higher prevalence of suicide: Newmarket, Brandon and Sudbury. The group agreed to set up a small working group to develop proposals around a system wide approach to demand management.

7.11. A presentation about the development of the Delivery Plan lead to a discussion about

demand management. A small group was established from steering group members to come up with proposals for wider discussion, and then inclusion in the plan.

7.12. System Finance Group – The System Resources Group is meeting regularly with partners

from the NHS, the County Council and the District Councils. The most recent meeting focused on financial challenges and continued to improve the level of financial transparency between the statutory organisations in the system. This assists with understanding how financial decisions taken by individual organisations can often have an impact on those around them. The next meeting is scheduled for 28 January 2020.

7.13. Quality Group – The Alliance Quality Group is due to meet on the 29 January 2020. This

new group will identify opportunities for quality improvement and areas where we are experiencing barriers in terms of system change. Additionally it will provide the Board function for the system wide Quality Improvement programme, which is a system wide programme hosted by WSFT.

8. Alliance Delivery Plan

8.1. Progress is being made with developing the West Suffolk Alliance Delivery Plan. This plan will show the action that is being taken across the alliance to deliver the strategy – All About People and Places. As well as having a focus on West Suffolk priorities the plan will set out how NHS must dos will be delivered (as detailed in the NHS Long Term Plan and reflected in the Suffolk and North East Essex Integrated Care System Strategic Plan). The plan is for the next five years, but will mainly focus on the first year. We will be able to use the plan to refresh the detail in our strategy, which set out our first year actions.

8.2. The main chapters for the plan are as follows:

• Chapter 1 – Key alliance programmes

- Development of localities and Integrated Neighbourhood Teams - the prevention and management of long term conditions including mental illness - Developing a co-ordinated approach to responsive support services - An integrated approach to demand management

• Chapter 2 – Enablers - Communications - Estates - Workforce

- IT/Digital - Finance - Quality Improvement

• Chapter 3 – NHS nationally mandated ‘Must Dos’, which include: Cancer, stroke, personalized care, primary care – encompassing digitally enabled primary care, out of hospital and community based care, urgent and emergency and hospital care services, mental health in adults, planned and emergency care, cardiovascular disease, stroke care, diabetes, respiratory disease and air quality, maternity and neonatal care, specialist children and young people’s services, learning disabilities and autism, oral and eye health, safe care.

8.3. In writing the plan the requirements of the Alliance and the ICS are having to be brought

together into one document. Further work will be carried out on a monitoring framework, and the development of more detailed activity plans to support progress in each of the areas above. These will be used to underpin future updates to the Board.

8.4. Timetable – The plan will be signed off by the SEG in March 2020. Following this it will go to

the ICS Board on the 13 March 2020. In the meantime a working group is meeting fortnightly, and discussions being held with partners and at the SG meetings in January and February 2020. Time has also been allocated for individual organisations to review the draft plan to ensure they are able to support.

8.5. It is anticipated that the delivery plan will be a live document. It will set out the actions that as

a partnership we have signed up to for 2020/2021 (and beyond) and provide a way of understanding collectively what our progress is, and working together to take action if delviery is not on track.

9. Recommendation 9.1. The Governing Body is asked to note the progress being made through the West Suffolk

Alliance and the Trusts wider partnership working.

REALISING AMBITIONS

West Suffolk

GIVETO WHAT YOULOVE GRANTS PANEL (West Suffolk)

GIVETO WHAT YOULOVE GRANTS AWARDED

(West Suffolk)

• Active Suffolk• Age UK Suffolk• Catch 22• EPIC Dad Community Interest Company• Gatehouse Caring• Green Light Trust • Home-Start Suffolk• Home Start Mid & West Suffolk• Memories are Golden Community Hub• Noise Solution Ltd• Our Special Friends

• Rural Coffee Caravan• Stour Valley Vineyard Church• Sudbury Gateway Club• Suffolk Archives Foundation• Suffolk Artlink• Suffolk Cruse Bereavement Care• Suffolk Rape Crisis• Suffolk User Forum• Suffolk West Citizens Advice Bureau• Theatre Royal Bury St Edmunds• Walnut Tree Health & Wellbeing CIC• Unscene Suffolk• Voluntary Network

GIVETO WHAT YOULOVE GRANTS AWARDED

West Suffolk Grants in detail – questions and answers• Age UK Suffolk

• EPIC Dad Community Interest Company• Green Light Trust • Memories are Golden Community Hub• Noise Solution Ltd• Our Special Friends• Suffolk West Citizens Advice Bureau• Theatre Royal Bury St Edmunds• Walnut Tree Health & Wellbeing CIC

GIVETO WHAT YOULOVE

Total awarded£437,127

Across 24 grantsReaching 22,855

beneficiaries

West Suffolk Alliance

What’s next?

• Meet all applicants - 12 to see - appointments made• Define outcome tools to be used • Individualised monitoring reports with guidance• Reviewing programme delivery• Follow up calls during programme/what learnings• Visits – awaiting dates to share• Case studies end of March 2020• Interim evaluation report at end of September• Final evaluation at end of 1 year for all applicants

Page 1 of 4

GOVERNING BODY

Agenda Item No. 08


Date. 29 January 2020

Title

Patient and Public Involvement – Vision for 2020

Lead

Lynda Tuck, Lay Member for Patient and Public Engagement

Author(s)

Isabel Cockayne, Head of Communications

Purpose

Information

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement √ 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement Action required by Governing Body: The Governing Body is asked to note the report.

1. Purpose

1.1 To update members on developments in patient and public involvement following an 18-month

review covering Suffolk clinical commissioning groups. 1.2 To note the changing responsibilities for the sub-committee for the Community Engagement

Group. 2. Background 2.1 Since West Suffolk CCG was set up in 2013, it adopted patient and public involvement as a

key priority. By keeping people at the centre of its work, it has been able to adjust services to meet the needs of the public. The Patient Revolution event was held each year between 2013 and 2018 to receive feedback from people within the populations we serve.

2.2 People in 2013 were clear of a need for integration of services. It was therefore adopted as

part of the main aim of the CCG. 2.3 Every year, the Patient Revolution has enabled an open conversation with people. It has

brought up themes that is important to people. We have been able to prioritise the following as a result

• developing mental health; • improving diabetes services, including education sessions for patients; • dementia; • long term conditions; • primary care development; • older people’s services; • working directly with voluntary sector; and • making better use of resources.

This vital feedback has helped the CCG develop its services over the years, grounded in involvement.

2.4 The next step in becoming even more integrated has centred around alliance working. This

has given us an opportunity to review our public and patient involvement work and exploring the join up with other partners. Last year the lay members for patient and public involvement for both Suffolk CCG carried out workshops with volunteers, staff and GP leaders. This was carried out in partnership with the volunteers and strategic partners that make up membership of our Community Engagement Group.

2.5 People told us that we have evolved since 2013. We have moved from simply telling people or

engaging them to truly involving people in our service development. We have even co-created in some cases, such as mental health, lymphedema services, eye care and heart conditions.

3. Why do we involve?

3.1 While is it our legal duty to involve people in our work under Section 242 of NHS Act 2012 and

the Equality Act 2010, it is also the right thing to do. 3.2 Increased involvement leads to improvements in health through:

• decision-making that is more deeply informed • partnership-working in co-design and co-production • creates more appropriate services to help bring about better outcomes gathering insight into

how services are delivered from those who use them helps address problems, enhance quality and build on good practice.

3.3 The PPI review was developed through four staff feedback sessions across the two CCGs, and the Community Engagement Group meetings.

4. Proposed changes 4.1 We have operated on a three tier system of engagement, with people either signing up to the

Health Forum newsletter, being engaged in specific service change pieces of work or being part of a sub-committee of the governing body.

4.2 What follows is a summary of what changes are suggested following the PPI Review. We

expect this to take a year to implement.

• The Involvement Network We will create a single forum, which is both actual and virtual creating a community for all interested in learning about patient and public involvement and being involved. It will allow opportunities from minor to major involvement, linking up all patients, carers and members of the public who want to take part, such as experts by experience. The Involvement Network will be self-selecting, and those who sign up will volunteer their involvement and can in turn express interest in opportunities to be involved. It replaces Points of View and the Health Forum.

• Beyond committees We will be outcomes focused and seek views at the beginning of projects, from those with current experience. The CCGs’ community engagement sub-committees will be better integrated into the CCGs’ work with a greater emphasis on co-production. For example over the last year, and in line with findings, the dynamic and energetic Clinical Engagement Group members are now partnered with each of the six localities to give advice or are able to give strategic focus, in accordance with their skills and the time they can offer us. Task groups will support specific issues, such as cancer, working with Healthwatch Suffolk. It will mean we will have feedback for each of these localities, and events in each designed by the communities through the alliance work. The first of these will be held in Brandon in March 2020.

• Targeted and inclusive We have information about our populations, which following the creation of Place Based Needs Assessments for each locality. We will use this to make sure our activity and partnership is relevant and speaks to them. This will support our aims to reduce health inequalities and focus on prevention. We will use this to customise involvement plans that develops our voice for young people, refugees, migrants, carers, drug and alcohol users, BAME, learning disabilities and ESOL groups, carers, older people in care homes. We will spend time going out to the right areas and participating in events rather than creating them and asking people to come to the CCG. This will be within localities especially working primary care, PPGs and linking closely with colleagues in the Families and Communities Teams and the voluntary sector. There has been progress in Ipswich to co-design and co-produce a way forward on addressing health inequalities with BAME and marginalised groups and we will look to mirror this in West Suffolk.

• Learning and development We will provide training and development opportunities for all in the Involvement Network including access to patient leadership courses and events. Wherever possible, staff and members of the public to be involved together in learning opportunities. We will introduce PPI section to all staff development plans. We aim to set up a PPI staff training programme, including an induction module, the opportunity to attend one or more patient/public events and/or to shadow a partner. We will offer training to staff and advice on how to write and speak clearly, without jargon.

• Partnership-working We will work with the wider system to help reach and include a broader range of people. Healthwatch Suffolk and the voluntary sector are clear strategic partners and we will continue to work proactively. We will link more closely with provider and commissioning organisations on public involvement. We will triangulate feedback by involving PALS across all providers and commissioners.

5. Recommendations

5.1 The Governing Body is asked to note the main themes.

5.2 It is proposed that a quarterly paper is received over 2020/21 to monitor progress.

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GOVERNING BODY

Agenda Item No. 09



Title Procurement Update: Summary of Activity 2019/20

Lead Director Jane Payling, Chief Finance Officer

Author(s) Jane Garnett, Procurement Lead

Purpose To update the Governing Body on the procurements completed since the last procurement update and those currently in progress and planned for 2019/20.

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement

Action required by Governing Body:

To note the work undertaken and the evolving procurement work programme for 2019/20.

1. Update 1.1 The table below summarises the current health service procurement activity.

Procurement Name ITT Bidders

Awarded to Contract Start

Stroke Early Supported Discharge tbc tbc 01/10/2020

Pathology Services

Mental Health due diligence Please note table does not include procurements being undertaken exclusively for Ipswich and East Suffolk CCG

Current Procurements

1.2 Stroke Early Supported Discharge The Stroke Early Supported Discharge tender was released on the 3rd January 2020, with a

submission return date of the 21st February. The tender was released seeking a single provider to deliver the service in an integrated manner across both CCGs. The service being procured will initially be delivered as specified, but the tender has left flexibility for delivery moving forward to take into account the progression of services towards Integrated Community Stroke Services.

1.3 Pathology Services

The CCG currently commissions Pathology Services with NHS West Suffolk CCG and NHS North East Essex CCG through a contract with North Essex & East Suffolk Pathology Services (NEESPS). During December it was agreed to extend the contract by 6 months until October 2020, whilst reviews of the service are continued.

1.4 Mental Health The transformation work continues with mental health services and it is expected that a full due diligence process will be undertaken during June and July 2020. The due diligence will assess the operational plans and contractual issues and the co-ordination of the process will be within the remit of the Procurement team.

1.5 Future Procurements A number of services are currently under review and the outcome of these reviews may fall into the procurement pipeline dependent on the need.

2. Other updates 2.1 Procurement Review

Work is progressing on the establishment of a Procurement Board, Terms of Reference have been drafted and are out for comment. Once a final draft has been agreed these will be sent to Clinical Executive and Governing Body to decide upon the role and responsibilities of the Board.

2.2 Governance Documentation and Routes Due to the imminent changes to the meetings structure within the three CCGs the current governance flow charts will be reviewed and updated. The Commissioning Procurement Policy is also due to be updated once the outcome of Brexit is understood in respect of the regulations governing procurement within the public sector.

3. Key Points 3.1 The following list of services are likely to be in the procurement portfolio over the coming year;

the shaded areas denote when it is anticipated that these will be actively procured and mobilised. Please note some projects do not have an anticipated start date.

Please note this list does not include any Ipswich & East Suffolk CCG only procurements

4. Patient and Public Involvement 4.1 Representatives for the Stroke ESD procurement were previously identified and the

Procurement Lead is re-engaging with them to understand whether they would still like to be involved in the evaluation and moderation process.

5. Recommendation 5.1 The Governing Body is asked to note the work undertaken and the evolving procurement work

programme for 2019/20.

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Date. 29 January 2020 Title Ipswich and East and West Suffolk Mental Health Update

Lead Director Richard Watson: Deputy Chief Executive and Director of

Transformation and Strategy

Author(s) Eugene Staunton: Deputy Director for Mental Health and Learning

Disabilities Transformation Lizzie Mapplebeck: Director, Suffolk Alliance Mental Health Transformation Programme

Purpose To update the Governing Body on:

• Delivery of current NHSE and local mental health transformation;

• Progress of the future mental health transformation model and associated timescales.

Applicable CCG Clinical Priorities: 1. Develop clinical leadership √

2. Demonstrate excellence in patient experience and patient engagement √

3. Improve the health and care of older people √

4. Improve access to mental health services √

5. Improve health and wellbeing through partnership working √

6. Deliver financial sustainability through quality improvement √

Action required by Governing Body: The Governing Body is requested to note the;

• Update on the delivery of current NHSE and local mental health transformation.

• Update on the progress the Suffolk Alliance Mental Health Transformation Programme

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1 Current NHSE and Local Mental Health Transformation

1.1 Introduction

The NHS England 10 Year Plan (January 2019) sets out clear expectations of what is required to be delivered from local mental health services. This section provides an update on progress against this programme of work. The web link below sets out the national requirements and associated funding flowing through to local health systems.

https://www.longtermplan.nhs.uk/wp-content/uploads/2019/07/nhs-mental-health-implementation-plan-2019-20-2023-24.pdf

East and West Suffolk have agreed a ten-year Mental Health and Emotional Wellbeing Strategy 2019-29 (#averydifferentconversation) available on the web link below, in January 2019 describing how a different future ‘system based’ model of mental health and emotional wellbeing services could work. A programme of work has commenced to develop and design this new model of care and is described in section three of this paper.

https://www.westsuffolkccg.nhs.uk/wp-content/uploads/2019/01/2977-NHSWSCCG-EW-Suffolk-MH-EW-Strategy-FINAL.pdf

1.2 Perinatal Services.

The Norfolk and Suffolk Foundation Trust (NSFT) service is required to support 4.5% of the birth rate, increasing to 7.1% in 2020/21 whilst ensuring delivery of NICE-concordant care that centres around the five Perinatal Mental Health Care Pathways. The Suffolk CCGs currently invest £680k (11.4 WTE) in the NSFT local specialist County wide perinatal service supplemented by a successful NHSE bid £177K (Wave 2 Community Development Fund) last year. The CCG is working with the NSFT service to ensure the minimum access targets are achieved. The service is currently identifying appropriate growth needs over the next three years to ensure minimum access targets are surpassed, this will be in line with expected additional investment from the CCG in to the service. A costed growth plan is expected by the end of February 2020. The service is expected to achieve the minimum standards for 2019/20.

1.3 Children and Young People’s (CYP) Services. CYP Community Mental Health Transformation Work is currently focussed on pathway design with prevalence, current demand, capacity and resource being mapped. Coproduction with young people, families, Alliance Partners and VCS organisations continues to be an embedded approach with both a core project group and a wider reference group supporting this work. An extensive workforce development programme underpins the CYP transformation work. Staff understanding of THRIVE and the principles of Signs of Safety and implementing the associated culture change across all partner organisations is essential. To facilitate this shared understanding two identical workshops are planned for the end of January 2020, inviting 350 frontline staff, with organisations proportionally represented. These workshops will be facilitated by the Anna Freud Centre who have researched, supported and evaluated organisations across the country implementation of the THRIVE framework model of responding to mental health.

CYP Crisis and Outreach In addition to the mobilisation of a new all age 24/7 Mental Health Crisis Service, a business case to develop an outreach service to specifically support children and young people in crisis has been developed led by the CCGs (on the Governing Body agenda). It is expected that this service will be implemented in line with the additional investment into the Psychiatric Liaison Services at West Suffolk Hospital and East Suffolk and North East Essex Foundation Trust and collectively will move to provide an age inclusive service in line with core fidelity 24/7 standards.





https://www.annafreud.org/what-we-do/improving-help/thrive-framework/

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Ensuring the SEND Acton Plan is implemented including the implementation of a new model of care for Children’s Speech and Language Therapy with the additional circa £1m investment previously agreed across Ipswich and East Suffolk and West Suffolk CCGs. This work is linked with the review work that has taken place within Community Services where a number of areas of focus have been agreed. Neurodevelopmental pathways The development of a new model of care by the end of February for Neurodevelopmental and Behaviour including new integrated pathways of delivery recognising challenges in the ADHD and Autism diagnostic based services. Working with Suffolk County Council and a number of local voluntary and community sector organisations we have already introduced a number of new service elements which are providing support to families pre/post assessment and diagnosis. CYP Eating Disorders Further development of the CYP Eating Disorders Service building on the peer review with NHS England/Improvement (NHSE/I) colleagues and the Hertfordshire CCG service and through ongoing monitoring of the action plan to ensure the service can deliver against the national target of 95% by 20/21 for both 1 week urgent and 4 week routine referrals. Mental Health Support Teams in Schools (MHST) In 2017, the government published its Green Paper for Transforming Children and Young People’s Mental Health, which detailed proposals for expanding access to mental health care for children and young people, including establishing new Mental Health Support Teams (MHSTs) jointly delivered with the Department of Education. MHSTs are a new mental health workforce (teams comprise 4 Education Mental Health Practitioners (EHMPs), two higher level therapists, one team manager and one administrative support) who will work with approximately 20 schools (with a total population of around 8,000 children and young people) each in order to: • deliver evidence-based interventions to (approximately 500) children and young people

experiencing mild to moderate mental health issues, • support the senior mental health lead in each school or college to introduce or develop

their whole school or college approach, • give timely advice to school and college staff, and liaising with external specialist

services, to help children and young people to get the right support and stay in education. The recruitment to these new teams has progressed well. The trainees will commence the formal training programme in January 2020 at UEA. Teams will then be co-located in schools.

Kooth - Children and Young Peoples (CYP) On-line counselling service

Kooth has now been launched across all of Suffolk and provides on-line support and counselling for CYP aged 11-18. Young people can access online counselling through their mobile device, 365 days a year. Experienced counsellors are available for virtual drop-in or bookable chat sessions from 12 noon until 10 p.m. on weekdays and from 6 p.m. until 10 p.m. on weekends.

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1.4 Improving Access to Psychological Therapies (IAPT): Long Term Conditions

A business case (£2.6M FYE) was agreed in April 2019 to support the Wellbeing Suffolk Service (NSFT) to increase its service capacity provision to deliver integrated Long Term Conditions (LTC) IAPT (Improving Access to Psychological Therapies) pathways and deliver 25% access to treatment target for expansion in IAPT by March 2021. Other requirements are to deliver a 50% IAPT recovery rate; meet 75% of people accessing treatment within six weeks IAPT waiting time and 95% of people accessing treatment within 18 weeks’ IAPT waiting time.

NSFT is working initially with West Suffolk Foundation Trust and East Suffolk and North East Essex Foundation Trust (ESNEFT) hospitals, initially focusing on Diabetes, Respiratory and COPD pathways. The next phase of specialties are now being considered and Wellbeing Practitioners are working in partnership with physical health colleagues, in some instances co-locating in clinical settings to deliver interventions and support, as well as providing support as part of existing rehabilitation courses for people with COPD and other long term conditions. Full recruitment to the additional posts is well underway and on target, with the clinical lead now successfully recruited and in post.

1.5 Severe Mental Illness (SMI): Physical Health Checks

NHSE requires that 60% of SMI patients receive an annual physical health check from 2019/20 (current performance Q2 19/20 (West: 35.7%, East: 41.5%). The two key local steps to support this target are the development of a GP enhanced service payment to support the annual physical health checks and also the commissioning from NSFT of a physical healthcare team who have been in place for almost 12 months. The physical healthcare team has been building close working relationships with primary care colleagues to ensure seamless and consistent care for those most at risk of developing poor physical health conditions and who are hard to reach/engage/treat. SMI registers are jointly reviewed and service users’ needs are discussed to ensure the right support at the right time. The team has presented at a recent regional clinical network event, and is now sharing its model of care with other providers/CCGs that are keen to replicate it. The CCG has also invested in software to be enable remote check performance in EMIS and SystmOne GP practices.

1.6 Severe Mental Illness: Early Intervention in Psychosis (EIP)

The NHS England standard states that ‘Referrals to and within the Trust with suspected first episode psychosis must start a NICE-recommended care package within two weeks of referral. A three part phased business case (£1.6M FYE) was agreed in September 2018 with NSFT. The Trust is in the process of implementing phase two with phase three funding earmarked for 2020/21. The local service must achieve 60% EIP Access standard and 95% Level 3 EIP NICE-concordance by 2020/21.

In January 2020 there will be one CBT(Practitioner) and one Band 3 Clinical Support Worker role advertised. A plan is being developed to establish how the staff embedded within the Integrated Delivery Teams (IDTs) can be moved across to the new dedicated EIP team. A further piece of work to be carried out is to establish a pathway for At Risk Mental State (ARMS).

1.7 Severe Mental Illness (SMI): Individual Placement Support (IPS)

The Five Year Forward View mandated CCGs to invest in high quality, evidenced based employment services for SMI patients. Essex Partnership University NHS FT (EPUT) with partners Employ-Ability were successful in a Suffolk and North Essex Integrated Care System bid to NHS England to provide IPS employment services in Suffolk and the service has now launched. Employ-Ability is a specialist employment support charity working with

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people experiencing mental health problems and the service sits alongside the NSFT Integrated Delivery Teams (IDT’s).

Individual Placement and Support is an internationally recognised evidence led supported employment approach with key characteristics of; • Competitive employment is the primary goal • Everyone who wants to work is eligible • Job search is consistent with individual preference • Job search is rapid • Employment Specialists and clinical teams are integrated • Support is time un-limited (to employee AND employer) • Welfare benefits advice

1.8 Crisis: Crisis Resolution and Home Treatment Teams (CRHTT).

A business case for a 24/7 all age crisis response and home treatment service (18+) amounting to £2.1m FYE was agreed by CCG Governing Bodies in March 2019. In Suffolk there is already a 24/7 crisis response service and this business case has provided the investment for additional capacity and moves the service to open access and enables the Home Treatment Team (HTT) (+18 years) to become 24/7 in line with high fidelity services by 31st March 2020.

The new Suffolk MH Crisis Model is currently being mobilised with recruitment for staff in the contact centre, additional nurses and peer support workers underway. An accompanying training plan for all crisis staff is being developed. Agreement has now been made for the contact centre to be based at the Wedgwood site, Bury St Edmunds.

As part of the new model, the 111 option two will have a dedicated separate number for professionals to use including ambulance, GPs and Police. Suffolk also has a Police Triage service with a MH nurse based in the Police Control room and a nurse available to go out with police to support incidents in the community (2pm – Midnight 7 days per week).

1.9 Crisis: Adult Alternative to Admission.

In Suffolk there are currently some crisis alternatives in place but this is an area under review. Suffolk Night Owls (Suffolk MIND) is now a seven day service offering telephone support from 6pm to 1am for patients with complex emotional problems or personality disorder. Suffolk already has three x 72 hour stay beds (activities and daily living support) and was running a pilot for two x residential beds (both from non NHS providers) for admission and crisis prevention which will become permanent thanks to funding received from NHS England. We are currently working up a proposal with Suffolk Users Forum and VCS partners with the potential to provide a crisis café function in Ipswich and Bury St Edmunds following a successful bid for some monies to NHS England in July 2019.

1.10 Crisis: Psychiatric Liaison Services at East Suffolk and North East Essex Foundation

Trust (ESNEFT) and West Suffolk Foundation Trust (WSFT).

Suffolk successfully received funding to move Ipswich Hospital psychiatric liaison service to Core 24/7 fidelity in 19/20 and West Suffolk Hospital psychiatric liaison service from 1 April 2020. We are currently mobilising the Ipswich Hospital site service (ESNEFT) and recruitment is planned at West Suffolk Hospital in order to become operational from 2020/21. The CCGs have committed to mainstream these services once bid monies expire.

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1.11 Suicide Prevention

Public Health Suffolk is our local lead agency for taking forward the delivery of the Suicide Prevention Strategy across the Suffolk and North East Essex Integrated Care System (ICS), working closely with CCGs. Allocation from NHS England for Suffolk & North East Essex STP is £252K per year for two years (2019-20 and 2020-21). We have now received confirmation of year three funding (2021-22) of £192,169.

The key criteria for supporting initiatives is middle-aged men; self-harm; primary care support; quality improvement within mental health services including acute hospitals; and use of resource to recruit relevant programme support.

A new community fund supporting small projects that improve men’s mental health will be launched this month with launch events in Suffolk and Essex on 16 January 2020. The fund will be managed in Suffolk by Suffolk Community Foundation and in Essex by Essex Association of Local Councils. The project team is leading a series of community campaigns, approaching football and sports clubs, those who work in the agricultural and rural sector and with specific target locations with higher suicide prevalence. In Suffolk, this will promote messages associated with the Suffolk Life Saver campaign, which invites individual and organisational pledges to raise awareness of the available support and to talk more openly about suicide.

In October 2019, the new Kooth service in Suffolk launched, providing an online platform for young people aged 11-18. The service is anonymous and completely confidential with counsellors available for discussion online and a forum for resources on a number of topics. Visit www.kooth.com. Essex’s self-harm toolkit is being evaluated for its suitability to be rolled out to educational settings in Suffolk. This provides a comprehensive toolkit for teachers and other professionals who work with young people. In addition to the toolkit, we will be promoting other available support in Suffolk such as the Moodwise website (www.moodwise.co.uk) and Samaritans’ ‘Step-by-Step’ programme for those affected by suicide in schools, colleges and university. Visit https://www.samaritans.org/how-we-can-help/schools/step-step/.

Working with CCG colleagues, the project team is offering suicide prevention training to primary care staff in the east and west of the county, providing general awareness and addressing common myths and misconceptions. Mental health first aid training will also be offered to businesses, prioritising employers with a high proportion of routine and manual workers

NSFT is developing and delivering a safety planning course aimed at service users who are due to be discharged from Inpatient Care.

2 Suffolk Alliance Mental Health Transformation Programme

2.1 The objective of the Suffolk Alliance Mental Health Transformation Programme is to support the design and implementation of a new all age mental health model for the population of East and West Suffolk.

2.2 The programme is being managed by four explicit priority group, each with a Senior Responsible Owners (SRO) from across the Alliance – the two in bold are new since the last GB update. The Four Priority Groups are:

Priority One: Children, Young People and Families. SRO: Alan Cadzow and Stuart Richardson Priority Two: Community (including IAPT/Wellbeing). SRO: Rebecca Pulford and Amy Eagle Priority Three: Crisis. SROs: Rowan Proctor and Stuart Richardson. Priority Four: Learning Disabilities and Autism. SROs: Lisa Nobes and Pete Devlin

http://www.kooth.com/

http://www.moodwise.co.uk/

https://www.samaritans.org/how-we-can-help/schools/step-step/

https://www.samaritans.org/how-we-can-help/schools/step-step/

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2.3 In September 2019 four high level models were presented to the Suffolk Alliance partners. The four high level models were developed by the priority groups, the high level models will provide the foundation for the development of detailed pathways. The four models have been developed in line with the East and West Suffolk Mental Health & Emotional Wellbeing 10 Year Strategy 2019-29 #averydifferentconversation.

2.4 In October the Suffolk Alliance Implementation Group approved the high level models based on the templates submitted and feedback captured. The approval has enabled progression onto the next steps.

2.5 The four priorities are now developing the detailed pathways that will sit behind the high level models. The pathways are being visually mapped and capture the different ways people can access services and what the service journey will look like (including treatment and intervention), how people will step up (to more intensive or specialist services), step down (to less intensive and community services) and transition in between services. The priority groups are leading on this piece of work, the groups have been formed with ‘experts’ from across providers and settings.

2.6 The programme has set clear deadlines for the completion of the detailed pathways (end of February 2020). Alongside the detailed pathways the Alliance Programme Team which is made up of system experts will provide all four priority groups with dedicated input to enable the following specialist models to be developed alongside the detailed pathways:

• Demand and Capacity: Detailed demand and capacity models will be developed for

each service pathway. This will be based on local data (historical and current) from across the Suffolk providers supported with national prevalence and trend data. The demand and capacity models will provide the evidence that will document how many people will utilise the services in at any given time.

• Workforce, HR and Training: Based on the demand a capacity models the workforce models will be developed. The models will evidence the skill set and number of staff needed to ensure the models can operate in a safe manner with skilled staff to ensure people experience timely access into services. This Workstream will also develop a system wide training needs and requirements model to ensure the workforce have the skills and education to meet people’s needs.

• Finance: Based on the demand and capacity and workforce models each of the services will be ‘costed’. This will enable a detailed picture of the financial implications for the new models.

• Governance and Risk: This workstream will focus on both the management governance and clinical governance of each of the pathways, ensuring services are safe and have clear lines of escalation, accountability and flow.

• Information and Systems: Each service and pathway will need adequate IT systems to support both service users and the workforce. This workstream will capture these requirements. There will be an obligation to report on certain outcomes both locally and nationally. An ‘Outcome Framework’ will be developed based on ‘I’ statements. For example ‘I want to feel well’. The measurement of these statements will be reflected as Key Performance Indicators (KPIs). The KPIs will be both outcome indicators (per service line) and activity indicators.

2.7 The Crisis and Learning Disabilities and Autism priorities have suites of well-developed pathways. They are both progressing through to workforce engagement review to gain further understanding of suitability and ensure the workforce feel confident with the proposals. .

2.8 The Children Young People and Families priority is progressing well with approximately half of the detailed pathways mapped and a clear plan to develop the remaining pathways.

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2.9 The Community Priority is focussing on defining the functions of primary care support and liaison and the specialist community mental health elements in the new model during January 2020. This will inform the future pathways. The Early Adopter site in Haverhill is also going to be re-launched due to a number of challenges and the sites in Ipswich and East are being considered to when these commence. The Crisis, Children, Young People and Families and Learning Disabilities and Autism priorities are reliant on the function of the Community priority to underpin the future model.

2.10 A period of public engagement will commence upon completion of the pathways. This engagement will be led by our co-production partners (Suffolk Family Carers, Suffolk Parent Carer Network, Suffolk User Forum and ACE Anglia). Pathways will be developed into materials such as videos and leaflets. Feedback will be collated by the partners and provided to the programme team to allow changes to be made to the pathways. A period of eight weeks has been scheduled for this process.

2.11 The finalised detailed pathways and the specialist models will then be converted into service specifications which will be used to aid discussion between the Alliance partners in regards to who is best placed to provide the services. The programme team will facilitate conversations with the provider(s) regarding who is best placed to deliver the services.

2.12 This period of the process will also start the drafting of the agreement which will be held between the providers and the CCGs to agree the working arrangements, roles and responsibilities, agreed joint outcomes for mental health and a further work plan pulled from the Service Development Improvement Plans. This will take place between March and May 2020.

2.13 In June 2020 the formal Due Diligence process will commence. This will be led by the CCGs. The document that will form the basis of the due diligence is the Assurance Framework. The Assurance Framework is a set of ‘Key Lines of Enquiries’ (KLOEs). These KLOEs are structured as questions, which will establish the risk profile and other parameters of the complex requirements.

2.14 The KLOEs are structured in specific sections as below: • Case for Change • Service Delivery • Immediate Actions • HR, Workforce, Training, Culture and Organisational Behaviour • Governance and Risk Management • Clinical Quality and Outcomes • Data, Information and Informatics • Finance and Sustainability • Working in collaboration • National Requirements • Mobilisation Plan

Each section will pose a list of formal enquiries that will require evidence to support the response. The Assurance Framework will be issued to providers in advance to enable a robust work up and collection of evidence.

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2.15 The Strategy Checklist will be developed by the programme team and completed by the provider(s). The CCG will use the Strategy Checklist during the due diligence process each ‘check’ will have an assured / not assured indicator.

2.16 As part of the due diligence process around six sessions will be led by the CCG to facilitate open dialogue between the CCG and provider(s) to seek assurance around solutions to deliver the core requirements prescribed in the Assurance Framework, specifications and strategies. Public Sessions will also be held via roadshows to seek assurance from the public on the proposed new models, this will ensure engagement reaches wider than the strategic core partnership.

2.17 Prior to the due diligence sessions led by the CCGs the provider(s) and the programme team will gain external assurance via the NHS England Clinical Senate to further review the proposals. If assurance is provided during the due diligence process the CCGs will work with the providers to adapt contractual arrangements and deliver the required transformational mobilisation of the services.

2.18 The programme plans looks to have contracts signed by September 2020. The mobilisation of the new services will be phased over an agreed period.

3 Recommendation 3.1 The CCG Governing Body is requested to:

• Note the update on the delivery of current NHSE and local mental health transformation. • Note the update on the progress the Suffolk Alliance Mental Health Transformation

Programme, including the due diligence process.

GOVERNING BODY

Agenda Item No. 11



Title

Business case for Child and Young Person (CYP) (0-18) Crisis Outreach Team for Mental Health

Lead Director

Lisa Nobes, Director of Nursing

Author(s)

Lianne Nunn, Associate Director or Nursing, CYP, MH and LD

Purpose

To consider approval of the business case to fund the development of a CYP (0-18) Mental Health Crisis Outreach Team.

Applicable CCG Clinical Priorities: 1. Develop clinical leadership

2. Demonstrate excellence in patient experience & patient engagement

3. Improve the health & care of older people

4. Improve access to mental health services

5. Improve health & wellbeing through partnership working

6. Deliver financial sustainability through quality improvement

Action required by Governing Body: To consider approval of option two within the business case to fund the development of a CYP (0-18) Mental Health Crisis Outreach Team.

1.0 Executive Summary

1.1 This business case will examine the background to the proposal to commission a children and young people’s Mental Health crisis outreach model across Ipswich and East Suffolk and West Suffolk CCGs.

1.2 The rationale for change lies within a national and local context; current service delivery

and the impact this has on children, young people (CYP) and their families including Tier 4 admissions; and the proposed model that has been developed from children and young people’s feedback.

1.3 Finally, the options with financial costings are available for the Governing Body to

consider.

The authors recommend Option 2. 2.0 Background 2.1 Suffolk’s current model and KPIs

The current model in Suffolk for children and young people is an all age assessment offer. If a child or young person is in crisis the options, following this assessment is limited and not equitable with adult services (over 18 years old). The options consist of a community offer or a tier 4 admission out of county. The current community offer is a clinic based community offer with limited flexibility for appointments outside of the clinics. Home visits are the exception due to demand and capacity and the general service specification of a Children and Adolescent Mental Health Service (CAMHS) community offer. The current service offer in Suffolk has identified gaps in the offer available, this would be described as the tier 3.5 offer that sits between community and inpatient services. This offer can be described as a home treatment/ intensive support or outreach type of service offer.

3.0 Key issues 3.1 The current gap in demand for a tier 3.5 service for children and young people within

community mental health settings within Suffolk has overwhelmed the community teams’ ability to respond. This has led to high CYP tier 4 admissions, out of area. The impact of a tier 4 admission on a child, young person and their family is felt through isolation from social and family settings, educational outcome impact and the potential of pathologising their condition and affecting their long-term recovery ability, which ultimately impacts on their life chances and success of achieving their potential.

3.2 Children and young people are also increasingly presenting within acute hospital

emergency departments and these children and young people are often frequently already under a community team which signals that CYP mental health issues are escalating without appropriate intervention to prevent crisis and potential hospital admission.

3.3 These children are often admitted to acute paediatric or adult wards during a period of

crisis, this delays the child’s mental health response and places additional demand on our acute services. These environments are often inappropriate for a child, young person and their family with the types of presenting problems they are experiencing.

This has become the default position due to our lack of service provision in Suffolk during these times of highest need.

3.4 There is also an increased risk currently of unavailable Tier 4 beds due to suspended

and terminated services following CQC concerns, i.e. Ellingham hospital in Norfolk. Children and young people are placed out of area. The oversight of OOA Tier 4 CAMHS admissions remains with Norfolk and Suffolk NHS Foundation Trust (NSFT) who have to travel to review the child, this has cost implications as well as resource.

3.5 Primary care and local authority colleagues have also reported concerns related to

accessing timely mental health support to prevent a child or young person’s mental health condition deteriorating and the unmet need that is experienced. This relates to some of our most vulnerable children and young people in Suffolk.

3.6 To support a reduction in self-harm and suicide, there is a need to develop new

approaches to responding to self-harm as part of wider approaches to suicide prevention given that around half of young people aged under 25 who died by suicide had previously self-harmed and self-harm in young people was often accompanied with excessive alcohol and illicit drug use.

3.7 In 2017, the National Confidential Inquiry into Suicide and Safety in Mental Health

services concluded that the following four focuses were needed in effective suicide prevention approaches with Children and Young People:

1. Support for young people who are bereaved, especially by suicide 2. Greater priority for mental health in colleges and universities 3. Housing and mental health care for looked after children 4. Mental health support for LGBT young people.

3.8 When reviewing PHE fingertips data Norfolk & Suffolk sit above the England and East

of England averages for hospital admissions from self-harm. Additionally, Norfolk & Waveney and Suffolk & North East Essex Sustainability and Transformation Partnerships (STPs) are both in receipt of suicide prevention transformation funding (wave 1 and 2 respectively) given suicide prevalence rates are above the national average. Whilst these programmes do not have a core focus on children and young people they do focus on self-harm and therefore provide an opportunity to strengthen the development of new programmes of work specific to CYP.

3.9 The following table provides an overview of this data from 2017/18 hospital admissions

data (most recent reported dataset) as rates per 100,000 population.

Location 0-17 years

15-17 years

15-19 years

20-24 years

England 180.8 700.2 648.6 406 East of England 148 576.7 587.6 403.2 Norfolk 194.4 739.7 686.1 329.5 Suffolk 189.3 740.5 645.3 485.7

(NHS England)

Suffolk Tier 4 admission rates for the last two years: (admissions to out of area hospitals)

YEAR Number of tier 4 admissions 0-18 years

Number of transforming care CYP within tier 4 admission numbers

01/01/18- 01/01/19 75 12

01/01/19- 01/01/20 74 19

3.10 Given the rates of Tier 4 out of area admissions (nationally and regionally) for CYP, and the risks this poses to suicide in the year following presentations, it is felt there is a need to provide a clear pathway for rapid access to specialist interventions for crisis presentations when needed. This is currently not in place within Suffolk.

4.0 Patient and public Engagement 4.1 CYP feedback:

Children and young people, who have experienced mental health crisis in Suffolk, have told us that they want a service to have four key components:

• Staff who answer the phone • Staff who do something following the assessment • Staff who work together, and • Staff who have confidence in working with children and young people.

4.2 Further feedback from CYP on children’s crisis service in general is…

o “Don’t be afraid to seek help” is the current mental health message, but when you seek help for crisis care, you have to go to A&E. There needs to be mental health nurses, or professionals trained in mental health manned at A&E 24/7. If you go to A&E when you have overdosed or self-harmed you are meant to see a psychiatrist, by law, but this does not always happen. There is also no privacy in A&E- you have to sit in the main waiting room, and then are put onto a corridor with the curtain open when you are being seen.

o “It’s like you have to time your crises”. Mental health crisis care is open 9-5 Monday-Friday. Young people have said that if you have a crisis on a Saturday evening, or during out of hours, you have to wait a long time to be seen.

o There needs to be a replica of A&E specifically for mental health. A&E does not know how to respond to mental health problems, and young people tend to find the triage process takes around 4 hours. Professionals have told some young people that it is ‘just their hormones’, ‘here we go again’, ‘oh I guess you’ve broken up with your partner or whatever’, ‘were you bored?’ etc.

o Crisis support needs to be stronger, especially for under 14’s as there currently is not crisis care for them.

Refer to Appendix 1 for further feedback from children and young people on the service they want.

4.3 What engagement took place?

This proposed model has undergone extensive co production. This has included:

• A full engagement day with all stakeholders including good representation from parents and carers. This day took place in December 2019. This was to sense check our proposals and the work has undergone numerous iterations following continued feedback.

• The work has been shared and feedback sought through our Suffolk CYP co-production group to ensure the child and young person voice is heard.

• Working groups have taken place over the last six months to progress this piece of work using an integrated system approach. This has proven extremely valuable when looking at the CYP journey across the system and utilising all skills and experiences to influence this work.

• Case studies of real life experience have been tested during our engagement sessions and working meetings to ensure we really learn from known experience currently.

5.0 NHS England/Improvement (NHSE/I) Key Performance Indicators (KPIs) and direction

5.1 The Long Term Plan (LTP) set a population-based target for Transforming Care Partnerships (TCP) of between 12-15 CYP in hospital per million U18 population. The table below indicates numbers at the end of August ‘19 as a rate per million. Viewed this way, the majority of East of England TCPs are in the highest rate group nationally and Suffolk has the second highest inpatient rate in the East of England.

5.2 Improved support for children and young people during a mental health crisis, 24 hours a day, seven days a week is included within the NHS Long Term Plan- “These will include specialist care at A&E, alternatives to hospital admissions, such as crisis and liaison teams and crisis cafes and safe havens, a single point of access to support through NHS 111 and intensive home treatment”. This service will focus on the intensive home treatment function.

5.3 Evidence from children and young people mental health vanguard sites suggests that effective crisis services are delivered by staff with strong CYP mental health competencies who offer a continuous and flexible pathway. The financial modelling suggests that mature, dedicated CYP crisis and liaison services will show a promising

Under 18 Inpatient Rates (LTP)Rates are under 18 inpatients as at Aug-19 per million under 18 ONS resident population

Rate Per millionTCP TCP Name ONS U18 Pop. Change Category

ENGLAND 20East Of England 31

TCP09 Norfolk 16 Below Average Rate GroupTCP13 Hertfordshire 26 Above Average Rate GroupTCP11 Essex 28 Highest Rate GroupTCP12 Bedford, Luton and Milton Keynes 35 Highest Rate GroupTCP08 Suffolk 46 Highest Rate GroupTCP10 Cambridge and Peterborough 47 Highest Rate Group

https://www.england.nhs.uk/mental-health/case-studies/mh-aldershot/

https://www.longtermplan.nhs.uk/case-studies/ne-lincolnshire-cyp/

return on investment to the wider system - despite the non-inclusion in this study of the impact on in-patient mental health beds (NHS England 2016).

See appendix 4 for further information 5.4 Intensive services provided in the community can act as a bridge between inpatient

services and community services, with the aim of preventing the need for an admission, or facilitating discharge back to the community when a child or young person presents in crisis. These services have previously been described as 'Tier 3.5', 'Tier 3+', 'assertive outreach' or 'intensive community' CAMHS services.

5.5 Out-of-hours and crisis services are also essential for responding to children and young people who need urgent assessment and treatment; paediatric liaison services, based within acute hospitals rather than CAMHS services, can also act as an important link, where they are available. The evidence we have received has described the important contribution these services can make, but has highlighted the fact that provision of such services is highly variable, and has suggested that this might be a more useful focus for investment than inpatient services.

(NHS England)

6.0 Proposed model 6.1 The philosophy that underpins the proposed model is the thrive framework, we want to

ensure that risk support is available at any stage during a child or young persons journey, whenever a young person needs it as identified below in the getting risk support quadrant.

6.2 The outreach model of care, for 0-18 year olds, will transform local service provision by integrating the tier four and tier three pathways through an intensive outreach service ensuring that children and young people of East and West Suffolk can access the services that meet their needs at the right time. The intensive outreach team will form part of the crisis response pathway.

6.3 The intensive outreach service will deliver an intensive support package focusing on high-risk children and young people who are at risk of hospitalisation.

6.4 This will include oversight and ownership of a dynamic support register. This will

provide a multi-disciplinary review function for all young people at risk of inpatient admission.

6.5 Each local area should have a dynamic register (as described in the national service

model) which at a population level will inform the commissioning of support services and at an individual level will identify those who may go on to or are starting to display behaviour that challenges. The aim is to improve service design and enable early identification and intervention. NHS England (2017)

6.6 The CYP CAMHS outreach model service will provide Children and young people with

an alternative to hospital admission supporting children and young people in their home, this means delivering evidence based clinical intervention close to their support networks, which is essential for good outcomes.

6.7 The service will support young people that do require Tier 4 inpatient treatment and work to facilitate early discharge ensuring positive links continue with local support systems including care and education services. The care coordination of those young people admitted will remain with secondary mental health teams but the outreach team will provide wrap around support to facilitate early discharge within the local area.

6.8 The team will provide targeted support to young people who are hard to reach and require a more assertive approach when most in need. These are some of Suffolk’s young people who currently struggle to engage with current commissioned services as we expect them to meet services needs rather than the other way around. This will target CYP who cannot leave their home, those who do not engage with traditional approaches of care delivery.

6.9 This service will work alongside local authority services and any other system partners that need to be involved. This service will wrap around any services that currently work with our CYP and complement existing provision.

6.10 If a young person is known to a community mental team, this offer will not stop and the community function still holds the coordination function under CPA (Care programme approach). The outreach function will be in addition to this and a short term intervention to focus specifically on the period of crisis need. This ensures we are not passing CYP from team to team. If a young person is not known to a community team, the outreach function will facilitate this at the beginning of their contact to ensure seamless transition.

Personal health budget offer within the model:

6.11 The personal health budget allocation is based on a Norfolk model that has seen great benefit to the young person and their families when given a personal health budget up to £500. With the implementation of the CYP outreach team, this would provide the clinical oversight and governance to provide this personalised offer alongside the outreach commissioned service. Examples of how this could be used include a young person buying a laptop to access self-help materials or a parent buying in short term support to help them get rest whilst managing a high level of risk at home.

6.12 Personal health budgets are a way of personalising care, based around what matters to people and their individual strengths and needs. They give people with long-term

health conditions and disabilities more choice, control and flexibility over their healthcare.

6.13 Personal health budgets are part of the NHS’s comprehensive model of personalised care, which will, as part of the NHS Long Term Plan, transform 2.5 million lives by 2023/24. (NHS England)

6.14 It is felt this offer of personalisation will respond to feedback from young people and families around how the experience has felt and what could improve their experience and outcome. This will also offer an additional offer of care that will work with children, young people and their families to reduce admissions and improve care outcomes. This is detailed further in option 2.

6.15 The CYP outreach team will form part of the wider all age mental health crisis pathway

as detailed in process map below. The CYP outreach team is identified in yellow.

CYP Outreach team involved for up to 8 weeks

CYP community teams remain involved or become involved if not known before presentation

CYP can receive step up outreach care whilst under a community team or can receive step down care from a hospital provision to aid early discharge

6.16 The outreach team will operate between the hours of 8-8pm Monday to Friday and 9-1pm Saturday and Sunday, however as part of the all age crisis model, 111 option 2, call centre, assessment, and brief intervention function will be operating 24 hours as part of the all age crisis offer. This will ensure an immediate response anytime of the day or night. The outreach service will ensure an equitable service provision for CYP up to age of 18-post assessment. The age range is 18years as there is already a home treatment function team from 18 years and above.

6.17 As already identified earlier within the business case, we have researched other models

of delivery across the country for this specific clinical offer and we have based the hours of operation on this alongside our own local data detailing demand.

6.18 Access points into the service are identified above in the process map. The blue ovals

identify the three access points into the CYP outreach offer. 6.19 Whilst we have identified age ranges, these are for the purpose of operational delivery

and all services will sit under the all age crisis umbrella. This will mean flexibility within service delivery based on a persons’ need. If someone over 18 has needs that would best be met by the child and young person outreach team, they would not be excluded purely on age.

6.20 Outcome and impact of proposed model

Outcome Impact

Young people and their family / carers will experience mental health services that are accessible and responsive in times of crisis

Children, young people and their families will receive care within Suffolk in their homes Families feel listened to and included in their child or young person’s care planning • Increased number of families /carers:

- feeling valued by staff - feeling supported

CYP OUTREACH

TEAM

Access point

Access point

Access point

Outcome Impact

- feeling listened to - feeling engaged

Young People are well supported to achieve their individual Recovery Goals

• Achievement of individual Goals • Number of young people who rated the

service as helpful to their recovery • Young people with a recovery plan • Young people with a Clear Crisis Plan

Young people, their family /carers are confident of their safety

• Number of young people reporting they feel safe

• Number of families /carers reporting they feel safe

Improvements in people’s mental health and wellbeing are sustained

• Reduced referral rates to crisis services • Reduced number of admissions and length

of stay Care and treat young people in their own home when clinically appropriate

• Reduced number of admissions and length of stay

• Reduced rates of Tier 4 admission for Suffolk

• Improved outcomes for CYP through local support networks remaining in place

Evidence based clinical interventions delivered when needed with evidence based clinical outcomes

• Reduced rates of Number of serious incidents

• Reduced Levels and frequency of self-harming behaviour

• Reduced risk of suicide and this is realised through local statistics

Clinically competent staff, confident in working with CYP

• Workforce development is continuous and meaningful for the CYP Suffolk population

• Clinically appropriate supervision in place • Reflective practitioners that embrace

learning and improvement • NICE compliant service delivery • CAMHS focussed workforce if invested in

and valued Young people’s mental health and wellbeing will improve as a result of the support and treatment they receive

• Improved scores across: Honosca (health of nation children’s

scale) Sdq (strengths and difficulties

questionnaire) RCADS (revised child anxiety and

depression scale) • Young people reporting services have

helped them see a positive future

6.21 This new care delivery model of care will:

Provide evidence based treatments to reduce crisis presentations and a need for admission

• Care and treat young people in their own home when clinically appropriate • Care actively for young people through their full episode of care, from their crisis

assessment through to supported transition. This service will complement and enhance the all age crisis offer that will be in place to support initial contact and presentation but also when and escalating presentation requires more intensive support to prevent a child or young person-reaching crisis.

• Care and treat young people who are difficult to engage and require a more intensive approach

6.22 The outcomes and impact we seek to achieve of implementing a new model of CYP

outreach is to ensure that: • All young people in East and West Suffolk who require admission to an adolescent

inpatient unit are cared and managed for in Suffolk where possible • All children and young people who require admission to a specialist unit are actively

managed, have reduced length of stay and are stepped down to the least restrictive unit through to the outreach team and back into the community in line with clinical need

• All young people are treated in the least restrictive environment, with the ability to step up seamlessly if clinically necessary

• All young people have a choice of treatment options whenever possible • Young people’s outcomes are significantly improved • Young people’s and family experience is greatly improved

6.23 This new outreach model’s approach is to only use in-patient care when there is no better clinical alternative. There are many benefits to reducing the need for a tier 4 service and developing alternatives to admission, these include:

• preventing dependency • preventing stigma • increasing general stability and sustainability of therapeutic gains • increasing young people’s choice • minimising and reducing disruption to education, family and social life • best use of funding

7.0 Options Appraisal 7.1 The following options have been developed looking at how the proposed model could

be commissioned and provided.

OPTION 1: We do nothing. Pros Risks

• No cost • No recruitment needed

• High levels of tier 4 admissions continue • Poor CYP and family carer experience • Poor psychosocial outcomes for CYP in

Suffolk • Risk to patient safety • Continued over demand on community

services leading to continued increasing crisis demand

OPTION 2:

This option will implement a CYP outreach model that will provide intensive crisis support for CYP up to the age of 18, this service will provide an offer for east and west Suffolk. The service will offer an intensive evidence based clinical offer to work with CYP in crisis to safely and effectively manage their needs when presenting in crisis for a period of up to eight weeks. This offer will work within the overall crisis all age model for Suffolk.

We have reviewed the current recorded face-to-face contacts from NSFT to try to understand the demand that is seen as ‘additional need’ within current community and crisis response teams. These contacts are recorded as urgent and emergency contacts so is defined as crisis need post assessment.

This below table details the number of contacts recorded within NSFT post assessment by the crisis and community defined as urgent and emergency contacts. This equates to approximately 15 contacts a week or two contacts a day across east and west Suffolk. Over the last 18 months, the following data was recorded:

Row Labels Number Contacts

Monday 165 Tuesday 156 Wednesday 170 Thursday 172 Friday 142 Saturday 126 Sunday 143 Grand Total 1074

We have also looked at the number of tier 4 admissions over the last two years to understand the likely demand for admission avoidance. The following table details that demand:

Suffolk Tier 4 admission rates for the last 2 years: (admissions to out of area hospitals)

YEAR Number of tier 4 admissions 0-18 years

Number of transforming care CYP within tier 4 admission numbers

01/01/18- 01/01/19 75 12

01/01/19- 01/01/20 74 19

We considered if all of these young people received an average of a four-week intervention, across a year with four appointments a week this would equate to 1200 hours of input. This is an average of what we think will be needed. We recognise some interventions will be longer and some will be shorter.

We then considered the demand detailed above that looks at 1074 urgent and emergency contacts from NSFT over 18 months and equated each contact to an hour of face-to-face contact time.

This enabled us to estimate a predicted need of 2274 hours of face-to-face time. We have then factored in the prevalence data to create a workforce we believe can meet needs based on this. In addition to this, we have had to factor in an average of an hour for every clinical contact in administration time and travel time as this will be a countywide service offer. We also recognise that demand is predicted on as much data and knowledge that is available but we have built in additional clinical time to cover additional demand that may present, as this is a new service. This demand has added an additional 25% of clinical hours on top of what has been predicted.

We have also considered the coverage needed based on what the data indicates are the times of highest need across a seven day week, we have then cross referenced this with other delivery models across the country with similar type populations sizes.

Pros Risks • Number of young

people reporting they: o Have a choice of appointment o Are able to get the right support

and treatment when they needed it, at a time and place that was convenient

• Reduced complaints • Improved clinical outcomes for CYP and

families and carers • Young people’s mental health and

wellbeing will improve as a result of the support and treatment they receive

• Decreased Tier 4 admissions- leading to cost savings longer term

• Provider clinical oversight of the Dynamic support register

• Level of unmet need is greater than predicted. We have factored in additional capacity to allow for additional need in addition to what our data and prevalence predicts. To consider a period of start-up flexibility to allow additional resource should demand outweigh what is predicted. This may involve buddying with another service. Discussion with NHS England to see if they can support our start up transition phase. To consider a phased implementation of offer to reduce the possibility of the service becoming overwhelmed as it embeds.

• Recruitment challenges Role Establishment needed

Band 6 practitioner To include LD nursing, Social work, skill set for drug and alcohol

2.95 wte at B6

Band 8b Psychologist

0.74 wte

Psychiatrist (To consider Nurse consultants if unable to recruit psychiatrist)

0 (To utilise crisis consultant in all age pathway, session support to be agreed as this function will cover the all age crisis CYP pathway)

Band 7 clinical leads (Nurse lead 1wte, systemic lead 1wte)

2.58 wte

Band 6 Speech and language therapy support

1.23 wte

Band 4 Family support practitioners

2.95 wte

Band 8a Family therapist

1.23 wte

Band 7 Team leader

1.23 wte

Team administrator B3

1.23 wte

The total investment of £973,660 would deliver the following CYP outreach rota across East and west Suffolk. We would suggest an initial investment of £486,830 in year 1 (this would include a phasing cost with implementation planned for October 20), followed by £ 973,660 in year 2 an addition of £486,830 from 2020/2021. Shift Workers 8-4 (Monday to Friday) 1x B4 1xB7 (clinical) 12-8 (Monday to Friday) 1x B4 2x B6 1xB7 (clinical)

CYP Home Treatment Team

Band Title Core WTE Cost inc on costSaturday enhancement

Sunday enhancement Total

52 week service to cover hols, sick etc Total cost Revised wte

Band 6 Practitioner 2.4 £100,870 £1,345 £2,690 £104,905 £24,209 £129,114 2.95Band 8 b Psychologist 0.6 £41,453 £41,453 £9,566 £51,019 0.74Band 7 Clinical lead 2.1 £100,887 £100,887 £23,282 £124,169 2.58Band 6/7 SALT 1 £41,332 £41,332 £9,538 £50,870 1.23Band 4 Family Support 2.4 £73,124 £1,345 £2,690 £77,159 £17,806 £94,965 2.95Band 8 a Family Therapist 1 £58,438 £58,438 £13,486 £71,924 1.23Band 7 Team Leader 1 £51,227 £51,227 £11,822 £63,049 1.23Band 3 Admin 1 £25,908 £25,908 £5,979 £31,887 1.23

11.5 £493,239 £2,690 £5,380 £501,309 £115,687 £616,996 14.15

Workforce Development £36,588PHB for CYP £50,000Travel £50,000Accomodation @ £1700 per annum £23,800Licences , phones etc £14,000Other £20,000

Sub total £811,384

Margin 20% £162,277

Total cost of service £973,660

Ipswich and East CCG 65% 632879.3

West Suffolk CCG 35 % £340,781

Additional Investment Total IESCCG WSCCGYear 1 (from October 2020) 486,830 316,440 170,391 Year 2 973,660 632,879 340,781

9-1 (sat- sun) 1xB6 1xB4 (to be clinically supported by all age crisis service)

Flexible working needed (Monday to Friday) with consideration of rotation cover over weekend if needed.

1x B7 (operational lead) 1x 0.6 wte B8b (Psychologist) 1x B8a (Family therapist) Access to CYP crisis Psychiatrist (agree session time)

This equates to shift hours of:

• 4680 hours of B6 time • 4680 hours of B4 time • 4160 hours of B7 time

Proposed staffing structure chart:

Clinical Psychologist

B8B

Clinical CYP nurse lead

B7

Operational lead

B7

B6 practitioners

B8a

Family therapist Team administrator

B3

CAMHS consultant

psychiatrist- all age crisis model

Systemic practitioner

B7

Family support practitioners

B4

Speech and language resource

7.2 All other roles outside of the rota will work flexibly Monday to Friday dependant on need but will be based on 8-hour working days.

7.3 The personal health budget allocation is based on a Norfolk model that has seen great

benefit to the young person and their families when given a personal health budget up to £500. With the implementation of the CYP outreach team, this would provide the clinical oversight and governance to provide this personalised offer alongside the outreach commissioned service.

7.4 Personal health budgets are a way of personalising care, based around what matters to

people and their individual strengths and needs. They give people with long-term health conditions and disabilities more choice, control and flexibility over their healthcare.

7.5 Personal health budgets are part of the NHS’s comprehensive model of personalised

care, which will, as part of the NHS Long Term Plan, transform 2.5 million lives by 2023/24. (NHS England)

7.6 It is felt this offer of personalisation will respond to feedback from young people and

families around how the experience has felt and what could improve their experience and outcome. This will also offer an additional offer of care that will work with children, young people and their families to reduce admissions and improve care outcomes.

7.7 Option two is the recommended option. If agreed the next stage of work will be to work

through how the model can be commissioned and who is best placed to deliver this. The team’s initial thoughts are that Suffolk County Council and NSFT should provide this in partnership as part of the wider developing CAMHS model.

8.0 Recommendation 8.1 To consider approval of option two within the business case to fund the development

of a CYP (0-18) Mental Health Crisis Outreach Team.

Appendix 1.

Workforce development needs and costs:

The APT Diploma in working with Children and Adolescents provides 120 hours of training over 12 months. The diploma comprises 20 days of training made up from your eight chosen modules/courses below. You can select four 3-day modules and four 2-day modules. The whole group attends the same modules.

• The RAID® Course

• Motivational Interviewing, and how to use it effectively

• DBT Essentials (Dialectical Behaviour Therapy)

• The Assessment and Risk Assessment of Children and Adolescents in Crisis™

• Running Skills Development Groups

• CBT Essentials (Cognitive Behavioural Therapy)

• ADHD: Key Knowledge and Skills for Effective Biopsychosocial Intervention

• There Must Be A Better Way® (Treating Non-Suicidal Self-Injury)

• Teaching Mindfulness in Clinical Practice, Level 1

• Mindfulness-Based Cognitive Therapy

• The Effective Treatment of Anxiety in Children and Adolescents

• SFT Essentials (Solution-Focused Therapy)

• Attachment in Practice™

• Repairing the Damage™

• Providing Good Clinical Supervision

• Removing the Blocks to Good School Attendance

We would be recommending a one off cost to train all of the clinical team in the above areas at a cost of £30,490 plus VAT. This would train the entire team, it would then be expected that the organisation providing the service continue with professional development.

Appendix 2

Crisis care:

• “Don’t be afraid to seek help” is the current mental health message, but when you seek help for crisis care, you have to go to A&E. There needs to be mental health nurses, or professionals trained in mental health manned at A&E 24/7. There is also no privacy in A&E- you have to sit in the main waiting room, and then are put onto a corridor with the curtain open when you are being seen.

• “It’s like you have to time your crises”. Mental health crisis care is open 9-5 Monday-Friday. Young people have said that if you have a crisis on a Saturday evening, or during out of hours, you have to wait a long time to be seen.

• There needs to be a replica of A&E specifically for mental health. A&E doesn’t know how to respond to mental health problems, and young people tend to find the triage process takes around 4 hours. Some young people have been told by professionals that it is ‘just their hormones’, ‘here we go again’, ‘oh I guess you’ve broken up with your partner or whatever’, ‘were you bored?’ etc.

• Crisis support needs to be stronger, especially for under 14’s as there currently isn’t crisis care for them.

• The group also mentioned crisis care in relation to the transformation plan, as they all have experienced crisis services. Jo John has agreed to explore further options for the group to be involved in rethinking crisis services.

Views on original Draft crisis proposal

Question 1: should we have one model across East and West Suffolk? yes, one service across East and West. This needs to be consistent - for example; Wedgewood and Woodlands work differently, so if crisis team are based in each one they will work differently.

Question 2: how shall we align the age group? 0-25 would be best, as youth pathway is up to 25. Adult pathway starts at 18.

Question 3: what are the right hours of operation, and who will manage crisis referral in between? timings from 15:30 – 23:30 hours. It’s better later, plus you will have cross over with working hours. “You can’t time a crisis!” Adults get night time crisis support (how can we link with this?). Crisis referrals in-between 23:30-09:00 will have to be managed by 999 and A&E, or got to IDT for triage.

If people over 18-25 are using the youth service and not adult services, could that free up time/people to respond over night for young people too?

Question 4: is it the right location? Woodlands and Wedgewood are adult wards. Young people over 18 could be admitted to either hospital, but under 18’s would have to go elsewhere (in Suffolk – Lothingland or out of Suffolk). The team could easily talk to Wedgewood or Woodlands for an easy transfer for over 18’s. Therefore, there will be different services for under and over 18s. Why are they based at Woodlands or Wedgewood – what is the reasoning for this? Will the staff be used for other things? They are good locations, if the above concerns are taken into consideration.

We need to use case studies to map pathways.

Question 5: is the team likely to deliver expectations? someone who’s able to help – be comforting and reassuring. Have access to any records such as care plans (e.g. care plan may say ‘I don’t talk well on the phone’). Be able to assess the young person and the situation. They should follow up with you – they take ownership of the call. If they need to pass you on, they should keep you in the loop and stay with you until your issues are sorted. Respond to each person as an individual; ‘what has worked well for you before? What have you tried? Is there anything I can do for you right now?’. Be led by the person on the phone, don’t just go through a rigid ordered checklist. Response needed depends on situation. Some young people might just want to be heard and listened to; sometimes they just need to talk. Don’t put a time limit on calls. Times when seeing someone face to face is needed. Explain this, who, how, when etc.

How would it work? Who would answer the phone; the band 3 or the band 6? Is it a lucky dip? Would the band 3 triage and then pass to the band 6?

Question 6: Is this enough staff? not enough staff! Just going to end up passing you on.

Question 7: given the other developments that are happening within Suffolk, such as the EWH and AAT review, what should the aims of the team be? respond to all, not just NSFT clients. Aim to support you to get the right help as soon as possible. What does brief intervention mean? E.g. is it like Home Treatment team?

Question 8: what should the primary functions and priorities of the team be? At the very least telephone calls and onward referral. At the most, all things on the list under ‘Function of the Team’ heading should apply. How does it link with police duty of care?

Question 9: does this team have an educative and training function to the rest of the workforce such as schools and colleges? Yes, but how will they have time to educate others, due to short staff numbers and shift patterns?

Weekends: consistency on Saturdays and Sundays to have the service between 15:30-23:30, as when you’re in a crisis you may not know what day it is. Problem with a clinic in A&E is you have to turn up, but the phone is more accessible in a crisis. Follow up appointments are really important. How will it work with the new 111+1? It can’t be the same number as the hub because of this, and also the hub closes at 20:00.

Appendix 3

Appendix 4

Page 1 of 1

GOVERNING BODY

Agenda Item No. 12



Title East of England Leadership Compact

Lead Director Amanda Lyes, Director of Corporate Services and System Infrastructure

Author(s) Amanda Lyes, Director of Corporate Services and System Infrastructure

Purpose To inform the Governing Body of the establishment of an East of England Leadership Compact.

Applicable CCG Clinical Priorities: 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement


To endorse the report.

East of England Leadership Compact• Developed by CEOs/AOs/ICS/STP leaders and Chairs, CCG Clinical Chairs

and Independent Chairs of ICSs with input from local government.

• Designed for use by the East of England Leadership community, to underpin how we work together and model leadership across systems and the region.

• Intended to complement systems and organisational values and behaviours.

• Intended to influence and shape the work on an NHS Leadership compact described in the Interim People plan led by Andrew Forster.

Leadership compact 1

We will be ambitious to improve the health and wellbeing of our population

We will:Put people and quality first.

Have honest relationships and act with integrity.

Be transparent and inclusive when making decisions.

Do what we say, celebrating success and learning from failure.

Hold each other to account.

East of England

Trust & inclusion

Compassion &

appreciation

Collaboration & learning

Transparency &

accountability


3 |

In working together as a leadership community, we will adopt the following behaviours and hold each other to account for upholding these…

• We will put people first – our patients, staff and citizens.• We will support each other to deliver excellence in quality and performance.

• We will respect and trust each other and share important information, so there are no surprises• We will have inclusive robust, honest and realistic conversations where all voices are heard,

views respected and differences resolved for the greater good of our population.

• We will be compassionate and caring, supporting each other, especially in difficult times.• We will value each others contributions, celebrate successes collectively and learn from failure

• We will ensure our collective decisions are transparent and inclusive and we will abide by them.• We will agree expectations and hold each other to account.

• We will be ambitious to improve health and wellbeing, sharing expertise, talent, knowledge, best practice, innovation and learning for the benefit of our patients, staff and citizens

• We will work together to have a strong, united external voice for our region.

Leadership compact

People and quality first

Trust and Inclusion

Compassion and appreciation

Transparency and accountability

Collaboration and learning

Next Steps• Use in system/regional meetings – commit to use the compact to

underpin our interactions, in system and regional meetings, having it as an agenda item at the beginning of meetings and using it at the end to review how the meeting went.

• Formally adopt the compact – STP/ICS, Provider and CCG Boards formally adopt the compact as the behaviours we will practice with each other across systems and the region.

• Survey practice – undertake a survey in March 2020 to test how we have lived up to our compact behaviours.


1




Integrated Performance Report

Lead Director

Joint Leadership Team

Author(s)

Joint Leadership Team

Purpose

To provide members with a summary of performance against national targets, contractual targets, clinical quality and patient safety issues, financial position and transformation activity.

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement Action required by Governing Body: To note the position regarding financial and service performance; review actions being taken with regard to patient safety and clinical quality issues; and any actions to mitigate risks or poor performance.

1

January 2020

Provider Focused

Integrated Performance Report

Contract headlinesContract Current Month Previous 6 months (most

recent on left)

Headlines

Ipswich Hospital Site (ESNEFT)

Nov ↔

• A&E performance at the Ipswich site was 82%, below the 95% requirement. All actions to improve performance are managed through the A&E delivery board.

• 18 weeks: Performance was 80.3% against 92% requirement. Ten specialities were non compliant. An improvement plan has been shared.

• 62 day cancer target was not achieved at (un validated) 75%. The trust is forecasting recovery to 85% by March 2020.

• Diagnostic Tests within 6 weeks improved to 99.7% against 99% target.

West Suffolk Hospital NHS Foundation Trust Nov ↓

• A&E trialling the new emergency department metrics. All actions to improve performance are managed through the A&E delivery board.

• 18 weeks: Performance was 80.5% in November (down from 81.2%) against 92% target. • 8 patient breaches of 52 weeks in October (4 in October). • 62 day cancer target was not achieved at 81% (unvalidated) (down from 83.0%). Weekly PTL monitoring

implemented. Recovery plan in place.• Diagnostic tests within 6 weeks was 96.7% against the 99% target.

Norfolk and Suffolk NHS Foundation Trust Nov

• Early Intervention in Psychosis performance, 82.6% in 14 days in October (November 89% un-validated - target 56%)

• Routine referral to assessment within 28 days performance rose to 70% in October (Nov 72%, unvalidated) for children, recovery action plan being redrafted.

• NSFT met the Improving Access to Psychological Therapies recovery rates in WS and IES at 54% and 50% respectively against 50% standard

Ipswich Hospital Site (ESNEFT) & West Suffolk Hospital NHS Foundation Trust - Community services (previously Suffolk Community Healthcare)

Nov

• Achieved response times for referrals; 4hrs, 72hrs. Did not achieve 18 week RTT consultant led paediatric services.

• Children in Care Initial Health Assessments completed within 15 days of service receiving completed paperwork was 88.89% (8/9) against 95% target

• The Care Coordination Centre performance was 90.23%

Care UK: Integrated urgent care - GP Face to Face Nov ↔ • GP face to face activity - 97.64% of patients were seen within the required timescales.

Care UK: Integrated urgent care – 111 Nov

• 111 calls answered in 60 seconds deteriorated to 78.26 % against 95% threshold. The CCG has escalated contractually (second formal escalation stage) with an Exception Report. A recovery plan and trajectory by 1 April 2020 has been agreed.

• 66.39% of Cat 3/4 calls were validated against a trajectory of 80%. ED referrals were 7.04% against a trajectory of 8%

East of England Ambulance Service NHS Trust Nov ↓ • A recovery plan is agreed between EEAST and CCG consortium.

• Performance and recruitment is being monitored at the bi-weekly Operational Performance Group.

Key

Improvements and/or continued good performance – no major concerns/risks noted

Slight deteriorations on performance – some concerns/risks noted

Considerable deteriorations on performance – major concerns/risks noted

Contract headlines

Contract Current Month Previous 6 months (most

recent on left)

Headlines

Patient Transport Service (non urgent) – E-Zec Medical

Nov

• Local PTS model has changed which has given more flexibility to the acute Trusts to utilise their capacity according to demand. Model went live early December and is demonstrating early success.

• 30% increase in vehicle fleet has been successfully delivered to support operations in Suffolk. • Additional 25% staff (crew) to be in place by end of January 2020. The additional staff required in the

meantime is being supplemented by 3rd party crew and pre-planned taxi support.

Key

Improvements and/or continued good performance – no major concerns/risks noted

Slight deteriorations on performance – some concerns/risks noted

Considerable deteriorations on performance – major concerns/risks noted

8

East Suffolk and North East Essex NHS Foundation Trust

PROVIDER ASSURANCE UPDATE

East Suffolk and North Essex NHS Foundation Trust

Thres

holdOct Nov Chg

92.0% 81.4% 81.4% →

0 2 4 ↑

1.0% 0.2% 0.2% ↑

95.0% 84.3% 85.1% →

93.0% 86.5% 85.5% ↘

93.0% 63.8% 62.2% ↘

96.0% 87.6% 94.4% ↑

85.0% 73.4% 78.3% ↑

0 14 2 ↓

0 7 7 →

0 0 0 →

8 8 6 ↓

40,144 55,934 55,346 ↓

0 0 0 →

100.0% 88.2% 85.3% ↓

0 348 207 ↓

HCAI measure (MRSA)-Nat'l

National Quality Requirements (2019/2020)

The Provider shall achieve:

18 wk RTT Incomplete-Nat'l

RTT 52 Week Waiters-Nat'l

Diagnostic test waiting times

A&E 4 Hour Standard-Nat'l

HCAI measure (clostridium difficile infections)-Nat'l

Total Number of Incomplete on RTT 18 week pathway

Nat'l

Non Clinical Cancelled Ops new date not within 28 days

All Cancer 2 week wait-Nat'l

Two week wait for breast symptoms-Nat'l

Cancer 31 day wait: Percentage receiving 1st treatment

within one month of cancer diagnosis -Nat'l

Cancer 62 day wait: urgent GP referral for suspected

cancer-Nat'l

Mixed Sex Accommodation (MSA) Breaches-Nat'l

Urgent operations cancelled for a second time-Nat'l

% of neutropenic sepsis presentations that receive

treatment within 1 hour (By Month Available)

Ambulance handover time > 30 mins-Nat'l

East Suffolk and North Essex NHS Foundation Trust

Governing Body Assurance Framework

Risk No. andOwner

Risk Description and Mitigations Previous RAG

Rating

Current RAG

Rating

ESNEFT 40

Jane Payling

Risk - Financial pressures at our largest provider, ESNEFT present a risk to service delivery and create knock on financial pressures across the IES Alliance. Mitigation – Financial Risk Working Group in place.

20 20

ESNEFT 27

Richard Watson

Risk - A&E failing to meet 4-hour standard presenting a potential risk to patient safety and experience. Mitigation – Daily performance reporting. A&E Board in place. 16 16

ESNEFT 38

Richard Watson

Risk - ESNEFT and Ipswich Hospital site are failing 62-day cancer targets. Mitigation – Weekly specialty reporting. NHSE/NHSI/ESNEFT/CCG monthly conference calls. 20 20

Demand Manage

ment(IESCCG 44 ESCCG 50)

Richard Watson

Risk - Non-elective demand (A&E attendances and Non Elective Admissions) rises at a greater level than is planned causing deterioration in performance at ESNEFT and WSFT. Mitigation -Updated daily, weekly and month analysis of demand. CCG escalation team working across the system.

16 16

Major Transformation Schemes

Integrated Care – Programme is on track

ICE 01 Admissions Avoidance ICE 06 Care Homes Demand Management

ICE 02 Community Transformation ICE 07 Integrated Therapies Pathways Re-design

ICE 03 D2A ICE 08 Responsive Home Care

ICE 04 EOL ICE 09 Falls and Fragility Fractures

ICE 05 Felixstowe Proactive Frailty Service ICE 11 High Intensity Users of Urgent Care

UTC Update

Elective Care – Programme is at risk

Elective Demand Management Outpatient & Diagnostics Model of Care Transformation

Gastroenterology (Rightcare) Ophthalmology

Outpatient Transformation Processes Theatres

Elective Care Centre Development

Cancer – Programme is at risk

Lung Breast

Prostrate Earlier and faster diagnosis

Colorectal Living with and beyond cancer

9

West Suffolk NHS Foundation Trust



Thres

holdOct Nov Chg

92.0% 81.2% 80.1% ↘

0 4 8 ↑

1.0% 1.4% 3.3% ↑

93.0% 91.0% 91.6% →

93.0% 88.4% 83.7% ↓

96.0% 100.0% 99.2% →

85.0% 85.0% 83.5% ↘

0 0 2 ↑

100.0% 100.0% 97.0% ↓

0 0 0 →

2 3 7 ↑

15,395 21,073 20,259 ↓

0 0 0 →

95.0% 94.3% 95.4% ↗

0 0 3 ↑

90.0% 92.8% 78.6% ↓

0 162 174 ↑

0 0 0 →

HCAI measure (clostridium difficile infections)-Nat'l

Total Number of Incomplete on RTT 18 week pathway Nat'l

Urgent operations cancelled for a second time-Nat'l

VTE risk Assessment: % receiving-Local

Duty of Candor

HCAI measure (MRSA)-Nat'l



18 wk RTT Incomplete-Nat'l

RTT 52 Week Waiters-Nat'l

Diagnostic test waiting times

All Cancer 2 week wait-Nat'l

Two week wait for breast symptoms-Nat'l

Cancer 31 day wait: Percentage receiving 1st treatment

within one month of cancer diagnosis -Nat'l

Cancer 62 day wait: urgent GP referral for suspected

cancer-Nat'l

Mixed Sex Accommodation (MSA) Breaches-Nat'l

Non Clinical Cancelled Ops new date within 28 days-Nat'l

Ambulance handover time > 30 mins-Nat'l

12 hour max trolley wait in A&E-Nat'l

% of neutropenic sepsis presentations that receive

treatment within 1 hour (By Month Available)

Thres

holdOct Nov Chg

90.0% 87.0% 86.0% ↘

95.0% 93.5% 92.0% ↘

95.0% 96.8% 96.3% →

95.0% 90.0% 90.0% →

100.0% 100.0% 100.0% →

100.0% 73.6% 72.6% ↘

0.159 2.161 1.068 ↓

100.0% 91.8% 91.4% →

95.0% 100.0% 99.1% →

95.0% 86.6% 86.6% →

85.0% 89.4% 89.8% →

95.0% 94.3% 95.4% ↗

95.0% 88.0% 90.0% ↗

95.0% 86.2% 90.0% ↑

VTE risk Assessment: % receiving-Local

Compliance with the WHO 5 moments of hand hygiene in

non-urgent situations

MRSA Decolonisation-Local

MRSA Isolation Compliance

MRSA elective screening-Local

MRSA emergency screening-Local

A maximum two-week wait standard for rapid access chest

pain clinic.

Discharge Summaries A&E-Local

Discharge Summaries-Inpatient -Local

Falls with Moderate/Severe/Death harm per 1,000 Bed

Days

All service users identified at risk have a multifactorial falls

assessment on admission

Local Quality Requirements (2019/2020)


Pressure Ulcers All admitted service users have a PU risk

assessment within 24 hours

Workforce: Mandatory Training

Nutrition: Nutritional screening (MUST score) and

assessment within 24 hours-Local

Thres

holdOct Nov Chg

75.0% 77.5% 78.4% ↗

48.0% 40.0% 47.6% ↑

77.0% 72.5% 84.8% ↑

96.0% 96.1% 91.3% ↓

80.0% 92.2% 89.1% ↓

100.0% 100.0% 100.0% →

75.0% 75.5% 88.6% ↑

90.0% 91.8% 93.2% ↗

80.0% 81.0% 77.4% ↓

25.9% 25.4% 20.6% ↓

1/30 1/26 1/28 ↓

100.0% 100.0% 100.0% →

Maintain maternity 1:30 ratio-Local

1:1 care in established labour-Local

Stroke: % of eligible Patients, Thrombolysed-Local

Stroke: % admitted to stroke Unit within 4 hrs-Local

Stroke: 80% people treated on a stroke unit >90% of their

stay.-Local

Breastfeeding initiation rates-Local

Percentage of Women having Caesarean Births-Nat'l

Stroke: % Patients who are assessed by full Stroke team

within agreed guidelines-Local

Stroke - Early Supported Discharge-Local

Stroke: % Patients with access to an urgent brain scan in

the next slot or <60 mins-Local

Stroke: % Patients with access to a brain scan within 12

hours-Local

Stroke - Assessed by Specialist Consultant physician within

24 hours of clock start-Local

Local Quality Requirements (2019/2020)




Risk No. andOwner


Rating

Current RAG

Rating

WSFT 33

Richard Watson

Risk - WSFT is failing in their 18-week RTT performance on both an aggregate level and individual specialty level. Mitigation - Steering Group meets at least monthly. Backlog clearance plan underway. 16 16

WSFT 37

Richard Watson

Risk - A&E failing to meet 4-hour standard presenting a potential risk to patient safety and experience. Mitigation – Daily reporting of performance. OOH cover and 111 support continually reviewed. 16 16

WSFT 45

Richard Watson

Risk - WSFT is failing in the nationally mandated quality requirement requiring that Service Users wait no more than 62 days from urgent GP referral to first definitive treatment for cancer. Mitigation – Remedial action plan drafted. Monthly breach reports.

16 16

WSFT 52

Jane Payling

Risk - Financial pressures at WSFT present a risk to service delivery and create knock on financial pressures across the WS Alliance. Mitigation - West Alliance Financial Strategy Group in place. CCG shadow contingency set aside to support financial pressures.

20 20

Demand Management

(IESCCG 44 ESCCG 50)

Richard Watson

Risk - Non-elective demand (A&E attendances and Non Elective Admissions) rises at a greater level than is planned causing deterioration in performance at ESNEFT and WSFT. Mitigation -Updated daily, weekly and month analysis of demand. CCG escalation team working across the system.

16 16

Finance RatingRating Key

On track to deliver control

totalFlagged risk for delivery of

control total

Not delviering control total


Integrated Care – Programme is on track

WIC 01 Integrated Urgent Care WIC 06 Responsive Service

WIC 02 Same day Emergency Care WIC 07 D2OA

WIC 03 HIU WIC 08 Care Homes

WIC 04 Frailty WIC 09 Trusted Assesment

WIC 05 Respiratory WIC 11 Locality Development

Elective Care – Programme is on track

PCW 01 Cardiology PCW 08 Neurology

PCW 03 Gastro PCW 11 Stroke

PCW 05 LPP PCW 13 Video Conferencing & Reducing FU’s

PCW 07 Vertical Integration PCW 15 Dermatology

Cancer – Programme is at risk

Lung Breast

Prostrate Living with and beyond cancer

Colorectal

7

Norfolk and Suffolk Foundation Trust (NSFT)


Norfolk and Suffolk NHS Foundation Trust

Note (1) These figures are the rolling 3 Month position

CCGThres

holdOct Nov Chg Note

95.0% 95.6% 98.6% ↑ (1)

56.0% 82.6% 88.9% ↑ (1)

IES11.1%/

12.7%13.13% 15.14% ↑

WS11.1%/

12.7%12.53% 14.11% ↑

IES 50.0% 50.2% 50.4% →

WS 50.0% 54.9% 53.8% ↘

10.0% 3.3% 2.8% ↓

IAPT Adult: People with depression and/or anxiety disorders who receive

psychological therapy-Local

IAPT Adult: People with depression and/or anxiety disorders who receive

psychological therapy-Local

IAPT Adult: IAPT Service Users shall have a recovery rate - Local

Patients with open referral who have entered treatment with no activity for

more than 90 days-Local



IAPT Adult: IAPT Service Users shall have a recovery rate - Local

People with a first episode of psychosis begin treatment within 2 weeks of

referral-Local

CPA: % under mental illness specialties followed up within 7 days of discharge

from IP care-Local

CCGThres


95.0% 90.7% 81.6% ↓

95.0% 96.0% 99.4% ↑

95.0% 90.2% 89.0% ↘ (1)

95.0% 73.2% 73.0% →

95.0% 88.9% 88.9% → (1)

95.0% 70.2% 71.6% ↗

95.0% 96.3% 97.4% ↗

90.0% 70.6% 78.6% ↑

95.0% 83.0% 92.0% ↑

0 58 66 ↑

95.0% 49.6% 33.2% ↓

Connect Service - Time from referral to treatment-Local

18 and Over Referrals treated within standard -Local

Under 18 Referrals treated within standard -Local

Under 18 Routine (Non-emergency) referrals assessed within 28 days-Local

Under 18 Emergency referrals assessed within 4 Hours-Local

18 and Over Routine (Non-emergency) referrals assessed within 28 days-Local

18 and Over Emergency referrals assessed within 4 Hours-Local

Psychiatric Liaison - Routine referrals seen within 24 hours-Local

Psychiatric Liaison - Emergency referrals seen within 1 hour-Local

Local Requirements (2019/2020)

The Provider shall:

Referrals awaiting treatment >18 weeks-Local

Patients total time Hub from referral to discharge of 10 working days-Local

CCGThres


0.0% 0.0%

0.0% 0.0%

95.0% 92.4% 88.7% ↓

95.0% 85.8% 83.7% ↘

95.0% 92.4% 90.1% ↘

95.0% 78.7% 80.3% ↗

95.0% 97.3% 100.0% ↗

95.0% 70.8% 58.5% ↓

95.0% 47.9% 34.2% ↓

0 6 5 ↘

7.5% 1.8% 3.4% ↑

63 49 27 ↓

95.0% 70.2% 68.7% ↘

IES 67.0% 10.0% 18.2% ↑ (1)

WS 67.0% 60.0% 25.0% ↓ (1)

IES 69.0% 66.7% 50.0% ↓ (1)

WS 67.0% 66.7% 87.5% ↑ (1)

4.0% 3.4% 3.2% ↓

95.0% 94.4% 92.0% ↘

CMAS - Time from referral to first assessment within 6 weeks-Local

CMAS: Diagnosis within 12 weeks of referral, unless further

assessments/investigations req'd-Local

Youth ADHD: 13 Weeks from Referral to Diagnosis (point at which ICD10 code is

applied)-Local

Youth Autism: 13 Weeks from Referral to Assessment in accordance with NICE

guidance-Local


The Provider shall:

Care Programme Approach (CPA): CPA service users having had a formal review

within standard-Local

Care Programme Approach (CPA): CPA Service users whose care plan is in place-

Local

Care Programme Approach (CPA): Non CPA service users have had a formal

review within standard-Local

Care Programme Approach (CPA): Non CPA Service users whose care plan is in

place-Local

CMAS: Initial contact is made with all newly referred people within two weeks of

referral-Local

Under 19's with an ED receiving NICE-approved treatment within 1 week for

urgent cases-Local

Under 19's with an ED receiving NICE-approved treatment within 4 weeks for

routine cases-Local

Under 19's with an ED receiving NICE-approved treatment within 4 weeks for

routine cases-Local

Active Referrals with no activity recorded within 9 months-Local

Learning Disability Service users have an up to date appropriate care plan-Local

Number of Adult Acute inpatients with Length of Stay > 117 days-Local

Inpatients whose transfer of care was delayed-Local

Inappropriate out of area placements for adult mental health services-Local

All patients admitted with a mental illness should receive a physical health check-

Local

Under 19's with an ED receiving NICE-approved treatment within 1 week for

urgent cases-Local



Risk No. andOwner

Risk Description and MitigationsPrevious RAG

RatingCurrent RAG

Rating

NSFT (IESCCG 26a WSCCG 27a)

Lisa Nobes

Risk - CQC and CCG inspections of NSFT services in Suffolk demonstrate that the service ‘requires improvement’ leading to a

risk of patient harm and poor experience. Mitigation – Joint quality assurance process. Weekly CCG / NSFT Director meeting.

25 25

NSFT(IESCCG 26b WSCCG 27b)

Richard Watson

Risk - Poor performance of mental health services. Mitigation –Additional CCG investment. Remedial action plans under review. Director of Nursing regularly reviewing progress with CQC action plan.

20 20

Finance Rating

Rating KeyOn track to deliver control


control total




control total



Mental Health – Programme is at risk

P1 Mental Health Model P9 Early Adopter Site: Ipswich

P2 Increasing Access to Psychological Therapies

P10 SMI Patient: Individual Placement Support (IPS)

P3 Living Life to the Full P11 Dementia Programme

P4 Severe Mental Illness (SMI): Physical Health Checks

P12 Early Intervention in Psychosis

P5 GP Education Programme P13 System Wide Crisis Response Service

P6 Personality Disorder P14 Serenity Intensive Monitoring & High Intensity networks

P8 Early Adopter Site: Haverhill

Children and Young People – Programme is on track

Children’s Emotional Health and

Wellbeing Plan. Neurodevelopmental and Behaviour Pathway

Special Educational Needs and Disability (SEND).

Children and Young Peoples Community Health Services.

Speech and Language Therapy and Communication Childhood Obesity

Primary Care – West Suffolk*Practice list closuresNone planned

*CQC UpdateUpcoming Face to Face Inspections: None scheduled

Primary Care – West Suffolk

Prescribing QIPP UpdateThe table below shows a financial breakdown of the individual schemes that make up the total prescribing QIPP for the first 7 months of this financial year. Most schemes are currently underperforming leaving the overall programme at 32% (£186,632) below target year to date .

Initiative 2019/20 QIPP Apr May Jun Jul Aug Sep Oct YTDYTD Planned

Savings Difference % Difference

Analgesics £270,000 £17,327 £14,542 £19,985 £0 £0 £0 £19,969 £51,853 £135,000 -£83,147 -62

Continence £40,000 £0 £529 £0 £0 £0 £4,248 £0 £4,777 £20,000 -£15,223 -76

Diabetes £60,000 £0 £0 £0 £1,751 £0 £0 £0 £1,751 £30,000 -£28,249 -94

Dietetics £60,000 £0 £2,629 £563 £1,750 £0 £0 £6,879 £4,942 £30,000 -£25,058 -84

Gonadorelin £12,000 £0 £1,804 £0 £957 £1,892 £0 £3,174 £4,653 £6,000 -£1,347 -22

LVM £70,000 £1,383 £4,533 £7,404 £20,651 £6,820 £4,550 £10,964 £45,341 £35,000 £10,341 30

Mental Health £40,000 £7,641 £18,949 £26,430 £6,554 £0 £6,369 £0 £65,944 £20,000 £45,944 230

Misc £110,000 £27,153 £30,713 £25,370 £18,412 £13,675 £19,666 £25,795 £134,989 £55,000 £79,989 145

OTC £90,000 £0 £0 £469 £0 £0 £0 £0 £469 £45,000 -£44,531 -99

Other Appliances £25,000 £0 £0 £0 £0 £0 £0 £0 £0 £12,500 -£12,500 -100

Respiratory £220,000 £24,466 £9,773 £6,373 £10,796 £0 £0 £0 £51,408 £110,000 -£58,592 -53

Stoma £45,000 £9,462 £0 £0 £0 £4,961 £0 £0 £14,423 £22,500 -£8,077 -36

Woundcare £35,000 £365 £0 £1,830 £0 £0 £0 £301 £2,194 £17,500 -£15,306 -87

Rebates £100,000 £3,187 £3,187 £3,187 £3,187 £3,187 £3,187 £147 £19,122 £50,000 -£30,878 -62

TOTAL £1,177,000 £90,985 £86,658 £91,612 £64,058 £30,535 £38,020 £67,229 £401,868 £588,500 -£186,632 -32

Community Services

ServiceThres

holdOct Nov Chg

East 92% 99.7% 99.9% →

West 92% 96.7% 99.3% ↗

East 0 0 0 →

West 0 0 0 →

East 0 0 0 →

West 0 0 0 →

National Requirements (2019/2020)

The Provider shall:

Referral to treatment – 18 weeks (incomplete waiting list), including

Wheelchair access for children.

Mixed Sex Accomodation

MRSA incidents

ServiceThres

holdOct Nov Chg

Specialist Children’s

Community Services95% 45.8% 55.6% ↑


Community Services95% 54.2% 88.9% ↑


Community Services95% 96.0% 96.2% →

Paediatric SLT

Community Clinics 95% 95.8% 94.7% ↘

Paediatric SLT

Mainstream Schools 95% 57.9% 47.0% ↓


Community Services90% 100.0% 100.0% →

East & West 95% 92.3% 90.2% ↘

Suffolk Integrated

Equipment Service98% 100.0% 98.6% ↘

Suffolk Integrated

Equipment Service95% 99.9% 99.7% →

Suffolk Integrated

Equipment Service95% 100.0% 99.8% →

Initial Health Assessments for Children in Care completed within 28 days

of becoming a Child in Care


The Provider shall:

Initial Health Assessments for Children in Care completed within 15 days

of becoming a Child in Care (having received all necessary paperwork)

Annual NHS Continuing Healthcare review health assessment

Speech and language therapy – start of treatment within 12 weeks of

initial assessment

Education, Health and Care Plan requests from Suffolk County Council

provided within 6 weeks

Care coordination centre – calls answered in 60 seconds

Standard equipment delivered as emergency within 4 hours, as indicated,

on receipt of order request

Standard equipment delivered within 5 working days, as indicated, on

receipt of order request

Standard equipment delivered within 10 working days, as indicated, on

receipt of order request

ServiceThres

holdOct Nov Chg

East 100.0% 100.0% →

West 100.0% 100.0% →

East 100.0% 100.0% →

West 100.0% 100.0% →

East 99.2% 99.2% →

West 98.9% 99.2% →

East 13.8% 9.5% ↓

West 13.6% 11.6% ↓

East 98% 100.0% 100.0% →

East & West 95% 82.6%

East & West 95% 50.0%

East & West 95% 100.0% 100.0% →

Simple leg ulcer healing rates (mobile patients) (Healed in 18 weeks)

Complex leg ulcer healing rates (mobile patients) (Healed in 24 weeks)

Bowel and bladder service – annual reviews

Referrals seen within 72 hrs.

Delayed Discharges of Care (community hospitals)

Efficient provision of Discharge Summaries within 1 day of discharge from

Community Hospitals to GPs

95%

95%

3.5%

95%

Emergency referrals seen within 2 hrs.

Urgent referrals seen within 4 hrs.


The Provider shall:


Risk No. and Owner


Rating

Current RAG

Rating

Community(IESCCG 43 WSFT 49)

Amanda Lyes

Risk - Lack of sufficient workforce across the system leading to risks to patient safety, care and services. Mitigation – System level workforce strategy in place. Local workforce assurance Boards established.

12 12

East of England Ambulance Service Trust (Regional)


4

East of England Ambulance Service Trust (Suffolk and North East Essex STP Area)


5

East of England Ambulance Service Trust (Suffolk and NE Essex STP Area)

Risk No and Owner Risk description and key mitigations Previous

RAG Rating

Current RAG

RatingEEAST

(IESCCG 32 WSCCG 39)

Ed Garratt

Risk - EEAST is failing performance targets against ambulance response categories, particular concern are delays in the higher acuity Category 1 and 2 calls. Mitigation - Monthly quality and performance meetings. Review of delay serious incidents.

16 16

Finance Rating



control total




control total


CCGThres

holdOct Nov Chg

IES 00:07:00 00:08:55 00:09:12 ↑WS 00:07:00 00:10:33 00:11:11 ↑NEE 00:07:00 00:08:14 00:08:40 ↑IES 00:15:00 00:16:52 00:17:22 ↗WS 00:15:00 00:21:13 00:21:54 ↑NEE 00:15:00 00:14:29 00:14:42 ↗IES 00:18:00 00:32:42 00:30:12 ↓WS 00:18:00 00:30:01 00:27:32 ↓NEE 00:18:00 00:35:17 00:36:33 ↑IES 00:40:00 01:06:30 01:01:03 ↓WS 00:40:00 01:01:03 00:54:27 ↓NEE 00:40:00 01:10:21 01:14:27 ↑IES 02:00:00 05:10:37 04:17:47 ↓WS 02:00:00 03:28:18 03:24:36 ↘NEE 02:00:00 07:14:09 06:34:35 ↓IES 03:00:00 04:43:36 04:33:27 ↓WS 03:00:00 03:46:56 03:16:28 ↓NEE 03:00:00 07:12:31 05:40:26 ↓IES 03:00:00 04:06:28 03:53:27 ↓WS 03:00:00 02:39:21 03:33:06 ↑NEE 03:00:00 06:46:22 04:35:53 ↓CGH 0 171 154 ↓IHT 0 336 368 ↑

WSFT 0 135 136 ↗CGH 0 14 8 ↓IHT 0 25 26 ↗

WSFT 0 15 7 ↓

Category 2 - 18 min mean response time

Category 2 - 40 min 90th centile response time

Category 3 - 120 min 90th centile response

time


time


time-Local

Crew clear delays over - 30 mins-Nat'l

Crew clear delays over - 60 mins-Nat'l



Category 1 - 7 min mean response time

Category 1 - 15 min 90th centile response time

3

Integrated Urgent Care (Care UK with Suffolk GP Federation)


Integrated Urgent Care

Risk No and Owner Risk description and key mitigations

Previous RAG

Rating

Current RAG

Rating

IUC 111(IESCCG 45 WSCCG 51)

Richard Watson

Risk - The IUC/111 service is failing the target for calls answered in 60 seconds. Care UK (Urgent Care Ltd.) predicting non-compliant performance until April 2020. Mitigation – Care UK completing capacity / demand staffing restructure.

12 12

Thres

holdOct Nov Chg

5.0% 1.7% 2.2% ↑

95.0% 81.5% 78.3% ↓

15.0% 4.9% 4.7% ↓

80.0% 64.8% 66.4% ↗

80.0% 23.7% 36.0% ↑

40.0% 18.1% 18.0% →

50.0% 72.1% 69.7% ↓

80% of calls with an initial ED disposition are clinically revalidated

111 - Local Quality Requirements (2019/2020)


Of calls offered, proportion abandoned after 30 seconds.

Time from call connect to call answer (percentage answered in 60 seconds)

15% of Calls Recommended as self-care by a Non- Clinician.

80% of calls with an initial category 3 and 4 ambulance dispositions are clinically

revalidated

Of calls triaged by a clinician, proportion closed in IUC with self-care advice only (and

not referred to an onwards service).

Achievement of a minimum % of NHS111 triaged calls transferred to a clinician/

receiving clinical advice, in line with the expectations of NHSE.

Thres

holdOct Nov Chg

95.0% 78.7% 82.9% ↑

95.0% 90.8% 91.6% →

95.0% 98.0% 98.9% →

95.0% 97.8% 100.0% ↗

Out Of Hours - Local Quality Requirements (2019/2020)


Face-to-face consultations (whether in a centre or in the patient’s place of residence)

must be started within the following timescales, after the definitive clinical

assessment has been completed Urgent: Within 2 hours



assessment has been completed Less urgent: within 6 hours



assessment has been completed Locally Agreed 12 Hours



assessment has been completed Locally Agreed 24 Hours

Thres

holdOct Nov Chg

90.0% 89.9% 85.9% ↓

90.0% 84.7% 79.7% ↓

98.0% 92.0% 88.6% ↓

90.0% 100.0% 100.0% →

98.0% 100.0% 94.1% ↓

Total call backs by priority for Clinical Hub - TOTAL 2hr call backs



Clinical Assessment Services - Local Quality Requirements (2019/2020)


Total call backs by priority for Clinical Hub - TOTAL 30min call backs


6

Non-Emergency Patient Transport (E-Zec Medical)


Non-Emergency Patient Transport (E-Zec)

Risk No and Owner Risk description and key mitigations

Previous RAG

Rating

Current RAG

RatingPatient

Transport(IESCCG 42 WSCCG 48)

Richard Watson

Risk - Poor performance of non-emergency patient transport services. Mitigation - New E-Zec regional director in place. New service re-design in place from beginning of December splitting discharge and outpatient workload.

16 9

Thres

holdOct Nov Chg

95.0% 67.4% 66.7% ↘

90.0% 92.1% 90.2% ↘

85.0% 77.7% 77.6% →

95.0% 82.2% 86.0% ↑

95.0% 68.4% 66.1% ↓

90.0% 98.5% 99.0% →

100.0% 99.3% 98.2% ↘

95.0% 100.0% 100.0% →

90.0% 60.0% 74.4% ↑

95.0% 99.3% 99.3% →

95.0% 95.6% 95.3% →

95.0% 97.8% 97.3% →

In-bound - % Service Users arriving between 5 and 60 mins prior to their booked

appointment time.

E-Zec Medical - Local Quality Requirements (2019/2020)


End of Life Trfs from hospital to choice of placement - % met in 2 hours of the original

request.

Front Door and Assessment Area -% Service Users collected less than 60 minutes after

init contact

Timed Care Packages - % Service Users returned to place of residence in time for timed

care package

Journey Times - % Service Users on the vehicle between 0 and 90 minutes.

Journey Times - % Service Users in the IESCCG & WSCCG footprint on vehicle between

0 and 60 min.

Outbound OP Journeys - % Service Users waiting no more than 60 mins after booked

collection time.

Outbound Discharge - % Service Users waiting less than 60 mins after their booked

collection time.

Unplanned short notice booking - % patients collected in a 4 hr timeframe from initial

request.

Unplanned short notice booking in hours service - % Short Notice Journeys Honoured

by the Provider.



assessment has been completed Urgent: Within 2 hours



assessment has been completed Less urgent: within 6 hours

January 2020(latest available data: November 2019)

National Reporting

National Reporting – West Suffolk

RTT Incomplete pathway - Target 92% Comments

2019-20 E.B.3 Apr May Jun Jul Aug Sep Oct Nov Latest

Total incomplete pathways 18,365 18,531 18,572 18,425 18,069 17,719 17,529 17,241 17,241

% completed in 18 weeks 86.5% 87.0% 87.5% 88.0% 88.5% 89.0% 89.5% 90.0% 90.0%

Total incomplete pathways 19,556 20,236 20,494 20,251 20,388 20,375 20,736 19,949 19,949

% completed in 18 weeks 85.6% 86.6% 86.3% 85.5% 84.1% 82.7% 82.1% 81.3% 81.3%

RTT 52 Week Waits - Target: zero

2019-20 E.B.18 Apr May Jun Jul Aug Sep Oct Nov YTD

Plan 0 0 0 0 0 0 0 0 0

Actual 1 1 3 2 3 6 4 5 25

Diagnostics Test Waiting Times (% Waiting more than 6 weeks) - Target 1%


3.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.2%

11.0% 10.2% 5.6% 4.5% 3.9% 4.5% 1.4% 2.9% 5.7%

Dementia - Estimated Diagnosis Rate for people aged 65+ - Target 66.7%

2019-20 E.A.S.1 Apr May Jun Jul Aug Sep Oct Nov YTD

63.5% 63.7% 64.0% 64.5% 64.8% 65.1% 65.4% 65.8%

63.2% 63.3% 63.4% 63.6% 63.4% 63.1% 62.2% 61.7%

Proportion of the population with access to online consultations

2019-20 ED16 Apr May Jun Jul Aug Sep Oct Nov YTD

23.2% 23.2% 23.2% 34.3% 34.3% 34.3% 47.7% 47.7%

26.1% 26.1% 32.2% 38.8% 44.5% 44.4% 44.4% 44.9%

Extended Access Appointment Utilisation

2019-20 ED17 Apr May Jun Jul Aug Sep Oct Nov YTD

57.7% 59.1% 60.5% 60.5% 60.5% 61.9% 65.1% 67.5% 61.6%

73.9% 75.6% 77.2% 86.6% 83.6% 83.2% 83.4% 88.2% 81.1%

Proportion of the population that the urgent care system 111 can directly book appointments into the contracted extended access service

2019-20 ED18 Apr May Jun Jul Aug Sep Oct Nov Latest

100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

98.4% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

WSCCG MONTHLY METRICS

Re

ferr

al

To

Tre

atm

en

t

Measuring against agreed trajectory, to achieve 92% by

March 20. Also target for March 20 is for less people

waiting than in March 18, which was 15,671 incomplete

pathways

Plan

Actual

Number of 52 week Referral to Treatment Pathways

PlanPercentage waiting more than 6 weeks for diagnostic tests

Actual

Proportion of the population that the urgent care system 111 can directly book

appointments into the contracted extended access serviceActual

On the 24th April, Care UK and Suffolk GP Federation

stopped providing resource to allow a ghost clinic within

111. Patients are currently called back by the GP

Federation and booked into these appointments, this is

against the IUC contract requirements, however there is

no IT interoperability between Care UK and Suffolk GP

Federation systems. This has been escalated to TPP and

within contract meetings.

De

me

nti

a

PlanNumber of People aged 65 or over diagnosed with dementia

Actual

Pri

ma

ry C

are

PlanProportion of the population with access to online consultations

Actual

PlanExtended Access Appointment Utilisation

Actual

Plan


Cancer Waiting Times: 2 Week Wait - Target 93%


93.1% 93.1% 93.1% 93.0% 93.1% 93.1% 93.1% 93.1% 93.1%

93.5% 93.5% 93.7% 94.3% 93.5% 92.8% 90.9% 91.9% 93.0%

Cancer Waiting Times: 2 Week Wait (Breast Symptoms) - Target 93%


93.0% 93.5% 93.0% 93.8% 94.0% 93.4% 93.8% 93.0% 93.5%

86.4% 89.7% 90.9% 92.4% 89.9% 92.1% 87.7% 88.0% 89.6%

Cancer Waiting Times - 31 Day First Treatment - Target 96%


96.5% 96.6% 96.4% 96.5% 96.7% 96.5% 96.1% 96.9% 96.5%

98.4% 97.7% 98.4% 98.0% 100.0% 100.0% 100.0% 99.2% 99.0%

Cancer Waiting Times - 31 Day Surgery - Target 94%


96.2% 96.2% 95.2% 94.1% 95.0% 94.1% 96.0% 96.4% 95.6%

95.2% 96.0% 100.0% 100.0% 100.0% 96.2% 95.7% 96.3% 97.4%

Cancer Waiting Times - 31 Day Drugs - Target 98%


98.3% 98.5% 98.6% 98.8% 98.9% 98.7% 98.6% 100.0% 98.8%

100.0% 100.0% 100.0% 100.0% 98.6% 100.0% 100.0% 100.0% 99.8%

Cancer Waiting Times - 31 Day Radiotherapy - Target 94%


95.1% 94.7% 97.0% 95.3% 96.8% 95.1% 94.7% 95.5% 95.4%

97.4% 97.5% 97.7% 98.0% 97.4% 95.2% 98.1% 100.0% 97.7%

Cancer Waiting Times - 62 Day GP Referral - Target 85%


85.5% 85.4% 85.7% 85.7% 85.7% 85.5% 85.2% 86.0% 85.6%

77.0% 73.6% 69.1% 82.1% 78.4% 82.9% 86.1% 78.8% 78.7%

Cancer Waiting Times - 62 Day Screening - Target 90%


90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0%

87.5% 84.6% 87.5% 100.0% 100.0% 87.5% 87.5% 100.0% 90.5%

Cancer Waiting Times - 62 Day Upgrade - Target is national average


81.8% 100.0% 100.0% 100.0% 85.7% 100.0% 100.0% 75.0% 87.2%

100.0% 100.0% 100.0% 75.0% 100.0% 88.9% 77.8% 88.9%

Percentage of patients receiving first definitive treatment for cancer within 62-days

of referral from an NHS Cancer Screening ServiceActual

Plan

See contracts section for actions on exceptions by

provider

PlanAll Cancer 2 week waits

Actual

PlanTwo week wait for breast symptoms (where cancer was not initially suspected)

Actual

Plan

Plan31-day standard for subsequent cancer treatments-anti cancer drug regimens

Actual

Percentage of patients receiving first definitive treatment for cancer within 62-days

of a consultant decision to upgrade their priority statusActual

Ca

nce

r W

ait

ing

Tim

es

Percentage of patients receiving first definitive treatment within one month of a

cancer diagnosisActual

Plan31-day standard for subsequent cancer treatments-surgery

Actual

Plan31-day standard for subsequent cancer treatments-radiotherapy

Actual

Plan Percentage of patients receiving first definitive treatment for cancer within two

months (62 days) of an urgent GP referral for suspected cancerActual

Plan

WSCCG MONTHLY METRICS


IAPT Rollout Comments

2019-20 EA3 Qtr1 Qtr2 Qtr3 Qtr4 YTD

4.75% 4.75% 4.75% 5.50% 9.50%

5.7% 4.9% 10.6%

IAPT Recovery Rate Comments

2019-20 EAS2 Qtr1 Qtr2 Qtr3 Qtr4 YTD

50.2% 50.2% 50.1% 50.2% 50.2%

52.1% 51.9% 52.0%

IAPT Waiting Times - 6 Weeks Comments

2019-20 EH1 _A1 Qtr1 Qtr2 Qtr3 Qtr4 YTD

75.2% 75.2% 75.2% 75.1% 75.2%

92.7% 94.4% 93.6%

IAPT Waiting Times - 18 weeks Comments

2019-20 EH2_A2 Qtr1 Qtr2 Qtr3 Qtr4 YTD

95.0% 95.1% 95.0% 95.1% 95.1%

100.0% 100.0% 100.0%

EIP - Psychosis treated with a NICE approved care package within two weeks of referral Comments

2019-20 E.H.4 Qtr1 Qtr2 Qtr3 Qtr4 YTD

56.3% 56.3% 56.3% 56.3% 56.3%

50.0% 66.7% 61.5%

CYPMH - Improve access rate to Children and Young People's Mental health Services (CYPMH) - target 34% full year Comments

2019-20 EH9 Qtr1 Qtr2 Qtr3 Qtr4 YTD

14.2% 7.1% 6.4% 6.2% 21.4%

11.7% 8.2% 19.9%

The proportion of CYP with ED (Routine cases) that wait 4 weeks or less from referral to start of NICE-approved treatment. (rolling 12 months) Comments


53.3% 66.7% 76.7% 90.0% 66.7%

76.9% 76.3% 76.3%

The proportion of CYP with ED (urgent cases) that wait one week or less from referral to start of NICE-approved treatment. (rolling 12 months) Comments


66.7% 66.7% 66.7%

34.8% 38.5% 38.5%

People with a severe mental illness receiving a full annual physical health check and follow-up interventions Comments


22.0% 34.7% 47.3% 60.0% 34.7%

35.5% 35.7% 35.7%

Personal Health Budgets Comments

2019-20 EN1 Qtr1 Qtr2 Qtr3 Qtr4 YTD

18 36 148 260 54

63 86 149

Children Waiting more than 18 Weeks for a Wheelchair Comments

2019-20 EO1 Qtr1 Qtr2 Qtr3 Qtr4 YTD

92.0% 92.0% 92.0% 92.0% 92.0%

100.0% 75.0% 90.6%

AHCs delivered by GPs for patients on the Learning Disability Register Comments

2019-20 EK3 Qtr1 Qtr2 Qtr3 Qtr4 YTD

23.0% 23.0% 18.8% 15.6% 23.0%

14.1% 26.0% 26.0%

Whe

elcha

ir

PlanChildren Waiting more than 18 Weeks for a Wheelchair

Actual

SMI

Plan People with a severe mental illness receiving a full annual physical health check and

follow-up interventionsActual

Perso

nal

Healt

h Bg

ts

AHC'

s

Deliv

ered

by

GPs

The quarterly figures are a cumulative position.PlanAHCs delivered by GPs for patients on the Learning Disability Register

Actual

PlanPersonal Health Budgets

Actual

EIP Plan EIP - Psychosis treated with a NICE approved care package within two weeks of

referralActual

CYP M

H

Plan The proportion of CYP with ED (Routine cases) that wait 4 weeks or less from referral

to start of NICE-approved treatment. (rolling 12 months)Actual

Plan The proportion of CYP with ED (urgent cases) that wait one week or less from referral

to start of NICE-approved treatment. (rolling 12 months)Actual

IAPT Waiting Times - 18 weeksActual

The provisional rolling 12 month position to November is

30.6%Plan CYPMH - Improve access rate to Children and Young People's Mental health Services

(CYPMH)Actual

WSCCG QUARTERLY METRICS

IAPT

Nat'l reporting running in arrears,

Local figures for Q3 to November show:

135/248 = 54.4%

PlanIAPT Recovery Rate

Actual



243/255 = 95.3%

PlanIAPT Waiting Times - 6 weeks

Actual



255/255 = 100%

Plan


Local figures to November show:

3,348/23,722 = 14.1% vs a 12.67% Target

PlanIAPT Roll Out

Actual

27

Finance

Month Ending December 19 (Month 9)

28

Month Ending 31st December 2019 (Month 9)

Finance – Headlines

Rating Key Movement Key

l On or better than target h Improvement

l Below target 1 No Change

l 95% -99% of target (QIPP only) i Deterioration

Variance from Plan £0.0ml 1 1 1

At the end of Month 9, the CCG is on target to achieve its £1.2m in year surplus.

Variance against plan for the main spend areas are highlighed in the chart below and explained in detail overleaf.

Forecast Risks and Mitigations £0.0ml 1 1 1

The CCG has reported a balanced position to NHS England. Identified risks are additional contract risks, overspend on

GP Delegated budgets and anticipated cost pressures on prescribing and CHC budgets These are mitigated by

contingency, reserves and year end flexibilities.

Underlying Surplus / (Deficit) £3.1ml 1 1 1

This indicator adjusts the forecast surplus by removing the impact of non-recurrent costs and allocations and the full

year effect of in year adjustments in order to show the recurrent position.

QIPP Delivery 91.8%l i h i

At the end of Month 9, the CCG delivered £4.72m of its savings plan (QIPP) against a target of £5.14m (91.8% delivery).

Full year forecast is 90.05% delivery.

Key Metric Value MovementRating Headlines

29


Finance – Key Variances

Primary Care £2.0m 5.7% lMainly due to prior year benefits on GP Prescribing and Local Enhanced Services

Acute (£0.5m) (0.3%) l

Mainly due to YTD over performance on Addenbrookes (elective, non-elective and

outpatients), brain injury placements, and payments to WSFT for Offender Health, Cath Lab

and RTT. Partly offset by YTD underperformance on Norfolk & Norwich and Papworth, and

prior year benefits on NCAs

Mental Health £0.6m 2.5% lMainly due to underspend against budget on Learning Disability placements and prior year

benefit on shared care placements

Other Programme (£0.03m) (0.3%) lMainly due to the surplus budget for the additional support to balance the regional position,

which is held here, but offset by under spends elsewhere

Continuing Care (£1.8m) (16.8%) lMainly due to a significant increase in the volume of fast track packages compared to budget

and average package cost of CHC Home Care higher than budget.

Primary Care

Delegated

Commissioning

(£0.5m) (1.9%) lMainly due to Primary Care Networks (PCN's) payments to GP practices in excess of budget

and estimated growth in the 19/20 list size

CategoryVariance

£mRating Commentary%

30


19/20 QIPP - Finance

Plan Actual

Prescribing Prescribing 835,305£ 9 1,305,194£ 898,235£ 406,958-£ -31% G G R

CHC CHC -£ 9 351,072£ -£ 351,072-£ -100% G R

Non Acute Contracts Contracts 361,289£ 9 392,053£ 316,825£ 75,228-£ -19% G R

Community Contracts Contracts 256,577£ 9 149,391£ 183,568£ 34,177£ 23% G G

Corporate Corporate 396,332£ 9 297,249£ 297,251£ 2£ 0% G G

Other Acutes Contracts 3,707,344£ 9 2,484,673£ 2,631,118£ 146,445£ 6% G G

OOH Contracts 618,081£ 9 149,623£ 354,243£ 204,620£ 137% G G

Other Programme Services Contracts 47,466£ 9 9,090£ 37,882£ 28,792£ 317% G G

6,222,394£ 5,138,345£ 4,719,122£ 419,223-£ -8.16%

90.05% 91.84%

On

Budget?Var

Reported

NHSE ForecastProgramme/Projects Workstream

PMO

Confidence

Scheme

finance

Totals

QIPP Coverage

MntYTD

Tra

nsa

ctio

na

l

1

Integrated Performance ReportSupporting Information

Finance & Information Pack December 2019 (Month 9)

2

ContentsMonth Ending 31st December 2019 (Month 9)

Financial Statement…………………………………………….……………………………….………………………..………….…. 3

Risks/Opportunities…………….………………………………………………………………………………………………….……. 4

Statement of Cash Flow……..…………………………………………..…………………………………………….……….…..…… 5

3

• At the end of Month 9, the CCG is on target to achieve its £1.2m in year surplus.

• Principal overspends are in Continuing Care (£1.8m), Acute (£0.5m) and Primary Care Co-Commissioning (£0.5m).

• This is mitigated by underspends in Primary Care (£2.0m), Mental Health (£0.6m) and Contingency (£0.1m).

Financial StatementMonth Ending 31st December 2019 (Month 9)

Source & Apps Budget Actual VarianceVariance

%

19-20

Budget

Forecast

OutturnVariance Variance

£m £m £m £m £m £m £m %

Recurrent 275.0 275.0 0.0 0.0% 366.4 366.4 0.0 0.0%

Non Recurrent 7.3 7.3 0.0 0.0% 10.8 10.8 0.0 0.0%

Total Income 282.3 282.3 0.0 0.0% 377.1 377.1 0.0 0.0%

Acute 143.8 144.3 (0.5) (0.3%) 192.8 193.4 (0.6) (0.3%)

Mental Health 25.4 24.8 0.6 2.5% 33.8 33.2 0.6 1.9%

Community 24.1 24.1 0.0 0.1% 32.1 32.1 0.0 0.1%

Continuing Care 10.6 12.4 (1.8) (16.8%) 14.2 16.5 (2.3) (16.3%)

Primary Care 35.7 33.7 2.0 5.7% 47.4 45.7 1.7 3.6%

Other Programme 9.7 9.7 (0.0) (0.3%) 12.9 13.4 (0.5) (3.7%)

Primary Care Delegated Commissioning 26.8 27.3 (0.5) (1.9%) 35.7 36.4 (0.7) (1.9%)

Total Programme Costs 276.1 276.2 (0.1) 0.0% 368.9 370.6 (1.7) -0.5%

Running Costs 3.9 3.9 0.0 0.0% 5.2 5.2 0.0 0.0%

Contingency 1.4 1.3 0.1 9.2% 1.8 0.1 1.7 92.6%

Total Expenditure 281.4 281.4 0.0 0.0% 375.9 375.9 0.0 0.0%

In Year' Surplus/ (Deficit) 0.9 0.9 (0.0) 0.0% 1.2 1.2 0.0 0.0%

YTD Full Year

4

• The CCG currently has a balanced position.

• Identified risks are additional contract risks, overspend on GPdelegated budgets, and anticipated cost pressures on prescribingand CHC budgets

• These are mitigated by contingency, reserves and Year EndFlexibilities

Risks/OpportunitiesMonth Ending 31st December 2019 (Month 9)

RisksFull Risk

Value

£m

Acute Contracts Systems Pressure 2.96

Acute Contract -Other 0.00

Primary Care Prescribing 0.51

Continuing Health Care 0.40

Community Health Services

Primary Care Other 1.03

TOTAL RISKS 4.90

Mitigations

Full

Mitigation

Value

£m

Shadow Contingency 1.84

Delay/ Reduce Investments

Contingency 1.70

Other 1.36

TOTAL MITIGATION 4.90

TOTAL NET RISK / HEADROOM 0.00

CCGs

5

Statement of Cash FlowMonth Ending 31st December 2019 (Month 9)

At 31st December 2019 Total Assets Employed were (£28.8m) / Nov 19 (£29.6m). At 31st March 2019 Total Assets Employed were (£24.4m).

Significant liabilities were as follows:-

Prescribing Creditor - £6.2m / Nov 19 £6.7mPayables and Accrued Expenditure with NHS Bodies - £7.4m / Nov 19 £7.5mPayables and Accrued Expenditure with Non NHS Bodies - £20.4m / Nov 19 £21.0mOther Payables - £1.0m / Nov 19 £0.7mContinuing Healthcare Provision - £0.3m / Nov 19 £0.4mOther Provisions - £1.1m / Nov 19 £1.2m

Significant assets were as follows:-

Cash - £0.1m / Nov 19 £0.0m Receivable Balances - £1.8m / Nov 19 £1.3m Prepaid Expenditure - £4.3m / Nov 19 £5.4m Accrued Income - £0.9m / Nov 19 £0.8m

NHS West Suffolk CCG 19/20Statement of Cash Flows - Detailed Breakdown YTD Actuals

Dec 19Period 09

£000CASH FLOWS FROM OPERATING ACTIVITIESNet Operating Cost Before Interest -281,366Depreciation and Amortisation 156Impairments and Reversals 0

(Increase)/Decrease in Current AssetsSales Debtors 3,701Prepaid Expenditure -3,370Accrued Income -813Other Receivables 27

Increase/(Decrease) in Current LiabilitiesPrescribing Creditor 393NHS Payables and Accruals 4,051Non NHS Payables and Accruals 864Tax, Social Security & Other Payables -163

Increase/(Decrease) in movement in non cash ProvisionsContinuing Healthcare Provision 8Other Provisions -482Net Cash Inflow/(Outflow) from Operating Activities -276,994

CASH FLOWS FROM INVESTING ACTIVITIES(Payments) for Property, Plant and Equipment 0Net Cash Inflow/(Outflow) from Investing Activities 0

NET CASH INFLOW/(OUTFLOW) BEFORE FINANCING -276,994

CASH FLOWS FROM FINANCING ACTIVITIESNet Funding 276,961Net Cash Inflow/(Outflow) from Financing Activities -33

NET INCREASE/(DECREASE) IN CASH AND CASH EQUIVALENTSCash and Cash Equivalents (and Bank Overdraft) at Beginning of the Period 160Cash and Cash Equivalents (and Bank Overdraft) at YTD 127


PMO/Transformation IPR

1

January 2020

2

Integrated Care West Programme Dashboard

Overall Programme RAG

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19GREEN GREEN GREEN GREEN GREEN GREEN GREEN GREEN GREEN

On Track

Project RAG Update/Action Required Project RAG Update/Action Required

WIC 01 Integrated Urgent Care At Risk

Ongoing challenges with performance being picked up by the contracts team. Poor performance is impacting on the ability of Care UK to meet the full IUC service specification as well as undertake any further transformation.

WIC 06 Responsive Service At Risk

Quick wins were discussed at last meeting to help winter pressures. Change in leads for the programme to Jayne Harvey and Sarah Hedges.

WIC 02 Same day Emergency Care On Track Further work to be done to link the FAU to a community frailty

model as part of the locality work. WIC 07 D2OA On Track Overall project is on track.

WIC 03 HIU On TrackContinued engagement from all services involved with the HIU. Progression into the locality/INTs on track, with further progression January 2020.

WIC 08 Care Homes On Track Overall project is on track. Tissue Viability Nurse starts on 2nd January.

WIC 04 Frailty On TrackThe frailty evaluation has been widely shared and the next phase in each locality is ready to commence. Strengthen and balance classes are also commencing in each locality in early 2020

WIC 09 Trusted Assesment On Track

Trusted assessment principles and ways of working to be embedded in all 'one team' locality/INT development work. To become synonymous with INT working. Trusted assessment priorities will move forward through maturing INTs and localities, and a defined PID is no longer required.

WIC 05 Respiratory On Track Working ICW wide to utilise funding from NHSE for spirometry, pulmonary rehab and COPD transformation funding.

WIC 11 Locality Development On Track

Each locality continues to grow at differing levels of maturity and engagement and therefore action.Phase 2 NNCT planning in progress based on embedding the Buurtzorg model inspired principles into the INTs - as approved by Suffolk health and wellbeing Board Post agreed for Bury Town to support identification of rising risk cohort and appropriate response / support. - currently being scoped by Bury Town One Clinical Community Group and opportunities for colocation of teams being progressed.

3

Integrated Care West Programme Dashboard

KPI Metric Description Measurement Metric KPI TargetCurrent Month

(Nov)

Last Month

(Oct)YTD

Ambulance arrival to

handover 15 minutes

All ambulance arrival to handovers to be within 15 minutes -

Number of breaches shown0 1,277 1,315 9,367

Ambulance handover to

clear 15 minutes

All ambulance handovers to clear to be within 15 minutes -

Number of breaches shown0 928 891 6,519

Reduction in A&E

attendances

169 reduction in A&E attendances for WSCCG patients age

65+ at WSFT compared to 2019/20 plan-169 100 123 769

Reduction in emergency

admissions

169 reduction in emergency admissions for WSCCG patients

age 65+ at WSFT compared to 2019/20 plan-169 1 75 406

People readmitted to

Acute care

% of over 75 year olds that are readmitted to WSFT within 30

days<=18% 21.1% 23.0% 21.6%

111 calls triaged by a

Clinical Adviser

50% of calls triaged to have a clinical contact by March 2018

and maintained throughout 18/19>=50% 61.5% 60.5% 55.8%

STP: IUC direct booking

capability in place

STP: IUC direct booking capability to be 100% from 1st May

2019100% 33.0% 33.0%

Average number of patients per day staying in WSFT for

more than 7 days<=150 161 145





Community delayed

transfers of care Maximum of 3.5% DToCs at community hospitals <=3.5% 14.5% 16.8%

Acute delayed transfers

of care Maximum of 3.5% DToCs at WSFT <=3.5% 3.5% 2.8%

Number of stranded

patients in WSFT

Integrated Care Key Performance Indicators - Programme Level as at November-19

Notes:-Reduction in A&E attends. October plan = -14, actual =123, November plan = -14, actual = 100. YTD plan = -112, actual = 769. Reduction in Emerg Admissions. October plan = -15, actual = 75, November plan = -14, actual = 1. YTD plan = -110, actual = 406. IUC Direct Booking:- Only 1 CCG is able to book directly (NEECCG)

2018/19 2019/20 Variance % Var

13,099 13,379 280 2.1%

Plan 2019/20 Variance % Var

13,444 13,379 65- -0.5%

Emergency Admissions

Year to Date

Activity

Plan Position

YTD @M8

2018/19 2019/20 Variance % Var

32044 35793 3,749 11.7%

2,448 2,143 305- -12.5%

34,492 37,936 3,444 10.0%

Year to Date

A&E Attendances

GP Streaming

Total

A&E Attendances


33,314 35,793 2,479 7.4%

2,447 2,143 304- -12.4%

35,761 37,936 2,175 6.1%

GP Streaming

Total

Plan Position

A&E Attendances

A percentage of GP referred to WSFT for WSCCG activity that resulted with the patient going to ambulatory care has been omitted from the data above. When adding these in, the A&E variance YTD is closer to 10.9%. At GP referred level, the variance YTD is approx. 0.5%.

4

Elective Care West Programme Dashboard


Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19

GREEN GREEN GREEN GREEN GREEN GREEN GREEN GREEN GREEN

Programme Status: Programme is on track

Project RAG Update/Action Required Project RAG Update/Action Required

PCW 01 Cardiology At Risk

No update on the Cardiology service review status, this will be picked up as art of the OP workshop planned by HP in Feb. Cardiology remains challenging however RTT has improved slightly in November although still below target as a speciality.

PCW 08 Neurology On Track

A decision has been made to integrate Neuro Rehab with the ESD/Stroke Service that is being developed for WSCCG and ESNEFT, this project is being led by Karen-Lynn Dowsing. Meetings are being held with independent Residential L2 providers to discuss increasing capacity of L2 residential beds at Ipswich.

PCW 03 Gastro On Track Service reviews being undertaken by the WSFT ADO’s PCW 11 Stroke At Risk

Stroke Support ServicesSpecification revised in light of new national guidance -procurement will be complete by May 2020 and will be for a stroke ESD service from 1 October 2020

HASU/ASU reviewA reference case reflecting the best solution for ICS stroke patients including the establishment of a thrombectomy centre within the ICS and increased collaborative working between ESNEFT and WSFT is being prepared for presentation to the ICS Board in January

PCW 05 LPP On Track Service reviews being undertaken by the WSFT ADO’s

PCW 13 Video Conferencing & Reducing

FU’s

On Track VC to be discussed as part of the overall Outpatient Transformation Programme.

PCW 07 Vertical

IntegrationOn Track Business Case for Integration with the Surgery prepared

and planned for WSFT Board 31 January. PCW 15

Dermatology Completed Work completed and now BAU.

5

Elective Care West Programme Dashboard

KPI Metric Description Measurement Metric KPI TargetCurrent Month

(November)

Last Month

(October)

YTD

(Apr-Nov)

Reduction in First

Outpatients

Reduce WSCCG first outpatients on selected specialties at WSFT by 406

compared to 19/20 plan-406 -116 -111 -319

Reduction in Follow Up

Outpatients

Reduce WSCCG follow up outpatients on selected specialties at WSFT by

3,071 compared to 19/20 plan-3,071 172 218 1392

RTT Incomplete waiting listTotal incomplete waiting list for WSFT to reduce to the March 2018 level by

March 2020

15,396 by

March 202020,259 21,073

RTT incomplete waits RTT incomplete waits for WSFT to achieve 92% by March 2020 >= 92% 80.1% 81.2%

52 week waits 52 weeks waits for WSFT to be at zero from 1st April 2019 0 8 4

2 week waits Cancer 2 week wait target for WSFT to be >=93% >=93% 91.6% 91.0%

Diagnostic waiting times Breaches against 6 week waits to be <=1% from May 2019 at WSFT <= 1% 3.3% 1.4%

Video conferencing Patient satisfaction (quarterly patient survey) at WSFT90% good or

excellent

Planned Care Key Performance Indicators - Programme Level, as at November-19

Notes:-First OP reduction - October plan -36, actuals -111, November plan -36, actuals -116. YTD plan -265, actuals -319.Follow up OP reduction - October plan -275, actuals 218, November plan -261, actuals 172. YTD plan -2,041, actuals 1,392.Diagnostic Waits - October showed 51, November showed 121.. YTD = 2,096. Incomplete Waits - The list hasn't seen any significant improvement since April, hovering around the 21,000 figure each month. The percentage achievement is worsening, currently at 80.1% as at November.

Plan 2019/20

49,561 48,565 -996 -2.0%

100,076 95,801 -4,275 -4.3%

149,636 144,366 -5,270 -3.5%

Outpatient vs Plan

Year to Date 19/20 vs Plan Variance

First

Follow-Up

Total

2018/19 2019/20

28,847 30,564 1,717 6.0%

53,895 60,366 6,471 12.0%

4,278 4,611 333 7.8%

13,902 11,938 -1,964 -14.1%

40,167 36,887 -3,280 -8.2%

141,089 144,366 3,277 2.3%

First Telephone

Outpatient by POD

Year to Date 19/20 vs 18/19 Variance

First Attendance

FU Attendance

FU Telephone

Procedure

Total


13,283 13,489 206 1.6%

1,751 1,719 -32 -1.8%

15,034 15,208 174 1.2%

Elective Admissions

Plan Position

Daycase

Elective

YTD @M8

2018/19 2019/20 Variance % Var

12,999 13,489 490 3.8%

1,711 1,719 8 0.5%

14,710 15,208 498 3.4%Total

POD

Daycase

Elective

6


Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19GREEN GREEN GREEN AMBER AMBER AMBER AMBER AMBER AMBER

Programme Status: This programme is amber

Project RAG Update/Action Required in Red or Amber

Lung On Track

Tuesday MDT is now part of regular job plans for respiratory consultants, with large numbers of patients being discussed and additional support available for admin and CNS. Reviewing pathway against best practice. Public health supporting with lung Significant Event Audit, trust have provided data and reviewed with public health, process agreed to send to primary care for review.

Prostate At Risk

Recruitment of additional CNS and SMDT coordinator to support the achievement of 28 day faster diagnosis. Straight to test (STT) mpMRI in place. Capacity for template biopsies increasing patient pathway, and consultants started to perform under local anaesthetic, next steps to move to outpatient setting. Reviewing options for one stop shop. 2WW form reviewed, changes now being finalised and uploaded to DXS. ICS wide meeting agreed to review risk stratified protocols scheduled for 07/02/20. CancerAlliance clinical meeting for risk stratified follow up delayed until February. Personalised care remote monitoring to be rolled out following implementation in breast, currently reviewing CNS support required.

Colorectal At Risk

1 STT nurse in post for West Suffolk. Practice visits made and more planned to share changes to pathway. PGD process almost complete for bowel prep. Pathways being finalised and agreed with clinicians, proposed launch beginning of February 20. Endoscopy capacity (up to 5 weeks for Colonoscopy), IST supporting with demand and capacity review for endoscopy. Changesto 2WW forms proposed following audit. Colorectal pathway to be reviewed with WSFT, as part of ICS actions following cancer summit. Personalised care remote monitoring to be rolled out following implementation in breast.

Breast At Risk Utilising patient portal to support remote monitoring of patients on self-managed pathway. IT support now agreed and will recruit to support implementation. Direct access process for returning patients now agreed.

Living with and beyond cancer On Track

Project lead and 3 x navigators in post. CNSs are actively and positively referring to the service. 15/25 GP practice visits undertaken and information and referral process shared and agreed, with points of contact for the GPs and navigators identified.Soft launch progressing well with significant number of referrals, formal launch of service end of January. Further information received regarding national evaluation by Ipsos Mori and aligning local evaluation to this, progressing with contract for local evaluation. Community engagement post agreed for Suffolk and MIA submitted to Macmillan for funding.

Cancer West Programme Dashboard

% of patients seen within two weeks of an urgent GP referra l for

suspected cancer93% 93% WSFT - Nov 19 91.6% 91.0% 93.3%

% of patients receiving fi rs t defini tive treatment for cancer within 62

days from an urgent GP referra l85% 85% WSFT - Nov 19 83.5% 85.0% 79.7%

Number of patients being diagnosed within 28 days or having cancer

ruled outTBC TBC WSCCG - Nov 19 66.8% 68.0% 66.5%3 Faster Diagnos is

Current

month

Previous

MonthYTD

1Cancer 2 week

waits

2Cancer 62 day

target

KPI RefKPI Title &

DescriptionMeasurement Metric

National

Target

Local KPI

TargetLatest Data

7

Children and Young People Programme Dashboard

Overall Programme RAG Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19GREEN GREEN GREEN GREEN GREEN GREEN GREEN GREEN GREEN

Programme Status: On trackProject RAG Update/Action Required in Red or Amber

Children’s Emotional

Health and Wellbeing Plan.

On Track

Transformation - The pathway mapping exercise is highlighting areas in and out of children’s services that are already established so giving us a clear idea of how to enhance the specialist mental health offer such that all partners can more effectively support children and young people and families experiencing distress or mental ill health. The work is now being correlated with known service demand and our understanding of unmet need to inform the workforce capacity and skill base going forward. CYPF Crisis response and outreach model - following a stakeholder session on 6 December we are currently engaging with children and young people to get their views on the proposed service model including views on service operational hours and the team make up. In January, we will receive this feedback and make any changes required to the service model and business case.Eating Disorders - Recovery Action Plan received - trajectory showing 1 week and 4 week KPIs will be met in Jan 2020. Fortnightly catch up calls set up to include NHSE/I colleagues.CYP Access -manual submission showing 44% versus 35% target. However wellbeing service continue to be delayed in flowing data via MHSDS therefore NHS Digital figures do not reflect this which NHSE/I are aware of. However Kooth launched on Oct 10th to provide online counselling and support for CYP 11-18 and activity does flow via MHSDS and has already worked with 50 CYP.Mental Health School Support Teams - Recruiting to the new teams - in Suffolk this is led by NSFT and in NE Essex this is led by MIND. Each Suffolk team consists of 0.5 Band 8a, 2 x Band 7, 4 x Band 4 EMHPs (who will begin training at UEA for 1 year from Jan 2020) and Band 3 admin. Each team will cover approx. 25 schools and 8,000 CYP - aiming to provide direct work with 500 CYP per team.CYP Transformation Plan - annual refresh of the plan is underway with first draft reviewed by NHSE. To be published on the CCGs and Health & Wellbeing Board websites. NHSE strategic visit on 22 Jan focussing on priority areas.

Special Educational Needs and Disability

(SEND). On Track

Specialist Education is progressing well, we have already successfully identified suitable providers for a number of SEND units. We are now considering further expressions of interest from mainstream schools who hope to open units in September 2021, this will allow us to identify another further compliment of suitable providers. The health and social care implications are now being worked through to form the sufficiency plan, Garry will be working with colleagues to ensure this reflects the gaps and needs across Suffolk. It has been agreed at that the sensory integration work is redefined to understand if the need can be fulfilled. There is also a need to redefine the therapy review workstream as this overlaps with the comm paeds review, which will now be looking to implement recommendations from the report. SLC roll out continues to progress well with majority of training in schools complete.

Speech and Language Therapy and

CommunicationOn Track

Year 1 of the mobilisation of the revised service is nearing completion which includes recruitment to new posts and training of schools in speech and language link, so far over 190 schools have been trained leaving the remainder of around 60 to be picked up in the first part of this year. The service specification is in draft form and meetings are arranged to finalise the spec so that it can be varied in to the contract by 1st April 2020

Neurodevelopmental and Behaviour Pathway On Track

Quick win projects have mobilised and are providing support to the autism and adhd cases that are coming to the Hub. Steering group has now met a number of times and working up the business case for the new service for Feb 2020. The family support elements will be going out to procurement we have already agreed a panel of parents that will support the procurement process.

Children and Young Peoples Community

Health Services. On Track

Stage 1 of the review was completed and presented to the CYP board in November and at that point it was agreed to do a focused piece of work around a smaller number of agreed prioritised services, they are medical, nursing and OT/PT. The scoping exercise was completed in December and the new delivery models are in the process of being agreed, expected completion is end of March 2020 at which point the detailed transformation of the individual services will commence.

Agreement of Acute/Emergency

Paediatric Pathway. PID in development

Childhood Obesity. Completed All milestones for 19/20 completed

8

Children and Young People Programme Dashboard

KPI Metric Description Measurement Metric KPI Target Latest data Area Type WS CCG

YTD inc

provisional23.97%

Rolling 12

Month Final

Only

26.58%

Rolling 12

Month inc

Provisional

29.31%

Plan 66.7%

Actual 76.3%

Plan 66.7%

Actual 38.5%

Plan 115

Demoninator 2,558

Plan Rate 4.5%

Actual 105

Rate 4.1%

CYP Key Performance Indicators - Programme Levels

Routine rolling 12 mth

Urgentrolling 12 mth

YTD and

rolling 12

month

position

shown with

final and

provisional

data

34%

-34% of CYP (0-18) with a mental health diagnosis are receiving NHS funded treatment

-Treatment is defined as a child having had 2 or more contacts relating to the same referral in a 12

month period (this can be direct or indirect (e.g. advice to carers etc))

-Only treatments recorded in the Mental Health Services Data Set (MHSDS) count towards the target

CYP Access Standard

Q2 1920Community Eating Disorders

Services (CEDS)

-Progress towards target of 95% of patient receiving first definitive treatment within four weeks for

routine cases

-Progress towards target of 95% of patients receiving first definitive treatment wthin one week for

urgent cases.

95% by 2020

Q2 1920

Oct-19

Sep-19

Oct-19

Sep-1910% by 22/23Perinatal Mental Health

The number of women accessing specialist community perinatal mental health services submitted to

MHSDS as a proportion of 2016 ONS birth data.

Access is defined as women who have had at least one attended contact (face to face or business skype

contact) with a specialist community perinatal mental health service (excludes telephone, SMS or email

contact).

based on

rolling 12

month

position

9

Mental Health Programme DashboardOverall Programme RAG

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19GREEN GREEN GREEN GREEN GREEN GREEN GREEN GREEN AMBER

Programme Status: Presentation in Dec 19 at Regional Clinical Senate setting out developing Suffolk MH model and agreed timetable for 2020. Agreement to site new crisis service contacts centre at Wedgwood House, Bury St Edmunds. Work ahead to set out pathways for all four priorities by the end of February 2020.

Project RAG Update/Action Required in Red or Amber Project RAG Update/Action Required in Red or Amber

P1 Mental Health Model Complete

New MH model presented to regional Clinical Senate in December 2019. Work timetable agreed between Jan-Sept 2020 to develop model further and support commissioning process.

P9 Early Adopter Site: Ipswich At Risk

Conversations continuing in line with Haverhill Early Adopter, and in Coastal area on working relationships with the Integrated Neighbourhood Team (INT)..

P2 Increasing Access to

Psychological Therapies

On Track

We have shared our core offer and advertised our LTC course and online CBT modules from LLTTF. We are delivering a Living Well with Physical Health Problems in two community settings (one East and one West Suffolk), this is a transdiagnostic 6-week course which has been run since September.

P10 SMI Patient: Individual Placement Support (IPS) On Track

Roll out of service progressing well. A number of sessions planned by Essex Partnership University Trust (EPUT) across East and West Suffolk during November and December 2019 to support new starters and orientation within NSFT. Specific training also offered from NHSE to new IPS staff.

P3 Living Life to the Full Completed P11 Dementia Programme At Risk

WS CCG November 2019: 61.7%. Work underway with NEE CCG to understand how they have improved their position in recent months with a focus on; Dementia Coding in Primary Care (potential to commission ‘EQUIP’ to undertake an audit of a number of practices)- Medicines Management Technician providing dedicated outreach to GP Practices on dementia coding; GP Practice Engagement: ‘Virtual Dementia Tool’

supporting direct ‘dementia’ visits to GP Practices including Memory

Assessment, MH Clinical Lead etc. and a continued focus on GP Education sessions and promotion of the ‘Diadem’ self diagnosis tool;

Memory Assessment Service: Renewed focus on this function, establishment, capacity and throughput to primary care and Care Homes: Renewed focus on care homes review, identification of patients and links to GP Practices

P4 Severe Mental Illness (SMI):

Physical Health Checks

On Track

Q2 figures for SMI PHC demonstrated 41.5% for Ipswich and East Suffolk CCG and 35.7% for West Suffolk CCG. Work continues on promotion of the NSFT Physical Health Care Service and Enhanced Payment for GP’s to

support physical health checks.

P12 Early Intervention in Psychosis At Risk

The 3 year investment into EIP services is now in Q4 of year 2 of the additional funding. In January 2020 there will be 1 CBT(Practitioner) and 1 Band 3 Clinical Support Worker roles advertised. A plan in being developed to establish how the staff still embedded within the IDT teams can be moved across to the stand alone team. Office and clinic space for the growing team is an issue and has been escalated to Director of Operations at NSFT for resolution. Further piece of work to be carried out to establish a pathway for At Risk Mental State (ARMS).

P5 GP Education Programme On Track Sessions agreed for Feb 20 (consultation skills 2) and March 20 (eating

disorders).P13 System Wide Crisis

Response Service On Track

The ESNEFT (Ipswich site) is currently finalising recruitment and completing a staff consultation to move to a 24hr shift pattern. It is expected that the service will be CORE 24 in early March 2020. For West Suffolk Hospital, adverts are out to recruit 3WTE B6 nurses now to enable the service to move to 9am – 9pm 7 days per week prior to 31/03/20 with the remainder of the recruitment taking place to hopefully come on line in April/May 2020.Recruitment challenges in Q4 for Crisis Resolution and Home Treatment Time, Psychiatric Liaison and Early Intervention in Psychosis business cases . Agreement reached for contacts centre to be based at Wedgwood.

P6 Personality Disorder On Track Workshop planned for end of January 2020 to consider how a future

Personality Disorder service offer sits within the new model.

P14 Serenity Intensive Monitoring & High Intensity networks

Completed

P8 Early Adopter Site: Haverhill At Risk Haverhill Early Adopter site to be re-launched with tighter project management. NSFT to join the project as joint SRO.

10

Mental Health Programme Dashboard

KPI Metric Description Measurement Metric KPI Target Latest data Type WS CCG

Dementia 66.7% Dementia Diagnosis 66.7% Nov-19 Rate 61.7%

Suicide Prevention 10% Reduction in Suicides 10% reduction on

17/18 2016/18

Age-standardised suicide

rates per 100,000

population

8.5

Plan 4.75%

National Actual 4.93% based on published NHSD monthly file

Local Actual 4.90% based on latest NSFT report

Sep19 - Nov19 Local Rolling Quarter 5.09%

Plan 50.2%

National Actual 51.89% based on published NHSD monthly file

Local Actual 52.54%

Sep19 - Nov19 Local Rolling Quarter 54.11%

IAPT Long Term Conditions Approaches TBC TBC TBC TBC

Plan 56.3%

Actual 66.7%

Jul19 - Sep19 Latest Rolling Quarter 66.7%

Plan 34.7%

Actual 35.7%

SMI: IPS25% increased access to Individual Placement and Support

(IPS) services in 2018/19 (for services in Wave 1 pilots)0% TBC TBC TBC

Crisis Resolution

Home Treatment

Teams (CRHTT)

Ensure that teams are able to offer 24/7 community crisis

response, including rapid response for people with urgent and

emergency needs

0% TBC TBC TBC

12 months to end

Q2 192060% at 31Mar20

60% of SMI register (50% of SMI register receiving in primary

care; 10% of SMI register receiving in secondary care)

SMI: Physical Health

Checks

IAPT 50% Recovery Rate for IAPT 50% at March 2020

Latest Quarter

National

(Q2 1920)

Q2 1920EIP

60% of people by 2020/21 receiving treatment in 2 weeks in

line with NICE recommendations for requiring early

intervention for psychosis

60%

Mental Health Key Performance Indicators - Programme Levels

Latest Quarter

National

(Q2 1920)IAPT Intervention Rate: 22% Access Rate for IAPT

22% by March 2020

(Q4 = 5.5%)


Contractual Performance

Appendix Pack

November 2019

Finance/Activity

What are the top 3 risks and issues?Rank Risk Owner Likelihood Impact Mitigation

1Underachieving against C1 ambulance targets resulting in potential safety and outcomes risks to patients. These are measured at trust level with indicative targets for each CCG area.

EEAST/CCG High High

• Bi- weekly performance meeting in place with EEAST and commissioners, focus on Cat 1. EEAST predicting of demand and modelling capacity. Greater scrutiny at Operational Performance Group meetings.

• Risk Summit actions will support improving performance for C1.• Independent Service Review complete and EEAST are working to achieving quarterly targets for recruitment

and performance. This is monitored contractually and operationally by CCG.

2Increasing activity of high risk categories. The risk is the more serious calls are not seen in a timely manner. Ongoing review of impact of new Cat 1-4 targets.

EEAST/CCG Med High

• 111 and 999 are meeting monthly to review referred calls. • EEAST focus on high acuity calls. Cat 1 achievement progress discussed in bi-weekly performance meeting• Ambulance Response Programme actual impacts addressed in ISR final report to align operational model

with C1 demand• Discussions with 111 service provider to ensure validation is maximised with changing targets and piloting of

new Category 2 review before dispatch.

3 Recruitment / staffing. EEAST continues to struggle to recruit and retain sufficient levels of qualified staff to meet target requirements. EEAST High High

• On-going recruitment plan being reviewed monthly as part of contractual meetings.• New internal recruitment and retention plan signed off by EEAST.• Plans are in place with other Providers to trial staff cross working / rotation.

East of England Ambulance Service NHS TrustPerformance - November

Final finance agreement is still being negotiated for 19/20 for consortium..

RAG Indicator Comments Change

Cat 1mean time <07:00 min

Category 1 mean arrival time was 11:11mins (10:33 mins in October 2019). ↓

Arrival to Handover>15mins

Performance for handover in <15mins was 33%.STP trajectory target of 100% of patients being clinically handed over <15mins. ↔

Cat 2 mean time <18:00min

Category 2 mean arrival time was 27:32mins.

↑

Updates

• New Independent Service Review targets for performance and recruitment being developed, to be available in November 2019.

• New EEAST HR director leading new recruitment and retention programme of work, actions/goals shared with the CCGs.

• Performance and recruitment is being monitored/reviewed at bi-weekly Operational Performance Group EEAST by CCGs against the Independent Service Report.

• Clinical Support Desk ‘hear and treat’ performance was 6.3% in September (was 6.2% in August 2019)

• 111 enhanced clinical validation of C3/4 calls. Currently validating 60% of calls and redirecting 70%. CCG have set up programme with 111 for ambulance validation to improve this position.

Updates

• New Independent Service Review targets for performance and recruitment being developed, to be available in 2020.

• EEAST capacity is under plan for Suffolk and NEE Sector, recruitment plan reviewed at local contract meeting and consortium contract meeting.

• Performance and recruitment is being monitored/reviewed at bi-weekly Operational Performance Group EEAST by CCGs against the Independent Service Report.

• Clinical Support Desk ‘hear and treat’ performance was 6.8% in November (was 6.4% in October 2019)

• 111 enhanced clinical validation of C3/4 calls. Currently validating 60% of calls and redirecting 75%. CCG have set up programme with 111 for ambulance validation to improve this position.

Finance 2019/20:

Risks and Issues Owner Likelihood Impact Mitigation

1

CQC rates NSFT as inadequate:Safety – ligature points, facilities, staffing numbers and mandatory training, risk assessments, restrictive practices, physical health checks and learning from SisEffectiveness – care planning and records, appraisal and supervision, application of DOLs and Mental Health ActLeadership – improvements not addressed, missing safety narrative, data inaccuracies, risk capture and learning

CCG/ NSFT Med High

CCG addressing all points of CQC review• Highest risk rating on GBAF• Alliance agreed strategy to stabilise NSFT prior to

commencing MCP process• Outcome of CQC October 2019 inspection awaited

2 Long waits for Youth services particularly waits for screening/triage with the EWB Hub, and within IDTs for Routine Assessment within 28 days, NSFT/CCG High High

• Remedial Action Plan and recovery trajectory of December 2019 for 28 day routine assessment. performance improving

• Trajectory to meet KPI of 10 working days total time in Hub agreed as Nov 2019

• Additional recurrent investment made into EWB Hub• Clinical Quality team have reviewed processes for managing

long waiters

3 Long waits for Adults routine Assessment (28 days) NSFT/CCG High High

• Focus on ensuring processes in place to ensure clinical safety of long waiters

• Agreement of AAT implementation plan (including timescales for agreement of recovery trajectory for 28 day KPI) with clear milestones

• Routine assessments being undertaken wihtin IDTs• Overtime/agency and locums continuing to cover vacancies


Suffolk CCGs Quality – taken from https://www.safetythermometer.nhs.uk/index.php/classic-thermometer/analyse-data-classic/dashboard-classic

RAG Indicator Comments ChangeEarly Intervention in Psychosis (EIP)

82.61% of patients with RTT within 14 days compared to 80% Sep 2019 (target 56%). Unvalidated Nov: 88.9% ↑

CPA: 7 day follow up post inpatient care

95.6% against 95.0% targetUnvalidated Nov 98.6% ↑

CPA:12 months review

92.36% against 95% target. Unvalidated Nov: 90.1% ↓

Under 18 routine referrals seen within 28 days

70.2%% of service users seen within 28 days (was 68.9%) Unvalidated Nov: 71.6% ↑

IAPT Prevalence At M8 I&ESCCG are ahead of target at 15.14%, WSCCG are ahead of target at 14.11% against a M8 target of 12.67%

↑

IAPT Recovery At M8 I&ESCCG are ahead of target at 50.4% and WSCCG are above target at 53.8%. Standard is 50% ↑

Updates: • CQC Inspection has taken place -outcome due 14.01.20• Trust restructuring continuing: localities now replaced by care groups – Senior

leadership team now in place• Serious concerns continue with regards to poor performance against some KPIs

for waiting times, and staffing challenges remain – vacancies ongoing• Priority focus for contracting is ongoing monitoring/review of recovery action plans

& processes; & procedures for management of waiting lists• Eating Disorders recovery plans received – under review with NHSE

Performance – Validated October 2019 position (plus unvalidated Nov 2019)

Contract Ipswich and East Suffolk CCG

West Suffolk CCG Total

Mental Health Main Contract

£41.6m £22.0m £63.7m

Primary Mental Health Care Contract

£6.4m £3.4m £9.8m

Total £47.0m £25.4m £73.5m

Measure LT median Oct Nov Dec NSFT Trend

Pressure ulcers (% of all patients) – all grades

NSFT wide 3.0 3.8 1.9 Falling

National 1.94 4.5 4.5 4.5 Below national

Falls (% of patients with or without harm)

NSFT wide 6.0 4.7 6.8 Rising

National 4.72 1.4 1.6 1.6 Above national

New VTE (% of patients)

NSFT wide 0.0 0.0 0.0 Stable

National 0.41 0.5 0.5 0.5 Below national

Harm free care (% of patients)

NSFT wide 96.0 94.3 96.1 Rising

National 93.92 94.0 94.0 94.0 Above national

https://www.safetythermometer.nhs.uk/index.php/classic-thermometer/analyse-data-classic/dashboard-classic

Finance/Activity

What are the top 3 risks and issues?

Rank Risk Owner Likelihood Impact Mitigation

1 Care UK have informed the CCG that they are currently unable to answer calls within the specified 60 seconds

CCG/Care UK High High

• Contract Performance Notice issued to Care UK, with recovery by 1 April 2019.• Care UK was unable to recover performance in the agreed timeframe. Exception Report issued (the next

stage of contract escalation). A revised recovery plan has been agreed for recovery by 1 April 2020.

2 Increasing number of ambulance and Emergency Department (ED) referrals sent from 111 linked with the risk above. CCG Medium High • Category 3/4 ambulance referrals are being clinically validated by ‘protected’ skilled clinicians across the

network - Clinical Validation queuing is taking place as directed by NHS England.

3 Number of ED referrals increasing as a result of redirected ambulance referrals. CGG Medium Medium

• 80% target for clinical validation of ED referrals taking place in Suffolk (currently only 24% of referrals are being validated).

• Informal Remedial Action plan in place

It has been agreed that financial penalties will be re-invested into the service to support remedial action to address those areas of performance failure (** 2.5% Cap of contractual value maximum fine has been met)RAG Indicator Comments Change

OOH KPIs 97.64% of all Suffolk patients seen within required timescales. ↔

111 – Calls answered in 60 secs – 95% threshold

78.26% against a trajectory of 95%, with the average speed to answer for Suffolk 111 calls being 51 seconds. ↓

Clinical contact –50%

69.69% of patients had direct contact with a clinician prior to any face to face consultation. ↔

Emergency Department referrals

Number of patients sent to ED was 7.04% of calls triaged against a trajectory of 8% ↔

Category 3/4Ambulance validation

66.39% of Cat 3/4 calls were validated against a trajectory of 80%. 49.7% of total C3/C4 ambulances were redirected to a more appropriate resource.

↑

Clinical Quality

Performance Indicator Threshold September October November Comments

Local Health Advisor Audits (111) over 3 months employment – average score 86% 92% 87% 89%

There were 4 Health Advisors on capability action plans in November

Local Clinical Advisor Audits (111) over 3 months employment – average score 86% 93% 92% 92%

There were no Clinical Advisors on capability action plans in November.

Suffolk Clinicians paper records documentation and assessment audit (OOH)

90% 94% 92.6% N/S

Suffolk & North East Essex Clinicians voice recording audits (OOH) 90% 90% 97 % 93.7%

Updates• 111 are now able to direct book into all GP surgeries within Suffolk.• An informal Remedial Action Plan has been agreed to recover C3/C4

Ambulance/ED Validation. This is on track.• The Suffolk Face to Face Minimum Data set from 24 April 19 is outstanding.

Work is ongoing with Care UK to provide this data. Resolution is expected by the end of January 20

• A care home pilot is being planned for this winter which will give care homes direct access to the Clinical Assessment Service. This development has been delayed, however mapping of the pathway has started.

• Calls answered in 60 seconds - performance is struggling and hasn’t improved as per the agreed recovery plan following issue of the Contract Performance Notice. The next level of contract escalation (an Exception Report) has been issued and a new Recovery Plan has been agreed with the provider for performance to fully recover to 95% by April 2020

November performanceCare UK Limited – Integrated Urgent Care service

020000400006000080000

100000120000140000160000180000200000

Jul-1

8

Aug-

18

Sep-

18

Oct

-18

Nov

-18

Dec-

18

Jan-

19

Feb-

19

Mar

-19

Apr-

19

May

-19

Jun-

19

Jul-1

9

Aug-

19

Sep-

19

Oct

-19

Nov

-19

Calls Answered

KPI penalties



1 Continued poor performance for Outpatient appointments and the associated costs to the Suffolk system. CCG / E-zec Medium Medium • Service redesign will allow for the Control function within Suffolk to focus on pre-planned and booked

outpatient journeys.

2 Continued poor performance in delayed discharges and lack of capacity to support both acute Trusts. CCG / E-zec Medium High • Service redesign allows for the acute Trusts to have direct input and control over capacity available to

them with dedicated discharge vehicles.

3 Reputation of Suffolk CCG’s in managing the current performance issues of the patient transport provision in Suffolk. CCG High Medium

• Ongoing work with stakeholders to manage patient comments and complaints accordingly. This includes correspondence with Healthwatch Suffolk and presenting at Health Overview and Scrutiny Committee along with regular updates to CCG and Associate Commissioner Boards.

RAG Indicator Performance ChangeLQR_01 - In-bound Journeys - % Service Users arriving between 5 and 60 minutes prior to their booked appointment time.

66.69% againsttarget of 95% ↔

LQR_2b - Journey Times - % Service Users travelling within the Ipswich and East Suffolk CCG and West Suffolk CCG combined footprint on the vehicle between 0 and 60 minutes.

77.63% against target of 85% ↔

LQR_3a - Outbound Outpatient Journeys - % Service Users waiting no more than 60 minutes after their booked and confirmed collection time.

86.05% against target of 95% ↑

LQR_3b - Outbound Discharge & Transfer Journeys - % Service Users waiting no more than 60 minutes after their booked and confirmed collection time.

66.07% against target of 95% ↓

LQR_8 - Front Door and Assessment Area Discharges -% Service Users collected no more than 60 minutes after initial contact or requested time.

74.42% againsttarget of 90% ↑

November performance – KPI’s under increased scrutinyE-zec Medical – Non-Emergency Patient Transport

Key Updates: • Local PTS model has changed which has given more flexibility to the acute Trusts to utilise

their capacity according to demand. Model went live early December and is demonstrating early success.

• 30% increase in vehicle fleet has been successfully delivered to support operations in Suffolk.

• Additional 25% staff (crew) to be in place by end of January 2020. The additional staff required in the meantime is being supplemented by 3rd party crew and pre-planned taxi support.

• Commissioners and E-zec were invited to present on current performance challenges at Health Overview and Scrutiny Committee in October and will be returning in January 2020.

KPI no. Indicator Target %

LQR_2a Journey Times - % Service Users on the vehicle between 0 and 90 minutes. 90% 90.23%

LQR_6Unplanned short notice/same day booking in hour’s service (after 1600 the previous day on the day requests) - % Short Notice Journeys Honoured by the Provider.

100% 98.16%

LQR_7 End of Life Transfers from acute hospitals to their choice of placement - % Bookings met within 2 hours of the original request. 95% 100.00%

LQR_9 Timed Care Packages - % Service Users returned to their place of residence in time for their timed care package. 95% 99.23%

LQR_10 Call Handling - % Calls received by the Health Care Professional Line answered within 2 minutes 95% 95%

LQR_11 Call Handling - % Calls received by the patient line answered within 3 minutes 95% 97%

LQR_4(Reporting Requirement) - Unplanned short notice/same day booking in hour’s service (after 1600 the previous day on the day requests) - % patients collected within a total 4 hour timeframe from initial request.

90% 99.04%

November performance – Remaining KPI’s

600065007000750080008500

Apr May June July Aug Sept Oct Nov

Number of Journeys (Inc. Aborts)

Baseline Actual

Finance/Activity

West Suffolk Hospital NHS Foundation TrustPerformance – November 2019 – data from WSFT KPI report/Trust board report

CCG Month 8 provisional data indicates WSCCG is £763K over and I&ESCCG is £35K over plan against the GIC values

Updates• In October the trust celebrated 4 years of having bleep volunteers. On an average

month the 29 volunteers save staff hours and make around 250 trips to and from the hospital pharmacy

• 66% of trust had their flu jab• CQC visit was completed and the trust await the outcome

RAG National Quality requirement Performance ChangeA & E - 4 Hour Target – WSFT are participating in the National pilot for A&E N/A N/A

Cancer 2ww 91.5% ↓ (was 93.5%)

Cancer 2WW Symptomatic breast 83.7% ↓ (was 88.7%)

18 Week RTT-Incomplete 80.5% ↓ (was 81.2%)

RTT waits over 52 weeks 8 ↓ (was 4)

Diagnostics 96.7% ↓ (was 98.6%)

Cancer 62 days GP referral 81% ↓ (was 83.0%)

RAG Local Quality requirement Performance Change

Stroke – admission to unit within 4 hrs 88.6% ↑ (was 75.5%)

Acute Oncology Service: Door to Needle 78.6% ↓ (was 92.8%)


1 Poor performance against national Cancer standards for 62 day wait referral to treatment Trust/CCG High High • Remedial action plan developed with detailed plans for 28 day diagnostic pathways

• Cancer summit in early November 2019

2 Significant challenges within RTT plan in order to deliver and sustain compliance of 18wks RTT target Trust/CCG High High

• Steering group in place to discuss and mitigate early risks to delivery of plan, attended by CCG• Weekly access meeting attended by CCG• RTT reduction model developed and tracked

3A&E failing to meet 4 hour standard presenting a potential risk to patient safety and experience Trust/CCG High High

• Trial of new standards ongoing• Daily performance information supplied and monitored, regular discussions and monthly formal

contract meetings.• Escalation of Health Dtoc daily for CCG and system support• OOH cover and 111 support continually reviewed to ensure rotas are in place to manage surges; GP

streaming in place• Detailed oversight from ED delivery Board

Clinical Quality

Performance Indicator Threshold Sept October November Change on mth

YTD Comments

MRSA - Total number of MRSA: Hospital 0 0 0 0 ↔ 2

C.Diff - Maintain Clostridium difficile Incidence below target (total incidence pre review)

16 per yrtrajectory

3 3 2 ↔ 10

Clinical - Pressure Ulcers - No. of hospital acquired pressure ulcers for inpatients*

0* 19 17 28 ↓ 155

Falls per 1000 bed days 5.6 4.94 ND ND 5.39

Mixed Sex Accommodation breaches 0 0 0 2 ↓ 32


Finance

What are the top risks and issues?

Community services

RAG Indicator Comments ChangeResponse times The Community Health Care Teams met most response

times for referrals within 4, 72 hours and 18 week RTT.

The 18 wk RTT for Paediatric Consultant Led services was missed at 75.32% (58/77).

↑

Children in Care Initial Health Assessments (provided by WSFT) (threshold 95%)

The % of children who had an initial health assessment completed within 15 days of receiving all paperwork was at 88.89% (8/9). See notes below in risk section.

↑

Care coordination centre (threshold90%)

% of calls answered in 60 seconds was at 90.23%. Three additional KPI’s have been developed and are being reported in relation to quality and accuracy audits for calls, electronic referrals and interactions. These all met the agreed thresholds.

↑

Delayed transfers of care (west)(threshold <3.5%)

Overall: 11.65%.The number of patients whose discharge was delayed was 27. The number of lost occupied bed days was 166. DTOC’s by Community beds site: 14.47% in Newmarket, 14.5% in Glastonbury and 0% in Hazell Court.

↓

Children’s wheelchairs – 18 wks. Referral to treatment (threshold 92%)

100.00% across both CCGs (22/22). IES CCG 100% (14/14)WS CCG 100% (8/8) ↔

November performance – West Suffolk NHS Foundation Trust

£1,900,000

£2,900,000

£3,900,000

East

Wes

t

East

Wes

t

East

Wes

t

East

Wes

t

East

Wes

t

East

Wes

t

East

Wes

t

East

Wes

t

East

Wes

t

East

Wes

t

East

Wes

t

East

Wes

t

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20

Community Contract - 2019/20 Finances

18/19 Baseline Growth Additional Investments

UPDATE- The whole service review of the Integrated Children’s Paediatric Service has been completed with

specific areas requiring further review identified – these include the nursing element of the service, Consultant Paediatrician capacity and therapies.

- The Alliance have served notice on the NEL contract for IT services from October 2020. The first exit meeting has taken place and individual work steams are currently being developed.

- Community Finance - Discussions have taken place with WSFT, ESNEFT and SGPF regarding some finance challenges around how the funding is apportioned across the contracts. Providers currently working up a finance model and principles to be agreed by all parties. Plan is to have this completed by no later than end of March 2020. This is progressing and the updated finance model is due to be completed by the end of January 2020 with principles to follow.

- The Children's Speech, Language and Communication needs service is continuing to be implemented. Recruitment has been successful and service changes are progressing. A dashboard has been developed to monitor the impact of the changes made using the additional funding that was approved. A trajectory for the 12 week target is also in the process of being developed. Outcome measures to determine the impact of the improved service for children are being developed.

- The Wheelchair service have developed a trajectory to reach the 18 week RTT target of 95% for the adult element (Children’s service already meeting target consistently) by April/May 2020. They are currently on target against the trajectory.


1

Children’s Complex Care Team – Difficulty in recruitment - There are continued struggles within the children’s service to recruit to the complex care team resulting in difficulties in commissioning packages of care to meet the needs of the child

All Medium Medium

• Recruitment is ongoing and risk is being mitigated by using agency staff and through the use of Personal Health Budgets.

• To incorporate the issue relating to this service, into the Integrated Community Paediatric Service review and appropriate recommendations determined.

• Terms of reference being developed for the deep dive into the service by end of January 2020.

2Delayed completion of Children in Care initial health assessments could mean the child’s health needs are not understood and acted upon in a timely way.

All High High

• Closely monitor the waiting list profile.• A business case has been received and reviewed to change the model to increase

the number and flexibility of appointments. This particularly affects the West and changes the model from cost per assessment to a salaried GP specialist. This has been agreed by the CCG in principle pending some outstanding queries raised with ICPS Lead. Awaiting final confirmation from service to begin pilot.

Finance/Activity

What are the top risks and issues?

Cambridge University Hospitals NHS Foundation TrustPerformance – November 2019

Update• At Month 8 CHUFT is £388k above plan for WSCCG (elective, non-elective and OP), and £651k below plan for IESCCG (elective, non-elective and critical care).• Delayed Transfers of Care – validated at 6.27% compared to 5.94% in October. There was an increase of 15.4% lost bed days attributable to social care, mainly due to waits for

nursing home placements• ED attendances have increased by 8.4% compared to last year. 369 patients had a length of stay in the ED of 12hrs+ in November. During November there were five 12hrs. breaches

and 8 in December.

RAG IndicatorNational Constitutional Indicators Change

A&E 4 hour – target 95% Reporting currently suspended as trust participating in the National Emergency Department Access Standards review pilot.

Cancer 2ww - target 93% Performance was 92.1%, an increase from 92% in September. The last 12 months performance is 92.3% ↑

Cancer 62 - day wait for first treatment from standard urgent referral – target 85%

Performance was 87.8%, an increase from 82.4% in September.The last 12 months performance is 85.1% ↑

RTT 18 weeks – target 92% Performance was 85.3%, a decrease from 85.5% in October.The last 12 months performance is 87.9% ↓

Diagnostic 6 weeks - target 99% Performance was 99.6% compared to 99.42% in October ↑

999 Handover delays –target 100%

54.5% of clinical handovers were managed within the target of 15 minutes. The department dealt with a 4.8% increase in conveyances to CUH compared to last year.Regionally, CUHFT was ranked 1st for ambulance handovers within 15mins and 5th for handovers complete within 30 and 60mins

↓


A&E – unprecedented numbers with high level of infection control issues due to norovirus and flu. Increasing number of DTAs. 30 so far in January – last Friday 22 in a day – most as patients were waiting isolation capacity – difficult decisions are being made

Trust High High

A CUH ED recovery plan is being overseen by the Chief Operating Officer. The plan includes• Pilot of Rapid Assessment and Treatment (RAT) process in the ED• Integrated working between Acute Physician in Charge and the Ops Centre bed management

team• Surgical Assessment Unit in place from January to support surgical flow from the ED• Recruitment of two clinical fellows to increase Same Day Emergency Care (SDEC) activity• Three additional discharge planning coordinators to support DTOC winter pressures.

Outstanding Performance Notices Contract R

AG

Performance Issue Contract Notice Stage

Last 3 months performance

Chan

ge fr

om p

rev.

mon

th

Current Status

Sept Oct Nov(unvalidated)

NSFT Indicator CO12/OP12a:Wait to Routine Assessment - Youth Services (0-18): Target 95% Remedial Action Plan 68.9% 71.43% 71.60% ↑

Recovery trajectory originally agreed as December 2019 : this was subject to Trust fully recruiting all vacant postsHigher levels than demand than anticpated via EWB Hub –trajectory to be reviewed when January 2020 data available

NSFT Indicator CO15/OP12b: Wait to Routine Assessment - Adult Services (18 and over): Target 95%

Remedial Action Plan 69.31% 73.7% 73.0% ↑

Recovery trajectory for May not met: under further revision in light of sustained underperformance: Performance not anticipated to recover until IDT acting as ‘stand alone’ team –AAT implementation plan now received: Significant levels of staff vacancies and capacity constraints continue to be the main reasons for non compliance against this indicator.

WSFTAcute Oncology: A&E performance

Exception Report(ER201516_01) 87.5% 92.8% 78.6% ↓

Acute oncology: MacMillan Unit

Contract RAG



Chan

ge fr

om

prev

.mon

th

Current Status

Sept Oct Nov

Care UK Calls Answered in 60 Seconds

Exception Report 79.2% 81.52% 78.26% ↓Improvement is expected with full recovery by the 1st April 2020

Contract RAG



Chan

ge fr

om

prev

.mon

th

Current Status

Sept Oct Nov

Glossary• EEAST- East of England Ambulance Service Trust• IH/IHT – Ipswich Hospital NHS Trust (merged with Colchester Hospital from 1 July 2018 to form

ESNEFT)• ESNEFT – East Suffolk and North Essex Foundation Trust (formed from merger of Ipswich and

Colchester Hospitals (CHUFT))• NSFT – Norfolk and Suffolk Foundation Trust – Mental health services provider for Norfolk and

Suffolk• WSFT- West Suffolk Hospital Foundation NHS Trust• IUC – Integrated Urgent Care• OOH- Out of Hours• MH- Mental Health• DTOC- Delayed Transfer of Care• EIP- Early Intervention of Psychosis• CQUIN- Commissioning for Quality & Innovation• IAPT- Improving Access to Psychological Therapies• DOLS- Deprivation of Liberty Safeguards• CQC- Care Quality Commission• RCA- Root Cause Analysis • RTT- Referral to Treatment

Top Contracts Key Performance IndicatorsContract Top Key Performance Indicators

East of England Ambulance Service NHS Trust• Category 1 calls mean arrival time <07:00 minutes• Category 2 calls mean arrival time <18:00min• Clinical handover from arrival <15mins 100% target

Norfolk and Suffolk NHS Foundation Trust• Early Intervention in Psychosis performance: 56% target• Routine referral to assessment within 28 days performance• Improving Access to Psychological Therapies recovery rates : 50% target• CPA: 7 day follow up post inpatient care: 95% target• CPA: 12 months review: 95% target

Care UK: GP Out Of Hours• Face to Face consultation within 2 hours • Base and Face to Face consultation within 2 Hours

Care UK: 111• Calls Answered in 60 Seconds: 95% target• Direct clinical contact prior to any face to face consultation: 50% target• C3/C4 Ambulance validation: 80 % target

Community services (was Suffolk Community Healthcare)• From referral to treatment within 18 weeks : 92% target• Patient bed days identified as Delayed Transfer Of Care: <3.5%• Children in care, initial health assessments completed within 15 working

days : 95% target• Timeliness of response to Education, Health and Care plans (EHCP)

‘information and advice responses’ submitted to LA within 6 weeks: 90% target

• Wheelchair Service Users (children)- equipment delivered in 18 weeks of being referred: 92% target

West Suffolk Hospital NHS Foundation Trust• A&E : Patients seen within 4 Hours: 95% target.• From referral to treatment within 18 weeks : 92% target• 62 day cancer pathway from GP referral to treatment: 85% target • Cancer 2WW: 2 weeks from GP referral to first appointment: 93% target • Diagnostic Tests within 6 weeks : 99% target

Cambridge University Hospitals NHS Foundation Trust• A&E - Patients seen within 4 Hours: 95% target.• From referral to treatment within 18 weeks : 92% target• 62 day cancer pathway from GP referral to treatment: 85% target • Cancer 2WW: 2 weeks from GP referral to first appointment: 93% target • Diagnostic Tests within 6 weeks: 99% target

Page 1 of 3




Governing Body Assurance Framework and Chief Officers Risk Registers

Lead Director

Amanda Lyes, Director of Corporate Services and System Infrastructure

Author(s)

Tony Buckle, Risk Manager

Purpose

To provide the Governing Body with the updated CCG Governing Body Assurance Framework (GBAF) document for January 2020.

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement Action required by the Governing Body: The Governing Body is requested to review and approve the updated West Suffolk CCG GBAF for January 2020.

1. Background 1.1 Content of the GBAF is reviewed by the Joint Leadership Team every month and by the Governing Body, Clinical Scrutiny and Audit Committees at each of their meetings. 2. GBAF - Key Issues

2.1 The following amendments have been agreed by the JLT at their regular review meeting, and are included in a separate table for West Suffolk CCG. The wording in the GBAFs has been revised to reflect the new leadership team structure.

2.2 The following amendments have been agreed by the JLT at their regular review meeting: Risk No and

Owner Risk description and actions update

NSFT 27a

Lisa Nobes

CQC and CCG inspections of NSFT services in Suffolk demonstrate that the service is inadequate leading to a risk of patient harm and poor experience. Action 1 complete – Quality assurance process to review every service line. Action 2 complete - Recruitment/secondment of NSFT senior leadership posts to drive improvement in NSFT / partnership working with East London Foundation Trust (ELFT).

NSFT 27b

Richard Watson

Poor performance of mental health services. Action 1 update - Children’s / adults routine assessment waits to recover to 28 days. Update: Dec 2019; Compliance for December unlikely due to vacancies and increasing demand via the EWB Hub. Updated trajectory awaited. Performance against Adult services indicator declining further, vacancies remain main cause of non-compliance, now being recruited into IDTs. Recovery plan for AAT received – trajectory for 28 day compliance due by 23/12/19.

Action 2 update - Long waits within EWB Hub. Update: Dec 2019; Trajectory received, compliance date of Nov 2019. This is now unlikely to be achieved due to higher than anticipated demand. Awaiting updated trajectory.

Action 3 update – Youth ADHD services. Update: Dec 2019; Service reviews established to scope scale of issues and oversee improvements. Agreed trajectory shows patients awaiting assessment to be cleared Nov 2019. This is achieved – max waits for assessment now at 8-12 weeks for new referrals. (Further work required to determine date for clearance of patients awaiting follow up). Completed: partially achieved – follow up issues ongoing.

Action 4 – Eating disorder waiting time. Update: Dec 2019, All new staff recruited. Recovery action plan received and under review with Trust and NHSE in bi weekly calls. Compliance date for both standards Jan 2019.

EEAST 39

Ed Garratt

EEAST is failing performance targets against ambulance response categories, particular concern are delays in the higher acuity Category 1 and 2 calls. Action 1c revised - Productivity/rota redesign work accelerated and revised strategic winter action plan agreed with NHSI/E. Action 1d revised - Local demand management schemes in place, these contribute to activity being 6% under agreed plan at month 8. Update December 2019 - Lead commissioner liaising with EEAST and NHSE/I on recovery trajectories as initial submission was unsatisfactory. EEAST closing front line resource gap for winter requirements and agreed overtime incentive scheme to target specific resource gaps (Q3).

SEND CAMHS 35

Lisa Nobes

If we do not improve access to CAMHS, community paediatric services (ICPS) and health checks in primary care and quality of CYP emotional wellbeing and mental health service consistently, then we will fail to deliver a good service to children and young people with SEND. Action 3 updates - High level model for neurodevelopment work complete, business case in development. ASD 12-18 yrs – Update; Dec 19 - action plan now in place and slippage monies agreed to work on waits. Trajectory awaited to detail clear timescales for recovery. Over 18 – Update; Dec 2019 - action plan now in place and slippage monies agreed to work on waits. Trajectory awaited to detail clear timescales for recovery.

CHC DOLS 35

Lisa Nobes

Significant reduction in the capacity of GP services in Haverhill affecting access times for patients, demand for other services and retention of clinical staff. Action 1 update - Paper detailing resource required to be prepared for presentation to Board by end of August 2018. Update December 2019; Draft paper has been written which will go to JLT and then Clinical Executive - IESCCG and WSCCG. Action 2 update - Priority cases applications- 4 per month to be in progress/completed – commenced July 2018. Update December 2019; 91 people meet acid test. 16 completed applications are with Kennedys who scrutinise them and then submit to a circuit judge for authorisation- only 1 has been put before a judge so far and we have yet to hear whether the deprivation has been granted. 75 applications outstanding, 8 of which are waiting for

receipt of a number of updated care plans / tenancy agreements / transition plans. Brexit 43

Amanda Lyes

Brexit and the possibility of a ‘no deal’ exit from the European Union. Part of granular operational risk revised. While the EU Withdrawal Bill was passed by Parliament on 20/12/19, negotiations on a new relationship are yet to start and with a timescale of just 11 months could again mean a ‘no deal’ exit becomes a possibility in January 2021.

Patient Transport 48

Richard Watson

Poor performance of non-emergency patient transport services. Additional key control established New service re-design in place from beginning of December splitting discharge and outpatient workload. Feedback from hospitals and E- Zec crews so far is this is working well and offering improved service to patients. Additional assurance of controls Weekly review of impact of new Service Redesign in place between E-Zec,, hospitals and CCG. Revised RAG rating reduced (from 16 to 9) Action 1 complete - Recovery plan agreed. Trajectory for compliance. Action 2 complete - Service redesign to be operational by 1 December 2019. Action 3 new action - Review impact of new service re-design in January 2020 and determine requirement of any further actions. Target date January 2020.

IUC calls answered in 60 seconds

51

Richard Watson

The IUC/111 service is failing the target for calls answered in 60 seconds. Care UK (Urgent Care Ltd.) predicting non-compliant performance until June 2020. Poor performance throughout winter period, potential of impacting on other services with demand ‘overspill’. All key controls established have had minor revisions. Action 3 update - Revised recovery plan to be shared with CCG end of November 2019. Update December 2019, After discussions, Care UK and the Commissioners have agreed April 2020.

3. Chief Officers Risk Registers

3.1 As previously agreed, a brief highlight report on current risks which may cause concern

to the CCGs from local Risk Registers is included in a summary table document with this report. These are reviewed on a regular basis by the JLT and by the Risk Forum.

3.2 The Risk Forum reviews all the departmental risk registers each month and they are all

up to date. The accompanying risk register summary table is from the Risk Forum meeting of December 2019, there have been some updates since then which are included.

Governing Body Assurance Framework and

Action Plan

2019 - 2020

Version Control:

MONTH

VERSION No

REVIEWED BY

SUMMARY OF CHANGES

April 2019

73

COT 6 April 2019 Clinical Scrutiny 24 April 2019

Approved

May 2019

74

COT 13 May 2019 Governing Body 22 May 2019

Approved

June 2019

75

COT 3 June 2019 Clinical Scrutiny 26 June 2019

Approved

July 2019

76

COT 1 July 2019 Governing Body 24 July 2019

Approved

August 2019

77

COT 5 August 2019 Clinical Scrutiny 28 August 2019

Approved

September 2019

78

JLT 2 September 2019 Governing Body 25 September 2019

Audit Committee 1 October 2019

Approved

October 2019

79

JLT 7 October 2019 Clinical Scrutiny 23 October 2019

Approved

November 2019

80

JLT 4 November 2019 Governing Body 27 November 2019 Audit Committee 3 December 2019

Approved

December 2019

81

JLT 2 December 2019 Audit Committee 8 January 2020

Approved

January 2020

82

JLT 6 January 2020 Governing Body 29 January 2020

February 2020

83

March 2020

84


Overview

The Governing Body Assurance Framework (GBAF) provides the NHS West Suffolk Clinical Commissioning Group (CCG) with a simple but comprehensive method for the effective and focused management of risk. Through the GBAF the CCG Governing Body gains assurance that risks are being appropriately managed throughout the organisation. The GBAF identifies which of the organisation’s strategic objectives may be at risk because of inadequacies in the operation of controls, or where the CCG has insufficient assurance. At the same time it encompasses the control of risk, provides structured assurances about where risks are being managed and ensures that objectives are being delivered. This allows the Governing Body to determine how to make the most efficient use of resources and address the issues identified in order to improve the quality and safety of care. The GBAF also brings together all of the evidence required to support the Annual Governance Statement. The GBAF should be seen as a working document and will be updated regularly by the Joint Leadership Team, monitored by the Audit Committee, Clinical Scrutiny and reported to the Governing Body at each of its meetings. The GBAF is linked to the Directorate’s Risk Register, the content of which is also provided for review by the Joint Leadership Team. A flow chart setting out how risks are identified and managed is set out overleaf. In order to ensure consistency in the risk assessment process, the likelihood and consequences of all risks on the Risk Register are assessed against the former National Patient Safety Agency (NPSA) 5X5 risk matrix and those scoring 15 and above and are of strategic concern migrate to the GBAF and thereby inform the Governing Body agenda. Once added to the GBAF, a risk should remain in place until its RAG rating has been mitigated to a score of 1-6 when it is considered manageable and therefore no longer a strategic concern. The 5X5 risk matrix and subsequent red, amber, green (RAG) score identify the level at which identified risks will be managed within the organisation. It also assigns priorities for remedial action, and determines whether risks are to be accepted on the basis of the colour bandings and risk ratings. In terms of evaluation of effectiveness, the RAG rating system is also used to present how well the agreed controls are operating.

RISKS IDENTIFIED THROUGH:

External Assessment & Audit + Guidance & Alerts

Serious Incidents, Complaints, Public Health &

Quality Issues

Public & Stakeholder Engagement

Business & Service Delivery Plans

CCG Governing

Body Own & Manage Risks & the Joint Leadership Team

Reviews the Directorate Risk

Registers and the GBAF


Overview & Scrutiny by the Audit Committee

Assurance to the Governing Body

Individual Risks Jointly Managed by Designated

Directors & Clinical Leads

Work Stream Risk Assessments

Review by Clinical Scrutiny Committee

Review by Local Risk Forum

RAG Score Framework

Likelihood score → 1: Rare 2: Unlikely 3: Possible 4: Likely 5: Almost Certain

Consequence score ↓

5: Catastrophic 5 10 15 20 25

4: Major 4 8 12 16 20

3: Moderate 3 6 9 12 15

2: Minor 2 4 6 8 10

1: Negligible 1 2 3 4 5

The subsequent red, amber, green (RAG) scores identify the level at which identified risks will be managed within the organisation. It also assigns priorities for remedial action, and determines whether risks are to be accepted on the basis of the colour bandings and risk ratings. In terms of evaluation of effectiveness, the RAG rating system is also used to present how well the agreed controls are operating within the following classifications:

In order to determine the likely consequence arising from an identified risk and using the 5X5 matrix:

• Define the risk explicitly in terms of the adverse consequence or consequences that might arise

• Use the table below for examples, by risk domains, to determine the consequence score relevant to the risk identified

RAG Score

Progress

Risk Assessment

Revising Risk Ratings

CRITICAL (15-25)

• There may be significant gaps in controls to ensure effective management.

• Controls are in place but insufficient resources

• Controls are in place but external forces may be preventing progress.

• There are insufficient controls in place to address the cause or source of the risk

• Controls are considered insubstantial or ineffective • Controls are being implemented but are not yet in place • If this risk were to materialise, the situation could be

irrecoverable in terms of the CCGs reputational/financial well being and or service continuity.

If controls are inadequate then the revised risk rating increases

If controls are uncertain, the revised risk rating stays the same as the original risk rating

If they are perceived as adequate, then the revised risk rating decreases

CHALLENGING (8-12)

Progress is being made but there is concern that the objective may not be achieved. Additional controls or management action is being taken to improve the likelihood of success.

There are few controls in place, which are considered substantial and/or effective and address the cause of the risk. The consequences of the risk materialising, though severe, can be managed to some extent via contingency plans.

MANAGEABLE (1-6)

Progress is being made in accordance with plans. There are no significant concerns.

The risk is considered to be small and there are sufficient controls in place which address or substantially effective the cause of the risk. The consequences of the risk materialising can be managed via contingency plans.

Consequence score (severity levels) and example of descriptions

1 2 3 4 5

Risk Domains Negligible Minor Moderate Major Catastrophic 1. Impact on the safety of patients, staff or public (physical/psychological harm)

Minimal injury requiring no/minimal intervention or treatment. No time off work

Minor injury or illness, requiring minor intervention Requiring time off work for >3 days Increase in length of hospital stay by 1-3 days

Moderate injury requiring professional intervention Requiring time off work for 4-14 days Increase in length of hospital stay by 4-15 days RIDDOR/agency reportable incident An event which impacts on a small number of patients

Major injury leading to long-term incapacity/disability Requiring time off work for >14 days Increase in length of hospital stay by >15 days Mismanagement of patient care with long-term effects

Incident leading to death Multiple permanent injuries or irreversible health effects An event which impacts on a large number of patients

2. Quality / complaints / audit

Peripheral element of treatment or service suboptimal Informal complaint/inquiry

Overall treatment or service suboptimal Formal complaint (stage 1) Local resolution Single failure to meet internal standards Minor implications for patient safety if unresolved Reduced performance rating if unresolved

Treatment or service has significantly reduced effectiveness Formal complaint (stage 2) complaint Local resolution (with potential to go to independent review) Repeated failure to meet internal standards Major patient safety implications if findings are not acted on

Non-compliance with national standards with significant risk to patients if unresolved Multiple complaints/ independent review Low performance rating Critical report

Totally unacceptable level or quality of treatment/service Gross failure of patient safety if findings not acted on Inquest/ombudsman inquiry Gross failure to meet national standards

3. Human resources / organisational development/staffing / competence

Short-term low staffing level that temporarily reduces service quality (< 1 day)

Low staffing level that reduces the service quality

Late delivery of key objective/ service due to lack of staff Unsafe staffing level or competence (>1 day) Low staff morale Poor staff attendance for mandatory/key training

Uncertain delivery of key objective/service due to lack of staff Unsafe staffing level or competence (>5 days) Loss of key staff Very low staff morale No staff attending mandatory/ key training

Non-delivery of key objective/service due to lack of staff Ongoing unsafe staffing levels or competence Loss of several key staff No staff attending mandatory training /key training on an ongoing basis

4. Statutory duty/ inspections

No or minimal impact or breech of guidance/ statutory duty

Breech of statutory legislation Reduced performance rating if unresolved

Single breech in statutory duty Challenging external recommendations/ improvement notice

Enforcement action Multiple breeches in statutory duty Improvement notices Low performance rating Critical report

Multiple breeches in statutory duty Prosecution Complete systems change required Zero performance rating Severely critical report

5. Adverse publicity / reputation

Rumours

Potential for public concern

Local media coverage – short-term reduction in public confidence Elements of public expectation not being met

Local media coverage – long-term reduction in public confidence

National media coverage with <3 days service well below reasonable public expectation

National media coverage with >3 days service well below reasonable public expectation. MP concerned (questions in the House) Total loss of public confidence

6. Business objectives / projects

Insignificant cost increase/ schedule slippage

<5 per cent over project budget Schedule slippage

5–10 per cent over project budget Schedule slippage

Non-compliance with national 10–25 per cent over project budget Schedule slippage Key objectives not met

Incident leading >25 per cent over project budget Schedule slippage Key objectives not met

7. Finance including claims

Small loss Risk of claim remote

Loss of 0.1–0.25 per cent of budget Claim less than £10,000

Loss of 0.25–0.5 per cent of budget Claim(s) between £10,000 and £100,000

Uncertain delivery of key objective/Loss of 0.5–1.0 per cent of budget Claim(s) between £100,000 and £1 million Purchasers failing to pay on time

Non-delivery of key objective/ Loss of >1 per cent of budget Failure to meet specification/ slippage Loss of contract / payment by results Claim(s) >£1 million

8. Service/business interruption

Loss/interruption of >1 hour

Loss/interruption of >8 hours

Loss/interruption of >1 day

Loss/interruption of >1 week

Permanent loss of service or facility

9. Environmental impact

Minimal or no impact on the environment

Minor impact on environment

Moderate impact on environment

Major impact on environment

Catastrophic impact on environment

WSFT – RTT. Risk 33 added February 2017

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GRANULAR OPERATIONAL RISKS

INIT

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KEY CONTROLS ESTABLISHED

ASSURANCE OF CONTROLS

RAG RATING OF

GAPS IN CONTROLS

RA

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REV

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RA

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ACTION POINTS & TARGET DATES FOR

COMPLETION

RW

WSFT is failing in their 18 week RTT performance on both an aggregate level and individual specialty level. Risk to CCG If WSFT fail to meet the 18 week RTT standard then the CCG will fail to meet its constitutional performance requirements as stipulated by the Department of Health.

Referrals have remained relatively consistent but RTT clock starts have increased. Outpatient Activity is stable as are non-admitted clock stops. However, elective activity and admitted clock stops are down. Specialities with the greatest need for improvement are orthopaedics, ophthalmology, vascular, cardiology and gynaecology. 52wk breaches continue but reducing in numbers WSFT financial position increased risk of recovery of RTT

4 x 4

16

Steering group meets at least monthly. Contractual performance review at each contract meeting as well as; • Weekly access

meeting. • Backlog clearance

plan underway: o Validation yielding

positive results o Demand and

capacity planning ongoing

o Additional internal activity in place

o Additional external activity outsourced and insourced

o Demand management projects.

Monthly review of waiting times and backlog clearance plan going forward CCG Priority Demonstrate excellence in patient experience

█

CHALLENGING

4 x 4

16

4 x 4

16

4. Achievement of 92% RTT target

Target: Has been agreed for 31st March 2020. Complete: Plan has been agreed by WSFT and CCG.

WSFT – A&E. Risk 37 added December 2017

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COMPLETION

RW

/FW

A&E failing to meet 4 hour standard presenting a potential risk to patient safety and experience. Risk to CCG If WSFT fail to meet the 4 hour standard then the CCG would have failed to meet its constitutional performance requirements as stipulated by the Department of Health

• Clinical risk of patients not being seen in appropriate timescales or insufficient beds to accommodate appropriate environments. • Risk of patient experience deterioration due to long waits. • Risk of breaching constitutional obligations. • Risk of no agreed plan to

manage increase in winter demand for services

4 x 4

16

• Daily reporting of

performance. • Escalation of Health

Dtoc daily for CCG and system support.

• OOH cover and 111 support continually reviewed to ensure rotas are in place to manage surges.

• Admission avoidance schemes fully operational and a rolling reminder in place to primary care and OOH.

• GP streaming in place.

• 111 targets to reduce inappropriate referrals to A+E.

• A&E Board in place. • Assess and address

staff shortages in medical and nursing rotas 10 days in advance.

• CCG escalation team working with WSFT to improve flow

Daily performance information supplied and monitored, regular discussions and monthly formal contract meetings. Formal contract notification to WSFT for joint working and review of performance in A+E requirement. Remedial Action Plan established by A+E delivery board.

CCG Priority Improve health and wellbeing through partnership working. Integrated performance report area. Contractual Performance

█

CHALLENGING

4 x 4

16

4 x 4

16

1. Complete actions from A&E Delivery Board Action Plans: h. Improve streaming

options in A&E i. Improve NHS111 call

triage and streaming to clinicians

j. Improve ambulance triage and streaming to alternative responses

k. Improved patient flow within the hospital

l. Improved discharge from hospital

Actions are monitored monthly by the A&EDB m. Revised remedial

action plan agreed with WSFT

n. Winter Surge and Pressure plan agreed

Target: March 2020 Completed:

WSFT – Cancer targets. Risk 45 added January 2019

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RAG RATING OF

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COMPLETION

RW

WSFT is failing in the nationally mandated quality requirement requiring that Service Users wait no more than 62 days from urgent GP referral to first definitive treatment for cancer. Risk to the CCGs If WSFT fail to meet the 62 day cancer standard then the CCG will fail to meet its constitutional performance requirements as stipulated by the Department of Health.

• Standard has been consistently missed. This is due to capacity and complex pathway issues in a number of specialties most notably Gynae, Skin, Head and Neck, Urology, and Lower GI.

• Clinical risk of patients not being seen in appropriate timescales.

• Risk of deteriorating patient outcomes and experience due to long waits.

• Risk of breaching constitutional obligations.

• Risk of increasing patient harm both physically and mentally due to being on Cancer pathway for extended period of time.

4 x 4

16

Remedial Action Plan drafted.

Review against targets and any remedial actions undertaken at monthly Quality and Contract performance meetings (QCPM).

Monthly breach reports submitted showing pseudonymised patient level details for days waiting with breach reason-reviewed at monthly QCPM.

Full RCAs undertaken for any patients waiting >104 days to establish if any harm caused- & reviewed at monthly Quality meeting.

Provider has reviewed attendance, process and governance for PTL meeting ensuring it works more efficiently.

Escalation process established for pathway co-ordinators for all services to avoid patients breaching.

Booking process from MDT discussion to OPD under review to ensure patients are booked within the same week.

Intensive Support Team visit and action plan developed.

Cancer improvement summit convened in November.

Written recorded /minutes produced of all discussions at contract/quality meetings. Written summary of performance and actions produced monthly for Lead CCG/Trust Directors meeting. CCG Priorities To ensure high quality local services where possible. Demonstrate excellence in patient experience. Integrated performance report area. Clinical Quality and Patient Safety

CHALLENGING

4 X 4

16

4 X 4

16

1. Trajectory has been agreed NHSE has reinforced importance of achieving target – CCG writing to Trust to outlines concerns and for reassurance of recovery. Cancer summit meeting being set up for November. NHSi and WSFT have completed a review of cancer performance – actions have been built into the recovery plan Cancer summit director level meeting occurred on 4th November, system wide actions action plan being completed. A further summit is booked for early March 2020. Target: March 2020 Completed:

WSFT – Finance Risk 52 added September 2019

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RAG RATING OF

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COMPLETION

JP

Financial pressures at WSFT present a risk to service delivery and create knock on financial pressures across the WS Alliance.

In year financial performance at WSFT is off plan and forecasts indicate non achievement of control total. Delivery of the financial control total (which releases additional funding for the trust) may require financial support from the alliance/ICS and/or service reductions. Suffolk and North East Essex ICS has elected to manage financial control totals at alliance level within the overall ICS control total– therefore financial risks at WSFT will put the achievement of the alliance and system control total at risk.

4 x 5

20

CCG shadow contingency set aside to support financial pressures relating to delivery of RTT and repatriation activity West Alliance Financial Strategy Group (FSG) now in place to monitor achievement of West Suffolk control total and discuss financial performance across the Alliance.

Reporting back discussions at Alliance FSG to CCG Executive and CCG FPC.

█

CHALLENGING

4 x 5

20

4 x 5

20

1. Work with trust to understand the drivers of the overspend

Target date: December 2019 Completion date: 2. West Suffolk Alliance

partners to determine actions to be taken to put the alliance back on track to achieve CT, escalating the issue to the ICS if necessary

Target date: November 2019 Completion date:

NSFT – CQC Inspection. Risk 27a added July 2015 (Renumbered January 2016)

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RATING OF GAPS IN

CONTROLS

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ACTION POINTS &

TARGET DATES FOR COMPLETION

LN

CQC and CCG inspections of NSFT services in Suffolk demonstrate that the service ‘requires improvement’ leading to a risk of patient harm and poor experience. Risk to the CCGs Statutory Duty to ensure patient safety within commissioned services: The Trust inability to demonstrate appropriate safety standards throughout it services present significant patient safety risks to the population of Suffolk.

• Inability to meet performance and clinical quality targets in access to service, care in service and discharge arrangements

• Inability to maintain safer staffing levels in accordance with NICE and National Quality Board guidance

• Lack of confidence in performance data

• Lack of patient safety culture throughout organisation impacting clinical risk assessment, care planning.

• Lack of clinical leadership structure throughout organisation

4 x 4

16

Quality assurance process initiated jointly with NSFT to review every service line in NSFT. Monthly meetings to review / challenge quality performance. Quality dashboard. Attendance at monthly stakeholder assurance meetings led by NHS Improvement / CQC. Oversight of quality improvement plans (trust / local) and monthly monitoring of progress. Monitor primary care contract issues and Trust response. New Chair appointed and partnership arrangement agreed with East London Foundation Trust (ELFT). Quality Improvement methodology introduced by Trust and training rolled out. Weekly CCG: NSFT Director meeting to check progress against actions and escalate concerns. Escalation through joint NHSI: CCG oversight meeting. Service user tracker list commenced and patient harm review process commenced.

Improvements to patient safety and experience noted through QA process.

Demonstrated improvement against identified contractual key performance indicators evidenced through quality dashboard escalation of issues via Contract Quality Performance Review (CQPR) meetings.

Confidence that NSFT have capability and capacity to deliver the required quality improvements.

Assurance that actions detailed in the quality improvement plan have been implemented. CCG Priority To improve access to mental health services

█

CHALLENGING

5 x 5

25

5 x 5

25

1. Quality assurance process to review every service line. Target: May 2019 Completed: December 2019 2. Recruitment/secondment of NSFT senior leadership posts to drive improvement in NSFT / partnership working with ELFT. Target: April 2019 Completed: December 2019 3. Implementation of Suffolk emotional wellbeing and mental health strategy to be commissioned through most capable provider process Target: March 2020 Completed: November update: NSFT CQC inspection completed; awaiting outcome. High level models signed off following submission in Sept 2019 for emotional / mental health transformation, continue to work on detailed model of delivery in the key areas of child / young person, LD / autism, Community all age and Crisis all age. Will be presented to clinical senate in Dec 2019. We continue to see some progress with NSFT performance and waiting times mainly in ADHD, the emotional wellbeing hub and emergency responses for all ages.

NSFT – Performance. Risk 27b added January 2016

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COMPLETION

W

Poor performance of mental health services Risk to CCG If performance does not improve to the contractual agreed standard then service users will continue to receive an inadequate service and the CCG would have failed in its duty to commission quality safe services

Poor performance against a number of performance indicators, most notably; Time to assessment. Routine Assessment of children (<18s) and Adults (>18) within 28 days. Long waits within the Emotional Wellbeing Hub (EWB) for patients aged 0-25. Youth ADHD services are reporting exceptionally long waits for assessment / treatment and concerns have been raised by patients/GPs and Community Paediatrician. Treatment of Children with Eating Disorders (urgent cases within 1 week and routine cases within 14 days).

Care Planning: Poor compliance with range of contractual standards

4 x 4

16

Remedial Action Plans under review for Children’s and Adults’ Routine Assessment performance indicators.

Additional CCG investment made into service: peer review undertaken with another ED service nationally to identify good practice that could be adopted locally.

CCGs have agreed non recurrent funding for EWB HUB to clear waiting list backlog and recurrent funding for additional HUB staff. New contractual standard in 2019/20 of 10 working days total time within Hub agreed.

ADHD service reviews held, CNO team undertaking review of waiting list focusing on processes for clinical safety/assessment of harm: CCG agreed additional investment for Consultant / Psychologist posts. New contractual standard in 2019/20 of 13 weeks from referral to diagnosis.

CNO regularly reviewing progress with CQC action plan via Clinical Quality meetings.

Range of new KPIs set in 2019/20 to give further transparency.

• Reported to the

workstreams, Clinical Executive and Governing Body as appropriate.

• CAHMS issues also overseen by EWB Hub Board

• Progress routinely monitored at monthly Quality Contracts & Performance (QCPM) meeting.

CCG Priority Improve access to mental health services

█

CHALLENGING

4 x 5

20

4 x 5

20

1 Children’s / adult’s routine assessment waits to recover to 28 days.

Target: Dec 19 (youth) Adults tba Complete: Update Dec 2019;

Compliance December unlikely due to vacancies and increasing demand via the EWB Hub. Updated trajectory awaited. Performance against Adult services indicator declining further, vacancies remain main cause of non compliance, now being recruited into IDTs. Recovery plan for AAT received – trajectory for 28 day compliance due by 23/12/19.

2 Long waits within EWB Hub. Target: Nov 2019 Update: Dec 2019; Trajectory

received, compliance date of Nov 2019.This is now unlikely to be achieved due to higher than anticipated demand. Awaiting updated trajectory

Complete: Issue ongoing. 3 Youth ADHD services. Target: Nov 2019 Reduce long

waits - Service reviews established to scope scale of issues and oversee improvements.

Agreed trajectory shows patients awaiting assessment to be cleared Nov 2019. This is achieved – max waits for assessment now at 8-12 weeks for new referrals.( Further work required to determine date for clearance of patients awaiting follow up. Completed: partially achieved – follow up issues ongoing.

4 Eating Disorder waiting time. Target: Compliance with national

standards by April 2019 Update: Dec 2019 - All new staff

recruited.

Recovery action plan received and under review with Trust and NHSE in bi weekly calls: Compliance date for both standards Jan 2020

Complete: Issues ongoing. 5 Care Planning, compliance with

KPIs. Target: TBA Update: Trust has shared detailed

plans, identifying specific teams/areas where targeted action required.

Completed: Issue ongoing.

EEAST – Performance. Risk 39 added February 2018 – risk is owned by Ipswich and East Suffolk CCG. For note on West Suffolk CCG GBAF

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RAG RATING

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ACTION POINTS &

TARGET DATES FOR COMPLETION

IQ/E

G

EEAST is failing performance targets against ambulance response categories, particular concern are delays in the higher acuity Category 1 and 2 calls.

Leadership Interim COO recently appointed Workforce EEAST under performing on recruitment against ISR plan impacting on the level of PFSH available to deploy on the road. Handover delays Arrival of ambulance to handover at ED delays and handover at ED to clear, ready for next call delays

5 x 3

15

Monthly quality and performance meetings held locally. Monthly quality and performance meetings held regionally. Commissioner attendance at EEAST internal Strategic Efficiency and Capacity review meetings. Review of delay serious incidents. Joint commissioner, EEAST and ESNEFT handover meetings held monthly. NHS 111/IUC enhanced clinical validation of C2, C3 and C4 ambulance dispositions.

Distribution of minutes and actions from sector and regional meetings. Weekly review of performance and handovers. Monthly review of NHS 111/IUC clinical validation performance. Clinical review of serious incidents through newly established SI panel. C1 and C2 performance improvements have been seen but not consistent CCG Priorities To ensure high quality local services where possible. To improve the health of those most in need

█

CHALLENGING

4 x 4

16

4 x 4

16

1. Action – EEAST have target workforce/capacity gap taking longer to fill than expected – overall EEAST Staff in Post is about 2894 vs ISR target of 3146 SIP meaning patient facing staff hours below funded levels. Actions/mitigations for safe service are:

a. Incidents monitored monthly through lead team/PQRM

b. Overtime/Private Ambulance Capacity targeted to peak demand shifts;

c. Productivity/rota redesign work accelerated and revised strategic winter action plan agreed with NHSI/E

d. Local demand management schemes in place, these contribute to activity being 6% under agreed plan at month 8

e. Handover delays at hospital managed/monitored weekly

Target: Lead commissioner liaising with EEAST and NHSE/I on recovery trajectories as initial submission was unsatisfactory. EEAST closing front line resource gap for winter requirements and agreed overtime incentive scheme to target specific resource gaps (Q3).

SEND - CAMHS. Risk 35 added March 2017

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ACTION POINTS & TARGET DATES FOR COMPLETION

LN/IK

If we do not improve access to CAMHS, community paediatric services (ICPS) and health checks in primary care and quality of CYP emotional wellbeing and mental health service consistently, then we will fail to deliver a good service to children and young people with SEND. Risk to the CCGs Statutory Duty to ensure patient safety within commissioned services: If improvements to service access is not made within CAMHs, ICPS and primary care, patient safety may be compromised.

• Delays in accessing

ASD/ADHD services. • Delays in accessing

speech and language therapy.

• Delays in accessing emotional wellbeing and mental health support for children and young people.

• Inconsistent quality of health input into EHCPs.

• Inadequate access to initial health checks for children in care.

• Access to health checks for young people with a learning disability require improvement consistently across Suffolk.

5 x 4

20

• SEND Programme

Board (& associated sub-groups) continue to provide strategic leadership and governance overseeing implementation of priority work streams

• Programme of transformation for CYP services

• Monitoring of access into CYP health services through CQPRMs

• QA process to review all NSFT

• Primary care QA visits involve LD health check review and support to improve performance

• Joint re-visit

(Ofsted/CQC) reviews.

• Access information reported to Clinical Scrutiny Committee.

• CAMHs operational meeting to be taken forward to track improvements against recommendations from QA visit.

CCG Priorities To ensure high quality local services where possible. To improve health and educational attainment for children and young people

█

CHALLENGING

5 x 4

20

5 x 4

20

1. Review of all NSFT CYP services and full implementation of recommendations.

Target: April 2019 Update No December 2019 update. 2.Review of Integrated Community Paediatric Service Target: January 2020 Update No December 2019 update. 3. High level model for neurodevelopment work complete, business case in development. Target March 2020

Update No December 2019 update. ADHD - September 2019; longest wait for assessment is 5 months. Young People referred now currently wait 2 months which is within expected timeframe.

ASD 12-18 yrs - Update; Dec 19- action plan now in place and slippage monies agreed to work on waits. Trajectory awaited to detail clear timescales for recovery.

Over 18 - Update; Dec 2019- action plan now in place and slippage monies agreed to work on waits. Trajectory awaited to detail clear timescales for recovery.

ICPS review completed by 31st October, and presented to CYP Board on 18th November.

Next steps are to consider redesign of a number of services to better meet the needs of children and young people. Initial thoughts are to look at the community nursing team, paediatric consultant service and OT & PT services.

A scoping report will be developed over coming weeks followed by a report around future delivery; expected February 2020.

GP Capacity. Risk 38 added January 2018

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COMPLETION

KV/

CB

Significant reduction in the capacity of GP services in Haverhill affecting access times for patients, demand for other services and retention of clinical staff.

Clinical risk of patients not being seen in appropriate timescales. Risk of patient experience deterioration due to increased waits. Risk of Haverhill practices not being able to function. List closures. Increased prescribing costs. Increased use of A&E and secondary care services, especially in CUHFT. Influx of 2500 Steeple Bumpstead patients increase demand

4 x 4

16

CCG Primary care strategy and support team in regular contact with practices. LMC / CCG / Fed meetings. Weekly Clinical Executive meetings. Bi-monthly Governing Body meetings. Resilience funding available. PCN work may offer efficiencies across sites, and align Haverhill. Comprehensive triage ensures patients who need to be seen are, those unable to be seen, who are triaged as non-urgent remain dissatisfied. Roll out of E – consult Steeple Bumpstead branch open 2.5 days per week

Currently: Primary care co-commissioning strategy. CCG Priorities Improve health & well-being through partnership working. Demonstrate excellence in patient experience and patient engagement.

Integrated performance report area. Clinical Quality and Patient Safety CCG monitoring of A&E attendances, shows no increase in demand Additional locum monies in place whilst conversion to salaried staff is undertaken

█

CHALLENGING

4 x 4

16

4 x 4

16

1. Ongoing support into Haverhill continues.

Target: August 2019 Completed: Ongoing 2. Solution to estate issues

being investigated. Target: November 2019 Completed: Ongoing

3. Key stakeholders are briefed, including neighbour practices.

Target: July 2019 Completed: Ongoing 4. Targeted extended access

to Haverhill to assist with demand.

Target: November 2019 Completed: Ongoing 5. Additional capacity into

extended hour’s initiative in Haverhill using winter monies.

Target: June 2019 Completed: Ongoing

CHC – DOLS. Risk 41 added July 2018

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COMPLETION

LN/IQ

There is a backlog in CHC patients with Deprivation of Liberty safeguards (DOLS) in place that require Court of Protection authorisation. This requires significant staffing resource and expertise in the Court of Protection process. This may have financial impact if the individuals or their families contest the restrictions in place. Risk to the CCG Statutory duties to Safeguard Individuals will not be met.

Risk to quality of care and safety of patients with DOLS in place within healthcare packages in their own homes - commissioned by CCGs.

4 x 4

16

Every patient has had a desktop review for their health and care needs related to their cognition to understand if they are likely to lack capacity to agree to their care plan. Compared review to the composition of package to understand if it is likely that they will meet the acid test of having their liberty deprived. Spoken to case management teams to understand risk and is starting to assess those patients. CHC register of patients requiring Court of Protection applications monitored and reviewed at regular Health DOLS Meetings.

External Advanced MCA and Advanced DOLS training commissioned by MCA/DOLS Lead and provided for CHC staff to upskill staff to make Court of Protection applications.

Concerns around CHC Register shared and discussed with CCGs MCA/DOLS Lead CHC Priority List shared and discussed at 6 weekly DOLS Meetings chaired by CCGs MCA/DOLS Lead. Priority cases discussed with legal representative from Kennedys as necessary Through dedicated case management system, patients frequently discussed and clinical supervision in place. Court of protection applications reviewed by legal prior to submission to Court Audit of controls to be completed by internal audit. CCG Priority Demonstrate excellence in patient experience and patient engagement

█

CHALLENGING

3 x 4

12

3 x 4

12

1. Paper detailing resource required to be prepared for presentation to Board by end of August 2018

Target: March 2019 Complete: Update Dec 2019: Draft paper has been written which will go to JLT and then Clinical Executive IESCCG and WSCCG.

2. Priority cases applications- 4 per month to be in progress/completed – commenced July 2018.

Target: March 2019 Complete: Update Dec 2019 91 people meet acid test. 16 completed applications are with Kennedys who scrutinise them and then submit to a circuit judge for authorisation- only 1 has been put before a judge so far and we have yet to hear whether the deprivation has been granted. 75 applications outstanding, 8 of which are waiting for receipt of a number of updated care plans/tenancy agreements /transition plans.

Cyber Security. Risk 42 added September 2018

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AL/

CB

Potential impact of cyber security incident could lead to wide scale IT system outages, meaning no access to patient records, e-dispensing services etc Risk to the CCGs The CCGs would suffer significant service disruption and potential patient harm and financial loss

National requirements have increased, in respect of the need to achieve cyber essentials + accreditation.

No national funding has been identified specifically for cyber security work to mitigate against the increased risk, and the increased requirements.

No access to systems – would require frontline services to fully enact Business Continuity and Disaster Recovery procedures.

Potential for lack of access to relevant IT skills and insight to develop a recovery plan (dependent on type of attack).

Restoration of services complex, would involve multiple vendors and take a significant period of time

4 x 5

20

Note - eliminating the risk of a cyber-attack completely is not possible.

Following external cyber assessment (conducted as part of post-Wannacry cyber-attack local review); a number of areas to be addressed to reduce both the risk of an attack and any potential impacts (see actions). In progress: Service provider (NEL) undergoing wide scale review of cyber assurance, have achieved cyber essentials accreditation March 2019, and working toward cyber essentials + accreditation in 2019. The CCG has its own domain (green) under NEL and will be working towards achieving cyber essentials accreditation for the CCG also.

TIAA have reviewed cyber security controls. Assurance received.

ETTF (GP IT Capital) funding has been successful to implement a security monitoring product (to be determined) to improve network monitoring.

Additional ETTF (GP Capital) funds have been successful to implement a NAC solution, details being worked up with NEL. Board level training delivered to IESCCG and WSCCG Board and Lay Members.

External Audit. Internal audit complete Monthly SLA provider meetings. Monthly service review provider meetings. Bi-monthly Joint Digital and IT Services Board. Audit Committee review. Scrutiny Committee review Governing Body

█ CHALLENGING

4 x 5

20

4 x 5

20

1. Rollout of threat detection capability (national solution – ATP). 65% complete.

Target date: Feb 2020 Completion: 2. Regular communications to

users re phishing threats. Target date: Ongoing Completion: 3. Wide scale review of patching

processes and application. Target date: Ongoing Completion: Proposed further actions as implementation plans progress: Procure and rollout new network switching system with NAC (stage 1). Implement new licencing. (Office 2019 and potentially an O365 F1 licencing add on). Procure and rollout identity management system. Rollout W10. Implement end user training programme. Rollout DarkTrace security software.

Brexit. Risk 43 added October 2018

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AL

Brexit and the possibility of a ‘no deal’ exit from the European Union Risk to the CCGs The outcome of negotiations and the forthcoming general election may result in a lack of definitive planning for CCGs.

• Continuing lack of clarity about the potential outcome of negotiations & resultant lack of definitive planning guidance.

• Inability of providers to deliver contractual obligations with possible shortages of drugs, medical equipment & staff

• Financial pressures become more acute after a no deal Brexit, resulting in direct knock-on effects on waiting times, recovery rates & quality of care.

• Additional administrative issues if resident EU citizens no longer qualify for NHS care under existing EU reciprocal healthcare arrangements.

• Access to public health contracts

• While the EU Withdrawal Bill was passed by Parliament on 20/12/19, negotiations on a new relationship are yet to start and with a timescale of just 11 months could again mean a ‘no deal’ exit becomes a possibility in January 2021

4 x 4

16

• Reports on preparedness requested from provider organisations

• Continued focus on strong financial & contract management

• ICS engagement on coordinated management of issues arising

• Engagement with NHSE full Incident Coordination Centre (new operational date now awaited) who will deal with any fall out from a negotiated or a no deal scenario

• DHSC EU Exit Operational Readiness Guidance including Action Card for Commissioners • Senior Responsible

Officer identified and supported by Emergency Planning and Resilience Manager.

• Internal CCG EU Exit team created to assess emerging risks.

• Local Health Resilience Partnership EU Exit Plan written,

Local Health Resilience Partnership had EU Exit exercise.

• Regular monitoring of developments by JLT

• Engagement with NHSE, STP & providers

• Reports to the Governing Body

• Engagement with Clinical Executive & GP’s

• Production of CCG EU Exit Action Log to ensure all Action Card for Commissioner requirements are completed

CHALLENGING

4 x 4

16

4 x 4

16

1. Preparedness Reports from Providers - these are provided to NHSE EU Exit team. Any challenges are relayed to us to review with the provider

Target date: 31/01/2020 Completion date: Underway 1. Completion of CCG Brexit

Action Log. Target date: 31/01/2020 Completion date:

Patient Transport Services Risk 48 added May 2019

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RW

Poor performance of non-emergency patient transport services. Risk to CCG If performance does not improve to the contractual agreed standard then service users will continue to receive an inadequate service.

The performance of the PTS provider remains below the expectation set out in the contract. The main reasons identified include: - Insufficient resource - Poor planning resulting in inefficiency - Difficulty recruiting and high attrition rates Failure to deliver a service in line with expectation may result in: - Continued poor patient experience - Delayed discharges from hospital - Missed OP Appointments Patients miss appointments adding further pressure on elective waiting lists

5 x 4

20

CCG escalation team and Acute Trust operational and patient flow teams increased scrutiny on service.

Supportive process of service review and development carried out (Red to Green week) and Service Development and Improvement Plan (SDIP) developed and actions to improve service agreed.

New experienced senior local management team at Provider

New service re-design in place from beginning of December splitting discharge and outpatient workload. Feedback from hospitals and Ezec crews so far is this is working well and offering improved service to patients

CCG escalation team continue to monitor individual discharge and transfer journeys to reduce to risk of delayed and failed discharges which would result in reduced capacity. Weekly conference calls with Provider to review agreed action plan and recovery performance. New E-zec regional director in place. Capacity and demand forward view shared with hospitals and CCG. Weekly review of impact of new Service Redesign in place between E-zec, hospitals and CCG

CHALLENGING

4 x 4

16

3 x 3

9

1. Recovery plan agreed. Trajectory for compliance Target: November 2019 Completion date: Complete 2. Service redesign to be to

be operational by 1 December 2019.

Target date: December 2019 Completion date: Complete

3. Review impact of new service re-design in January 2020 and determine requirement of any further actions.

Target date: January 2020 Completion date:

Provider Workforce Risk 49 added July 2019

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Lack of sufficient workforce across the system leading to risks to patient safety, care and services

The system has ageing clinical workforce with insufficient younger workforce to replace, leading to clinical risk of patients not being seen in appropriate timescales and inability to meet clinical and performance quality targets.

Brexit instability affecting overseas workforce.

Inability to maintain safer staffing levels in accordance with NICE and National Quality Board guidance.

Higher sickness absence of staff due to workload further impact on patient safety, care and services impact on staff retention, losing staff due to increased workload. Risk of patient experience deterioration due to long waits.

Risk of breaching constitutional obligations.

Primary care risk of some practices not being able to function and list closures.

EEAST under performing on recruitment against ISR plan impacting on the level of PFSH available to deploy on the road.

3 x 5

15

At system level, a workforce strategy is in place.

• Collaborative working across providers to deliver;

• Joint recruitment initiatives,

• Career development, portfolio careers,

• Joint training (clinical and non-clinical)

Interim NHS People Plan released. Local Workforce Assurance Boards established.

System wide Primary Care Training Hub established.

IESCCG and WSCCG LWAGs (Local Workforce Assurance Group) reporting to Local Workforce Assurance Board (LWAB). IESCCG and WSCCG Training Hub Advisory Groups (THAG) reporting to the Training Hub Governance Group.

CHALLENGING

3 x 4

12

3 x 4 12

1. LWAB workforce intelligence group to develop system workforce plan with agreed recruitment targets.

Target date: March 2020 Completion date: 2. LWAG, THAG established

2019 to work collaboratively on local recruitment, opportunities to develop new roles, staff training and development.

Target date: March 2020 Completion date:

3. Established nursing programme. Meeting target to raise student nurse placements by 15%. Fundamentals programme available for all new nurses.

Target date: March 2020 Completion date: 4. Next Generation Project

established to provide careers advice and joint recruitments events across Suffolk and NEE. Working with schools and colleges to raise awareness of job opportunities.

Target date: March 2020 Completion date: 5. GP Support Hub providing

support for the recruitment and retention of GPs. Monthly data showing progress.

Target date: March 2020 Completion date:

Demand Management Risk 50 added August 2019

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RW

and

KV

Non elective demand (A&E attendances and Non Elective Admissions) rises at a greater level than is planned causing deterioration in performance at West Suffolk NHS Foundation Trust

A&E attendances grow by more than projected which causes significant waits for patients within A&E NEL admissions grow by more than projected which causes patient flow issues and the need to open additional capacity in the acute hospital System wide recruitment challenges impacting on ability to manage increases in demand

4 x 4 16

• Updated daily, weekly

and month analysis of demand broken down into categories

• CCG Escalation Team working across the health and care system on day to day demand pressures

• System Demand Management Action Plan developed and in place

• Additional CCG funding in place to support demand management initiatives

• Daily performance

information supplied and monitored, regular discussions and monthly formal contract meetings.

• ED Board in place meeting monthly overseeing system demand.

█

CHALLENGING

4 x 4

16

4 x 4

16

1. System demand management and escalation plans targeting high volume activity with focus on: - walk in activity from Bury Town and Sudbury - Over 75s admissions - Long length of stays

Target date:1.12.19 Completion date: 4. System leaders operational

group in place with shared access to demand data providing oversight and operational delivery of system demand and capacity plans

Target date:1.11.19 Completion date: 5. Alliance local workforce

group in place with system recruitment and retention plan approved with focus on priority staffing challenges

Target date:1.12.19 Completion date: 6. Locality plans developed

with PCNs localising demand management delivery

Target date:1.12.19 Completion date:

IUC calls answered in 60 seconds Risk 51 added August 2019

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The IUC/111 service is failing the target for calls answered in 60 seconds. Care UK (Urgent Care Ltd.) predicting non-compliant performance until April 2020. Poor performance throughout winter period, potential of impacting on other services with demand ‘overspill’.

• Clinical risk of

patients not being spoken to in appropriate timescales

• Risk of deteriorating patient outcomes and experience due to long waits.

• Risk of breaching constitutional obligations.

• Risk of increasing patient harm.

• Potential impact on increasing demand for other providers

4 x 4

16

Care UK have completed a capacity/demand staffing restructure, this has re-aligned the Health Adviser rota with demand. Commissioners have served Contract Performance Notice and Exception report notice due to failure to achieve previous recovery plan. New trajectory and action plans have been agreed with the provider. Commissioners are working with Care UK and are reviewing the activity baseline and associated finances agreed in the Contract.

• Updates from Care UK through regular conference calls.

• Contractual communication with Provider to ensure all immediate actions are being taken including use of clinical advisors (clinicians) front ending calls.

• Updated recovery plan to be received fortnightly

CHALLENGING

4 x 3

12

4 x 3

12

1. Contract Performance Notice and Exception report issued. Contract management and agreement of new recovery plan proposed.

2. Front end staffing consultation/restructure to be completed 11th November

Target: Care UK current proposal was not agreed by commissioners with a recovery date of June 2020. New Proposal April 2020 Completed: Agreed with Care UK to be April 2020. 3. Revised recovery plan to

be shared with CCG end of November 2019.

Target: To agree with Care UK to bring forward the recovery plan or to achieve greater recovery earlier.

Completed: After discussions, Care UK and the Commissioners have agreed April 2020.

Directorate Risk Register summary of top risks

Date: January 2020

Department Risk Description / consequences

Current controls / assurance RAG Actions with status Completion date

Responsible person

1. Corporate Services

Failure to recruitment and retain GPs locally.

Range of GP initiatives being delivered across the ICS. GP Support Hub operational for four months. GP Fellowship programme. GP Trainee Skills Programme. Pastoral support for GP Trainees. Coaching offer for GP at all stages. GP Flex programme. Improve data quality on GP.

12

Achieved 2018/19 plans agreed for 2019/20. Additional funding secured for GP Support Hub. Part of portfolio career offer for GPs. Support for GP Trainees to transition into employment. Support for all GPs through mentoring and coaching. Flexible contract. Better understanding of workforce and gaps.

31 March 2020 Amanda Lyes


Hawthorn Drive Surgery are 100% over capacity in current premises; housing developments in the area will add further pressure to the patient list

A feasibility study is being conducted to identify all public assets in the area and the potential for the relocation of the surgery to co-located premises or a new build health and care hub (first proposal due Dec 19) A short-term plan is being developed whilst the long-term plan is underway to place a portacabin on site to offer 2 additional clinical rooms and admin space

6

Monthly meetings are in place with the surgery and key partners involved in the long-term and short-term plan including Ipswich Borough Council, the CCG and the One Public Estate project manager.

End Feb 2020 Julia Hiley


Staff uncertainty due to organisational change is becoming apparent. Discussion of the required reduction in administrative costs does not allay fears of redundancy

Staff are being reassured as far as possible, with restructuring planned to be as smooth as possible.

12

Continue to reassure staff and that they are informed as soon as reasonably appropriate of any changes. Run team meeting on planned changes to ensure understanding in place.

End Jan 2020 Amanda Lyes

Risk Description / consequences


Responsible person

1. COO Ipswich & East and West

Church Farm surgery. Lead GP retiring September 2019, remaining Partner part-time. Therefore significant reduction in clinical staff.

Resilience funding secured from NHSE to provide support.

15

Meeting with Practice to discuss options. NHSE has agreed to use resilience money to invite Royal College of General Practitioners to carry out a diagnostic.

31 March 2020 David Brown

2. COO Ipswich & East

Social Prescribing: Connect for Health - Information Governance.

Patient data and information governance concerns between GP practice, CCG, Citizens Advice Bureau and Suffolk Community Foundation.

12

Work progressing well. Working with GP DPO, CAB, CCG Primary Care IG Lead and team. SLA in place, consent form and partnership agreement. Concerns re summary of client records after appointment with Community Advisor. Currently GP practice enter this information but looking at getting System One Unit.

31 March 2020 Louise Hardwick



Responsible person

1. Contracts Ivry St have given 6m notice for the level 3 minor surgery (dermatology) and vasectomy procedure. No obvious alternative in place. Needs to be provided somewhere to avoid impact on acute services. Activity currently as expected and transfer of referrals need to be in place by December to maintain continuity.

Working with current and potential providers to ensure options are available to GPs and that the impact of any potential gap is minimised.

12

Potential short term supplier identified - way forward being agreed by JLT: • Close Ivry St list • Very short term - AQP

with Bury, Thetford and Norwich Services

• Short term – source temp alternative in IES

Medium term – complete tender

March 2020 Jon Reynolds

2. Contracts Community Contract Children in Care Not meeting statutory indicators in relation to initial health assessments for children in care. New model has been

Additional monies were awarded to the service to recruit additional GP's into the service to enable flexibility of appointments. No progress seen in performance against the targets.

16

WSFT Paediatric lead developing business case to present new way of working offering necessary flexibility for children and carers. GP capacity to look to offer

Jan 2020

Nicola Brunning

implemented but performance low and showing children not being seen in expected timescales. Risk: Model is not appropriate and working for children in Suffolk.

weekly appointments instead of monthly. Look at Paediatric capacity to offer week appointments instead of monthly. Looking at how new Named Doctor post can provide capacity for initial health assessments. Update 13.01.20 - After discussion between CCG and ICPS, a 6 month pilot has been agreed to employ a salaried GP to undertake the IHA, pending final agreement from ICPS along with revised costings and start date. Aim to have finalised and in place before end of January 2020.



Responsible person

1. Finance The CCG required to make 20% saving in running costs in FY 2020/21. In FY 2019/20 requirement to maintain running costs at current rate. Risk is that unless plans are made / implemented in good time, within the current FY, the CCG will fail to meet running cost targets for 2020/21.

The CCG has put in place a recruitment freeze, is consolidating roles across the 3 CCGs in the STP at a senior level in order to reduce costs, and has already got a single AO and DoF across the 3 bodies. The CCG plans to fully integrate all management delivery teams.

12

The risks have been significantly reduced and restructure consultation period has ended. Current information indicates we should meet the 20% savings requirement. Until all posts / appointments have been finalised this cannot be fully confirmed, likelihood remains at 3.

March 2020 Jane Payling

2. Finance Failure to achieve in year financial balance, secure financial sustainability and deliver optimum service from financial resources available.

Guaranteed Income Contracts in place with key providers. Clinical Executive and Governing Body review expenditure and significant investments. Project management approach to delivery of QIPP through PMO

10

Monthly SLA provider meetings. Monthly Financial Performance Committee reporting. Continued push for further QIPP opportunities.

March 2020 Jane Payling



Responsible person

1. Nursing

E-Zec not able to meet performance requirements, which impacts on; patient experience, quality of service offered, performance / service for other Providers, CCG / Provider reputation.

CPN and RAP in place. Weekly monitoring of RAP and KPIs.

12

CCG Clinical quality team providing support to the Provider with reporting for SIs, incidents and complaints. Additional monthly meetings at E-Zec Medical with CCG Clinical quality team to provide support and assurance.

Nov 2019 Rowena Harland



Responsible person

1. Transformation CYP ADHD - Unable to commission long-term, sustainable under 18s ADHD service for Suffolk - Linked to SEND Action Plan requirements and also priority within the CAMHS Transformation Plan.

Recovery Plan and trajectory in place with regular operational meetings to oversee progress.

9

Currently on target to clear waits by Nov 2019. Business case received to be considered within Neurodevelopmental service

30 Dec 2019 Jo John

2. Transformation Impact on system wide capacity to deliver core service to support ED and emergency care.

Significant operational resourcing gaps across system wide providers, having a negative impact on demand management, that will ultimately impact on delivery of Integrated Care Programme for 2019/20. System wide workshop being held on 13/6/19 to understand demand drivers and plan to mitigate risks

12

Pan Suffolk - Concerns over lack of system engagement from Care UK in the West

31 March 2020 Clare Banyard and

Sandie Robinson

Page 1 of 2




Freedom of Information

Lead Director

Amanda Lyes, Director of Corporate Services and System Infrastructure

Author(s)

Tony Buckle, Risk Manager

Purpose

To update the Governing Body on Freedom of Information activity within the CCG

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement Action required by the Governing Body: The Governing Body is asked to note the report.

1. Background 1.1 The Freedom of Information Act 2000, provides a general right of access to information

held by public authorities, including the NHS. Anyone can request information and has the right to be told:

• Whether the public authority holds the information, and • If it does, to be provided with the information (subject to exemptions)

The Management Delivery Team handles requests on behalf of both West Suffolk CCG and Ipswich and East Suffolk CCG and as of 1 April 2019 on behalf of North East Essex CCG (NEECCG).

2. Key Issues 2.1 This report covers the second and third quarter of 2019/20.

2.2 Suffolk CCGs requests received average around 20 - 25 per month with NEECCG receiving slightly less. Almost all of the Suffolk requests cover both CCGs with only a few being directed specifically to one Suffolk CCG.

2.3 Both Suffolk and NEECCGs had all requests answered within the 20 working days allowed under the Act, apart from one request for each that was responded to one day after the 20 day deadline.

2.4 The source of requests remains consistent and the majority still come from requesters identifying as members of the public and general businesses.

Interest groups are also responsible for high numbers of requests and patterns seem to develop depending on what is being reported in the newspapers and on TV.

The media (local and national) also make a small number of requests, again generally related to issues currently being discussed by parliament or other media sources.

2.5 The main topics requested have been varied with no real popular topic. 3. Future Action 3.1 The Risk Manager will continue to manage the responses to requests for information

received under the legislation. 3.2 The tables in Appendix 1 give an overview of the number of requests received for the second and third quarter of 2019/20 for Suffolk and NEE CCGs. Appendix 1

Jul – Sept 2019 Number of requests July Suffolk - 23 NEE - 17

August Suffolk - 30 NEE - 22 September Suffolk - 18 NEE - 16

Oct – Dec 2019 Number of requests October Suffolk - 18 NEE - 14

November Suffolk - 33 NEE - 30 December Suffolk - 22 NEE - 18

Quarter totals Number of requests Jul - Sep Suffolk - 71 NEE - 55 Oct - Dec Suffolk - 73 NEE - 62

Total Suffolk - 144 NEE - 117

GOVERNING BODY

Agenda Item No. 16



Title Minutes of Meetings

Lead Director Amanda Lyes, Director of Corporate Services and System Infrastructure

Author(s) Jo Mael, Corporate Governance Officer

Purpose To receive a report from the Lay Member for Governance seeking the endorsement of minutes and decisions from West Suffolk CCG Sub Committees,

a) Financial Performance CommitteeThe unconfirmed minutes of a meeting held on 18 December 2019

b) West Suffolk CCG Primary Care Commissioning CommitteeThe unconfirmed minutes of a meeting held on 27 November 2019

c) Commissioning Governance CommitteeDecision from ‘virtual’ meeting held on 12 November 2019

Applicable CCG Priorities 1. Develop clinical leadership 2. Demonstrate excellence in patient experience & patient engagement 3. Improve the health & care of older people 4. Improve access to mental health services 5. Improve health & wellbeing through partnership working 6. Deliver financial sustainability through quality improvement


To endorse the minutes and decisions as attached to the report whilst noting that ‘unconfirmed’ minutes remain subject to change by the relevant Committee/Group.

Unconfirmed Minutes of a meeting of the West Suffolk CCG Financial Performance Committee held on 18 December 2019

PRESENT: Steve Chicken Lay Member (Chair) Dr Zohra Armitage GP Governing Body Member Dr Christopher Browning CCG Chair Geoff Dobson Lay Member for Governance Ed Garratt Chief Executive (Part) Amanda Lyes Director of Corporate Services and System Infrastructure Jane Payling Director of Finance (Part) Dr Godfrey Reynolds GP Governing Body Member Dr Bahram Talebpour GP Governing Body Member Lynda Tuck Lay Member for Patient and Public Involvement Dr Firas Watfeh GP Governing Body Member Dr Victoria Wilson GP Governing Body Member Dr Andrew Yager GP Governing Body Member IN ATTENDANCE: Mark Clinton Senior Management Accountant Lucy Game Operational Manager, NHS Continuing Healthcare Dr Andrew Hassan Enhanced Associate GP Martin Jarrett Senior PMO Manager (Part) Jo Mael Corporate Governance Officer Lisa Nobes Director of Nursing Kate Vaughton Chief Operating Officer

19/014 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and no apologies for absence were received.


No declarations of interest were received.

The Chair advised that item 6a) (Continuing Healthcare) would be taken first, followed by the PMO report.

19/015 FINANCIAL RISK AREAS

Continuing Healthcare The Committee was in receipt of a report which provided financial information in respect of continuing healthcare as there was concern at the increasing overspend in that area. It was reported that the over-spend was due to an increase in fast-track referrals, 522 last year in West Suffolk with a forecast for 2019/20 of 620. There was an expectation that 95% of fast-track referrals would be accepted and the CCG level was currently 98-99%. There had also been an increase in the number of continuing healthcare referrals although conversion rates remained steady. There had been 1391 care packages to October 2019, with a forecast

at year-end to have commissioned an additional 500 packages than the previous year. There had been a need to increase one to one care provision as a result of increased challenges and the issue was being taken forward via the Care Home Strategy with action including discussions with specialist providers re future provision. West Suffolk Hospital NHS Foundation Trust (WSFT) was keen to support the CCG in respect of continuing healthcare and discussion in relation to a review of high cost packages was planned. Whilst care for complex patients made up the bulk of the expenditure, there were all subject to review by the High Cost Complex Case Panel and robust validation processes were in place. Comments included; • It was confirmed that the fast-track process was subject to a national criteria/framework. • Having noted that robust governance processes were in place and that the High Cost

Complex Case Panel operated effectively, it was felt that the care of individuals was being demonstrated and subsequently questioned whether continuing healthcare was funded appropriately.

• Having queried whether the right providers were in place, the Committee was informed that there was a domiciliary joint framework in place with ACS and utilisation of a strong specialist provider. However, all providers were experiencing workforce issues.

Having considered future action, it was agreed that the Continuing Healthcare Team would work closely with the Finance Team to identify a suitable forecast for the 2020/21 budget, and that discussions with WSFT regarding package costs should be pursued. The Committee requested an update report to its March 2020 meeting.

(Jane Payling joined the meeting and Lucy Game left)

19/016 PROJECT MANAGEMENT OFFICE (PMO) REPORTS

The Committee was in receipt of a report from the Senior PMO Manager with key points highlighted being; • There was currently and 95% achievement of QIPP delivery which was being monitored

closely. • Individual projects were detailed within the report and there had been an 5%

underperformance over the last quarter. • Transformation funding schemes were progressing well and were mostly on track with

only a small number of up to date evaluation forms awaited. With regards to the Atrial Fibrillation Detection project, it was explained that a cost implication for pharmacies had been identified. Nine pharmacies had signed up to the project but not all had submitted activity reports. The Chief Operating Officer agreed to present more detailed information to a future Executive. The Committee noted the report.

19/017 MINUTES OF PREVIOUS MEETING

The minutes of the meeting held on 18 September 2019 were agreed as a correct record.

19/018 MATTERS ARISING AND REVIEW OF ACTION LOG


19/019 FINANCIAL REPORTING MONTH 08

The Committee was in receipt of a report which set out the CCG’s financial position at month 08 of 2019/20. Key points highlighted during discussion included;

• The CCG was on track to deliver its planned £1.2m surplus at year-end.

• Key risks identified were prescribing and continuing healthcare. Whilst risks were mitigated by the use of contingency, reserves and year-end flexibilities, the situation was becoming more challenging.

• There was an underlying surplus and QIPP delivery was 95%. • The acute underspend was in relation to the Addenbrooke’s, Papworth and Norfolk and

Norwich contracts. • There was a £280k overspend in relation to brain injuries which was due to an increase in

the volume and cost of placements. • Learning Disability (LD) placements were below budget. • There was a £171k over-spend in relation to prescribing due to CAT M and NCSO drugs

with the forecast over-spend at year-end being £1m. Prior year benefit contingency available in 2019/20 is unlikely to be available in 2020/21. The CCG, along with other CCGs continued to lobby nationally in respect of the additional costs associated to CAT M and NCSO drugs.

• There had been an uplift to the Care UK contract from November 2019 which was indicated within the report.

• The primary care delegated commissioning budget was over-spent due to primary care network development which had been under-funded.

• In response to questioning, it was explained that there was a quarterly recharge from WSFT for offender health activity had been higher than in the previous quarter 1 and 2. The Committee requested that the offender health budget be investigated further with NHS England.

• The effect on the 2020/21 budget was queried, and it was explained that formal guidance in relation to planning for 2020/21 was expected in January 2020. It was likely that a further Committee meeting would need to be convened in January/February 2020 to discuss 2020/21 plans in detail.

The Committee noted the report.

(Ed Garratt joined the meeting)

19/020 FINANCIAL RISK AREAS

Steeple Bumpstead The Director of Finance reported that work continued to transfer the practice to the CCG and ascertain any cost implications. The importance of coding activity correctly was emphasized, together with the need to ensure that the relevant allocation was received by the CCG. It was confirmed that the CCG had been in discussion with its finance colleagues in West Essex CCG and NHSE regarding how the funding could be accessed within the current financial year and going forward. – For 2019/20 WSCCG would recharge West Essex CCG for any additional

costs incurred relating to secondary care for Steeple Bumpstead patients – For 2020/21 onwards an allocation transfer would be actioned It was felt there could be opportunity to improve prescribing figures going forward. Having queried whether individual funding requests associated to Steeple Bumpstead patients had been factored into the allocation, the Director of Finance agreed to discuss the issue further with the Director of Nursing outside of the meeting The Committee noted the report.

19/021 ALLIANCE FINANCES

Minutes of the Alliance Finance Committee

The Committee was in receipt of the minutes from a meeting of the Alliance Finance Committee held on 30 October 2019. There had been good discussion and the next meeting was planned for January 2020 when it was hoped a work-plan for the Committee would be developed.

The Committee noted the minutes as presented. Alliance Discretionary Funding The Committee was in receipt of a report which detailed 2019/20 Alliance discretionary funding. The Committee noted the report.

19/022 INTEGRATED CARE SYSTEM UPDATE

ICS Finance Report Month 7

The Director of Finance advised that the report outlined a breakdown of spend across the three Alliances. As the reporting of social care costs across the ICS was carried out slightly different by each County Council, work was underway to attempt to align reporting methods going forward. The report identified that the CCG spent more on acute and less on mental health than others across the ICS. Both the East Suffolk and North Essex NHS Foundation Trust (ESNEFT) and West Suffolk NHS Foundation Trust (WSFT) were reporting in-year overspends of c£5m. WSFT’s position was the most concerning and discussions continued to attempt to utilise locally monies previously put aside to assist neighbouring CCGs. Borrowing across the ICS continued to be monitored closely and activity trends were not out of line with regional growth figures. Workforce continued to be the key challenge and it was anticipated that the ICS Partnership Board would receive a report in January 2020 on the development of a new People and Culture Board which was being set up to replace the Local Workforce Advisory Board (LWAB). It was suggested that report also be presented to the Alliances at some point. Having queried action in respect of WSFT’s over-spend, the Committee was informed that the issue was due to be discussed at an Executive/Executive meeting to be held later that day. Update on Long Term Plan The Director of Finance reported that since presentation of the draft Long Term Plan to the CCG’s Executive there had been no update and instruction and next steps were awaited from NHS England. The Chief Executive subsequently reported that NHS England had recently advised that the CCG was now free to publish the plan if the regional office had approved it. Delivery of the plan within the Alliances would be key and it was expected that a draft operational plan would be required by the end of February 2020. As the regional office had recently established a group to review allocations across the region, the importance of the CCG having representation on that group was emphasized. The Committee noted the update.

19/023 ANY OTHER BUSINESS

No items of other business were received. 19/024 REFLECTION

The Chair gave a reflection on business conducted at the meeting and wished everyone a

Merry Christmas and Happy New Year.

19/025 DATE OF NEXT MEETING

The next meeting was scheduled to take place on 18 March 2020 0900-1030hrs in Ground Floor Room 14, West Suffolk House

Unconfirmed Minutes of a meeting of the West Suffolk CCG Primary Care Commissioning Committee held in public on Wednesday, 27 November 2019 at

Conference Room West, West Suffolk House, Western Way, Bury St Edmunds, Suffolk

(The meeting was inquorate)

PRESENT: Geoff Dobson Lay Member for Governance (Chair) Ed Garratt Chief Officer Jane Payling Director of Finance Kate Vaughton Director of Integration Dr Christopher Browning West Suffolk CCG Chair Wendy Cooper NHS England Simon Jones Local Medical Committee Stuart Quinton Suffolk Primary Care Contracts Manager, NHS England IN ATTENDANCE: Jo Mael Corporate Governance Officer Jane Taylor Estates Development Manager, North East Essex CCG Daniel Turner Estates Development Manager Lois Wreathall Head of Primary Care

19/66 APOLOGIES FOR ABSENCE

In the absence of both the Chair and Vice Chair, it was agreed that the Lay Member for Governance Chair today’s meeting. It was agreed that absent Committee members should be asked, via email, to consider items presented for approval and respond with their decision. Once concluded the outcome of each decision would be circulated to all Committee members. Apologies for absence were noted from; Steve Chicken, Lay Member Amanda Lyes, Director of Corporate Services and System Infrastructure Cllr James Reeder, Health and Wellbeing Board Lynda Tuck, Lay Member, Patient and Public Involvement Andy Yacoub, Healthwatch


No declarations of interest were received.

19/68 MINUTES OF THE PREVIOUS MEETING

Those present approved the minutes of a West Suffolk CCG Primary Care Commissioning Committee meeting held on 22 October 2019 subject to their further approval by absent members of the Committee (03/12/19 – subsequent to the meeting these minutes were approved by absent members)

19/69 MATTERS ARISING AND REVIEW OF OUTSTANDING ACTIONS


19/70 GENERAL UPDATE

The Director of Integration reported: • An education event had been held on 14 November 2019 with key topics being

safeguarding and prevent. The event had included a session for practice nurses. Forums had also been established for medical secretaries/care navigators and practice managers.

• A recent Care Quality Commission inspection had resulted in Market Cross surgery being reconfirmed as ‘outstanding’

• Steeple Bumpstead had now become a branch surgery of Christmas Maltings and Clements practice. All staff involved in the transition were thanked for their hard work.

Those present noted the update.

19/71 SERVICE CHARGE POLICY

Those present were in receipt of a report which provided an overview of the recent service charge policy which had been developed and released by NHS England as part of its update of the ‘Primary Medical Care Policy Guidance Manual. Directions 46 and 47 of ‘The National Health Service (General Medical Services – Premises Costs) Directions 2004 and 2013 (PCDs) enabled GP practices to submit a claim to the Clinical Commissioning Group, for support in the payment of both running and service charge costs associated with their premises for the delivery of their GMS contract. The Directions were quite explicit in respect of the items which a practice could not seek reimbursement and those fell within one of the following four categories:

i. Fuel and electricity charges; ii. Insurance costs; iii. Costs of internal or external repairs; and iv. Building and grounds maintenance costs.

Whilst any costs deemed to fall within one of the above categories must be excluded from a claim for financial assistance, other costs associated with the running of the premises could be submitted to the CCG under a claim for financial assistance. Where a claim was submitted, the CCG must consider it and, in appropriate cases, having regard to its budgetary targets, grant the application.

Applications for reimbursement of costs would be associated with practices which were within shared multi tenanted buildings as they were likely to be incurring costs beyond those listed above (i-iv).

In addition whilst some Directions within the PCDs prescribed a time limit within which a claim must be submitted, Directions 46 and 47 did not. Therefore Directions 58 (for claims under the 2004 Directions) and 53 (for claims under the 2013 Directions) applied, which allowed a practice to submit a claim for up to six years back dated reimbursement.

Whilst the provision for reimbursement had been within the PCDs since at least 2004, it did not appear that practices had taken the opportunity to seek assistance with such costs until very recently. Similarly, NHS England had only published guidance via the form of the service charge policy in 2019. The report went on to outline the policy detail which included the responsibilities of commissioners, GP contractors and landlords/leaseholders; together with information in respect of eligibility and financial assessment. Points highlighted during discussion included;

• Although the need to assess the financial implications was highlighted, it was

recognised that the opportunity for practices to claim had been present since 2004 as part of the (General Medical Services – Premises Costs) Directions.

• Whilst it was thought that currently two practices within the CCG area might be able to lodge claims, it should be noted that with increased emphasis on co-location, other instances might transpire going forward.

• The need to be aware of opportunities to gain more control over the estate, going forward, was highlighted.

• The service charge policy was an NHS England policy that the CCG was being asked to adopt. It was not a regulation. The policy had been produced by NHS England in conjunction with the London Local Medical Committee.

• In response to questioning, it was explained that the policy should be helpful and less onerous for staff than having no policy in place.

After consideration, those present approved implementation of the service charge policy across West Suffolk CCG, subject to its final approval by absent members of the Committee. (03/12/19 – subsequent to the meeting and having obtained the agreement of all members of the Committee the decision was altered to the following:)

The Committee approved implementation of the service charge policy across West Suffolk, subject to development of a framework for use in application of the policy, and an assessment of any future financial liability.

19/72 PRIMARY CARE CONTRACTS AND PERFORMANCE

Those present were in receipt of a report which provided an update on contractual and

performance related matters in respect of GP Practices, together with actions taken. The report provided information and outlined ongoing actions in respect of the following areas; • Care Quality Commission • Quality Outcomes Framework reporting • Prescribing and medicines management • Learning Disabilities (LD) health checks • Severe mental illness physical health checks • Dementia Key points highlighted during discussion included; • Serious mental illness and physical health check numbers were increasing.

• Work continued to promote learning disability health checks in practices and it remained a high priority for the CCG.

• Having queried Quality Outcome Framework (QOF) exception reporting, it was explained that once practices had made three valid attempts to engage patients with no success they were permitted to mark as an exception so as not to be penalised. Data was reviewed regularly by the CCG to ensure the appropriateness of exception reporting.

• There was increased access to memory clinics and work being carried out within care homes to identify individuals with dementia.

Those present noted the content of the report.

19/73 PRIMARY CARE DELEGATED COMMISSIONING – FINANCE REPORT

Those present were provided with an overview of the Primary Care Delegated Commissioning Budget at month seven. At the end of month seven, the GP Delegated Budget spend was £342k over spent. Key variances were detailed in paragraph 2.1 of the report. In month seven the CCG had identified the following opportunities amounting to £951k;

Underperformance on the 2019/20 GP+ contract. Remaining prior year benefit relating to GPFV Access funding had been transferred to

Primary Care Contingency.

Risks not reflected in the above full year forecasts were further increases in rent reimbursement and additional practice management support. Having queried whether there might be opportunity for primary care network underspend to be utilised to support the CCG’s financial position it was explained that all budgets were considered in the round and closely tracked. As the primary care network budget had been over-committed initially, any opportunity should be prioritised for primary care in the first instance. The Local Medical Committee (LMC) representative advised those present that as it was recognised that the primary care delegated budget had been underfunded, the LMC was intending to take the issue up with NHS England. Those present noted the financial performance at month seven.

19/74 PRIMARY CARE NETWORKS

Those present were provided with an update on the ongoing maturity of Primary Care

Networks (PCNs) in West Suffolk as described in the document, ’Investment and Evolution; a five year framework for GP contract reform to implement the NHS Long Term Plan’. Key elements of the document were detailed in Section 2 of the report. All practices had now become members of a Primary Care Network (PCN) and it was anticipated that, with support, they would mature on the trajectory indicated in the maturity matrix. Key points highlighted included; • Six PCNs had been established.

• Six social prescribers had been recruited and were due to commence in the role from January 2020.

• Three clinical pharmacists had been directly employed by PCNs.

In response to questioning it was explained that PCNs were not legal entities. There remained a lack of clarity in respect of finances as PCNs were an extension of the GP GMS contract which would cause confusion were they to take on other parties or bodies. Those present noted the content of the report.

19/75 ANNUAL PLAN OF WORK

The annual plan of work was received and it was noted that it would be updated in line with today’s discussions.

19/76 DATE OF NEXT MEETING

The next meeting was scheduled to take place on Wednesday, 26 February 2020 from

2.00pm-4.00pm in the Conference Room, West Suffolk House, Western Way, Bury St Edmunds, Suffolk, IP33 3SP

19/76 QUESTIONS FROM THE PUBLIC

No questions were received.

West Suffolk CCG

Commissioning Governance Committee (via email)

12-15 July 2019

Decision Record

Integrated Front Door Model at West Suffolk NHS Foundation Trust To receive and approve a report from the Director of Strategy and Transformation

Richard Watson Report No:

WSCCG/CGC 19-08 Commissioning Governance Committee Members: Geoff Dobson (Chair), Governing Body Lay Member for Governance Steve Chicken, Lay Member Ed Garratt, Chief Officer Jane Payling, Chief Finance Officer Lynda Tuck, Lay Member for Patient and Public Involvement Declarations of Interest No declarations of interest were received.

Decision

To approve an extension of the current GP streaming contract by 17 months, subject to the Clinical Executive receiving an evaluation of the new model in the summer of 2020. The cost to extend the contract is £662,525 for 17 months. This is a reduction in the current models costs by approximately £8,000 a month.

Page 1 of 4




Terms of Reference for Community Engagement Group

Lead Director

Lisa Nobes, Director of Nursing Kate Vaughton, Chief Operating Officer

Author(s)

Kate Vaughton, Chief Operating Officer Lynda Tuck, Lay Member for Patient and Public Involvement

Purpose

To set out for review and approval, refreshed terms of reference for the Community Engagement Group.

Applicable CCG Priorities 1. Develop clinical leadership x 2. Demonstrate excellence in patient experience & patient engagement x 3. Improve the health & care of older people x 4. Improve access to mental health services x 5. Improve health & wellbeing through partnership working x 6. Deliver financial sustainability through quality improvement x Action required by Governing Body: To review and approve, refreshed terms of reference for the Community Engagement Group, a Committee of the Governing Body

Page 2 of 4

1. Purpose Background 1.1 To set out for review and approval, refreshed terms of reference for the Community

Engagement Group (CEG). 2. Background 2.1 To complement the CCG’s continuing development of its patient and public involvement plan

and to enable effective Alliance working, revised terms of reference for our Community Engagement Group are proposed.

3. Key Points 3.1 The changes made are quite significant and therefore ‘tracking’ creates a document which is

difficult to read. A summary of the changes is therefore presented below:

• The purpose, remit and responsibilities have been adjusted to put greater emphasis on working in partnership with patients and the public and with the CCG’s Clinical Executive. Further emphasis is also placed on bringing about greater inclusion of members of minority and marginalised groups.

• The number of members remains as 15 but there is explicit reference to extending

invitations to representatives of other organisations forming part of the West Suffolk Alliance.

• There is no change to the current terms of office, which is two years with an option of serving for a further two years.

• There is clarity that meetings will be held in public at least quarterly.

• The option is provided for one of the Co-Chairs of the CEG to report from the Committee to

the Governing Body. This has been very positive in West Suffolk.

• The option is provided for either the Chief Nurse or Chief Operating Officer to report to the CEG on the CCG’s business.

• The quoracy clause has been supplemented to include that a member of the Clinical

Executive (GP, Chief Officer or their representative) must be present.

• The statements about the conduct of the group have not been altered.

• The language used in the terms of reference is now considered by the Group to be more accessible, ‘plain English’.

4. Recommendation 4.1 The Governing Body is invited to review and approve the refreshed terms of reference for

the Community Engagement Group.

Page 3 of 4

COMMUNITY ENGAGEMENT GROUP (CEG)

TERMS OF REFERENCE

1. PURPOSE

To support the CCG’s Lay Member for Patient and Public Involvement in helping to ensure:

• that the public voice of the local population is heard in all aspects of the CCG’s business

• that opportunities are created and sustained for patient and public partnership-working across the CCG’s activities

To operate as a formal committee of the CCG reporting regularly to the Governing Body. To provide a forum for West Suffolk’s communities to communicate directly with the CCG on matters of interest, concerns or desired developments. To work as a partnership bringing together service users, clinicians, CCG staff, voluntary sector and Alliance partnership representatives to explore matters of mutual interest, concern or development. To help bring about greater inclusion of members of minority and marginalised groups. 2. RELATIONSHIP WITH THE GOVERNING BODY AND CLINICAL EXECUTIVE Written reports from the CEG will be received at Governing Body meetings. At least two members of the Clinical Executive will be nominated to attend CEG meetings. 3. MEMBERSHIP The Community Engagement Group will comprise:

• Lay Member for Patient and Public Involvement.

• Elected co-chairs drawn from members of CEG not including paid employees of the CCG, Healthwatch Suffolk or Community Action Suffolk. Chair-ship will be rotated every three years to maintain continuity and succession planning.

• The Chief Operating Officer and the Director of Nursing and Clinical Quality or their

representative.

• No more than 15 members, including the Co-Chairs.

• A member will be affiliated where possible with each of the CCG’s locality areas.

• To reflect our strategic partnerships, a member of Healthwatch Suffolk and Citizens Advice will be invited to attend meetings. Invitations may also be extended to representatives of other organisations forming part of the West Alliance.

Page 4 of 4

4. QUORACY The following members must attend for the Committee to be quorate:

• One of the Co-Chairs • A member of the Clinical Executive (GP, Chief Officer or their senior representative) • A minimum of seven members in total

5. LOCATION The CEG meetings are to be held within West Suffolk. Meetings in public will be held at least quarterly. Planning and business meetings will take place every other month except August and December. 6. TERMS OF OFFICE Members of the CEG serve for two years with the option to serve for a further two years. At the end of four years membership of CEG concludes. Tenure of each Co-Chair is for a three-year period, ideally with an overlap to ensure continuity. 7. REPORTING ARRANGEMENTS Either a Co-Chair or the lay member with lead responsibility for patient, carer and public involvement will provide a report of its meeting to the CCG Governing Body. The CEG will receive a verbal report from the Chief Operating Officer and a written Patient and Public Involvement report at its planning and business meetings. 8. CONDUCT OF THE GROUP The Co-Chairs will manage the meeting agenda to make best use of the time available to ensure equal opportunity for contributions to be heard. The Group will review its effectiveness including terms of reference on an annual basis. The Governing Body will be asked to approve any resulting changes to the terms of reference or membership.

Documents

AGENDA The Governing Body will be available to meet with ......2020/01/29 · Governing Body GP Member Godfrey Reynolds Member of the Local Medical Committee P Direct Ongoing 29/10/2019