Chair’s Report able Officer’s Corporate Report12ibcm2f1hm941gh4lrvpwk1-wpengine.netdna-ssl.com/wp-content/u… · 10/12/2019 · - Dr Girish Purohit asked that the word ‘refusing’

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Meeting Title

East Leicestershire and Rutland Clinical Commissioning Group – Governing Body meeting

Date Tuesday 10 December 2019

Meeting no.

61 Time 9:30am – 11:10am

Chair Dr Ursula Montgomery CCG Chair

Venue / Location

Council Chamber, County Hall, Glenfield, Leicester, LE3 8RA

AGENDA ITEM ACTION PRESENTER PAPER TIMING

B/19/128 Welcome and Introductions

Dr Ursula

Montgomery 9:30am

B/19/129 Apologies for Absences:

Dr Girish Purohit

To receive

Dr Ursula Montgomery verbal 9:30am

B/19/130 Notification of Any Other Business To

receive

Dr Ursula Montgomery

verbal 9:30am

B/19/131 Declarations of Interest on Agenda Topics To

receive All verbal 9:30am

B/19/132 Minutes of the meeting held on 8 October 2019

To approve

Dr Ursula Montgomery A 9:35am

B/19/133 Matters Arising: Update on actions from the meeting held on 8 OCtober 2019

To receive

Dr Ursula Montgomery B 9:40am

B/19/134 To receive questions from the Public in relation to items on the agenda only

To receive

Dr Ursula Montgomery verbal 9:45am

REPORTS

B/19/135 Chair’s Report To

receive Dr Ursula

Montgomery C 9:55am

B/19/136 Accountable Officer’s Corporate Report

To agree

Donna Briggs on

behalf of Andy Williams

D 10:05am

ITEMS FOR DECISION, ACTION AND ESCALATION

B/19/137 Finance Report: Month 7 update To

receive Donna Briggs E 10:15am

B/19/138

Summary report from the Provider Performance Assurance Group meeting (November 2019)

To receive

Warwick Kendrick

F 10:25am

B/19/139

Summary report from the Integrated Governance Committee meeting

(5 November 2019)

To receive

Warwick Kendrick

G 10:35am

2

AGENDA ITEM ACTION PRESENTER PAPER TIMING

B/19/140 Corporate Performance Report To

receive Paula Gibara H 10:40am

ITEMS FOR INFORMATION

B/19/141

Summary report from the Primary Care Commissioning Committee (5 November 2019)

To receive

Fiona Barber I 10:50am

B/19/142

Summary report from the Collaborative Commissioning Committee meeting (November 2019)

To receive


J 10:55am

B/19/143 Minutes of the System Leadership Team meeting (September 2019)

To receive


K 11:00am

DATE OF NEXT MEETING

B/19/144

The next meeting of the ELR CCG Governing Body will be held in common with LC CCG and WL CCG, which will take place on Tuesday 14 January 2020, LOROS, Groby Road, Leicester. The next meeting of the ELR CCG Governing Body will be held on Tuesday 11 February 2020, Council Chamber, County Hall, Glenfield, Leicester.


11:05am

EXCLUSION OF THE PUBLIC

In accordance with the provision of Section 1(2) of the Public Bodies (Admissions to Meetings) Act 1960, to exclude representatives of the press and general public from the meeting due to the confidential nature of the business to be transacted.

A

Blank Page

Paper A East Leicestershire and Rutland CCG Governing Body Meeting

10 December 2019

EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP

Minutes of the Governing Body Meeting held on Tuesday 8 October at 9.30am,

In the Council Chambers, Glenfield, Leicester, LE3 8RA

Present: Ms Fiona Barber Deputy Chair and Independent Lay Member (Chair of

meeting, in the absence of Dr Ursula Montgomery, CCG Chair)

Mrs Donna Briggs Chief Finance Officer and Deputy Managing Director (on behalf of the Managing Director)

Mr Colin Groom Deputy Chief Finance Officer (on behalf of Chief Finance Officer)

Mrs Tracy Burton Interim Chief Nurse and Quality Officer Mr Paul Gibara Chief Commissioning and Performance Officer Mr Tim Sacks Chief Operating Officer Mr Warwick Kendrick Independent Lay Member Dr Girish Purohit GP Locality Lead, Syston, Long Clawson and Melton Dr Anuj Chahal GP Locality Lead, Harborough Dr Vivek Varakantam GP Locality Lead, Oadby and Wigston In Attendance: Dr Janet Underwood Chair, Healthwatch Rutland Dr Katherine Packham Public Health Consultant Mrs Daljit K. Bains Head of Corporate Governance and Legal Affairs Mrs Emma Casteleijn Head of Communications and Public Affairs Mrs Claire Middlebrook Corporate Affairs Support Officer (minutes) Members of the public: Two members of the public were seated in the public gallery.

ITEM DISCUSSION LEAD RESPONSIBLE

B/19/109 Welcome and Introductions Ms Fiona Barber welcomed members of the Governing Body and members of the public to the Governing Body meeting. Members of the Governing Body introduced themselves to the members of the public.

B/19/110 Apologies for Absences Apologies for absence were received from: • Mrs Karen English, Managing Director • Mrs Ursula Montgomery, Chair • Mr Clive Wood, Independent Lay Member • Dr Nick Glover, GP Locality Lead, South Blaby and Lutterworth • Dr Hilary Fox, GP Locality Lead, Rutland

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B/19/111 Notification of Any Other Business Ms Fiona Barber informed that she had not received any additional items of business.

B/19/112 Declarations of Interest on Agenda Topics All GP members declared an interest in items relating to primary care where a potential conflict may arise and also where there are any items concerning the Leicester, Leicestershire and Rutland Provider Arm where GP members’ are minor shareholders. The conflict was noted and will be managed during the discussions as required, it was also noted that the Register of Interests is published on the CCG website detailing declarations made by Governing Body members. No specific declarations on agenda items were recorded. It was RESOLVED to: • RECEIVE the declarations of interest and NOTE the actions being

taken.

B/19/113 Minutes of the meeting held on 10 September 2019 (Paper A) • Page 5 third paragraph – Mr Colin Groom highlighted that the

first sentence of the paragraph needed checking, as the sentence did not make sense. Mr Tim Sacks will review and confirm the correct wording outside of the meeting.

• Page 10, section FT/19/103 – Mr Groom suggested that the

fourth and fifth paragraphs required some slight re-wording, as the fifth paragraph related to the Independent Sector and he would clarify the wording outside of the meeting.

• Page 4, SLAM update, second bullet point - Dr Girish Purohit

asked that the word ‘refusing’ is replaced with the word ‘unable’. It was RESOLVED to: • APPROVE the minutes of the meeting held on Tuesday 10

September 2019 were approved subject to the amendments agreed.

B/19/114 Matters Arising: Update on actions from the meeting held on 10 September 2019 (Paper B) The action log (Paper B) was received and the following updates were provided:

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• B/19/54 – Summary Report from the Provider Performance Assurance Group meeting - home visiting service – It was noted that this item is not due until December.

• B/19/86 – Appointment of Secondary Care Clinician – It was noted that this item is not due until the end of October.

• B/19/99 – Locality Chairs Report, CHC checklist information –

Mr Paul Gibara updated the members that a flow chart has been produced and will be circulated to practices by the end of the week, in order to help them complete the checklist. Action closed

It was RESOLVED to: • RECEIVE the update.

B/19/115 To receive questions from the Public in relation to items on the agenda only Ms Barber invited questions from the members of the public relating to items on the agenda. There were no questions raised on agenda items. It was RESOLVED to: • NOTE that no questions were raised on agenda items from the

public.

B/19/116 Chair’s Report (Paper C) In the absence of Dr Ursula Montgomery, Ms Barber took this report as read and noted that the main item relates to the Annual General Meeting, which took place on 10 September 2019. Ms Barber noted that Dr Montgomery hopes to return to work shortly, following her sick leave. It was RESOLVED to: • RECEIVE the report.

B/19/117 Accountable Officer’s Corporate Report (Paper D) Mrs Briggs highlighted the report and noted the two following items: The Board Assurance Framework (BAF) was presented to the Audit Committee on 20 September 2019 and previously reviewed by the

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Executive Management Team (EMT) in August. Following both these meetings and feedback received, the Audit Committee have made some recommendations, which are outlined in this paper. A full copy of the BAF is appended at appendix 1. Mrs Briggs noted that BAF 5a and 5b have been cross referenced and aligned to the Quality Innovation Productivity and Prevention (QIPP) Programme Management Office (PMO) risks and therefore remain as is. There are six risks that the Audit Committee are recommending are closed and archived, these are shown on page 2 of the report; the reason for the suggested closure is included. The main reason for the suggested closure is that all actions have been completed for the risks. BAF10 relates to the financial year 2018/19, which is now completed. There are two new suggested risks, which are highlighted at the top of page 3. The description for BAF16 risk is yet to be reviewed and refined, but relates to the risk of the management of the Primary Care Networks (PCNs) and the need to establish working relationships with the new Clinical Directors. Dr Vivek Varakantam asked for clarity around the reasons for archiving BAFs 6a, 6b and 6c. Mrs Daljit Bains confirmed that all actions on the risk register have been completed for these risks, and that the risk appetite score, or the target score, had been achieved through the implementation of these actions. Dr Varakantam questioned the outcome and the current risk; Mrs Bains used BAF 6b as an example, stating that EMT initially gave a risk score of 15 and this has since been reduced and evaluated as 6, by completing the actions listed. Mr Warwick Kendrick confirmed that all risks are suitably scrutinised by the Audit Committee members and he supported the content of the BAF. Mr Tim Sacks noted that for these three risks, which relate to Primary Care, the removal of the risks from the BAF does not mean that the risks do not exist anymore, however, recognises the work that is being carried out to minimise the risk; especially in relation to GP workforce, which continues to be worked on. Ms Barber highlighted the recommendations on the paper and that the two news risks relate to finances in 2019/20 and the relationship with PCNs. Mrs Briggs noted the second part of the report, which is the results of the 360 survey with our stakeholders. This report provides the CCG with support for areas of organisational development and helps to build strong relationships with our stakeholders. For ELR CCG 28 out

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of 51 stakeholders completed the survey, which is 55%, which is slightly below the national average of 60%. Appendix two provides the full results of the survey and the main item to note is that 93% rated ELR as very good or fairly good for ‘how much would you rate the effectiveness of your working relationship with the CCG?.’ This is a very encouraging result and gives the CCG confidence that the leadership is positive; this was discussed further at the EMT meeting held yesterday. Ms Barber noted that as the questions have been changed since last year, it is harder to compare; although the same survey has been used for all organisations and therefore we can see trends. Dr Varakantam spoke about the question asked in relation to member practices engaging with the CCG and suggested that PCNs / CDs should be used to improve this section. Mrs Briggs confirmed that this was discussed at EMT and the CCG will be looking at how it can engage and communicate better in the future. Mr Sacks confirmed that he will be working with Mrs Emma Casteleijn to look at the free text answers provided and hopes to discuss the answers further, with GPs, at their clinical meeting. Ms Barber noted that work with patient groups will form part of the ongoing discussions. It was RESOLVED to: • RECEIVE the report. • RECEIVE the updated Board Assurance Framework as at

Appendix 1 and AGREE to close / archive the risks as detailed within the report and note the two new risks identified.

B/19/118 Locality Chairs’ Report (Verbal) Syston, Long Clawson and Melton (SLAM): Dr Girish Purohit highlighted the following for the SLAM locality; • As the transition from Localities to PCN structures continues, it

may be necessary to consider how this report is provided in future. • Last months’ meeting focused on commissioning, whereby this

months’ meeting focused on discussion around the proposed changes to the membership roles on the Governing Body. This helped the members make an informed submission to the CCG.

Market Harborough Dr Anuj Chahal highlighted the following for the Market Harborough

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locality. Harborough has not met as a locality since the previous meeting; however, have met as PCNs. • Cross County PCN discussed the Social Prescriber link worker,

who should be starting in post next week and the challenges faced regarding the employee contract. Help was provided by the CCG and the Local Medical Committee and this information is available to other PCNs, on request

• Also discussed was the PCN Pharmacist role and the financial support available for this post, which means that the current funding of 60% only allows the PCN to appoint a Band 7 Pharmacist; which may mean they have no community experience

• Joint working was also highlighted, as the PCN is keen to work as hubs for some back office functions from April 2020.

• ELR GP Federation is supporting the PCN during the transition period

Ms Barber noted the problems with the recruitment of the Pharmacist role and asked how this is being progressed. Dr Chahal confirmed that this is a challenging time, due to the lead time of recruitment for an experienced Pharmacist being 4 months and therefore the PCN is considering advertising independently; which Dr Chahal noted is probably the same for all of the LLR PCNs. At this time the Cross County PCN has not made a firm decision on the way forward. Mr Sacks noted that due to the PCN Directed Enhanced Service, this has created a ‘sellers’ market’ and even with 70% funding this does not means that PCNs can get the level of experience they require. This has been recognised and therefore in future a more system response is planned for other areas, such as physios and paramedics. Options to jointly employ paramedics are already being explored with East Midlands Ambulance Service and this will help to remove some of the salary inflation problems. Oadby and Wigston Dr Vivek Varakantam highlighted the following for the Oadby and Wigston locality; Oadby and Wigston are meeting as a PCN, with a small Locality meeting; Locality update: • Representatives from the Medicines Quality Team attended the

PCN meeting to provide an update and concerns were highlighted about midwives ordering medications, such as paracetamol

• The Respect form implementation and training was discussed • An update was received from the Governing Body on the

Integrated Care System (ICS) and what this may look like for the locality

PCN update:

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• A discussion took place on the social prescribing role • The business plan for the PCN was reviewed • A medicines review, as part of the Quality Outcome Framework is

taking place, with Dr Richard Palin as the lead and Dr Varakantam leading on the End of Life review

• The Oadby and Wigston Health and Wellbeing Board discussed health inequalities and plans are progressing in this area.

Ms Barber confirmed that maintaining good relationships with members of the Health and Wellbeing Boards is important and helpful.

Dr Purohit reiterated his comment made earlier about how this report is given in future, in line with the move to PCNs and suggested that in the future, the locality report may not be in the same format and this needs consideration outside of the meeting. Ms Barber agreed to this suggestion, to ensure in future reports are suitable and meaningful. It was RESOLVED to: • RECEIVE the verbal update.

B/19/119 Leicester, Leicestershire and Rutland CCG’s Collaborative Governance Proposal (paper F) Mrs Bains noted that this paper is being presented and has been compiled in conjunction with colleagues from West Leicestershire CCG (WL CCG) and Leicester City CCG (LC CCG), following previous iterations of the paper, presented previously to the members. This paper is being presented following feedback received, for which members were thanked for their input. Mrs Bains took the paper as read, highlighting the current governance structures for the LLR CCGs are shown on page 8. All three Governing Body meetings will be discussing this paper today, at their meetings. Mrs Bains drew attention to page 10 of the report which shows the proposed governance structure noting specifically the proposal to establish meetings-in-common and joint committees. It was noted that the report details the internal governance committee structures across the three CCGs and the wider partnership governance structures will be discussed following completion of this first phase of the governance work. The proposal is that all committees are Chaired by Lay Members, the exception being the Clinical Reference Group which will be Chaired by a Clinical Chair. The appendices to this report include suggested Terms of Reference and work programmes for the new committees and the Governing Body is

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requested to approve the terms of reference and work programmes. Mrs Bains highlighted paragraph 48 onwards, in relation to the Collaborative Commissioning Committee (CCC) and the suggestion that this committee has a higher financial threshold than previously held by the Commissioning Collaborative Board (CCB). The suggestion has been made that the CCC is authorised to approve up to £5m, which is an increase of £3m from CCB. Appendix 11 shows the proposed timescales for these changes to take place; including the inaugural meeting of the Clinical Reference Group which is planned for 19 October. Mrs Bains went through the recommendations in detail and the following was noted: • This proposal is due to be put in place until March 2021 • ELR Audit Committee can still meet separately, if required • ELR Remuneration Committee can still meet separately, if

required • ELR’s Integrated Governance Committee and Financial

Turnaround Committees will be disestablished • Provider Performance Assurance Group and Commissioning

Collaborative Board meetings will be disestablished • Integrated Governance and Quality Committee (IGQC),

Performance Finance and Activity Committee and Collaborative Commissioning Committees will be established as new, joint committees

• The Clinical Reference Group will be a joint advisory group only • All changes will need to be reflected in the constitution, as per the

final recommendation listed Mr Gibara noted the complex nature of the report and commented that this is the right direction of travel, which will help the CCGs move forward in the future. It was confirmed that the proposal will be in place until March 2021, unless further changes are required during the interim period. Mrs Bains confirmed that the committee structure will continue to be reviewed and further changes made, if required. Mr Gibara expressed some concern that there was no commissioning representation on the terms of reference for the IGQC. Mrs Bains confirmed that this was an initial draft and that the groups will evolve and if it appears that a commissioning lead is required then this will be considered over the next few months. Furthermore, Mrs Bains explained that the idea is for there to be less duplication between committees, but recognising the need for interdependencies between committees. In terms of commissioning, the responsibility would be with the Governing Bodies and the new proposed Collaborative

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Commissioning Committee (CCC) and the new proposed IGQC will focus on integrated governance areas and statutory corporate duties. Mrs Tracy Burton queried where the EMT sits in the new structures, as she had noted the differences in titles of members being used in the terms of references and suggested that a more generic title should be used, rather than a specific job title. Mrs Bains confirmed that this was done deliberately, during this transition phase, as the single management team is yet to be formed and therefore the EMT function is slightly unclear at this time. The membership of the new CCC has been kept the same as CCB as requested by the feedback received by West Leicestershire CCG and Leicester City CCG, as this was felt to be best for the time being and then a review will take place in future, once the structure of the senior management team is confirmed. Mrs Burton noted that the Governing Body will need to ensure that correct assurance regarding statutory functions, from the new committees is given and is clear to the members. Ms Barber acknowledged the comment made by Mrs Burton. Dr Varakantam noted the amount of work involved with this paper and thanked the authors for compiling it. He suggested that the new arrangements ensure closer alignment of decisions and as long as the arrangements are monitored for effectiveness going forward feels that this is the right decision to make. A question was asked if meetings-in-common require a constitutional change; Mrs Bains confirmed that as per the final recommendation, the constitution will need amending to reflect the proposed changes. This will also depend on if WL CCG and LC CCG agree the changes at their Governing Body meetings being held today. Dr Purohit suggested that the number of attendees at the meetings-in-common could be quite high and asked about the practicalities of this and ensuring that decisions are effective. Mrs Bains confirmed that if all three CCGs approve the recommendations today, the next step will be to sort the logistics, including venues and template reports. It was confirmed that Primary Care Commissioning Committee (PCCC) have already started conversations about the possible change and how this could be managed. Mr Groom raised two issues; 1) the suggested £5m approval limit for CCC and if the timescales involved in relation to approval are practical and 2) if the administration support will be pooled across the CCGs. Mrs Bains confirmed that if CCC is unable to approve something as it is above their financial limit, then this will have to be escalated to Governing Body meeting, as they are currently and this may impact on approval timescales. This will also depend on if the members approve the higher approval limit for CCC. The logistics of

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the joint and meetings-in-common are due to be worked through following the Governing Body meetings being held today. Mrs Briggs confirmed her support of the change in approval limit for CCC, to up to £5m, as this will ensure that the meeting can discharge its responsibilities in line with the proposed revised terms of reference. Dr Purohit queried the level of clinical representation on the committees as clinical roles vary per CCG, depending on the size of the locality and the proposed changes to the GP roles on the Governing Body. Ms Barber queried what discussions have taken place around this issue; Mrs Bains confirmed that clinicians will remain as members of all committees, as they continue to support the CCG in their clinical roles; although noted that the roles may change going forward, there will always be a need to have clinicians on the Governing Body and sub-committees. Ms Barber thanked the Head of Corporate Governance and Legal Affairs and her counterparts in the other two CCGs for all the hard work that has gone into this report and review of systems, noting that further work was required to implement the changes. The recommendations were highlighted in order and agreed. It was RESOLVED to:

• APPROVE that the ELR CCG Audit Committee meet in common

with the Audit Committees of LC CCG and WL CCG with effect from November/December 2019, and approve the terms of reference at Appendix 1a and the initial work programme at Appendix 1b.

• APPROVE that the ELR CCG Remuneration Committee meet in common with the Remuneration Committees of LC CCG and WL CCG with effect from November 2019, and approve the terms of reference at Appendix 2a and the initial work programme at Appendix 2b.

• APPROVE that the ELR CCG Primary Care Commissioning

Committee meet in common with the Primary Care Commissioning Committees of LC CCG and WL CCG with effect from December 2019 every alternate month, and approve the terms of reference at Appendix 3a and the initial work programme at Appendix 3b for meetings in common.

• APPROVE the establishment of the Integrated Governance and Quality Committee as a joint committee of LC CCG, ELR CCG

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and WL CCG with effect from November 2019. To approve the terms of reference at Appendix 4a and the initial work programme at Appendix 4b.

• DISESTABLISH the ELR CCG Integrated Governance Committee with effect from November 2019 once the Integrated Governance and Quality Committee is ready to hold its inaugural meeting.

• APPROVE the establishment of the Performance, Finance and Activity Committee as a joint committee of LC CCG, ELR CCG and WL CCG with effect from December 2019. To approve the terms of reference as at Appendix 5a and the initial work programme at Appendix 5b.

• DISESTABLISH the Provider Performance Assurance Group (PPAG) with effect from December 2019 once the Performance, Finance and Activity Committee is ready to hold its inaugural meeting.

• DISESTABLISH the Financial Turnaround Committee with effect from December 2019 once the Performance, Finance and Activity Committee is ready to hold its inaugural meeting.

Further discussion took place on the recommendation below around the level of delegated authority that the CCC should have and a suggestion was made that previous approvals should be looked at to establish if £5m is an appropriate amount. Mrs Bains confirmed that this exercise has been done in the past; however, this could be revisited. It was noted that for ELR, the PCCC meeting has a slightly different remit, as the financial approval covers the primary care commissioning element only. Items over a particular financial limit are escalated, as per the terms of reference. Following a query from Ms Barber it was confirmed that CCC could approve several items at one meeting, as long as they were all individually below £5m. Mr Groom stated that as long as the CCC meeting worked in conjunction with other meetings, in that they ensure funding has been identified for each scheme they are asked to approve, then he would be happy to agree the recommendation. It was agreed to amend the recommendation slightly to include reference to the £5m approval limit. It was RESOLVED to:

• APPROVE the establishment of the Collaborative Commissioning

Committee as a joint committee of LC CCG, ELR CCG and WL CCG with effect from November 2019. To approve the terms of reference as at Appendix 6a and the initial work programme as at Appendix 6b and the proposal to allow CCC to approve schemes

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up to £5m for ELR CCG.

• DISESTABLISH the Commissioning Collaborative Board (CCB) with effect from November 2019 once the Collaborative Commissioning Committee is ready to hold its inaugural meeting.

• APPROVE the establishment of the Clinical Reference Group as an advisory group of LC CCG, ELR CCG and WL CCG with effect from October 2019 / November 2019, and approve the terms of reference as at Appendix 7.

• APPROVE the revised Competition and Procurement Group terms

of reference as at Appendix 8.

• APPROVE the relevant amendments to be made to the CCG Constitution to reflect the new proposed governance structure, and note that the amended Constitution, including the updated Scheme of Reservation and Delegation, will be submitted to NHS England for approval.

• APPROVE the proposal outlined within this paper for the introduction of the collaborative governance architecture for Leicester, Leicestershire and Rutland CCGs, with the CCG specific recommendations detailed as set out below.

Ms Barber thanked Mrs Bains and the rest of the team for the amount of time spent in ensuring that this paper was presented today. Dr Purohit stated that the approval of this paper, by the members of the governing body, is a big step for the CCG and asked how the CCG plans to engage with its membership on the decision made. Mrs Casteleijn confirmed that this information will be included in the GP update for this month. Dr Janet Underwood asked if the CCG need to consult with the public on this issue and if so, has this taken place. Mrs Casteleijn confirmed that no public consultation is required as the change is to committee structure only and there is no change to services.

B/19/120 Summary report from the Financial Turnaround Committee (Paper G) Mr Colin Groom presented the paper and took it as read; as Paper H provides more detail on the financial situation. Further to this, Mr Groom highlighted the following from the report: ELR CCG is working with WL and LC CCGs to ensure actions in the Financial Recovery Plan (FRP) are taking place and to try and control

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costs. Even with FRP mitigations in place there is a unmitigated risk to ELR of £5.725m. ELRs QIPP target of £26.6m is noting a potential under-delivery of £8.1m and LLR wide there is a shortfall of £18m. The system is struggling and the FRP is the key to achieving break-even. It was RESOLVED to: • RECEIVE the report.

B/19/121 Finance Report: Month 5 update (Paper H) Mr Groom presented this report which details the year to date and forecast position as at August 2019 (Month 5) based on four months of activity information and three months of prescribing data. It was highlighted that the CCG’s QIPP saving target for the year is £26.647m, £6m of which remains unidentified. There is an ongoing cost pressure in acute, in relation to the year to date position at month 5; the overspend of £3m is still in place, even after the release of the £2m contingency. NHS England / Improvement are aware of the risks and have highlighted their concerns around assurance that the CCG can break even at year end. The overall gross risk is £12.195m, with a residual net risk of £5.725m. Included in the report this month are tables showing additional information in relation to University Hospitals of Leicester NHS Trust (UHL) and the acute spend. The contract with UHL shows that ELR is on track for activity, being under by £338k, but with a year to date overspend of £2.57m. Mr Sacks left the meeting. The overspend is due to planned activity, where prices are higher, and the increased acuity of patients. Appropriate challenges are put in place with UHL, through counting and coding, which feed into the overall system position. The aim of the FRP is not to just move a problem around the system, rather to remove costs by ensuring processes are correct etc. The table in section 13 of the report shows that the independent sector is currently over spent by £1.8m. Mr Sacks re-joined the meeting.

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Paragraph 17 of the report highlights the current situation for Continuing Health Care (CHC), which is showing a strong QIPP delivery of £1.7m above target. Paragraph 20 shows the prescribing forecast of £873k overspent; included in this overspend is £644k of a drug price change, which has been a national cost pressure. This is currently being discussed with NHS England / Improvement, to see if there is any mitigation to be found. Mr Kendrick noted paragraph 9 and questioned when we will know the outcome of the discussions with UHL. Mr Groom confirmed that the CCGs are keen to avoid imposing fines on UHL and more conversations have to take place to try and ensure the system can be balanced. The options for taking costs out of the system are being explored with UHL and Leicestershire Partnership Trust (LPT) and it is hoped that a mature solution can be found. Mr Kendrick reiterated that the CCG needs to know when this will be resolved, as this is a huge financial risk to ELR. Mrs Briggs agreed with Mr Kendrick’s comments and confirmed that this is being monitored on a monthly basis and new challenges put in, if appropriate. The CCG is trying to look at the problem differently, in conjunction with NHS England / Improvement and the CCG’s contracting teams. Dr Underwood asked who was doing the coding at UHL, as in her experience, this could be done by a number of different levels of staff, who have a number of different coding options available to them. Further to this Dr Underwood queried the level of control in place. Mr Groom confirmed that the UHL process varies, depending on the service; however, all coding is regularly reviewed through the Commissioning Support Unit and contracting teams. Audits are carried out where necessary, to ensure a multi-layered approach to the problem. Mrs Sarah Shuttlewood’s team are working closely with UHL and Mr Groom is happy that there is consistency in processes taking place. Dr Varakantam reported that the members of the Financial Turnaround Committee continue to be frustrated by this situation and will continue to look at this in detail each month. It was RESOLVED to:

• RECEIVE for information the contents of the report and the appendices attached.

• NOTE the year to date overspend and forecast breakeven positon

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reported at month 5 along with the risks currently being assessed to the delivery of the breakeven control total.

One member of the public left the meeting. Dr Chahal left the meeting.

B/19/122 Summary report from the Provider Performance Assurance Group (PPAG) meeting (26 September 2019) (Paper I) Mr Kendrick took the report as read and noted the following items: Paragraphs 6, 7 and 8 of the report highlights the ongoing issues with East Midlands Ambulance Service (EMAS), especially in relation to Ambulance Response Programme (ARP) targets; three of which have improved and three declined during August. EMAS are also struggling with workforce; a plan is in place by EMAS to increase their workforce, however, PPAG have agreed that a deep dive into this issue is required for November. Paragraphs 13-20 provide information on UHL, including details of three Serious Incidents; one of which may potentially become a Never Event, following an investigation that is to take place. It was noted that UHL did not achieve the 2ww breast, 31 day surgery or the 62 day standard for cancer in June 2019; although did achieve the 2ww standard. PPAG were not assured that UHL will achieve their 2019/20 trajectories. Dr Purohit noted that the activity at Loughborough Urgent Care Centre (UCC) has increased recently and asked if there was a reason for this. Mr Kendrick stated that he would be happy to discuss the specifics around this outside of the meeting. Dr Purohit questioned if, since Derbyshire Health United took over the Melton UCC in April, this could have impacted on the level of activity in Loughborough. Mr Sacks confirmed that there has been an overall increase in activity at UCCs by 10-15% and a slight drop in activity in Melton, which equates to the slight reduction in opening times at the centre. Loughborough UCC is the only site in WL CCG with extended access and is the main UCC site within the WL patch. Dr Underwood reported that Healthwatch have consistently struggled to get statistical information from EMAS regarding Category 1 calls and noted that the recent information received shows an above 11 minute response time in Rutland, which is not acceptable. Dr underwood is happy to share the information received with the CCG. Mr Gibara reported that the response time problem is consistently

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raised at PPAG and Mr Kendrick assured Dr Underwood that PPAG will continue to monitor response times for City and County residents. It was RESOLVED to: • RECEIVE the assurance report from Provider Performance

Assurance Group (September 2019). Dr Chahal re-joined the meeting.

B/19/123 Summary report from the Integrated Governance Committee meeting (1 October 2019) (Paper J) Mr Kendrick took the report as read and no questions or queries were raised. It was RESOLVED to: • RECEIVE the Summary report from the Integrated Governance

Committee meeting (October 2019).

B/19/124 Corporate Performance Report (Paper K) Mr Gibara took the report as read and highlighted the following items; In August / September a new joint oversight framework was published and therefore future reports may have to be amended to bring the report in line with the Integrated Care System. This report provides conflicting information in relation to cancer standards, as is shows that ELR has improved slightly in a number of areas. A more detailed review of the performance will be presented to the next PPAG meeting. UHL have been invited to attend LC CCG’s Governing Body meeting in future to discuss the ongoing issues. Mr Gibara confirmed that the transformation programme is ahead of schedule; although no improvement in performance has been noted. PPAG have sought assurance from UHL regarding winter planning, to ensure that robust plans are in place. Deep dives are due to take place on cancer in October and EMAS in November. It was RESOLVED to: • RECEIVE the Corporate Performance Report

B/19/125 Summary Report from the Audit Committee (September 2019) (Paper L)

Page 16 of 17


10 December 2019


Mr Kendrick took the paper as read. Mrs Briggs noted that since the report was written, she has recently received confirmation from the Auditors that the outcome of the Mental Health Investment Standard Audit will be an unqualified opinion; Mr Kendrick noted this positive result. It was RESOLVED to: • RECEIVE the summary report from Audit Committee

B/19/126 Summary report from the Primary Care Commissioning

Committee (1 October 2019) (Paper M) Mrs Barber took the paper as read and no questions or queries were raised. It was RESOLVED to: • RECEIVE the Summary report from the Primary Care

Commissioning Committee (October 2019)

B/19/127 Date of next meeting The next meeting of the Governing Body of the East Leicestershire and Rutland CCG Governing Body will be take place on Tuesday 10 December 2019, County Hall, Glenfield, Leicester, LE3 8TB The meeting concluded at 11.15am.

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B

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Paper B ELR CCG Governing Body Meeting

10 December 2019

NHS EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP

ACTION NOTES

Minute No.

Meeting Item Responsible Officer

Action Required To be completed

by

Progress as at December 2019

Status

B/19/54 11 June 2019

Summary report from the Provider Performance Assurance Group meeting

Tim Sacks To contact and obtain information from WL CCG in respect of the review into the home visiting service.

August 2019

October 2019

December 2019

Data analysis awaited. A verbal update to be provided at the meeting.

AMBER

B/19/86

12 March 2019

Appointment of Secondary Care Clinician (raised under Leicestershire Partnership NHS Trust - Care Quality Commission Inspection Report)

Daljit Bains A new Secondary Care representative to be appointed to the Governing Body.

July 2019 end September 2019 end October 2019

Discussions have re-opened with LC CCG, who are supportive of having their secondary care clinician jointly appointed across the CCGs. Discussions continue to enable a conclusion to be reached by January 2020.

AMBER

Outstanding On-going Completed

Key

1

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2

C

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Paper C East Leicestershire and Rutland CCG Governing Body meeting

10 December 2019

EAST LEICESTERSHIRE AND RUTLAND CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING

10 December 2019

Chair’s Report Introduction 1. The purpose of this report is to provide an overview and update of some of the key

constitutional and strategic updates that affect the Governing Body; and provide an overview of meetings that I have attended.

Appointment of the Accountable Officer 2. I am pleased to welcome Mr Andy Williams as the new joint Accountable Officer

across the three Clinical Commissioning Groups in Leicester, Leicestershire and Rutland (LLR). Andy commenced in post on 11 November 2019.

3. Andy has previously worked in a similar role for Sandwell and West Birmingham CCG and possesses a wealth of experience having undertaken senior leadership roles across NHS commissioning and provider organisations.

4. As a Governing Body we look forward to working with Andy to continue

strengthening our collaborative arrangements across the three CCGs, and build stronger partnership arrangements across health and social care as we make our journey towards an integrated care system.

LLR Women in Clinical Leadership Networking Event 5. In conjunction with Leicester City CCG and West Leicestershire CCG, we held a

“Women in Clinical Leadership Networking Event” on 14 November 2019, which was open to all GPs across LLR. The purpose of the event was an initial step towards addressing the gender inequality on CCG Governing Bodies.

6. Nationally the aim was for the NHS to have a 50/50 gender split on all NHS Boards by 2020.

7. The event was attended by a number of female GPs. Professor Mayur Lakhani

(Chair, West Leicestershire CCG), hosted the event and I presented as one of the guest speakers, highlighting the positive experiences of leadership roles in the NHS within primary care and at CCG Governing Body level. An overview was provided about the leadership and management opportunities available across LLR. The event also provided an opportunity to understand some of the challenges and barriers that women face when looking for leadership roles across the NHS.

8. The event demonstrated the enthusiasm and energy amongst clinical colleagues;

and there was a recognition that encouragement and the right level of support is required to enable access for women who are looking for opportunities in leadership roles.

1 Dr Ursula Montgomery ELR CCG Chair


10 December 2019

“Women in Clinical Leadership Networking Event”, 14 November 2019 Meetings attended: 9. Other meetings I have attended over the last month include the following:

a) I attended the NHS Clinical Commissioners’ annual event in London on 31 October. There were presentations from Healthier Fleetwood about the work as a community to transform lives and health; and Prerana Issa, Chief People Officer for the NHS on transforming NHS from a workforce perspective and population health management, as well as an address by Mr Simon Stevens.

b) On Tuesday 5 November I attended the Leaders in Healthcare conference where NHS England / Improvement held an all day workshop focusing on clinical leadership within the NHS Long Term Plan.

c) On 12 November 2019 the CCG Governing Body participated in a development session on Equality, Inclusion and Human Rights; and Cyber Security and information security. Both sessions enabled the Governing Body members to refresh their knowledge on the legislative framework and key areas of compliance. In particular, the session highlighted the role and responsibilities of the Governing Body in ensuring we seek assurance that appropriate due regard and consideration has been given to the equalities regulations when making decisions; and with respect to cyber security, again ensuring we seek assurance that appropriate risk management systems and processes are in place to manage the risk of any such occurrence.

d) On 14 November 2019 I joined part of the LLR Clinical Director Forum where Andy Williams introduced himself and set out the vision for future working with primary care networks.

e) I attended the inaugural meeting of the LLR CCGs’ Clinical Reference Group on 14 November 2019 which is one of the groups established as part of the new collaborative governance arrangements.

f) I chaired the inaugural meeting of the new LLR CCGs’ Collaborative Commissioning Committee which is a joint committee established as part of the new collaborative governance arrangements.



10 December 2019

g) Governing Bodies of the three LLR CCGs continue to hold development

session to enable stronger collaborative working.

h) On 5 December 2019 I attended the Health and Wellbeing Board development session reviewing the existing strategy and how the Board might work in 2020 to address wider determinants of health in partnership together.

Recommendations The East Leicestershire and Rutland CCG Governing Body is requested to:

• RECEIVE the contents of the report.


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Paper D East Leicestershire and Rutland CCG Governing Body meeting

10 December 2019


10 December 2019

Accountable Officer’s Corporate Report Introduction 1. This report sets out to the Governing Body some of the key updates and activities

the Executive Management Team (EMT) and I have been involved in since the last meeting of the Governing Body in October 2019.

2. There are a number of reports on the main Governing Body meeting agenda covering the areas which the EMT have been involved with.

Leicester, Leicestershire and Rutland STP System Review meeting 3. The quarterly Leicester, Leicestershire and Rutland (LLR) Sustainability

Transformation Partnership (STP) System Review meeting with NHS England / NHS Improvement took place on 28 November 2019. NHS England / Improvement are now holding the system to account for its performance and hence the meeting was attended by the LLR CCGs and senior members from University Hospitals of Leicester NHS Trust (UHL), and Leicestershire Partnership NHS Trust (LPT).

4. The focus of the meeting was on some of the key challenges faced by the system, including finance and system level performance, followed by a discussion about priorities moving forward as we work towards becoming an integrated care system.

Community services Redesign Implementation 5. A new community model of care went live on 1 December 2019 across the three

CCGs in Leicester, Leicestershire and Rutland. This system-wide change is the result of significant co-production with partners and a new service model for adult community services delivered by Leicestershire Partnership NHS Trust (LPT), commissioning of a new enhanced medical model of primary care medical support, and changes in local authority reablement services. The new offer will include: • Integrated Neighbourhood Teams: community nursing, therapy services and

relevant health and care partners working as integrated teams aligned to Primary Care Networks (PCNs). These teams will provide the majority of community nursing and therapy interventions including both planned care and a ‘same day’ urgent community nursing response.

• Home First services: enhanced step up and step down services offering rapid response, rehabilitation and reablement delivered jointly by LPT nursing and therapy alongside social care. GPs delivering enhanced medical support will also support patients at home.

Donna Enoux 1 Chief Finance Officer and Deputy Managing Director (on behalf of Mr Andy Williams)


10 December 2019

• Locality Decision Units as place based access points into integrated, multi-disciplinary triage, assessment, care planning and treatment for Home First services and community hospital care.

6. A Transformation Group is overseeing a system-wide mobilistation plan, including

a communications plan across system partners. Changes to LPT team structures were completed by 1 December, to enable a phased launch of the rest of the model through December. The new model represents a significant change in multi-agency care delivery through LPT, social care, DHU and primary care, as well as the interface with University Hospitals of Leicester NHS Trust (UHL) and other acute providers to ensure appropriate referral information and earlier identification and planning for patients prior to their expected discharge date.

7. Significant work has gone into developing the enhanced medical model and supporting PCNs and their member practices to determine their ability to provide this. There are some risks in relation to having full coverage but it is hoped that most practices will be delivering enhanced support to Home First patients in December and contingencies are being put in place through Derbyshire Health United and LPT.

8. A multi-agency platform to raise, address and monitor daily issues and regular

multi-agency teleconferences from go live will be used to continually review any implementation issues. Case studies will also be collected frequently to share with referrers to build confidence in the new offer. Ongoing evaluation of the model and pathways will continue to refine delivery and inform refinement of investment plans for 2020/21.

9. The changes taking place this year form part of a longer term plan to strengthen

community services in LLR, in line with the national expectations for Ageing Well. Additional capacity will be commissioned from April 2020 and there will be further work to develop pathways and support organisational development and the growth of an integrated team culture for community services.

Equality and Inclusion Annual Report 2018/19 10. The Governing Body received the Equality and Inclusion Annual Report 2018/19

in November 2019 for comment and approval. The report was approved with some minor amendments and it was agreed for it to be published on the CCG website. The report is due to be published ahead of the Governing Body meeting.

11. In line with the specific duties under the Equality Act 2010, the CCG publishes annual equality and inclusion information on the CCG website (https://eastleicestershireandrutlandccg.nhs.uk/about/equality-diversity-and-human-rights/), which includes progress against the equality objectives and various mandated requirements such as the Equality Delivery System 2 (EDS2), Workforce Race Equality Standard (WRES).

12. The Equality and Inclusion Annual Report 2018/19 highlights the CCG’s

compliance over the year, and includes equality data for both workforce and


https://eastleicestershireandrutlandccg.nhs.uk/about/equality-diversity-and-human-rights/

https://eastleicestershireandrutlandccg.nhs.uk/about/equality-diversity-and-human-rights/


10 December 2019

service delivery issues that the CCG has and how this links to us delivering on our agreed Equality Objectives, which are as follows:

i. Addressing the needs of older people and access to services ii. Targeting provision and access to seldom heard groups iii. Access to early intervention and prevention of Mental Health issues iv. Learning Disability.

13. Any significant gaps in equality data is highlighted within the report, including

how these will be addressed going forward.

14. The CCG continues to use the EDS2 (as detailed within Appendix 2 of the Equality and Inclusion Annual Report) to self assess and to demonstrate where the CCG is against the following 4 Goals and 18 Outcomes:

• Goal 1 - Better health outcomes; • Goal 2 - Improved patient access & experience; • Goal 3 - A representative & supported workforce; • Goal 4 - Inclusive leadership at all levels

15. Colleagues from across the CCG have contributed to the content of the Equality

and Inclusion Annual Report, including the Public Health team in Leicestershire County Council.

16. The Equality and Inclusion Annual Report details positive actions taken during the year to promote and demonstrate compliance with the Public Sector Equality Duty and the legislative framework, recognising that further work is required and will continue into 2019/20.

Emergency Preparedness, Resilence and Response (EPRR) Core Standards Review 2019/20 17. In August 2019 the CCG undertook a self-assessment against the relevant

individual core standards and rated its compliance. In total there are 43 standards that relate to CCGs against which full compliance was declared as supported by the Governing Body in September 2019. The submission was followed by a confirm and challenge meeting held on 8 October 2019, and subsequently NHS England / Improvement have evaluated the compliance level and confirmed that ELR CCG, along with LC CCG and WL CCG, are fully compliant. Appendix 1 provides confirmation of this.

18. Three recommendations have been made as set out below and action will be taken accordingly as detailed:

• Business continuity is to be a standard item on the Board agenda to ensure

risk areas are addressed as the CCG goes through the transition to a single accountable Board - the Heads of Governance and Corporate Affairs across the three CCGs are currently reviewing the current systems and processes in place to enable a consistent policy and approach to business continuity to be drafted by January 2020.



10 December 2019

• Include Climate Change on the CCGs risk register and hold a discussion on it at the next EPRR Group meeting.

• Liaise with landlords/estates colleagues regarding deep dive standards 16-20

as potentially they will be completing similar questions/returns that align to these standards - Standards 16- 20 are as follows:

o 16 - Long term adaptation planning – risk assess. Are all relevant organisations risks highlighted in the climate change risk assessment incorporated into the organisations risk register.

o 17 - Long term adaptation planning – overheating risk. The organisation has recorded those parts of their buildings that regularly overheat (exceed 27°C) on their risk register. The register identified the long term mitigation required to address this taking into account the sustainable development commitments in the long term plan, such as avoiding mechanical cooling and use of cooling hierarchy.

o 18 - Long term adaptation planning – building adaptations. The organisation has in place an adaptation plan which includes necessary modifications to buildings and infrastructure to maintain normal business during extreme temperatures or other extreme weather events.

o 19 - Long term adaptation planning – flooding. The organisations adaptation plans to reduce their buildings and estates impact on the surrounding environment for example sustainable urban drainage systems to reduce flood risks.

o 20 - Long term adaptation planning – new build. The organisation considers for all its new facilities relevant adaptation requirements for long term climate change.

It is noted that some of these standards may not apply as the CCG is a tenant within the Local Authority office accommodation, however the detail will be reviewed and a discussion will take place at the next EPRR Group meeting.

PUBLICATIONS 19. Publications and updates published by NHS England via its fortnightly newsletter

Bulletin for CCGs can be found at the following http://www.england.nhs.uk/publications/bulletins/bulletin-for-ccgs/. The Executive Management Team undertakes a regular review of the content of the Bulletin and ensure actions are taken accordingly. Assurances and updates are reported through to the Governing Body as evident on the agenda and through updates in the Accountable Officer’s report.

Recommendation The East Leicestershire and Rutland CCG Governing Body is requested to: • RECEIVE the report.


http://www.england.nhs.uk/publications/bulletins/bulletin-for-ccgs/

Appendix 1

OFFICIAL

Dear Caroline

Re: EPRR Core Standards Review 2019/20

Following the submission of your Core Standards self-assessment for EPRR 2019/20 and subsequent confirm and challenge meeting on Tuesday 8th October 2019, I can confirm that NHS England / Improvement has evaluated the compliance level at all three LLR CCGs to be Fully Compliant.

Compliance Level Evaluation and Testing Conclusion

Full

The organisation is 100% compliant with all core standards they are expected to achieve.

The organisation’s Board has agreed with this position statement.

Substantial

The organisation is 89-99% compliant with the core standards they are expected to achieve.

For each non-compliant core standard, the organisation’s Board has agreed an action plan to meet compliance within the next 12 months

Partial

The organisation is 77-88% compliant with the core standards they are expected to achieve.

For each non-compliant core standard, the organisation’s Board has agreed an action plan to meet compliance within the next 12 months.

Non-compliant

The organisation compliant with 76% or less of the core standards the organisation is expected to achieve.

For each non-compliant core standard, the organisation’s Board has agreed an action plan to meet compliance within the next 12 months.

The action plans will be monitored on a quarterly basis to demonstrate progress towards compliance.

Sent via email

Caroline Trevithick Accountable Emergency Officer LLR CCGs

NHS England and NHS Improvement – Midlands

Fosse House 6 Smith Way

Grove Park Enderby

Leicestershire

T: 07713795870 E: [email protected]

26 November 2019

mailto:[email protected]

OFFICIAL

It was recognised that some good work has taken place since last year and any improvements required over the next 12 months are shown below:

POST CONFIRM & CHALLENGE TABLE Ref Domain Standard Post Confirm & Challenge RAG

Green Amber Red

Recommendations: • Business Continuity is to be a standard item on the Board Agenda to ensure

risk areas are addressed as the CCGs go through the transition to a single accountable board. You are encouraged to remain vigilant and continually risk assess.

• Include Climate Change on your risk register and hold discussion on this at yournext EPRR Group meeting.

• Liaise with landlords / estates colleagues regarding Deep Dive standards 16-20as potentially they will be completing similar questions / returns that align tothese standards.

Please can I take this opportunity to thank you for all your hard work and your continuing support as part of the Core Standards Process.

Yours sincerely

Frances Shattock Director of Strategic Transformation (Northants, LLR and Lincolnshire) NHS England and NHS Improvement – Midlands

Mike Sandys Director of Public Health Leicestershire County Council

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Paper E East Leicestershire and Rutland Governing Body

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1


Front Sheet

REPORT TITLE: Finance Report – October 2019 (month 7)

MEETING DATE: 10 December 2019

REPORT BY: Colin Groom, Deputy Chief Finance Officer

SPONSORED BY: Donna Enoux, Chief Finance Officer

PRESENTER: Donna Enoux, Chief Finance Officer

EXECUTIVE SUMMARY:

This report confirms the reported financial position for 2019/20 for East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) at month 7. The first page of this report contains an Executive Summary.

RECOMMENDATIONS:

The ELR CCG Governing Body is requested to:

Receive for information the contents of the report and the appendices attached

Note the year to date overspend and forecast breakeven positon reported at month 7 along with the risks currently being assessed to the delivery of the breakeven control total

REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2019 – 2020:

Transform services and enhance quality of life for people with long-term conditions

Improve integration of local services between health and social care; and between acute and primary/community care.

Improve the quality of care – clinical effectiveness, safety and patient experience

Listening to our patients and public – acting on what patients and the public tell us.

Reduce inequalities in access to healthcare

Living within our means using public money effectively

Implementing key enablers to support the strategic aims (e.g. constitutional and governance arrangements, communications and patient engagement).

EQUALITY ANALYSIS

An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in the development of this report as it is judged that it is not proportionate on the basis that the financial reporting underpins the commissioning strategy and priorities of the CCG. The commissioning strategy and priorities have and continue to be equality impact assessed as the strategy is reviewed and refreshed and this includes the financial plans. This completes the due regard required.


10 December 2019

2


10 December 2019

Finance Report

Executive Summary

2019/20 Financial Position 1. This report confirms the year to date and forecast position as at October 2019 (Month 7)

based on six months of activity information and 5 month of prescribing data.

2. The CCG QIPP savings for the year is £26.647m, £6.3m of which was unidentified at the

start of the year. Due to slippage in the progression of these savings requirements and

material cost pressures within Acute contracts and GP Prescribing, the year to date

position at month 7 is an adverse variance of £5.312m, despite the release of the £2.008m

0.5% contingency and significant underspends across non acute commissioning.

3. Pressures against acute contracts and GP Prescribing are forecast to continue to the end

of the year and confirmed solutions are not as yet in place to deliver the full value of the

original unidentified QIPP requirement. The CCG therefore continues to work in

collaboration with other NHS partners within Leicester, Leicestershire and Rutland (LLR)

to implement a Financial Recovery Plan (FRP), to ensure the control total breakeven for

the year can be achieved.

4. At month 7, the gross operational risk, pre FRP, has been assessed as £16.501m against

which £6.828m of FRP and other forecast actions have been entered, reducing the

residual risk to £9.673m. Work is ongoing to develop the additional actions required to

ensure that this gap can be closed before the end of the financial year but it remains a

significant risk and has been confirmed in the most recent monthly returns to NHS

England/Improvement (NHSE/I)

Other Financial Metrics

5. Cash flow – Cash target met for the month.

6. Better Payment Practice Code – continued strong performance in month. All cumulative

metrics in excess of 99% compliance.

7. CSU Performance – CSU report for month 7 confirms all formal KPIs achieved.


10 December 2019

3


10 December 2019

Detailed Finance Report

Introduction

1. This report provides details of the financial position for East Leicestershire and Rutland

Clinical Commissioning Group (ELR CCG) at month 7 of 2019/20, the pressures contained

within that position and the risks to the delivery of the CCG’s financial targets for the year.

2019/20 Allocations

1. The overall revenue allocation for ELR CCG at month 7 stands at £447.642m, a net reduction of £0.295m over month 5 including nearly £1m transferred to Leicester City CCG in respect of the transfer of the Narborough Road Surgery.

2. The CCG has no identified core capital funding for 2019/20.

3. The allocation is detailed in Appendix A. Included in the allocation is the carry forward from 2018/19 of the CCG cumulative surplus of £2.462m.

Financial Performance

4. The budget statement in Appendix B details the ledger position for 2019/20 as at month 7. Due to timing, verified QIPP reporting for month 6 has been used in compiling the month 7 financial position with updates made by exception for any further known items. At this stage potential shortfalls are emerging against the planned schemes which, together with the as yet unidentified value of approximately £6m are contributing to a potential shortfall of £8.191m against the £26.647m plan. The CCG is working collaboratively with local partners to identify system wide solutions to ensure the delivery of the control total.

5. At this stage of the year, only six month’s activity information and five month’s prescribing data is available on which to produce a year to date and forecast position. As a result, some margin for error will exist in the forecasting of pressures to the end of the year but it is clear that Acute contract and GP Prescribing overspends are the main operational pressures facing the CCG.

6. Due to slippage in the progression of QIPP savings requirements and material cost

pressures within Acute contracts and GP Prescribing, the year to date position at month 7 is an adverse variance of £5.312m. Within this position, £3.509m relates to the year to date element of the unidentified QIPP, £3.178m relates to acute overspends, £1.413m relates to GP Prescribing overspends and all other budget areas are £0.781m underspent in aggregate making a total overspend of £7.319m partially offset by releasing the 0.5% contingency of £2.008m.

8. The CCG is currently forecasting that the material acute and GP Prescribing overspends

will continue to the year end and therefore despite the release of the 0.5% contingency

and significant underspends across non acute commissioning the CCG is projecting a

material level of risk to the control total by the end of the year. The CCG therefore

continues to work in collaboration with other NHS partners within Leicester, Leicestershire


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4

and Rutland (LLR) to implement a Financial Recovery Plan (FRP), to ensure the control

total breakeven for the year can be achieved.

9. At month 5, the gross operational risk before FRP actions was assessed as £12.195m with

£6.47m of FRP actions entered to the forecast reducing the residual risk to £5.725m. By

month 7 the potential operational forecast overspend has been assessed as £13.460m.

Risks relating to further QIPP slippage and the potential for further growth beyond forecast

levels totalling £3.041m contribute to a gross risk of £16.501m. Against this value,

£6.828m of FRP and other mitigations have been identified resulting in a net residual risk

of £9.673m. Work is ongoing to develop the additional actions required to ensure that this

gap can be closed before the end of the financial year but it remains a significant risk and

has been confirmed in the most recent monthly returns to NHS England/Improvement

(NHSE/I).

7. Acute budgets total £225.086m. The overall forecast overspend for Acute services has increased from £5.699m at month 5 to £6.181m at month 5. The contract for the year with University Hospitals of Leicester (UHL) has been set at £153.135m for the year, but as a combination of activity overperformance and casemix (pricing) variances is overspending by £2.233m at month 7. Approximately £1.1m of FRP actions are targeted against the UHL contract and reduce the forecast overspend to £2.219m by year end.

8. The UHL overspends are across planned and unplanned points of delivery, primarily

outpatient procedures, day cases and Emergency inpatients. The majority of this overspend, however, is not directly activity (ie volume) driven, instead the main variances are stemming from the average prices of activity charged being higher than allowed for in the base plan. This points to a level of additional acuity of patients being treated than planned and is still being challenged by the LLR CCGs in order to ensure no unplanned counting and coding changes have been actioned by the Trust. The high level impact of the activity and price variances are shown below ;

UHL High Level Variance Analysis - Year to Date

Volume

Variance

£000

Price

Variance

£000

Total

Variance

£000

Planned Care (Outpatients, Daycases and Inpatients) 663 (12) 651

Accident and Emergency 121 50 171

Other Urgent Care (Urgent and Emergency Inpatients and

Maternity)

(932) 1,337 405

Other (340) 1,534 1,194

Total Year to Date Variance (488) 2,909 2,421

9. The independent sector contracts deliver only planned activity and total £8.040m. In aggregate these contracts are £1.341m overspent at month 7 and forecast to rise to £2.017m by year end. The overspends being experienced are almost entirely activity driven and have remained relatively stable over the last two months following a significant spike in activity at the start of the year.

10. Out of County Acute NHS provider contracts total £34.631m and are now forecast to

underspend by £0.301m. Nottingham University Hospitals and Kettering General Hospital are the only contracts with a material forecast overspend, more than offset by material


10 December 2019

5

underspends in the North West Anglia and University Hospital of Coventry and Warwickshire contracts.

11. At the start of the year, budgets were set within acute reserves to reflect a level of

anticipated QIPP savings that had not been transacted with individual providers, planned investment in the Alliance PCL pillar and a further reserve to guard against planned care overperformance. At month 7, despite material slippage in the forecast Alliance PCL investment and the release of the planned care reserve the net pressure on these reserve lines is forecast to be £2.569m.

12. The main components of the acute forecast variance are summarised below;

Acute Forecast Variance Components £000

UHL 2,219

Independent Sector Contracts 2,017

Out of County NHS Contracts (301)

Acute reserves and untransacted QIPP 2,569

Other (including EMAS, Alliance, Patient Transport, Out of

Hours, NHS111)

(323)

Forecast Variance 6,181

13. Non acute budgets total £111.180m, largely unchanged from month 5. A budget of £58.135m is held for Leicestershire Partnership Trust (LPT) which includes an allowance for out of area mental health placements and dementia drugs recharges. Underspends against these latter items are contributing to a forecast underspend of £0.135m.

14. Separate budgets are held relating to a level of QIPP and other investments and QIPP

savings targeted against LPT services but not built into the baseline contract. Slippage in both the targeted investment and savings linked to these initiatives is resulting in a net forecast pressure of £0.417m, the analysis of which is shown below;

Planned QIPP Investment and Savings relating to LPT

services

Budget

£000

Forecast

£000

Variance

£000

Investments 857 708 (149)

Savings (600) (34) 566

Forecast Variance 257 674 417 15. Budgets for Continuing Healthcare (CHC) and similar individually commissioned packages

of care total £32.076m. These areas continue to benefit from strong QIPP delivery, including the full year effect of schemes commenced in 2018/19 and lower than predicted growth and are currently forecast to underspend by £1.556m. The majority of expenditure areas continue to underspend with only Section 117 aftercare packages forecasting a material overspend.

16. Underspends in a range of other service agreements are contributing to an aggregate forecast underspend across non acute commissioning of £1.585m.

17. Primary Care budgets for the year total £101.793m. Prescribing elements total £47.746m. Despite strong QIPP delivery across a range of prescribing initiatives the prescribing


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6

budgets are £1.413m overspent at month 5 and forecasting an overspend of £2.290m by year end. This forecast includes a £0.644m cost pressure linked to an increase in a range of nationally negotiated drug prices (category M) with effect from October but is encountering levels of growth beyond planned levels across a number of areas including Direct Oral Anti Coagulants (DOACs) used to reduce the risk of blood clots. A deep dive is being undertaken across prescribing expenditure areas to ensure the drivers for the overspends are fully understood and identify any further actions that can be taken to mitigate them.

18. The CCG has a co-commissioning allocation for the year of £43.077m following a reduction of £0.249m relating to the transfer of the Narborough Road practice to Leicester City CCG. £0.095m relating to the GP training function is shown within the miscellaneous line on Appendix B leaving £42.983m on the specific co-commissioning line. The month 7 forecast is for the Co-Commissioning budget to overspend by £0.286m by year end as a result of a number of cost pressures arising from the core contract and premises uplifts. A range of other primary care budgets are held totalling £11.065m including local service investments and Forward View investments hosted on behalf of LLR. The majority of these areas remain broadly on plan and in aggregate are forecast to underspend by £0.291m.

19. Miscellaneous (Inc. reserves) represents a range of budgets totalling £1.853m supporting the Commissioning function and a net (£1.175m) of identified reserves including the £6m unidentified QIPP.

20. These identified reserves include the 0.5% contingency reserve of £2.008m referred to above which has now been released. The remaining £2.835m of reserves was earmarked in the plan for anticipated costs pressures, including any adverse impact of finalising accruals from 2018/19. At this stage it is forecast that these particular reserves will overspend by £0.82m by year end.

21. The remaining forecast on this reserves line is the entry of approximately £3.846m of

additional targeted FRP mitigations and further actions being pursued to mitigate the £9.673m of residual risk highlighted above, contributing to an aggregate forecast underspend of £7.248m by year end on miscellaneous including reserves. The analysis of miscellaneous (Inc. reserves) is shown below;

Analysis of Miscellaneous (Inc.Reserves)

Budget

£000

Forecast

£000

Variance

£000

Corporate Support functions 1,853 1,707 (146)

Reserves - Contingency 2,008 0 (2,008)

Commissioning reserve (including pressures from 2018/19

accruals)

2,833 4,091 1,258

Unidentified QIPP (6,016) 6,016

Further risks and identified FRP actions affecting reserves (2,695) (2,695)

Additional FRP actions to mitigate net risk (9,673) (9,673)

Total Miscellaneous (Inc.Reserves) 678 (6,570) (7,248)

Running Costs

22. Running cost budgets for the year total £6.443m. The budgets were set deliberately lower than the total allocation of £6.913m in order to support patient facing services and a challenging QIPP has been set for the year. The current forecast is that despite a


10 December 2019

7

significant level of QIPP delivery, the budgets are likely to be £0.367m overspent by year end but still remain within the Running Cost allocation.

Capital

23. The CCG had not been allocated any capital in its base plan for 2019-20. The CCG is managing schemes to support GPIT investments on behalf of NHSE but the resultant assets are held on the NHSE asset register and are not counted as CCG capital expenditure.

Better Payment Practice Code (BPPC)

26. The BPPC performance for the CCG as at month 7 is shown in Appendix C and confirms continued strong performance across all metrics taking the cumulative performance to the following levels;

NHS creditors (number) – 99.19%

NHS creditors (value) – 99.75%

Non NHS creditors (number) – 99.23%

Non NHS creditors (value) – 99.01% CSU Performance 27. The ‘Month End Summary CFO Report’ for month 7 confirms all formal KPIs have been

achieved by the CSU.

28. All payroll payovers were made by the deadlines and all control accounts were reconciled and the full reconciliation pack distributed. All control codes are rated green, confirming no reconciling items remain over one month old.

29. The CCG closing cash book balance for month 7 was £0.013m and the closing bank balance was £0.081m. Since its authorisation, the CCG has monitored itself against the initial NHSE requirement to hold no more than 1.25% of their monthly draw down at month end. The implied target for November was £0.405m and therefore the CCG has comfortably met the target.

Balance Sheet and Cash Flow Statement

30. Appendix D contains the balance sheet at 31 March 2019 and the most recent two months of 2019/20. Current assets have decreased significantly in the month following the collection of corporate recharge debtors from neighbouring CCGs.

31. In aggregate, current liabilities have increased in the month by £1.6m, predominantly

relating to increased overperformance in acute contracts and increasing GP prescribing spend.

32. Appendix E outlines the Cash Flow Statement for ELR CCG for Months 1 to 7.

Compared to a 1/12ths profile this shows the CCG had drawn down £0.605m less than might have been expected at month 7. The CCG is required to operate within a Maximum Cash Drawdown (MCD) target set by NHSE (effectively a cash limit) At this stage, despite the risks to the breakeven control total that are being experienced, the CCG is not currently anticipating any risks to operating within the MCD.


10 December 2019

8

NHSE Reporting 2. For 2019/20, the NHSE metric return has been revised to focus on nationally reported

activity and Referral to Treatment Time (RTT) information. This return utilises the most recent activity information available and therefore the CCG has submitted the required return for month 6 and appendix F contains the summary report. As at month 6, the main areas of concern remain the adverse variances in the following areas;

a. Other referrals b. Outpatient procedures c. Elective daycases d. Non Elective admissions above 1 day length of stay e. RTT admitted pathways

Narrative has been added to the return to explain the drivers for some of the variances and the actions being taken to address them. A significant proportion of the adverse variance in other referrals has since been confirmed as a data issue within UHL and not due to overall increases in activity. The adverse variances in outpatient procedures and elective daycases do directly contribute to overspends in those lines within the relevant acute contracts.

Risks and mitigations 33. There are several risks that have the potential to adversely affect the CCG’s financial

position for 2019/20 as outlined below:

Non achievement of savings schemes, in particular currently unidentified QIPP and additional FRP mitigations.

Continued in year Acute overspends

Growth in CHC, S117, prescribing and NCSO

Further potential pressures from 18/19

In year cost pressures relating to Running Costs

34. The CCG, in collaboration with system partners, continues to progress the FRP to ensure the delivery of the control total.

Summary 35. At month 7 the in-year financial position of ELR CCG is reporting a year to date overspend

of £5.312m and a year-end forecast position of breakeven. The delivery of £6.823m of targeted FRP and other actions and a further £9.673m of additional mitigations remains a significant risk to the delivery of the control total breakeven.

Recommendations:

The ELR CCG Governing Body is requested to:

Receive for information the contents of the report and the appendices attached

Note the year to date overspend and forecast breakeven positon reported at month 7 along with the identified risks to the delivery of the breakeven control total.

ELR CCG Allocation 2019/20 Appendix A

M1 M2 M3 M4 M5 M6 M7

Movement

from M1

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Recurrent allocation (programme)

Recurrent baseline 393,963 393,963 393,963 393,963 393,963 393,963 393,963 0

Primary Care Co-Commissioning 44,691 44,691 44,691 44,691 44,691 44,691 44,691 0

Published Allocations - Other funding after pace of change 276 276 276 276 276 276 276 0

Reduction for central indemnity scheme (1,286) (1,286) (1,286) (1,286) (1,286) (1,286) (1,286) 0

IR PELs transfer 350 350 350 350 350 350 350 0

Month 12 IR changes 256 256 256 256 256 256

Narborough Road GP Practice Transfer - Acute Activity (1,275) (1,275) (1,275) (1,275) (1,275) (1,275)2018/19 FYE - IR Final Changes - Detail available at local Hub (189) (189) (189) (189) (189) (189)

2019/20 IR - PELs Changes - Detail available at local Hub (16) (16) (16) (16) (16) (16)

Orthotics NHSE transfer (298) (298) (298) (298) (298)

Narborough Health Centre funding transfer - Co-commissioning (249) (249) (249)

Narborough Health Centre funding transfer - Programme (724) (724) (724)

Narborough Rd HC funding transfer adjustment 32 32

Total recurrent allocation (programme) 437,994 437,994 436,770 436,472 436,472 435,499 435,531 (2,463)

Non recurrent allocation (programme)

2018/19 Brought Forward Surplus/Deficit 2,450 2,462 2,462 2,462 2,462 2,462 2,462 12

Reallocation of transitional support (2,624) (2,624) (2,624) (2,624) (2,624) (2,624)Excess Treatment Costs - see CCG Bulletin 277 (20) (20) (20) (20) (20) (20)

IPS Wave 2 Transformation funding (Q1 & Q2) 88 88 88 88 88 88

GPFV - GP Retention - STP Funding 232 232 232 232 232 232

GPFV - Practice Resilience - STP Funding 146 146 146 146 146 146

GPFV - Reception & Clerical - STP Funding 191 191 191 191 191 191

GPFV - Online Consultation - STP Funding 311 311 311 311 311 311

GPFV - Primary Care Networks - STP Funding 799 799 799 799 799 799

Improving Access Allocations 19/20 from National Programme 1,805 1,805 1,805 1,805 1,805 1,805

Community Crisis TF allocation 424 424 424 424 424

GPFV - STP Funding - Workforce Training Hubs 183 183 183 183 183

GPFV - STP Funding - Fellowships Core Offer 165 165 165 165 165

GPFV - STP Funding - Fellowships Aspiring Leaders 210 210 210 210 210

International GP Recruits Salary costs etc. 137 137 137 137

Suicide Prevention Post Bereavement 32 32 32 32

2019/20 Armed Forces CCG OOH allocation 11 11 11 11

Co-Commissioning Sterile Products / Suspended Doctors transfer (79) (79) (79)

IPS Wave 2 Transformation Funding Q3 allocation 44 44 44

LD transformation funding per Rick Salmon & Sarah Morgan 100 100 100

Flash glucose monitoring Q1 18 18 18

BCF Support 329 329

Non Recurring funding for Adult and Children’s Palliative and End of Life Care Services 126 126

Sucide Prevention Post Bereavement 16 16

CCG FT CHC Development - Personalised Care Group 8 8

Enhanced GP IT infrastructure and resilience arrangements 84 84

Total non recurrent allocation (programme) 2,450 2,462 3,390 4,372 4,552 4,635 5,198 2,748

Total allocations (programme) 440,444 440,456 440,160 440,844 441,024 440,134 440,729 285

Recurrent allocation (running costs)

Recurrent baseline 6,913 6,913 6,913 6,913 6,913 6,913 6,913 0

Total allocations (running costs) 6,913 6,913 6,913 6,913 6,913 6,913 6,913 0

TOTAL ALLOCATIONS 447,357 447,369 447,073 447,757 447,937 447,047 447,642 285

Capital Funding Approved by NHSE 0 0 0 0 0 0 0 0

East Leicestershire & Rutland CCG Summary - 2019/20 Month 7 Appendix B

Budget

(£000)

Expenditure

(£000)

Variance

(£000)

Budget

(£000)

Expenditure

(£000)

Variance

(£000)

Total allocation Excluding Brought

Forward Surplus261,987 261,987 0 445,180 445,180 0

Acute Commissioning 132,833 136,011 3,178 225,086 231,267 6,181 5,449 732

Non-acute Commissioning 64,341 63,650 (691) 111,180 109,595 (1,585) (1,185) (400)

Practice Prescribing 27,902 29,315 1,413 47,746 50,036 2,290 2,422 (132)

GP Commissioning 24,966 25,043 77 42,983 43,268 286 132 154

Primary Care Services 6,228 6,146 (81) 11,065 10,774(291)

(139) (152)

Miscellaneous (inc reserves) 1,948 3,309 1,361 677 (6,570) (7,248) 2,333 (9,581)

Total Programme Expenditure 258,217 263,474 5,257 438,737 438,370 (367) 9,012 (9,380)

Total Running Costs 3,770 3,825 54 6,443 6,810 367 93 274

Total Expenditure 261,987 267,298 5,312 445,180 445,180 0 9,106 (9,106)

In year position

Programme control total (262) (208) 54 (470) (103) 367

Running Costs control total 262 208 (54) 470 103 (367)

Total control total 0 0 0 0 0 0

Cumulative Surplus

Programme control total 1,174 (4,084) (5,257) 1,992 2,359 367

Running Costs control total 262 208 (54) 470 103 (367)

Total control total 1,436 (3,876) (5,312) 2,462 2,462 (0)

Year to Date Forecast Outturn Month 12

Straight Line

Variance using

month 7 YTD

(£000)

Variance

Difference

(between

straight line

and forecast)

(£000)

Appendix C

A B C D E F A B C D E F

No of Bills

Paid Within

Period

No of Bills

Paid Within

Target

% of Bills

Paid Within

Target

Value of Bills

Paid Within

Period

Value of Bills

Paid Within

Target

% Value of

Bills Paid

Within

Target

No of Bills

Paid Within

Period

No of Bills

Paid Within

Target

% of Bills

Paid Within

Target

Value of Bills

Paid Within

Period

Value of Bills

Paid Within

Target

% Value of

Bills Paid

Within

TargetNo. No. % £'000 £'000 % No. No. % £'000 £'000 %

April 219 216 98.63 22,383 22,330 99.77 478 473 98.95 3,067 2,993 97.58

May 205 205 100.00 18,001 18,001 100.00 616 615 99.84 3,482 3,474 99.77

June 343 341 99.42 22,986 22,962 99.90 602 598 99.34 4,250 4,233 99.60

July 323 321 99.38 24,701 24,620 99.67 569 561 98.59 4,245 4,208 99.13

Aug 193 193 100.00 22,465 22,465 100.00 638 635 99.53 3,500 3,494 99.83

September 300 298 99.33 23,066 23,059 99.97 649 648 99.85 3,435 3,433 99.95

October 279 273 97.85 23,407 23,178 99.02 594 584 98.32 3,971 3,857 97.13

Totals 1,862 1,847 99.19 157,010 156,615 99.75 4,146 4,114 99.23 25,949 25,691 99.01

East Leicestershire & Rutland CCG

Better Payment Practice Code October 2019

NHS Creditors Non NHS Creditors

Appendix D

Balance as at

31 March 2019

Balance as at

30 September

2019

Balance as at

31 October

2019

£'000s £'000s £'000s

Non Current Assets:

Premises, Plant, Fixtures & Fittings 1,100 981 961

IM&T 43 33 31

Other 0 0 0

Long-term Receivables 0 0 0

TOTAL Non Current Assets 1,143 1,013 992 Sub Analysis 31 October 2019

Current Assets:

Inventories 0 0 0

Trade Receivables 2,008 1,739 1,258 Trade Receivables Volume

Bad & Doubtful Debts Prov (23) (23) (23)

UHL Maternity Prepayment 1,673 1,673 1,673 Not yet due 21 248

Prepayments – In Month 586 774 755 1-30 days 17 371

Includes £104k raised to West Leicestershire CCG in respect of GP Online

consultation and £229k raised to City CCG in respect of 19-20 Q1 and 2 urgent

care centre recharges.

Accrued Income 1,671 669 849 31-60 days 8 196

Includes £106k outstanding with West Leicestershire CCG for corporate

recharges. Includes £60k recharges to UHL re capital charges.

VAT and CHC Risk Pool 274 86 45 61-90 days 4 30Includes £22k outstanding with a GP practice for recovery of overpayments

Cash and Cash Equivalents 40 390 13 91+ days 40 412

Other Receivables 0 24 0 90 1,258

TOTAL Current Assets 6,229 5,332 4,570

TOTAL ASSETS 7,372 6,345 5,562

Value (£'000)

Trade Payables (1,167) (1,025) (2,104) Trade Payables Volume

Prescribing Accruals (7,084) (7,426) (8,190) Not yet due 206 1,323

£8.936m of creditors removed as they are future period invoices relating to

November 19.

Other Accruals (11,995) (17,365) (17,173) 1-30 days 58 596Includes £440k paid in November 19.

Payroll Creditors (505) (466) (438) 31-60 days 27 18Net debit balances with a small number of providers.

Provisions (94) (121) (116) 61-90 days 14 51Includes £34k outstanding with Cambridgeshire and Peterborough NHSFT, that is

fully credited.

Borrowings 0 0 0 91+ days 27 117 Includes £96k paid in November 19.

Total Current Liabilities (20,845) (26,403) (28,021) 332 2,104

TOTAL LIABILITIES (20,845) (26,403) (28,021)

ASSETS LESS LIABILITIES (Total Assets Employed) (13,473) (20,058) (22,459)

TAXPAYERS EQUITY

General Fund (Opening Balance, Fixed) (9,089) (13,473) (13,473)

Income & Expenditure (year to date) (434,020) (228,808) (267,298)

Parliamentary Funding (year to date) 429,637 222,223 258,312

Co Commissioning (year to date) 0 0 0

Revaluation Reserve 0 0 0

Other Reserves 0 0 0

Total (13,473) (20,058) (22,459)

Statement of Financial Position

Value (£'000)

Includes £47k outstanding with Central Nottinghamshire Clinical Services,

company is in administration.£224k outstanding with UHL re LTC and Alliance

assets and £34k for D2A risk share and £30k for International GP recruitment

funding.

Appendix E

East Leics and Rutland03W

2019/20 April May June July August September October

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Receipts

Balance b/fwd 276 276 151 146 226 273 96 393

NCB-Drawdown 233,150 30,500 31,900 36,450 37,100 31,500 33,300 32,400

Other (including VAT) 4,415 823 225 464 454 538 762 1,149

Total Receipts 237,841 31,599 32,276 37,060 37,780 32,310 34,158 33,942

PaymentsCreditors NHS 162,909 22,737 22,850 23,102 24,877 22,603 23,275 23,465

Creditors BACS/CHAPS 38,902 4,129 4,476 6,877 6,921 4,801 6,033 5,665

Salary BACS/CHAPS 1,897 305 265 266 269 279 257 255

Pensions (Including GP pensions) 2,326 356 328 340 350 235 371 346

Tax & NI 910 129 151 119 132 134 124 122

Standing Orders /Direct Debits 0 0 0 0 0 0 0 0

PCS Payments 30,818 3,792 4,060 6,130 4,958 4,163 3,706 4,009

Total - Expenditure 237,761 31,448 32,130 36,834 37,508 32,215 33,765 33,861

Balance c/fwd 151 146 226 273 96 393 81

April May June July August September October

£'000 £'000 £'000 £'000 £'000 £'000 £'000

Cumulative Cash Drawn 30,500 62,400 98,850 135,950 167,450 200,750 233,150

Drawdown expressed in equal

1/12ths 33,394 66,787 100,181 133,574 166,968 200,361 233,755Cumulative Variance to equal 1/12ths

profile (2,894) (4,387) (1,331) 2,376 483 389 (605)

Cashflow ReportingMonth 7 2019/20

Year to date

F

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Paper F East Leicestershire and Rutland CCG Governing Body meeting

10 December 2019


Front Sheet

REPORT TITLE: Assurance Report from the Provider Performance Assurance

Group (PPAG) – November 2019


REPORT BY: Jayshree Raval, Commissioning Collaborative Support Officer ELR CCG

SPONSORED BY: Donna Briggs, Chief Finance Officer and Deputy Managing Director

PRESENTER: Warwick Kendrick, Independent Lay Member and Chair of PPAG

PURPOSE OF THE REPORT: This report is from the Provider Performance Assurance Group (PPAG); a meeting held in common of the 3 Leicester, Leicestershire and Rutland CCGs. This report provides the Governing Body with assurance about the arrangements in place to collaboratively monitor the contract arrangements and performance of our key providers.

RECOMMENDATIONS: The East Leicestershire and Rutland CCG Governing Body is requested to:

• RECEIVE the assurance report from PPAG.

Page 1 of 4


10 December 2019

EAST LEICESTERHSIRE AND RUTLAND CLINICAL COMMISSIONING GROUP

GOVERNING BODY MEETING December 2019

Assurance Report from the Provider Performance Assurance Group (PPAG)

November 2019 Introduction

1. The purpose of this report is for Provider Performance Assurance Group (PPAG) to provide the Governing Body with a summary of the assurance received from the Contract Leads in relation to performance across the collaborative contracts, and the respective providers’ performance.

2. In addition, the report provides a summary of the items for escalation from PPAG

during November 2019 for consideration by the Governing Body, and to ensure that the Governing Body is alerted to emerging risks or issues.

3. PPAG is a meeting held in common consisting of members from across each of the 3

Leicester, Leicestershire and Rutland CCGs. PPAG’s role is to:

• Receive assurance and hold to account the Contract Leads; • Advise, make suggestions and recommend actions on provider performance as

appropriate; and • Provide onward assurance to the respective Governing Bodies.

4. The chair informed PPAG members that following the approval by all 3 LLR CCGs’

Governing Bodies in October 2019, the new collaborative governance arrangements are being implemented. The establishment of the new arrangements means that the PPAG is being disestablished following the meeting today of 28 November 2019.

Provider review and areas of concern

5. At the meeting in November 2019, PPAG received a report from each of the Contract

Leads from across the 3 CCGs. The main focus of the meeting was on the three Deep-Dive Reports:

• Cancer Performance • East Midlands Ambulance Service (EMAS) • Urgent and Emergency Revised Winter Plan

6. This report provides an overview and update on key areas of discussion and highlights

issues for escalation from PPAG to the Governing Body.

Exception Report from West Leicestershire CCG: (Non-Acute Contract)

7. East Midlands Ambulance Service (EMAS): It was reported that EMAS performance deteriorated in October 2019 for all regions. For LLR, all six standards deteriorated in October 2019 compared to the month of September 2019 with only one of the national standards achieved. It was noted that the LLR performance was better than the regional average for Category 1 (Mean), but was worse than the regional average for the other five standards.

8. Furthermore PPAG noted that the Coordinating Commissioner issued EMAS with a Contract Performance Notice (CPN) due to failing to deliver the contractual performance

Page 2 of 4


10 December 2019

standards in Quarter 2 2019/20. EMAS has requested a joint investigation to understand in more detail the internal/external factors that impact upon poor performance.

9. Handovers: PPAG were informed that there were a total of 6,182 handovers at UHL, which was the highest number of handovers in a month of October 2019 over the last three years. It was noted that Handover performance has deteriorated significantly with 4.7% of patients waited more than 2hrs to be handed over to UHL and this is the highest number and percentage over the three-year period.

10. The contracts team informed that a handover action plan has been devised which

highlighted actions such as: • Consultants working with EMAS in responding to calls to discharge on scene. • Looking into having Ambulance Handover Pod that could be sited outside UHL for

the ambulance service to offload into during periods of Ambulance Handover Delays (AHD).

• GP Assessment Unit (GPAU) opening overnight to provide space to de-bulk majors.

• More consistent use of the “Fit to Sit Protocol” which allows suitable ambulance patients to sit in Majors Ambulatory, thus releasing the ambulances. Decisions about which patients are suitable can be taken by ED clinical staff and ambulance crews.

• Better management of the volume through fully implementing direct access to assessment clinics: Deep Vein Thrombosis (DVT) Pathway and GPAU in particular.

• More proactive and consistent role for senior onsite EMAS manager to assist compliance with protocols, safety and overall turnaround.

11. PPAG members acknowledged the actions being taken in order to enable ambulances to be more effective, however also expressed concerns in terms of handover delays.

12. Thames Ambulance Service Limited (TASL): It was reported that TASL’s performance continues to be good for the time on vehicle Key Performance Indicators (KPIs), however performance declined for the other five KPIs. Under outpatients’ arrival time, it was noted that performance declined for the month of September 2019.

13. PPAG were informed that the contract leads continue to support TASL and continue to

monitor the activity.

14. Winter Plan: PPAG received a revised LLR Urgent and Emergency Winter Plan which outlined the planning and readiness information to support all aspects of LLR service delivery throughout winter period 2019/20. PPAG members did not feel assured that the revised winter plan was robust enough to withstand the winter pressures.

Exception Report from Leicester City CCG: (Acute Contract)

University Hospitals of Leicester (UHL) and LLR Alliance

15. Cancer standards: It was reported that UHL delivered the 2ww standard in September 2019, however did not achieve the 2ww breast, 31 day surgery standard or 62 day standard targets due to insufficient capacity within UHL and inadequate systems and processes in place. Due to an increase in the 2ww, key actions are being looked at for the next 6 month which will include:

• Review of demand and capacity;

Page 3 of 4


10 December 2019

• Map out optimum performance position and agree improvement trajectory to recover cancer standards;

• Urology deep-dive, which will be looking into the findings of the Intensive Support Team review of the Rapid Prostate timed pathway;

• A review of the >104 day process has taken place and the is significant oversight within the system on patients that are waiting a long time.

16. 62 Day standard: It was highlighted that UHL continues to concentrate on recovering

this standard however the backlog position is static. The majority of the backlog sits within Urology. It was reported that 5 of the tumour sites (Haematology, Upper GI, Lung, Breast and Gynaecology) were either achieving or better than their backlog trajectories. The impact from the Head and Neck pressures currently facing the Trust are likely to continue to impact on the 62 day position.

17. There has been an improvement in UHL receiving less late tertiary referrals and this is having less of an impact on the long waiters. The main factor impacting on backlog and 62 day performance continues to be theatre and HDU/ITU capacity constraints. PPAG were assured that although delays are noted all Cancer patients are continued to be tracked until they have been treated and the Chief Operating Officer of UHL are appraised daily on the latest status. The CCG is informed on a weekly basis.

Exception Report from East Leicestershire and Rutland CCG: Leicestershire Partnership Trust (LPT)

18. Progress on the Care Quality Commission (CQC) actions: It was reported that 86% of warning notice actions have been completed and audits to ensure improvements are embedded and sustained. PPAG were informed that the Improvement and Assurance Meetings continue to take place to oversee and monitor progress.

19. From a Quality perspective it was highlighted that as part of the quality review process, information is considered from a variety of sources including monthly staffing data, Complaints and Patient Safety reports, Patient Experience data, a review of serious incidents, information from the Care Quality Commission (CQC), Commissioner Quality Visits and themes taken from General Practice (GP) concerns.

20. Out of Area Placements: On a positive note it was reported that there is a significant

reduction in the Adults Mental Health out of area placements. It was noted that work continues to progress to ensure there is appropriate reduction in the number of inappropriate out of area placements.

21. Under the Neurodevelopment (ND) Pathway, it was highlighted that there is still a waiting list and the pathway is not meeting the trajectory. Furthermore it was noted that there is a risk that this element of the CAMHs waiting time programme will not be completed within the agreed timeframe. The Trust have a recovery plan which includes diversion of cases to Community Paediatrics, regular validation of waiting lists and a revised CAMHS referral form which includes additional supporting information for ND assessments. This is a risk on the Trust risk register.

RECOMMENDATIONS

East Leicestershire and Rutland CCG Governing Body is requested to: • RECEIVE the assurance report from the Provider Performance Assurance Group.

Page 4 of 4

G

Blank Page

Paper G East Leicestershire and Rutland CCG Governing Body Meeting

10 December 2019

NHS EAST LEICESTERSHIRE AND RUTLAND CCG GOVERNING BODY MEETING

Front Sheet

Title of the report: Integrated Governance Committee summary report (5 November 2019)

Report to: Governing Body meeting

Date of the meeting: 10 December 2019 Report by:

Claire Middlebrook, Corporate Affairs Support Officer

Presented by: Mr Warwick Kendrick, Independent Lay Member

PURPOSE OF THE REPORT: This report provides a summary of the key areas of discussion and outcomes from the Integrated Governance Committee meeting held on 5 November 2019; and items for escalation and consideration by the Governing Body ensuring that the Governing Body is alerted to emerging risks or issues.

RECOMMENDATIONS: The East Leicestershire and Rutland CCG Governing Body is requested to: • RECEIVE the report.

REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2019 – 2020: Transform services and enhance quality of life for people with long-term conditions







EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in respect of this report. RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK: The Integrated Governance Committee has the remit to have oversight and seek assurance in respect of the mitigation actions in relation to all risks on the Board Assurance Framework where appropriate.

Page 1 of 3


10 December 2019


GOVERNING BODY MEETING 10 December 2019

Summary Report from the Integrated Governance Committee

(5 November 2019) Introduction 1. Since the last report to the Governing Body in September 2019, the ELR CCG

Integrated Governance Committee held a meeting on 5 November 2019; the following provides a summary of the key areas of discussion during the meeting.

2. ELR CCG Financial report month 6 – the Committee received the summary report on the financial position for 2019/20 at month six. It was noted that due to Quality Innovation Productivity Prevention (QIPP) slippage and material acute cost pressures, the year to date position at month six is an adverse variance of £4.554m

3. LLR Governance Arrangements – the Committee were informed, that following

approval of the new governance arrangements at the Governing Body meeting in October 2019, this was the final meeting of the Committee as it was being disestablished. Any outstanding issues or actions will be taken forward by the new joint LLR Integrated Governance and Quality Committee.

4. Information Governance Report - the Committee received an update on information governance, including an update on the CCG’s compliance against the Data Security and Protection Toolkit (DSPT) standards. It was noted that an interim DSPT submission was made on 31 October 2019 in line with the national submission timeline. The final submission of the DSPT self-assessment is due at the end of March 2021.

5. CCG Corporate Performance Assurance Report 2019/20 – the Committee

received the CCG Corporate Performance Assurance Report 2019/20, noting that the framework has changed since the last report was issued; with six new metrics being included. Some improvement has been noted in the 2 week wait for urgent breast; there is fluctuation in the Improving Access to Psychological Therapies; although at present there are no patients waiting over 52 weeks.

6. Quarter one Primary Care Performance Report, GP Situation Report, Demand Management - the Committee received an update on the GP Support and Investment Plan for 2019/20 and noted that this was a quality report, rather than a QIPP report. Each indicator is RAG rated, either red or green, with narrative providing mitigations etc.

7. Summary report from the Medicines Quality related sub-groups – The

Committee received the monthly updates on actions taken and key priority work areas undertaken by the various medicines quality related sub-groups.

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10 December 2019

8. Patient Group Directions – the Committee received and approved the following PGDs: o CLARITHROMYCIN for Human Bites in Conjunction with Metronidazole (If

patient allergic to penicillin) o oral CO-AMOXICLAV for Human and Cat & dog Bites o oral METRONIDAZOLE for Human and Cat & dog Bites, in penicillin allergic

patient and ONLY in conjunction with doxycycline PGD for cat & dog bites, or clarithromycin PGD for human bites

o for the administration of OXYBUPROCAINE HYDROCHLORIDE 0.4% eye drops as local anaesthesia for eye trauma Oxybuprocaine

o for the administration of LIDOCAINE HYDROCHLORIDE 1% and 2% for Local Anaesthesia

o for the Administration of FLUORESCEIN SODIUM 1% and 2% eye drops for the detection of Corneal Abrasions

9. Quarter 2 2019/20 Infection, Prevention and Control Report – the quarter 2 update on the Infection Prevention and Control was received. It was noted that there have been fluctuations since the last report with the number of E-coli infections reducing.

10. Quarter 2 2019/20 Patient Safety Report – the Committee received the quarter 2

patient safety report which included a summary of the number and type of serious incidents reported during this period. The team are working closely with Leicestershire Partnership NHS Trust (LPT) due to the number of serious incidents they reported in the period.

11. Quarter 1 2019/20 Safeguarding report - the quarter two update on critical

messages, emerging safeguarding themes, and detail on the implementation of local and national safeguarding issues was received by the Committee. The level of adult safeguarding training was noted to have dropped slightly since the last report.

RECOMMENDATIONS The East Leicestershire and Rutland CCG Governing Body is requested to: • RECEIVE the report.

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Blank Page

Paper H East Leicestershire and Rutland CCG Governing Body meeting

10 December 2019


Front Sheet

REPORT TITLE: Performance Report 2019/20


REPORT BY: Alison Buteux, Performance Manager, (MLCSU)

SPONSORED BY: Donna Enoux, Chief Finance Officer and Deputy MD

PRESENTER: Paul Gibara, Chief Commissioning and Performance Officer, (ELR CCG)

EXECUTIVE SUMMARY: The NHS Oversight Framework 2019/20 was published by NHS England and NHS Improvement (NHSE/I) on the 23rd August 2019. The new framework supersedes the 2018/19 Improvement Assessment Framework. In 2019/20 it will be for regional teams to determine the level of oversight that best meets their assurance needs.

The NHS Oversight Framework for 2019/20 sets out measures against the key performance indicators that LLR CCGs are held to account for. These now include; New Service Models, Preventing Ill Health and Reducing Inequalities, Quality of Care and Outcomes, Leadership and Workforce and Finance and Use of Resources. Summary Recent data releases for the oversight framework shows for 2019/20 Q2 two metrics that were previously red and now green. These are rate of unplanned hospital admissions for urgent care sensitive conditions and Injuries from falls in people aged 65 and over.

Percentage of NHS Continuing Healthcare full assessments taking place in an acute hospital setting has achieved target throughout 2019/20.

Appropriate prescribing of broad-spectrum antibiotics in primary care (Antibiotic-Co-Amoxiclav) continues to improve from April 2019.

Estimated diagnosis rate for people with dementia continues to achieve target throughout the financial year for 2019/20.

The RTT target of 92% was not achieved in August, showing 83.4%.

There has been no change in the CCGs cancer performance from last month with regards to rag ratings. In September, 3 out of 8 cancer metrics achieved target.

A&E four-hour performance for October is 77%, this is at UHL level including urgent care centres. Performance has steadily declined from April 2019/20, with UHL performance

Paper H East Leicestershire and Rutland CCG Governing Body meeting

10 December 2019

deteriorating in October to 67%.

RECOMMENDATIONS: The East Leicestershire and Rutland CCG Governing Body is requested to: receive the contents of the report. REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2016 – 2017: Transform services and enhance quality of life for people with long-term conditions







EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in the development of this report as it is judged that it is not proportionate on the basis that the Performance Assurance reporting underpins the commissioning strategy and priorities of the CCG. This completes the due regard required.

RISK ANALYSIS AND LINK TO BOARD ASSURANCE FRAMEWORK: The content of the report identifies action(s) to be taken / are being taken to mitigate the following corporate risk(s) as identified in the Board Assurance Framework:

BAF 1: ACUTE – The quality of care provided by acute providers does not match commissioner’s expectation with respect to quality and safety. BAF 2: QUALITY – The quality of care provided by non-acute providers does not match commissioner’s expectation with respect to quality and safety. BAF 8: URGENT CARE – Increased pressure on the Emergency Department which could results in sub-optimal care due to ability to access urgent care services.


GOVERNING BODY Performance Report December 2019

INTRODUCTION

1. The NHS Oversight Framework 2019/20 was published by NHS England and NHS Improvement (NHSE/I) on the 23rd August 2019. The new framework supersedes the Improvement Assessment Framework. (https://www.england.nhs.uk/publication/nhs-oversight-framework-for-2019-20/)

2. A new approach to oversight will set out how regional teams review performance and

identify support needs across sustainability and transformation partnerships (STPs) and integrated care systems (ICSs).

NHS OVERSIGHT FRAMEWORK 2019/20

3. In 2019/20 it will be for regional teams to determine the level of oversight that best meets their assurance needs. Regions have been testing new ways of working and arrangements already in place will continue. Oversight Framework will incorporate:

• System review meetings: discussions between the regional team and system leaders, and covering:

• Performance against a core set of national requirements at system and/or organisational level. These will include: quality of care, population health, financial performance and sustainability, and delivery of national standards;

• Any emerging organisational health issues that may need addressing • Implementation of transformation objectives in the NHS Long Term Plan; • In the absence of significant concerns, the default frequency for these

meetings will be quarterly, but regional teams will engage more frequently where system or organisational issues make it necessary.

4. During 2019/20 NHSE/NHSI will make their reporting and dashboards, integrated

performance data on activity and quality standards, available to organisations, systems, regional and national teams to enable performance discussions to use a ‘single version of the truth’.

PERFORMANCE METRICS 2019/20

5. The specific dataset for 2019/20 broadly reflects existing provider and commissioner oversight and assessment priorities. These metrics are split by their alignment to priority areas in the NHS Long Term Plan.

6. From 2020/21, the metrics for oversight and assessment purposes will include the headline measures described in the NHS Long Term Plan Implementation Framework against which the success of the NHS will be assessed. The Long-Term Plan measures will be used as the cornerstone of the mandate and planning guidance for the NHS for the next five years.

1

https://www.england.nhs.uk/publication/nhs-oversight-framework-for-2019-20/

ANNUAL ASSESSMENTS 7. As required by law, the annual assessment of CCGs by NHS England will continue in

2019/20. It is a judgement, reached by considering a CCG’s performance in each of the indicator areas over the full year and balanced against the financial management and qualitative assessment of the leadership of the CCG. Formally NHS England will continue to assess how CCGs work with others (including their local Health and Wellbeing Boards) to improve quality and outcomes for patients.

DEVELOPING A NEW OVERSIGHT FRAMEWORK FOR 2020 ONWARDS 8. The approach in this document combines current approaches to overseeing

commissioners and providers. As teams come together and start working with systems and organisations, NHSE/I will use 2019/20 to develop proposals for a new framework.

The specific metrics that will be used for oversight and assessment will include the measures identified in the NHS Long Term Plan Implementation Framework.

NHS OVERSIGHT FRAMEWORK 2019/20 9. The report sets out measures against the Key Performance Indicators that CCG’s are

held to account for.

1. New Service Models (Appendix A) 2. Preventing Ill Health and Reducing Inequalities (Appendix B) 3. Quality of Care and Outcomes (Appendix C) 4. Leadership and Workforce (Appendix D) 5. Finance and Use of Resources (Appendix E)

Monitoring continues for the constitution metrics along with exception reporting where required:

• Constitution & Other Key Performance Indicators (Constitution) –

(Appendix F) • LLR Long Waiters Cancer Report (Cancer Long Waiters) – Appendix G

SUMMARY

10. Recent data releases for the oversight framework shows for 2019/20 Q2 two metrics that were previously red and now green. These are rate of unplanned hospital admissions for urgent care sensitive conditions and Injuries from falls in people aged 65 and over. Percentage of NHS Continuing Healthcare full assessments taking place in an acute hospital setting has achieved target throughout 2019/20. Appropriate prescribing of broad-spectrum antibiotics in primary care (Antibiotic-Co-Amoxiclav) continues to improve from April 2019. Estimated diagnosis rate for people with dementia continues to achieve target throughout the financial year for 2019/20. The RTT target of 92% was not achieved in August, showing 83.4%.

2

There has been no change in the CCGs cancer performance from last month with regards to rag ratings. In September, 3 out of 8 cancer metrics achieved target. These were 2-week breast symptom, 31 day wait - patients receiving drug treatment and 62 day wait – patients receiving treatment from an NHS cancer screening service. The 62 day wait standard target underachieved in September at 77.4% against 85% target. This target has not been achieved throughout 2019/20. A&E four-hour performance for October is 77%, this is at UHL level including urgent care centres. Performance has steadily declined from April 2019/20, with UHL performance deteriorating in October to 67%.

3

NHS OVERSIGHT FRAMEWORK 2019/20

1. NEW SERVICE MODELS Integrated Primary Care and Community Health Services

Indicator LC ELR WL Action in Place 1 - Patient experience of GP services

Target: >= previous out-turn 2018

GP patient survey summaries provided to each Primary Care team across LLR and publicly available. https://www.gp-patient.co.uk/surveysandreports Midlands and Lancashire CSU Business Intelligence team have helped to collate patient experience data into a graphical report to support the quality improvement checklist. This to be discussed at the Primary Care Networks (PCN) meetings and will form part of Accountable Clinical Director (ACD) discussions within PCNs to drive up patient experience but also to share good practice. The Quality Improvement Checklist is not a list of mandatory tasks for completion but is a checklist is a list of suggested actions for consideration of implementation or support for practices; these are actions which have benefitted neighbouring practices within the PCN to make quality improvements. Source; Primary Care Team Oct 2019

74% 84% 85% 2019

75%

82%

83%

2 - Patient experience of booking a GP appointment

Target: >= previous out-turn 2018

PLACEHOLDER BY NHSE/I. No data available.

2019

3 - Emergency admissions for urgent care sensitive conditions

Target: <= Q1 19/20 3085 2115 2328

Q2 19/20 2825

1923

2102

Acute Emergency Care and Transfers of Care

Indicator LC ELR WL Action in Place 4 - Percentage of patients admitted, transferred or discharged from A&E within four hours

National Target: 95%

UHL Target: 87.5% Oct 19

There has been an upward trend in attendances since September 2018, partly associated with changes to the paediatric emergency pathway changes implemented in July 2018 and partly reflecting overall increases in demand for urgent and emergency services across the LLR system and more widely. Demand for UHL Type 1 and 2 ED attends in Aug 2019 was greater than the same period in the previous year, which is a combination of planned growth, known changes to the paediatric front door.

4

https://www.gp-patient.co.uk/surveysandreports

Indicator LC ELR WL Action in Place

UHL Data Oct 19 77%

Emergency Departments only 67%

Urgent Care Centres only 99%

The AEDB continue to oversee the urgent care demand management plan, arising from the workshop held on 2/7/19. The A&E Delivery Board is overseeing the wider High Impact Action Plan to address system-wide issues affecting performance, and in addition, UHL have revamped their internal CCGs are represented on the system-wide A&E Delivery Board, which is overseeing the implementation of the High Impact Actions Plan to recover ED 4 hour performance. There is system-wide monthly escalation meeting with NHSE/I to oversee actions and performance. Contractual oversight of ED 4-hour performance has been increased by receiving monthly reports from the Deputy Chief Operating Officer at the UHL-CCG Contract Performance Meeting. Source; PPAG October 2019

5 - Achievement of clinical standards in the delivery of 7-day standards

Clinical standards met the 90% threshold in 17/18

The indicator will be drawn from the responses to the key survey questions covering the 4 priority clinical standards. These are set out below. Clinical Standard 2: Percentage of patients reviewed by an appropriate consultant within 14 hours of admission Clinical Standard 5: Proportion of consultants who said that diagnostic tests were always or usually available when needed for critical and urgent patients Clinical Standard 6: Proportion of the nine possible consultant- directed interventions provided by the trust 7 days a week on-site or by formal arrangement Clinical Standard 8: Proportion of patients in the trust who need it, receive a daily or twice daily review by a consultant.

3 out of 4

2 out of 4

3 out of 4

6 - Delayed transfers of care per 100,000 population

Target: <= previous years out-turn

The numbers relate to the average delays per day within the month.

15 36 (Leics)

2 (Rut)

36

September 19 16

33 (Leics)

2 (Rut)

33 (Leics)

7 - Population use of hospital beds following emergency admission

Target: <= previous out-turn NO UPDATE TO Q2 18/19 ON OVERSIGHT FRAMEWORK AS @ NOVEMBER 2019. Delivery narrative to be reported next month.

492 519 544 Q2 18/19

509

537

575

8 - Percentage of NHS continuing healthcare full assessments taking place in an acute hospital setting

National Target: <15% October 2019

7%

3%

11%

5

Personalisation and Patient Choice

Indicator LC ELR WL Action in Place 9 - Personal Health Budgets

Target: >= than Q2 19/20 plan

These numbers are going to increase in Q3 as the PWB are now fully operational including with direct issue wheelchair referrals. There are approximately 130 referrals per month per CCG into the wheelchair service (WCS), so delivery of target is achievable. We are at default for new cases - adults and children in Continuing care there are 61 patients on traditional packages to be reviewed this year. These reviews will convert to PHBs and are split across the 3 CCGs. Source; PHB Team, ELR November 19

270 255 270 Q2 2019/20

310

206

206

10 - Use of the NHS e-referral service to enable choice at first routine elective referral

National Target: 100% The current performance remains below expected target. The CCGs continue to work with providers, member practices and NHS Digital to use eRS to improve the quality of services for patients and to implement the Paper Switch Off (PSO) projects. WL- PSO updates and data are provided to all practices via locality meetings monthly. LC - continues to collate intelligence from practices to establish the underlying reasons why some referrals are not sent electronically. This has been raised at monthly HNN meetings and Citywide PLTs. No single overriding cause of lower referral rate emerges therefore HNN managers continue to work with targeted individual practices. ELR-eRS continues to be promoted through discussion at locality meetings and through the monthly practice newsletters. Source: LAT Nov 2019

August 19 86%

85%

87%

2. PREVENTING ILL HEALTH AND REDUCING INEQUALITIES

Smoking Indicator LC ELR WL Action in Place 11 - Maternal smoking at delivery

Target: <= previous annual out-turn

The smoking at the time of delivery (SATOD) has overall gone down within Leicester, Leicestershire and Rutland. Pregnant women within LLR are offered a home visiting service with 12 weeks behavioural intervention and 12 weeks of free medication. Medication includes nicotine replacement therapy (NRT) and in Leicestershire E-Cigarettes (starter pack and 12 weeks-worth of nicotine liquid) are offered as an alternative to NRT.

10.2% 6.7% 10.1 % Q2 19/20

6


9.7%

7.9%

10.4%

Quarter 1- 2019/20-Quit Ready Stop Smoking Service (QRSSS) received 102 referrals for pregnant women in this quarter. All 102 women were contacted by the QRSSS, 59 women engaged with the service with 42% going onto successfully quitting at 4 weeks followed by 34% who were Long Term Follow Up (LTFU) and 24% who did not go onto quit smoking.

27% pregnant women went onto using NRT with 71% opting for an E-Cig and were more successful in quitting smoking than compared to those who tried NRT alone.

Training- Both Leicester and Leicestershire stop smoking services are involved in the UHL mandatory training programmes for all midwives and neonatal and children’s hospital staff. 31 training sessions have been delivered to date (2019) and have trained 346 staff with further planned sessions to take place this year and into 2020.

All County Midwife team leads are provided with a monthly breakdown of how many pregnant women are referred into the QRSSS, who accepted treatment, who declined treatment and anyone the service was unable to get hold off. It is worth mentioning that QRSSS ensures that at least 3 contacts are pursued in trying to get hold off pregnant women i.e. a telephone call, text message and finally a letter through the post.

Delivery narrative to be updated regarding Q2 position for next meeting.

Source: Public Health 2019

Obesity Indicator LC ELR WL Action in Place 12 - Percentage of children aged 10-11 classified as overweight or obese


Leicestershire has been an early adopter of the whole system and whole family approaches to tackle obesity and has a balanced obesity strategy across three broad priority areas – physical activity, healthy weight and food sustainability and nutrition. There are many commissioned programmes aimed to tackle childhood excess weight, such as Healthy Together 0-19 years Health Child Programme, Commissioned Programmes delivered by Leicestershire Partnership Trust and Leicestershire Nutrition and Dietetic Service. Programmes commissioned and delivered by Public Health include Food for Life (aimed at schools) Whole School Physical Activity Programme, Leicestershire Healthy Schools Programme, Leicestershire Healthy Tots Programme.

Maternal Obesity is a Priority in the Leicestershire Children & Family Partnership Plan 2018-22- An action plan is in place – which includes embedding healthy weight before/ during and post pregnancy into the MECC Plus conversation/ developing a suite of Maternal obesity resources/ developing an evaluation framework to evaluate Maternal obesity related activities to inform the evidence of what works. Public Health Team – August 2019

36.5% 28.7% 31.4% 17/18

37.5%

29.4%

32.6%

7

Falls

Indicator LC ELR WL Action in Place 13 - Injuries from falls in people aged 65 and over

Target: <= Q1 19/20 1. Postural Stability Continuation of service offer in County & Rutland as per 2018/19. New service in City from 01/04/2019. 2. Digital Assessment IG sign off received for EMAHSN received 05/2019. eFRAT for roll out to EMAS Jul-Aug 2019. Date for mFRAT roll out TBC. 3. Non-Blue Light LFRS pilot for Emergency First Responders support for EMAS Falls calls to commence for Coalville area 01/07/2019. 4. Therapy Triage LPT Continuation of service offer in County & Rutland as per 2018/19. Continues to provide Acute First Outpatient Avoidance for circa 50-60 patients per month. 5. Care Homes Support Pilot has yet to commence owing to recruitment barriers. Falls Team – June 19

1908 1640 1817 Q2 19/20

1767

1571

1736

Antimicrobial Resistance

Indicator LC ELR WL Action in Place 14 - Anti-microbial resistance: Appropriate prescribing of antibiotics in primary care

National Target: <=0.965

The July data for antimicrobial resistance indicators for ELR show month on month improvement and is now achieving the desired target for Appropriate Prescribing of Antibiotics in primary care vs target (0.934 items / STAR PU vs 0.965 items / STAR PU). ELR CCG has 24 practices achieving the target of 0.965, whilst the other 4 practices have improved since December. The indicator for Appropriate prescribing of broad spectrum antibiotics in primary care has reduced to 10.3% which has reduced consistently since early 2019. ELR CCG has 65% of practices achieving this target. The practices not achieving the target have seen a month on month improvement and we are working with those individual practices to support the reduction in inappropriate antimicrobial prescribing. It has been identified that within the reporting for ELR CCG are other non-GP services included for examples: South Wigston Asylum Seekers, Out of Hours services, Urgent care centres and minor Injury units. These prescribers have very different patient populations attending to use the service and their proportion of broad-spectrum antibiotics used in May ranges from 37.5% to 10.6%, Through removal of these from the indicator the CCG delivery against the indicator is 10% against a target of 10%. Source: - ELR CCG Prescribing Team October 2019

12 months rolling to July 19 0.866

0.936

0.938

15 - Anti-microbial resistance: Appropriate prescribing of broad-spectrum antibiotics in primary care

National Target: <=10%

12 months rolling to July 19

8.0%

10.2%

9.6%

8

Health Inequalities Indicator LC ELR WL Action in Place 16 - Proportion of people on GP severe mental illness register receiving physical health checks in primary care

18/19 Target: >= 50% Primary Care Mental Health Facilitators (MHF) targeting support to GP Practices with lowest take up against defined target (under 20%). Approx. 30 Practices across 3 CCG's. MHF staff checking remission coding of patients on register being done in line with definition and highlighting to practices those who should not been on SMI register in order to be taken off. Leicestershire Health Informatics Service are developing a single GP template capturing all Physical Health checks activity and supporting read codes Ongoing work with LPT to ensure physical health activity within secondary care is shared with GP Practices. Source: Primary Care Team ELR CCG – October 2019

30.2% 26.1% 27.2% by Q4 19/20 Target: >= 60% Rolling 12mths to Q2 19/20 33.7%

25.7%

29.0%

17 - Inequality in unplanned hospitalisation for chronic ambulatory care sensitive & urgent care sensitive conditions


NO UPDATE TO Q2 18/19 ON OVERSIGHT FRAMEWORK AS @ November 19 Delivery narrative to be reported next month.

2273 1905 1794 Q2 18/19

2450

1939

1995

3. QUALITY OF CARE AND OUTCOMES General

Indicator LC ELR WL Action in Place 18 - Provision of high-quality care: hospitals

Target: >= Q1 18/19 Overall scores indicative of the quality of care in a CCG area as determined by CQC inspection ratings based on five key questions are: Is it safe? Is it effective? Is it caring? Is it responsive? Is it well-led?

54 54 54 Q1 19/20

53

54

54

19 - Quality of Care metrics: a set of 30 quality proxies to identify any emerging quality concerns at acute, mental health, ambulance and community trusts

Provider assurance only (https://improvement.nhs.uk/documents/5914/NHS_Oversight_Framework_A2_Provider_oversight_metrics_aug2019.pdf)

20 - Provision of high-quality care: primary medical services

Target: >= Q1 18/19 Overall scores indicative of the quality of care in a CCG area as determined by CQC inspection ratings based on five key questions are: Is it safe? Is it effective? Is it caring? Is it responsive? Is it well-led?

67 67 65 Q1 19/20

64

66

65

21 - Evidence that sepsis awareness raising among healthcare professionals has been prioritised by CCGs

2017 Amber - Evidence that the requirement for awareness raising and education on the use of National Early Warning Score (NEWS) is included in the commissioning priorities of the CCG and is included (or there is evidence of a planned commitment to include) in service specifications and in any local incentive schemes funded by the CCG.

2018

9

https://improvement.nhs.uk/documents/5914/NHS_Oversight_Framework_A2_Provider_oversight_metrics_aug2019.pdf

https://improvement.nhs.uk/documents/5914/NHS_Oversight_Framework_A2_Provider_oversight_metrics_aug2019.pdf

Evidence-Based Interventions

Indicator LC ELR WL Action in Place 22 – NEW Evidence-based interventions

Q1 19/20 Rate of cost-weighted total number of spells matching the criteria for each indicator in the previous 12 months. Interventions monitored are; • Surgery to prevent snoring in the absence of Obstructive

Sleep Apnoea (OSA) • Surgery to investigate and relieve heavy periods • Knee arthroscopy for patients with osteoarthritis • Injections for non-specific low back pain without sciatica • Breast reduction • Removal of benign skin lesions • Grommets for glue ear in children • Tonsillectomy for recurrent tonsillitis • Surgery to treat haemorrhoids • Surgery to remove chalazia • Arthroscopic shoulder decompression for subacromial

shoulder pain • Carpal tunnel syndrome release • Dupuytren’s contracture release • Ganglion excision • Trigger finger release • Varicose vein surgery

Maternity Services

Indicator LC ELR WL Action in Place 23 - Neonatal mortality and stillbirths

Target: <=previous out-turn A multiagency Leicester, Leicestershire & Rutland Infant Mortality Strategy Group has been in existence since 2015. The first LLR Infant Mortality Strategy and Action Plan was published in September 2016. This original strategy has been updated and refreshed and renamed as ‘The Strategy to Support Healthy Pregnancy, Birth and Babies Strategy 2019- 2024.’ And the multiagency group is now called ‘The LLR Healthy Babies Strategy Group’ Scope of the strategy The HBSG recognises that many of the factors that affect the health of babies will also affect unborn babies. For this reason, it has been agreed that this strategy encompasses health in relation to pre-conception, pregnancy and for the first year of a babies’ life. The actions to address Neonatal Mortality and Stillbirths include:

• Learning from Good Practice -peer comparator areas

• Promotional campaigns & Communications -health for under 5’s website, Chat Health

• Support for Strategic and Partnership work -sign up from key organisations

• Research and consultation with Maternity Voices Partnership (MVP)- parent surveys / insight work

• Bespoke work with foster carers/kinship carers looked after children) bespoke training

5.22 4.65 6.82 2016

10

Indicator LC ELR WL Action in Place 6.8

5.1

3.9

• Addressing cumulative impact of risk factors – work with the Lullaby Trust

• Modifiable risk factors relating to mothers -RSE education, smoking, maternal obesity, domestic violence

• Modifiable risk factors relating to the baby -breast feeding, safe sleep

• Modifiable risk factors relating to the living environment – poverty, second-hand smoke etc

In addition, saving babies lives is a key work stream for the Maternity Transformation Programme – monitored through the LMS. Key targets are a key work stream within the LMS, Target: To reduce rates of still birth, neonatal deaths, maternal death and brain injury during birth by 20% by 20/2021 and 50% by 2025. Please refer to the report by following the link: https://www.leicester.gov.uk/media/184822/strategy-to-support-healthy-pregnancy-birth-and-babies-in-leicester-leicestershire-and-rutland-2019-2024.pdf. Source; Children and Families Leicester City CCG & Leicestershire County Council – June 19 & Public Health October 2019

24 - Women’s experience of maternity services

Target: >=2017 out-turn Delivery narrative to be reported next month. 78.6 79.6 80.8

2018 81.5

83.0

80.6

25 - Choices in maternity services

Target: >=2017 out-turn Delivery narrative to be reported next month. 67.4 62.8 60.7

2018 70.3

60.9

55.9

Cancer Services

Indicator LC ELR WL Action in Place 26 - Cancers diagnosed at early stage

Target: >= previous out-turn There has been a programme of interventions throughout 2019/20 to improve the cancer early diagnosis for patients including; - Colorectal Cancer Pathway Redesign - lung Cancer Pathway Redesign - Prostate Cancer Pathway Redesign Rapid diagnostic pathways are being considered and explored.

45.1% 52% 52.6% 2017

49.1%

52%

51%

11

https://www.leicester.gov.uk/media/184822/strategy-to-support-healthy-pregnancy-birth-and-babies-in-leicester-leicestershire-and-rutland-2019-2024.pdf



Indicator LC ELR WL Action in Place 27 - People with urgent GP referral having first definitive treatment for cancer within 62 days of referral

National Target: >=85% Narrative forms part of the cancer waits delivery and long waiters report. ConstitutionNarrative Sep 19

71.5%

77.4%

79.0%

28 - One-year survival for all cancer

Target: >= previous out-turn 2017 diagnosis results due April 2020. 67.3% 72.5% 71.6%

2016 diagnosis 67.7%

73.4%

71.9%

29 - Cancer patient experience

Target: >= previous out-turn Cancer care is focusing on 4 key areas: -Prevention - working with patients through Make Every Contact Count Plus and supporting patients for tobacco control -Earlier diagnosis - patient engagement events including learning disabilities and LGBT in June 2019. Available drop in cervical screening clinics throughout 19/20. Engaging with the public around #dontfearthesmear which has reached over 100,000 population on social media. -Access to treatment - pathways are transformed and made quicker for patients. The priority is around lung, colorectal, prostate and Upper GI. -Personalised care - every person diagnosed with cancer will have been offered a holistic needs assessment, develop a personalised care plan. Patients are able to access health and wellbeing opportunities in the community. Communication to the patient and their GP via treatment summaries will enhance the quality of cancer reviews focussing on what matters most to the person living with cancer. From 2018-2020 patient feedback is being sought on services through an LLR patient survey and 25 Let’s Talk about Cancer events across LLR. Patient experience is also improved through risk stratified follow up. There is also a patient survey being undertaken at UHL in the skin clinic to determine if patients are given the right levels of information at referral; a QR code has been developed where all patient and public cancer information can be accessed through the LCCCG website – including translated materials and videos and patients are part of key strategic and project group meetings. Source: Strategy and Implementation Team, LC. June 2019

8.4 8.8 8.8 2018

8.6

8.7

8.7

12

Mental Health

Indicator LC ELR WL Action in Place 30 - Improving Access to Psychological Therapies – Recovery

National Target: >50% Moving to recovery and waiting time have been affected by the increased number of referrals received, which is increasing waiting times and therefore decreasing the likelihood of recovery. In addition a number of patients are self-discharging from digital therapies and group work without a second measure being recorded therefore a second recovery level is not being captured. Leicester City are experiencing low referral numbers and have also experienced high DNA rates in September. The long-term conditions action plan is in place and commissioners are meeting with the provider lead to ensure progress is on track. The diabetes and COPD services have begun to refer into the service. A further meeting was held in June to progress the cancer pathway – expected progress to be made October / November 2019. Source: PPAG – October 2019

Aug 19 55%

43%

46%

31 - Improving Access to Psychological Therapies – Access

19/20 Planning Targets >19.8% >19.8% >19.8%

YTD Aug 19

16.7%

17.1%

17.5%

32 - People with first episode of psychosis starting treatment with a NICE recommended package of care treated within two weeks of referral

National Target: >56% This metric relates to the percentage of patients receiving a care package within two weeks of the first episode of psychosis. For ELR CCG 1/3 patients were treated within two weeks of referral.

Sep 19 75%

33%

67%

33 - Mental health out-of-area placements

Target <Q1 19/20 Delivery narrative to be reported next month.

728 Q1 19/20

1215

34 - Quality of mental health data submitted to NHS Digital (DQMI)

Target >Jan 19 Calculation of weighted average of MHSDS DQMI score based on the activity levels of main providers of mental health services for the CCG. MHSDS SCORE (%).

85% 84.6% 85.2 May 19

92.1%

79.4%

90.4%

Learning Disability and Autism

Indicator LC ELR WL Actions in Place 35 - Reliance on specialist inpatient care for people with a learning disability and/or autism

Target as per 19/20 planning round

The Transforming Care Partnership (TCP) recognise the challenges with the trajectory requirements and will be working closely together across health and social care during 20419-20 to: -Have a greater overview and governance of LLR TCP cohort, with escalation of issues to ensure discharge trajectory supported -Undertake an LD Community Services Review -Work with Moorhouse Consultancy who have been commissioned by NHSE/I to support the TCP, in meeting trajectory requirements Source: Learning Disability Team Aug 19

<19 patients

<7 Patients

<12 patients

Q2 19/20 21

10

14

13

36 - Proportion of people with a learning disability on the GP register receiving an annual health check

Target: >= Q1 19/20 Planning Round

Delivery narrative to be reported next month.

291 91 160 Q1 19/20

285

76

118

37 – Completeness of the GP learning disability register

Target: >= 17/18 QoF The proportion of the population (all ages) that are included on a GP learning disabilities register (QoF) 0.57 0.38 0.41

18/19 QoF 0.58

0.39

0.41

38 - NEW: Learning disabilities mortality review: the percentage of reviews completed within 6 months of notification

University of Bristol, LeDeR programme. Link to be published (annual data)

Diabetes

Indicator LC ELR WL Action in Place 39 - Diabetes patients that have achieved all the NICE recommended treatment targets: three (HbA1c, cholesterol and blood pressure) for adults and one (HbA1c) for children

Target: >= previous annual out-turn LLR received NHSE Diabetes Transformation Funding to

improve three treatment targets (3TT) in 2017/18. The bid was based on a targeted improvement programme which included DSNs working with practices and an education and training programme delivered by EDEN. The practices selected were those that were achieving 3TT below England average and a second cohort which were low in blood pressure management.

The reduction in achievement of 3TT seems to be a national trend and not just for LLR. Given the timeframe which the last data set captures data for, we would be expecting an improvement in 2018/19 data which will be more reflective of the work we have undertaken in LLR. England average 3TT in 2017/18 was 39.8%.

To date, almost 60% (82) practices have engaged with the programme and 55% (75) practices have attended one or more of the training/education sessions. The improvement programme is open to all practices across LLR for 2019/20.

The first quarterly release of NDA is the quarter three mid-year data release for 2018/19 data. It shows progress to date covering 01 Jan 2018 – 31 Dec 2018. This is a provisional data set and should not be used to assess performance against 3TT as it does not include the full 15-month audit. It is to show the partial year progress and may change once the quarter four data is released.

Source; Integrated Teams October 19

43.0% 42.6% 41.5% 17/18

39%

39%

38%

14

Indicator LC ELR WL Action in Place 40 - People with diabetes diagnosed less than a year who attend a structured education course

Target: >= previous annual out-turn (2016)

1.8% 2.6% 2.2% 2017 cohort

7%

11%

7%

People with Long Term Conditions and Complex Needs

Indicator LC ELR WL Action in Place 41 - Estimated diagnosis rate for people with dementia

National Target: 66.7%

September 19 85.9%

68.8%

71.2%

42 - Dementia care planning and post-diagnostic support

Target: >= previous out-turn Across LLR we are looking to have the Joint LLR Living Well with Dementia Strategy 2019 – 2022 launched in January. Underneath this will be a CCG level action plan which will have number of ‘asks’ for general practice re dementia best practice, diagnosis and care planning being in them. As at June 19 the above fits in with the new GP incentive scheme for dementia. Source: Primary Care Team, WL. June 19

78.3% 73.2% 72.8% 18/19 QoF

77.3%

71.5%

74.9%

43 - The proportion of carers with a long term condition who feel supported to manage their condition

Target: <= previous out-turn (2018)

This metric will help understand the amount of support given to carers who have one or more long term conditions. In 2018, the LLR health and social care economy developed a joint carers strategy (2018-21). This strategy, Recognising, Valuing and Supporting Carers in Leicester, Leicestershire and Rutland, is focused on supporting our carers to continue to play this key role in the care of our population. The strategy contains eight guiding principles:

• Carer identification: we will raise awareness of the importance of carers with all our health and social care organisations and the individuals that work in them

• Carers are valued and involved: we will recognise the role of carers across all clinical pathways

• Carers are informed: we will ensure our carers have

access to all relevant information

• Carer friendly communities: we will support the development of local initiatives to improve the experience of carers

61% 54% 60% 2019

53%

52%

53%

15

Indicator LC ELR WL Action in Place • Carers have a life alongside caring: we will promote

the role of carers among non-health and social care organisations as well as look to provide flexible carers respite

• Carers and the impact of technology products and the living space: we will involve carers in housing assessments and understanding carers’ requirements

• Carers can access the right support at the right time:

we will work collectively as a system to ensure carers can access the required support at the right time

• Supporting young carers: we will raise awareness and support our young people by focusing on the entire family.

Source: - LLR Long Term Plan Sept 19

4 - Percentage of Deaths with 3 or more emergency admissions in last 3 months of life

Target: <= previous out-turn In July 19 NHSE refreshed all data relating to this metric, therefore the 2016 and 2017 data is different to reports prior to August 19. RAG-rating remains the same. In February 2019 the Senior Leadership Team (SLT) agreed that End of Life Care (EoLC) should be considered a system priority due to on-going concerns about performance including variable quality and patient safety incidents. SLT mandated that a time-limited End of Life Task Force (EOLTF) be set up (6 months), with the instruction to drive the design and delivery of the LLR system of care for patients at the end of their life. The key objective of the Task Force is to analyse and re-design the high-level system of care for EOL patients, cutting across the current work programmes of the STP. This involves defining the ‘ask’ of each of the workstreams in a much more granular, directive manner, setting clear direction and timescales for delivery. To support the Task Force an LLR End of Life Care Working Group has been established with representations from across LLR including Social Services, EMAS and 111. Alongside the Working Group is a Task & Finish Group leading the implementation of ReSPECT.Source; EoL /LLTIC Project Lead, WLCCG June 2019

8.0% 7.9% 8.0% 2017

10.2%

9.0%

9.2%

Planned Care

Indicator LC ELR WL Action in Place 45 - Patients waiting 18 weeks or less from referral to hospital treatment

National Target: 92% The waiting list size trajectory in August was not achieved with 318 more patients on the waiting list than trajectory; this is at risk in September also. The risks to achieving the trajectory continue as reduced elective capacity due to emergency pressures and prioritisation of capacity for cancer referrals over routine elective activity. Further risks are also clinical capacity pressures in Neurology and Allergy, a reduction in WLI due to pension taxation changes and delayed start to RSS schemes.

Sep 19 83.3%

83.4%

83.7%

46 - Overall size of the waiting list

National Target: <= March 18 Waiters

24,120 20,661 23,384 Sep 19

16

Indicator LC ELR WL Action in Place 24,578 waiters

20,467 waiters

North West Anglia

data not available

25,264 waiters

The RTT 92% standard was not achieved in September. The longest waits for patients are those awaiting an admitted procedure with shorter waits for non-admitted patients. UHL are planning to reduce the overall waiting list by 102 in 2019/20 however they have forecast ~85% performance against the RTT standard at the end of March 2020. The level of cancer referrals into UHL has increased which has meant that capacity has been diverted to achieve the 2ww standards. The Trust is uprating the theatre productivity programme to increase admissions and FourEyes are providing external validation to support this and undertake clinical engagement. Specific areas of concern are in Neurology, Allergy, ENT, Urology and Gynaecology. Actions are in place to improve performance and include recruitment, additional weekend list, reviewing capacity modelling and exploring use of IS via subcontract arrangements.

The RSS is now live for MSK, dermatology, ENT and general surgery (hernias) with Ophthalmology (cataracts) planned to go live in October and the remainder of Ophthalmology in November, which will support the stabilisation of the waiting list. Engagement with the Independent Sector is on-going to ensure appropriate deflection from UHL at point of referral by the use of capacity alerts in e-RS for urology and GI & liver which encourage referral to alternative providers that have indicated capacity is available in those specialities. This is also being considered or allergy and neurology.

Source: PPAG October 19

47 - Patients waiting over 52 weeks for treatment

National Target: Zero Sep 19

0

0

0

48 - Patients waiting six weeks or more for a diagnostic test

National Target: <1% The diagnostic performance has been achieved in July at UHL. Additional endoscopy capacity continues to be insourced via Medinet. Daily monitoring of specialties continues with thresholds set for breach numbers and CT capacity has been increased. Source: PPAG September 2019

Sep 19

0.8%

0.6%

1.11%

17

Constitutional & Other Key Performance Indicators This identifies other KPIs not associated with the NHS Oversight Framework above, but that are still notable. Further information is contained within Appendix B. Narrative relates to ‘At risk’ indicators:

Indicator LC ELR WL Action in Place % of patients seen within 2 weeks for an urgent GP referral Constitution

National Target: >= 93% 2 Week Wait The pressures in Head & Neck continue to impact on the 2ww performance position. The Trust are predicting to recover the standard in November. KGH and NGH are supporting the Trust with 2ww clinics. 2 Week Wait Breast The breaches reported for 2ww breast symptoms in September were all associated with patient choice. To support the Breast service, a reminder communication to GPs about referring the patient on the right pathway is being disseminated. 31 Day Surgery The majority of the breaches are in Urology. Tertiary referrals remain a concern specifically for Urology (robotic surgery) and late tertiary referrals to Lung. 62 Day Wait Patients waiting >104 days as at early November 2019 continues to be an improved position, with 20 patients in the backlog; of which 15 are in Urology.

Urology – Actions developed from the findings of the Intensive Support Team audit of the RAPID Prostate pathway have now been incorporated into the RAP. These will support improvements to first OPA, streamlining of pathway, reducing DNAs and cancellations

The Trust are recruiting additional Next Step staff and project management to support Urology.

Source: LAT November 19

Sept 19 90.0%

88.9%

90.5%

% of patients seen within 2 weeks for an urgent referral for breast symptoms Constitution

National Target >=93% Sept 19

97.8%

96.8%

96.8%

% of patients receiving definitive treatment within 1 month of a cancer diagnosis Constitution

National Target >=96% Sept 19

95.6%

95.6%

95.1%

% of patients receiving subsequent treatment for cancer within 31 days (Surgery) Constitution

National Target: >=94% Sept 19

86.2%

77.7%

85.0%

% of patients receiving subsequent treatment for cancer within 31 days (Drug Treatment) Constitution


100%

96.4%

100%

% of patients receiving subsequent treatment for cancer within 31 days (Radiotherapy Treatment) Constitution

National Target:>=94% Sept 19

97.6%

94.4%

87.7%

18

Indicator LC ELR WL Action in Place % of patients receiving 1st definitive treatment for cancer within 2 months (62 days) Constitution


61.5%

77.4%

78.9%

% of patients receiving treatment for cancer within 62 days from an NHS Cancer Screening Service Constitution


100%

100%

86.3%

% of patients receiving first definitive treatment for cancer within 62 days of a consultant decision to upgrade their priority status Constitution

No national target Sept 19

78.5%

79.1%

81.4%

Proportion of patients on Care Programme Approach (CPA) discharged from inpatient care who are followed up within 7 days Constitution2

National Target: >=95% To improve performance against the CPA seven-day standard, the Adult Mental Health and Learning Disabilities directorate (AMH.LD) have redesigned the monitoring process for CPA seven day with an aim to undertake the CPA seven-day follow-ups within 48 hours. Daily individualised proactive reports and reminders will be provided to wards to undertake reviews; and missed reviews will be escalated to the service manager. Weekly performance reports will be reviewed by the business team with escalations made to the business manager for relevant action. Source; LPT Board Report October 19

Q2 19/20

91%

93%

90%

IAPT Waiting Times - 6 Week Waiters Constitution2

National Target: >=75% IAPTdelivery

Aug 19 83%

74%

72%

IAPT Waiting Times - 18 Week Waiters Constitution2

National Target: >=95% Aug 19

99%

100%

99%

19

Indicator LC ELR WL Action in Place The number of completed CYP Eating Disorders routine referrals within 4 weeks Constitution2

National Target: 95% by 2020 Due to small numbers within the service, large fluctuations in performance are seen. Routine Referrals- 4 week The team are focussing on urgent referrals as a result the routine referrals are placed on a waiting list. Assessments are undertaken by 2 senior practitioners over a full day which impacts on the number of C&YP seen. Source: PPAG October 2019

Q2 19/20 60%

3/5 Pts

0%

0/3 Pts

50%

2/4 Pts

The number of completed CYP Eating D urgent referrals within 1 week Constitution2

National Target: 95% by 2020 Q2 19/20

67%

2/3 Pts

0%

0/3 Pts

67%

2/3 Pts

Mixed sex accommodation breaches - All Providers Constitution2

National Target: Zero No Mixed Sex Accommodation breaches in Aug, however there have been breaches in previous months in 19/20 Aug 19

0

0

0

Number of MRSA incidences Constitution3

National Target: Zero The MRSA BSI for ELR CCG specimen date August 2019: The PIR has been arranged for the 4th October 2019 (this was to ensure primary care input) Looking at the HCAI DCS the case in August 2019 for WL CCG is a hospital onset case to which UHL are currently carrying out the review. Source; Infection Prevention & Control Team September 2019

YTD October 19 2

4

3

Number of C.Difficile incidences Constitution3

Below 19/20 CCG standard 73 76 97

YTD October 19 40

37

59

Ambulance Waits Category 1 Constitution4

National Mean Target: <=7 mins

A detailed report on EMAS performance to be presented at PPAG in November 2019 Key themes of focus for handover improvements are process efficiencies and ‘fit to sit’. Actions include: • Reviewing role of the nurse co-ordinator to provide leadership and focus to the assessment team • EMAS/UHL to review role of HALO and how this can be improved or completely changed • Joint campaign with EMAS re ‘fit to sit’ across Assessment Zone, with plans to communicate to the wider healthcare community • Initial ED Head of service meeting with EMAS clinical lead to look at possibility of bloods being completed prior to arrival at LRI • Joint weekly review of 10 patients who are transported by EMAS to LRI who are then discharged with ‘no abnormality detected’, to understand trends and required actions to prevent this group of patients attending

Sept 19 05:32

09:17

7:45

National 90% Target:

<=15mins Sept 19

09:05

15:34

13:33


National Mean Target: <=18mins Sept 19

28:26

32:52

31:06

National 90th Centile Target:

<=40mins

20


Sept 19 It is positive to report that EMAS performance for LLR improved for all six standards in September. However, only one of the national standards was achieved for LLR (C1 90th percentile). LLR performance was better than the regional average for C1 (both) but was worse than the regional average for the other four standards. EMAS responses have increased, but LLR has the lowest percentage of conveyance in the region. The EMAS Strategic Delivery Board met last month and have agreed deep dives in each county to understand the demand for the service which is impacting upon performance Source; PPAG October 19

1:02:20

1:03:43

1:01:54


National Target: 90th in 2hrs Sept 19

4:58:14

4:27:59

4:02:14


National Target: 90th in 3hrs Sept 19

2:33:16

2:58:12

3:40:30

Ambulance Handovers Constitution3

National Target: 0% waiting over 30mins

Sept 19

13.5% waiting 30-60min

8.1% waiting +60mins

Ambulance Crew Clear Constitution3

National Target: 0% waiting over 30mins

Sept 19 14% waiting 30-60min

1.2% waiting +60mins

Cancelled Ops – % all patients who have operations cancelled, on or after the day of admission (including the day of surgery), for non-clinical reasons to be offered another date within 28 days (UHL) Constitution3

National Target: 100%

The standard remains at risk due to continuing emergency demand. The Theatre Program Board (TPB) and Weekly Access meeting monitor the theatre related cancellations. Cancer patients and those over 46 weeks are prioritised in terms of avoiding a cancellation and any cancellations go through the Gold Command structure in UHL with final approval required from the Chief Operating Officer. An action plan has been developed by UHL and is aligned to the Four Eyes work and the Theatre Programme Board work streams. The Four Eyes work is focusing on preoperative assessment, optimal scheduling, reducing cancellations and starting on time.

21

Indicator LC ELR WL Action in Place October 19

88.7%

The key actions to reduce list overruns/lack of theatre time are to utilise an improved scheduling tool, improve forward planning with a prospective utilisation assessment, use of Standard Operating Procedures for setting the order of patients on theatre lists, and to focus on movement of patients to theatre with patients walking to theatre rather than requiring a porter where possible. It is expected these actions will reduce this area of cancellations by 30%. Further actions in each of the other areas include; ensuring up to date equipment maintenance and schedules, implementation of contingency procedures to ensure collation of ‘safe’ relevant document to allow procedures to go ahead, equipment identification discussed at weekly scheduling meeting, implementation of 48-hour call outs and supportive scripts and production of data quality report to monitor non-compliance with the Trust Access Policy and highlight training requirements. Source: LAT November 19

Children’s wheelchair waits Constitution3

National Target: >=92% September 19

97%

RECOMMENDATIONS: The Governing Body is requested to:

• NOTE the contents of the report

22

APPENDIX A

Latest Baseline

Outturn/Position

Standard/

TargetApr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 YTD

1Overall Patient Experience of G.P Services 2018 84% >=82%

2Patient experience of booking a GP appointment

3Rate of unplanned hospital admissions for urgent care sensitive conditions, per 100,000 registered patients

2018/19Q4 2106

BelowBaseline

UHL Trajector

y83.1% 86.9% 85.8% 83.9% 84.1% 85.1% 83.8% 82.4% 81.2% 77.7% 82.5% 82.8%

75.5% 73.5% 74.1% 72.0% 69.8% 71.4% 66.7%

A&E Waiting Time - % of people who spend 4 hours or less in A&E (Based on HES 17/18 ratio)(CCG Level)

2018/19 78% 95% 76.3% 76.7% 77.1% 75.9% 73.0% 74.4% 70.8%

UHL Trajector

y87.5% 90.3% 89.5% 88.3% 88.4% 88.6% 87.5% 86.2% 85.3% 84.0% 87.1% 87.4%

82.5% 81.4% 81.7% 80.9% 79.3% 79.8% 76.6%

Urgent Care Centres Only 2018/19 98.5% 99.4% 99.9% 99.9% 99.6% 99.8% 99.2% 99.1%

5Achievement of clinical standards in the delivery of 7 day services

2017/182/490%

DTOCAverage delays per day in reporting month NHS & LA (Leicestershire LA)

Average per day in 2018/19

36Reductio

n on baseline

34 41 37 33 43 33

DTOCAverage delays per day in reporting month NHS & LA (Rutland)

Average per day in 2018/19

2Reductio

n on baseline

1 2 1 3 4 2

7Population use of hospital beds following emergency admission - days per 1,000 population

2017/18 519Reductio

n on baseline

8

Percentage of NHS Continuing Healthcare full assessments taking place in an acute hospital setting(CCGs to ensure that less than 15% of all full NHS CHC assessments take place in an acute hospital)

18/19 7.7% <15% 0.00% 0.00% 5.26% 12.50% 0.00% 0.00% 3.33% 2.67%

Target

10Utilisation of the NHS e-referral service to enable choice at first routine elective referral

Mar-19 78%

80% by Sept 17

and 100% by Sept

18

88% 89% 88% 86% 85%

Person

alisati

on &

Patien

t Choi

ce

Indicator Description

9

82% 2019

In Development

4

6

Acute

Emerg

ency C

are &

Transf

er of C

are

Personal health budgets (Number of patients with a PHB)

Q4 18/19 218

215 patients

A&E Waiting Time - % of people who spend 4 hours or less in A&E (UHL Provider Level Type 1 & 2)

2018/19

NHS OVERSIGHT FRAMEWORK 2019/20 EAST LEICESTERSHIRE AND RUTLAND CCG

1 NEW SERVICE MODELS

Integr

ated P

rimary

Care

& Com

munit

y Heal

th Ser

vices

2019/20Q1

2386

2019/20Q2

2125

77%

Total % All UHL A&E + UCC < 4Hrs 2018/19 83%

No Publication date Compliance with the four priority clinical standards 2, 5, 6, 8 for delivery of 7 day services

165 206

2018/19537

2018/19537

255 patients 315 patients 335 patients

23

APPENDIX B

Latest Baseline Outturn/Position

Standard/Target Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 YTD

Smok

ing

11 Maternal Smoking at Delivery 2018/19 6.7% Below Baseline

Child

hood

O

besi

ty

12Percentage of children aged 10 - 11 classified as overweight or obese 2016/17 28.7%

Below Baseline

Falls 13

Injuries from falls in people aged 65 and over(per 100,000 population) 2018/19

Q41637

Reduction on baseline

14Anti-microbial resistance: Appropriate prescribing of antibiotics in primary care (Star PU)

Mar-19 0.946

2018-19 CCG IAF Target

Valueto be 0.965 or

below

0.946 0.940 0.934 0.936

15Anti-microbial resistance: Appropriate prescribing of broad spectrum antibiotics in primary care (Antibiotic-Co-Amoxiclav)

Mar-19 10.5%

2018-19 CCG Target Value to

be 10% or below

10.4% 10.3% 10.3% 10.2%

16Proportion of people on GP severe mental illness register receiving physical health checks

18/19 26.1% 60% by Q4 19/20

17

Inequality in unplanned hospitalisation for chronic ambulatory care sensitive and urgent care sensitive conditions (linked to deprivation) (Low score is good. Baseline indicates average inequality levels compared to other CCG)

2017/18Q4

Gradient of 1804

Reduction in Gradient

2 PREVENTING ILL HEALTH & REDUCING INEQUALITIES


Ant

i-mic

robi

al R

esis

tanc

eH

ealt

h In

equa

litie

s

Q17.4%

Q27.9%

2017/18CCG 29.4%

Rolling 12mths to Q1 19/20 21.8%

Q11640

Q21571

2018/19Q1

1827

2018/19Q2

1939

24

APPENDIX C

Latest Baseline

Outturn/Standard


18 Hospital 2017/18

Q4 54 => 54

19 Primary Medical Services2017/18

Q4 66 => 54

Patie

nt

Safe

ty

20Evidence that Sepsis awareness raising amongst healthcare professions has been prioritised by the CCG

Evid

ence

-bas

ed

inte

rven

tions

21 Evidence-based interventions New for 19/20

22Neonatal mortality and still births per 1,000 population 2015

4.65ONS Data

Below Baseline

23 Women's experience of maternity services (England) 201779.6

(CCG)Higher Than

Baseline

24 Choices in maternity services 201762.8

(CCG)Higher Than

Baseline

Above 2016 Position

Above 2016 Q4

52%

26Cancer 62 Day Waits - % of patients receiving first definitive treatment for cancer within 62 days of an urgent GP referral for suspected cancer

2017/1878.3%YTD

National 85% 80.7% 70.8% 73.6% 79.1% 76.3% 77.4% 76.4%

27 One-year survival for all cancer 2015 72.5%Above

Baseline

28 Cancer patient experience 20178.8

CCGAbove

Baseline

No data available 54

20165.1

(Data Source - MBRRACE-UK - Perinatal Mortality Surveillance Report)

60.92018

83.02018

Overall scores indicative of the quality of care in a CCG area as determined by CQC inspection ratings based on five key questions are: Is it safe? Is it effective? Is it caring? Is it responsive? Is it well-led?

54

Cancers diagnosed at early stage - % of cancers diagnosed at stage 1 & 2

Gen

eral

New Indicator

67 No data available 66

25

20188.7 (CCG) Published September 2019

Patient`s average rating of care scored from very poor to very good

3 QUALITY OF CARE AND OUTCOMES

2016 52.0% 2017/18Q3

49%

2016 (Followed up December 2015)

73.4%

52%2017

2017/18Q1

55%

2017/18Q2

53%

Canc

er S

ervi

ces

2018 Annual self-certification to be completed by CCG.Evidence that the requirement for awareness raising and education on the use of National Early Warning Score (NEWS) is included in the commissioning priorities of the CCG and is included (or there is evidence of a planned commitment to

include) in service specifications and in any local incentive schemes funded by the CCG

New Indicator In Development

Mat

erni

ty


25

APPENDIX C Latest

Baseline Position

Outturn/Standard


29 IAPT Recovery Rate (CCG) 2018/19 52.00% 50% 50% 47% 55% 48% 43%

30IAPT AccessProportion of people that enter treatment against the level of need in the general population (CCG)

2018/19 16.60% 19% 14.6% 16.7% 16.0% 16.9% 17.1%

32

Out of area placements for acute mental health inpatient care (no of bed days for inappropriate OAPS in mental health services for adults in non-specialist acute inpatient care (eliminate by 20/21)

Reduction on baseline

Eliminate by 20/21

33Quality of mental health data submitted to NHS Digital (DQMI) Jan-19 85% Improve/

Maintain 85%

Target38.04

(33 patients)

Trajectory2019/20

35Proportion of people with a learning disability on the GP register receiving an annual health check 2018/19 56.0%

66.3%Planning Round

36Completeness of the GP Learning Disability Register Proportion of the population (all ages) that are included on a GP Learning Disability register

2017/18 0.38%Above

baseline

37Learning disabilities mortality review: the percentage of reviews completed within 6 months of notification NEW for 19/20

38

Diabetes patients that have achieved all of the NICE-recommended treatment targets3 Targets - Adults HBA1C - Cholesterol & Blood Pressure - Children HBA1C

2016/17 42.6%Above

Baseline

39People with diabetes diagnosed less than a year who attend a structured education course 2016 2.6%

AboveBaseline

<6 Patients

3456.48

(49 patients for LLR)

ELR

Q42017/18

76Target 91

NEW for 19/20

Dia

bete

s

<7 Patients

Reliance on inpatient care for people with learning disability and/or autism - care commissioned by CCG and NHS England(per 1m pop) ALL LLR

<7 Patients

Q1 19/201215

0.392018/19

13

<6 Patients

10

100% 100% 33% 40%

Men

tal H

ealth

50% 33%March2018 100%31

38.6%2017/18

11%(2017 Cohort)


Lear

ning

Dis

abili

ty

50% of people experiencing first episode of psychosis to access treatment within two weeks of referral (CCG)

53%

26

APPENDIX C Latest

Baseline Position

Outturn/Standard

Standard/Target

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 YTD

Estimated diagnosis rates for people with dementia 66.7% 68.5% 68.5% 68.5% 68.7% 68.8% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

People Diagnosed with Dementia (Age 65+) Numerator Recorded 3212 3222 3232 3250 3282

People estimated Prevalence (Age 65+) Denominator Estimated 4686 4703 4719 4732 4767

42

Dementia care planning and post-diagnostic support(The percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months)

2016/1774.3%(CCG)

Above 16/17baseline

43Quality of life for carers (Proportion of carers with a long term condition who feel supported to manage their condition)

N/A N/AAbove 2018

Position

44Percentage of Deaths with 3 or more emergency admissions in last 3 months of life

2016 6.1Reduction on

baseline

21112 20656 22084 22444 21696 21729 21697 21631 21379 21458 21054 20651

Waiters 20,849

Waiters 21,180

Waiters 20,950

Waiters19575

Waiters20276

92% 85.18% 86.04% 85.58% 84.81% 83.40% 83.37%

47 52 Week Waiters 2018/19 18 Zero Tollerance 0 1 2 1 0 4

48 Diagnostic Test Waiting Time >6 weeks (CCG) 2018/19 1.89% 1.00% 0.87% 0.93% 1.51% 1.87% 0.70%

Peop

le w

ith

long

term

con

diti

ons

and

com

plex

nee

ds

54%2018

412017/18March

68.2%

9.0%2017


Plan

ned

Care

2017/1873.2%

(IAF Nov 18)

45 / 46

RTT - Incompletes - Patients waiting 18 weeks or less from referral to hospital treatment (ELR CCG)

March 2019

Total Waiters 20,86018 wk 85.4%

Total Pathways<= 20,661 by March

18

27

APPENDIX D

Latest BaselineOutturn/Standard

Standard/Target Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20

48

Quality of CCG leadership The indicator is based on three key lines of enquiry, concerning:Robust culture and leadership sustainability, Quality, Governance, including financial governance

2017Q4

Rated as compliant or not

49 Probity and corporate governance

2017/18Fully Compliant in the

most recent annual return

Rated as compliant or not

50Effectiveness of working relationships in the local system (NHS England – annual CCG stakeholder 360 survey) 2017/18 60.9

Score between 0-100

100 is the best possible score

51Compliance with statutory guidance on patient and public participation in commissioning health and care 2017

Overall Score out of 15

52 Primary care workforce Mar-18 1.19

53Staff engagement index - engagement index on a 1 to 5 scale (5 good) 2017 3.78

1 to 5 scale (5 good)

54Progress against the Workforce Race Equality Standard - score (higher scores indicate higher differences, 0 indicates equality) 2017 0.16

Higher scores indicate higher differences, 0

indicates equality

4 LEADERSHIP AND WORKFORCE

2018/19Q1

2018/19Q2

2018/19Q3

2018/19Q4

Requires Improvement


Q42018/19

Fully Compliant

Q22018/19

Fully Compliant

Q32018/19

Fully Compliant

Q12018/19

Fully Compliant

Lead

ersh

ip &

Wor

kfor

ce

2018/1967.26

2018With an underlying score of 12 out of 15

Sept 181.29

Full Time Equivalent Number of GPs, Practice Nurses and Direct patient care staff per 1,000 weighted patients

20183.77

20180.17

28

APPENDIX E


Late

st

Base

line

Posi

tion

Out

turn

/St

anda

rd

Stan

dard

/Ta

rget

Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19

60) In-year financial performance - An assessment of CCG financial plans by NHS England local teams

61) Delivery of the mental health investment standard (MHIS)No

previous data

62) Children and Young People and Eating Disorders investment as a percentage of total mental health spend NEW for 19/20

63) Expenditure in areas with identified scope for improvement

64) Children and young people's mental health services and transformation

No previous

data65) Reducing the rate of low priority prescribing NEW for 19/20

5 FINANCE AND USE OF RESOURCES

Fina

nce

and

use

of re

sour

ces

2018/19Q1

2018/19Q2

2018/19Q3

2018/19Q4

2018/19Q1

2018/19Q2

2018/19Q3

2018/19Q4

29

APPENDIX F YTD

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Mar

RAG G R R R R R R

Status P P P P P U -

Actual 95.67% 92.45% 90.80% 91.68% 91.58% 88.94% 91.85%

Target 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00%

RAG R R G G G G G


Actual 88.10% 87.72% 94.00% 93.33% 98.21% 96.81% 93.59%

Target 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00%

RAG G R R G R R R


Actual 96.86% 95.11% 93.57% 97.04% 95.09% 95.63% 95.57%

Target 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00%

RAG R R R G G R R


Actual 87.88% 92.86% 89.13% 95.24% 95.56% 77.78% 90.16%

Target 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00%

RAG G G G G G R G


Actual 100.00% 100.00% 100.00% 100.00% 100.00% 96.43% 99.36%

Target 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00%

RAG G G G G R G G


Actual 97.92% 100.00% 98.15% 97.01% 91.11% 94.44% 96.39%

Target 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00%

RAG R R R R R R R


Actual 80.73% 71.84% 73.56% 79.12% 76.29% 77.42% 76.55%

Target 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00%

RAG R R R G R G R


Actual 88.89% 72.73% 84.62% 93.75% 76.92% 100.00% 85.29%

Target 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00%

RAG


Actual 80.00% 72.00% 80.65% 89.47% 86.36% 79.17% 80.77%

Target

Metric ReportingLevel Information

2019-20Q1 Q2 Q3 Q4

Feb

Cancer Waiting Times191: % Patients seen within two weeks for an urgent GP referral for suspected cancer (MONTHLY) The percentage of patients first seen by a specialist within two weeks when urgently referred by their GP or dentist with suspected cancer

East Leicestershire and Rutland CCG

Latest Date: 30/09/2019

P = PublishedU = Unpublished

93.00%

17: % of patients seen within 2 weeks for an urgent referral for breast symptoms (MONTHLY) Two week wait standard for patients referred with 'breast symptoms' not currently covered by two week waits for suspected breast cancer




93.00%

535: % of patients receiving definitive treatment within 1 month of a cancer diagnosis (MONTHLY) The percentage of patients receiving their first definitive treatment within one month (31 days) of a decision to treat (as a proxy for diagnosis) for cancer




96.00%

26: % of patients receiving subsequent treatment for cancer within 31 days (Surgery) (MONTHLY) 31-Day Standard for Subsequent Cancer Treatments where the treatment function is (Surgery)




94.00%

1170: % of patients receiving subsequent treatment for cancer within 31 days (Drug Treatments) (MONTHLY) 31-Day Standard for Subsequent Cancer Treatments (Drug Treatments) East Leicestershire

and Rutland CCG



98.00%

25: % of patients receiving subsequent treatment for cancer within 31 days (Radiotherapy Treatments) (MONTHLY) 31-Day Standard for Subsequent Cancer Treatments where the treatment function is (Radiotherapy)




94.00%

539: % of patients receiving 1st definitive treatment for cancer within 2 months (62 days) (MONTHLY) The % of patients receiving their first definitive treatment for cancer within two months (62 days) of GP or dentist urgent referral for suspected cancer




85.00%

540: % of patients receiving treatment for cancer within 62 days from an NHS Cancer Screening Service (MONTHLY) Percentage of patients receiving first definitive treatment following referral from an NHS Cancer Screening Service within 62 days.




90.00%

541: % of patients receiving treatment for cancer within 62 days upgrade their priority (MONTHLY) % of patients treated for cancer who were not originally referred via an urgent GP/GDP referral for suspected cancer, but have been seen by a clinician who suspects cancer, who has upgraded their priority.




ConstitutionNarrative

30

APPENDIX F

Indicator DescriptionLatest

Baseline Position

Outturn/Standard


Numbers of over 104 day breaches, treated in month(ELR patients All Providers)

2018/19 68 Reduction 11 6 6 5 3 4 35

75% of people with relevant conditions to access talking therapies in 6 weeks

2018/19Mar 19

71% 75% 69% 60% 55% 72% 74%

95% of people with relevant conditions to access talking therapies in 18 weeks

2018/19Mar 19

99% 95% 99% 100% 99% 100% 100%

Mental Health - Care Programme Approach (CPA) - % of patients under adult mental illness on CPA who were followed up within 7 days of discharge from psychiatric in-patient care

2018/19 85.2% 95%

% of routine CYP Eating Disorder Referrals waiting within 4 weeks (complete)

2018/19 58.8% 95% by 2020

% of urgent CYP Eating Disorder Referrals waiting within 1 week (complete)

2018/19 50% 95% by 2020

Trolley Waits in A&E - Number of patients who have waited over 12 hours in A&E from decision to admit to admission (UHL only)

2017/1840

Total UHLZero Tollerance 0 0 0 0 0 0 0

4890 Patients between 30 mins 1 sec- 1 hour 715 906 648 1073 855 790 4987

65938 Total (all time bands) 5893 6126 5874 5865 5717 5843 35318

7.4% Zero Tollerance 12.1% 14.8% 11.0% 18.3% 15.0% 14% 9% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 14.1%

2498 Patientsover 1 hour 1 sec 263 312 254 595 577 473 2474

62714 Total (all time bands) 5893 6126 5874 5865 5717 5843 35318

4.0% Zero Tollerance 4.5% 5.1% 4.3% 10.1% 10.1% 8.1% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 7.0%

Ambulance Handover time - Number of handover delays of > 30 mins and <60 mins (UHL)

2018/19

Ambulance Handover time - Number of handover delays of > 1 hour (UHL)

2018/19

93%

NHS CONSTITUTION AND OTHER KEY CCG METRICS

The following provides the positon for EL&R CCG on the NHS Consitution and other key metrics that have previously been reported

Canc

erM

enta

l Hea

lth

67%0%

0/3 Patients

40%

97%

0%0/3 Patients

Urg

ent a

nd E

mer

genc

y Ca

re


31

APPENDIX F


Late

st

Bas

elin

e Po

siti

on

Out

turn

/St

anda

rd

Standard/Target

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20

EMAS 00:07:17 00:07:23 00:07:35 00:07:41 00:07:22 00:07:32

LLR 00:07:01 00:07:13 00:07:23 00:07:27 00:07:17 00:07:03

ELR 00:08:56 00:09:08 00:09:10 00:09:14 00:09:15 00:09:17

EMAS 00:13:03 00:12:56 00:13:43 00:13:42 00:13:22 00:13:29

LLR 00:12:15 00:12:28 00:13:03 00:13:11 00:13:26 00:12:34

ELR 00:15:59 00:17:12 00:16:16 00:16:48 00:16:13 00:15:34

EMAS 00:25:56 00:25:45 00:28:13 00:32:41 00:29:39 00:28:33

LLR 00:27:59 00:27:31 00:30:57 00:38:41 00:35:51 00:30:37

ELR 00:30:13 00:30:50 00:33:40 00:41:25 00:39:16 00:32:52

EMAS 00:54:28 00:53:47 00:58:02 01:08:05 01:02:07 00:58:36

LLR 00:59:13 00:56:40 01:04:14 01:21:05 01:16:44 01:02:29

ELR 01:01:13 01:00:04 01:06:12 01:24:12 01:22:03 01:03:43

EMAS 02:28:08 02:27:41 03:04:34 04:05:31 03:31:00 03:29:31

LLR 03:34:28 03:27:20 04:03:56 04:45:12 05:03:22 04:30:48

ELR 04:00:03 03:31:06 03:50:16 04:37:55 04:43:20 04:27:59

EMAS 02:25:00 02:34:37 02:51:57 01:23:56 03:25:45 02:55:45

LLR 02:32:23 02:55:07 03:57:48 02:55:31 03:54:51 03:19:23

ELR 01:44:51 02:57:24 04:05:33 02:43:31 03:53:40 02:58:12

Crew Clear delays of > 30 and <60 minutes (LRI) 7.4% Zero Tollerance 9.8% 12.4% 12.9% 12.3% 13.9% 14.0%

Crew Clear delays of > 1 hour (LRI) 0.5% Zero Tollerance 1.1% 1.2% 1.1% 1.2% 1.5% 1.2%

Category 1 – Calls from people with life-threatening illnesses or injuries (eg; cardiac arrest or serious allergic reaction)

Average <7mins

90th centile <15mins

2018/19

Category 2 – Emergency calls (eg; burns, epilepsy or stroke)

Average <18mins

90th centile <40mins

Category 3 – Urgent calls (eg; late labour, non-severe burns or diabetes – may be seen in own home)

90th centile <2hrs

Category 4 – Less urgent calls (eg; diarrhoea & vomiting or urinary infections – may be referred to GP or called back)

90th centile <3hrs


32

APPENDIX F

Indicator DescriptionLatest

Baseline Position

Outturn/Standard

Standard/Target

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 YTD

52 Week Waiters 2018/19 18Zero

Tollerance 0 1 2 1 0 0 4

Cancelled Operations - % of patients re-admitted within 28 days (UHL) 2018/19

82.4%250

100%National

Target

86.5%14 Breaches

86.5%14 Breaches

81.9% 21 Breaches

89.2%17 Breaches

82.7%26 Breaches

80.9%22 Breaches

Mixed Sex Accommodation 2018/19 18Zero

Tollerance 0 0 1 3 0 4

Healthcare acquired infection (HCAI) measure (MRSA) 2018/19 2Zero

Tollerance 0 0 0 0 1 3 4

Trajectory2018/19 6 12 18 24 30 36 42 49 55 62 69 76

YTD 3 7 13 23 26 37

NHS111 - Abandoned Calls after 30 seconds Mar-19 0.9% <4% 0.9% 0.7% 0.9% 2.7% 2.0% 1.4%

NHS111 -Calls answered within 60 secsonds Mar-19 96.2% >95% 96.3% 96.6% 96.6% 87.3% 90.5% 91.7%

Children waiting more than 18 weeks for a wheelchair(LLR Level) 2018/19

Mar-1999%

92%100% by Q4 99% 100% 100% 94% 100% 97%

Healthcare acquired infection (HCAI) measure (Clostridium diffficile infection) 2018/19

Add

itio

nal I

ndic

ator

s Ee

quir

ing

Focu

s

67

Elec

tive

Acc

ess


33

APPENDIX G

34

APPENDIX G

35

APPENDIX G

36

I

Blank Page

Paper I ELR CCG Governing Body meeting

10 December 2019


Front Sheet

REPORT TITLE: Summary report from the Primary Care Commissioning Committee (PCCC) in November 2019

MEETING DATE: 12 November 2019

REPORT BY: Amardip Lealh, Corporate Governance Manager

SPONSOR: Ms Fiona Barber, Deputy Chair and Independent Lay Member

PRESENTER: Ms Fiona Barber, Deputy Chair and Independent Lay Member

PURPOSE OF THE REPORT: This report provides a summary of the key areas of discussion and outcomes from the Primary Care Commissioning Committee meeting held on 5 November 2019; and items for escalation and consideration by the Governing Body ensuring that the Governing Body is alerted to emerging risks or issues.


• RECEIVE the report.

REPORT SUPPORTS THE FOLLOWING STRATEGIC AIM(S) 2019 – 2020: Transform services and enhance quality of life for people with long-term conditions







EQUALITY ANALYSIS An Equality Analysis and due regard to the positive general duties of the Equality Act 2010 has not been undertaken in respect of this report.

Page 1 of 3


10 December 2019


10 December 2019

Summary Report from the Primary Care Commissioning Committee (PCCC)

Meeting held in November 2019 1. Since the last report to the Governing Body in October 2019, the next PCCC

meeting was held in public on 5 November 2019. The key areas of discussion and outcomes from this meeting are summarised below.

2. Governance arrangements: the Committee noted that following the recent

review of committee structures across the Leicester, Leicestershire and Rutland (LLR) CCGs, the Governing Body approved the recommendation for the ELR PCCC meeting to be held in common with the PCCCs of both Leicester City CCG and West Leicestershire CCG on a bi-monthly basis with effect from December 2019. The rationale for the change in committee structures was to support the increase in collaborative working across LLR, which was welcomed.

3. As the ELR CCG PCCC meeting remains unchanged due the delegated

statutory functions authorised from NHS England, the membership of this Committee remains the same; however, will meet on a bi-monthly basis from November 2019 going forward.

4. Primary Care Finance Report 2019-20 (Month 6 – September 2019): The

Committee received its regular monthly financial report and noted the annual budget for Primary Care Services totals £101.7m for 2019-20; with a year to date overspend of £855k; and forecast outturn overspend of £1,679k being forecast as at Month 6. The Committee noted that in comparison to the previous month, the position has worsened by £618k, which is largely attributable to increased expenditure within GP Prescribing that has been previously reported to the Committee.

5. In light of the above, it was noted that GP Prescribing budgets are forecast to

overspend by £1,578; of which £645k is due to the increase of Category M drug prices in August 2019.

6. Digital First - Consultation Outcome: an update on the outcome of the Digital

First consultation was noted. It was noted more than 230 submissions were made in response to the consultation, which were widely supported by NHS England and NHS Improvement.

7. Leicester, Leicestershire and Rutland (LLR) GP Information Management

and Technology (IM&T): Work Programme Update – the regular update was received.

8. Sustainability and Transformation Partnership (STP): Primary Care Network (PCN) Development Programme – The Committee received an update on the development of PCNs. Following receipt of the PCN Development Support Guidance and Prospectus from NHS England and NHS Improvement in

Page 2 of 3


10 December 2019

August 2019, discussions have been held with the PCN Clinical Director Forum and the high level PCN organisational and Clinical Director leadership development proposals have been developed into a 5 year investment plan.

9. Members of the Committee supported the need to expand the training and

development elements wider and to ensure all Practices within each PCN ‘buy-in’ to the leadership; with better forms of communication. It was also noted a number of external organisations are offering varying degrees of support and advice for the development of PCNs and ACDs, however, agreed, this should remain within the NHS and provided locally.

Recommendation: The East Leicestershire and Rutland CCG Governing Body is requested to:

• RECEIVE the report.

Page 3 of 3

J

Blank Page

Paper J ELR CCG Governing Body meeting

10 December 2019


Front Sheet

REPORT TITLE: Summary Report from the Public Collaborative

Commissioning Committee (CCC) – November 2019


REPORT BY: Jayshree Raval, Commissioning Collaborative Support Officer, ELR CCG

SPONSORED BY: Donna Briggs, Deputy Managing Director and Chief Finance Officer

PRESENTER: Dr Ursula Montgomery, Clinical Chair of CCC

PURPOSE OF THE REPORT: This report is from the Collaborative Commissioning Committee (CCC); which is a joint committee of NHS East Leicestershire and Rutland CCG, NHS West Leicestershire CCG and NHS Leicester City CCG. The CCC supports joint decision making and undertakes collective strategic decisions on those areas where authority has been delegated by the respective CCG Governing Bodies.


• RECEIVE the report from CCC.

Page 1 of 4


10 December 2019


10 December 2019 Highlight Report from the Public Collaborative Commissioning Committee (CCC)

(November 2019)

Introduction 1. The purpose of this report is for Collaborative Commissioning Committee (CCC) to provide

the Governing Body with an update on decisions made and escalate risks and issues identified.

2. CCC is a joint committee of NHS East Leicestershire and Rutland CCG, NHS West

Leicestershire CCG and NHS Leicester City CCG. CCC’s role is to:

• Support CCGs to create a financially sustainable health system in LLR, working beyond organisational boundaries to make best use of the public purse;

• Provide a forum where commissioners can agree and align priorities and identify opportunities for further collaboration and consistency.

3. The chair informed Committee members that following the approval by all 3 LLR CCGs’ Governing Bodies in October 2019, the new governance arrangements were going to be implemented. The establishment of the new arrangements meant that the Commissioning Collaborative Board (CCB) in its current form to be disestablished following the meeting on 17 October 2019. The new Collaborative Commissioning Committee (CCC) was established and the inaugural meeting of the new Committee took place on 21 November 2019.

4. The key areas of discussion and outcomes from the CCC meeting held on 21 November 2019 are summarised below.

5. The committee received the approved terms of reference for the CCC, along with the work

programme and schedule of meeting dates for 2019/20. The Committee commented on the terms of reference requesting some minor amendments in order for them to reflect the new Committee’s structure.

6. Consultant to Consultant Policy: The purpose of the report was to recommend CCC to

approve the refreshed Leicester, Leicestershire and Rutland (LLR) Consultant to Consultant (C2C) policy. It was reported that there were no significant changes made to the policy and the review only focussed upon refresh and clarification to enable patients to be treated in primary care where alternative services exist or to be referred into another specialty in secondary care, where clinically appropriate to do so.

7. The Committee noted that the policy review process had been led by the Transferring Care

Safely Group (TSCG) and signed off by the UHL and CCG contracting teams. It was noted that the oversight of the refreshed policy has been provided by the Planned Care Board.

8. Some of the Committee GP members raised a concern under the urgent referral pathway between consultants to consultants, stating that the referral criteria should be consistent across the board. This was in terms of consultants should be able to refer patients using the 2 week wait (2ww) pathway similar to GPs in general practices. After having explained the process, in that UHL do not use the 2ww terminology but it is referred to as urgent referrals pathway. The Committee recommended that the concerned paragraph to be rephrased to ensure that it is explicit which informs that patients under C2C policy referral

Page 2 of 4


10 December 2019

pathway are and or will not be disadvantaged in the context of those patients referred by GPs under the 2ww pathway.

9. CCC approved the policy subject to rephrasing the paragraph and recirculating the policy

to the Committee to ensure they are happy with the revised version. 10. 2019/20 QIPP Schemes Position and Financial Recovery Plan: CCC received an

update from the LLR Programme Management Office (PMO) on the Finance QIPP position. It was reported that LLR CCGs are forecasting an under delivery of the QIPP plan for 2019/20 of £19.926m, of which £10.989m is attributed to unidentified QIPP. It was highlighted that East Leicestershire and Rutland CCG and West Leicestershire CCG have unidentified QIPP which is amounting to £6.166m and £4.823m respectively.

11. It was reported that the Senior Responsible Officers (SROs) are forecasting QIPP delivery

of £46.037m which is reported formally on a monthly basis. The LLR PMO undertakes a monthly assurance exercise reviewing workbook submissions alongside their knowledge of schemes to RAG rate delivery across a number of categories. The PMO have provided an assured value which represents the amount of QIPP savings that will be delivered at month 7 and the assured value for LLR QIPP delivery is predicted at £43.778m.

12. CCC noted that the shortfall in QIPP Delivery against requirement is clearly going to have

a detrimental impact on the CCG’s ability to achieve their financial targets within 2019/20. It was reported that work has been undertaken to identify further efficiency opportunities which have been incorporated into a System Financial Recovery Plan (FRP) to ensure achievement of financial targets.

13. It was reported that to date £8.190m FRP savings have been delivered with a further

£11.864m due to be delivered in the remaining months of the financial year. Although the overall system risk for month 7 has not yet been determined, the forecast FRP delivery of £20.054m for the financial year is likely to only partly offset the overall system risk. The FRP was submitted to NHS England and NHS Improvement outlining the size of the financial gap across the system and how the system intends to manage the risk.

14. One of the schemes’ that was highlighted which was causing adverse variances was under

the Diagnostics scheme. It was reported that the under delivery in the level of QIPP delivery is due to sickness absence of the project manager and amendment to the % reduction in activity achievable. The original assumption of a 43% reduction in activity has been deemed unrealistic and therefore it has been amended to 10% accordingly. This level will be refined again once a decision is made as to the nature of the interventions.

15. In terms of next steps, it was noted that the PMO are working closely with the project

teams responsible for developing and delivering the FRP in order to agree a process for reporting progress made, whilst minimising reporting requirements. Further Planning workshops are being proposed to support the development of the operational plan responding to the NHS Long Term Plan. CCC noted the concerns raised and the actions taken to mitigate the financial gaps.

16. Community Business Case Steering Group Draft Terms of Reference: The report

outlined the process to develop proposals for the future clinical model of services which will be delivered from Community Hospitals in Leicester Leicestershire and Rutland (LLR).

17. At the meeting of the Commissioning Collaborative Board (CCB) in October 2019, the draft

terms of reference for the Community Business Case Steering group were not approved based on them being fluid. The CCB had recommended that the terms of reference were reviewed in line with the comments received at the meeting and revised in time for the 1st

Page 3 of 4


10 December 2019

augural meeting of the Collaborative Commissioning Committee (CCC) taking place in November 2019.

18. The Committee noted that the terms of reference presented at the meeting were the

revised version which highlighted the amendments made. Following review of the terms of reference, the Committee proceeded to approve them.

RECOMMENDATIONS

East Leicestershire and Rutland CCG Governing Body is requested to:

• RECEIVE the Collaborative Commissioning Committee report.

Page 4 of 4

K

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System Leadership Team Meeting No. 30

Chair: John Adler Date: Thursday 19 September 2019

Time: 9.00am – 11.00am Venue: 3rd Floor Conference Suite, Voluntary Action Leicester, 9 Newarke Street,

Leicester LE1 5SN Present: John Adler (JA) Chief Executive, University Hospitals of Leicester NHS Trust Caroline Trevithick (CT) Interim Managing Director, West Leicestershire CCG Professor Mayur Lakhani Clinical Chair, West Leicestershire CCG Professor Azhar Farooqi (AFa)

Clinical Chair, Leicester City CCG

Michelle Iliffe Director of Finance and Deputy Accountable Officer, Leicester City CCG Donna Briggs (DB) Chief Financial Officer Andrew Furlong (AFu) Medical Director, University Hospitals of Leicester NHS Trust Paul Traynor (PT) Director of Finance, University Hospitals of Leicester NHS Trust Evan Rees (ER) Chair, BCT PPI Group, East Leicestershire and Rutland CCG Stephen Bateman (SB) Chief, Executive Officer, Derbyshire Health Care CIC Ben Holdaway (BH) Director of Operations, EMAS Mark Andrews (MA) Assistant Director Adult Services, Rutland County Council Sue Elcock (SE) Medical Director, Leicestershire Partnership Trust Sharon Murphy (SM) Deputy Director of Finance, Leicestershire Partnership Trust In Attendance: Clare Mair (CM) Board Support Officer, Leicester City CCG (Minutes) Sarah Prema (SP) Director of Strategy and Implementation, Leicester City CCG Spencer Gay (SG) Director of Finance, West Leicestershire CCG Apologies: Andy Williams LLR CCGs Accountable Officer Designate Ursula Montgomery (UM) Chair, East Leicestershire and Rutland CCG and GP Frances Shattock (FS) Director of Strategic Transformation/ Locality, NHS England and

Improvement Sue Lock (SL) Interim LLR STP Lead, Managing Director, Leicester City CCG Angela Hillery (AH) Chief Executive, Leicestershire Partnership Trust John Sinnott (JS) Chief Executive, Leicestershire County Council Dr Nick Pulman (NP) West Leicestershire CCG Steven Forbes (SF) Strategic Director for Adult Social Care, Leicester City Council

SLT 19/99 Welcome and introductions JA welcomed everyone to the meeting.

SLT 19/100 Apologies for Absence and Quorum Apologies were noted as above. The quorum was discussed in that ELR CCG were at present unable to field a clinical representative. DB advised this was being addressed.

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SLT 19/101 Declarations of interest on Agenda Topics The papers had been reviewed by a CCG Governance Officer and no conflicts of interest had been identified.

SLT 19/102 Notification of any other business The Chair was not notified of any other items of business.

SLT 19/103 Minutes of meeting held on 22 August (Paper A) The minutes from the System Leadership Team held on 22 August 2019 were presented and agreed to be an accurate record of the meeting.

SLT 19/104 Action notes of the meeting held on 22 August (Paper B) The action log was reviewed and the following noted; 21/01/08 – Partnership Group Terms of Reference The Partnership Group are due to meet on Monday 23 September 2019. JA did not anticipate that Leicestershire County Council would participate for now due to the Council having issues about clarity on what an ICS is. Leicestershire County Council took a paper to their full council a week or so ago to reconfirm their commitment to collaborative working but raised a series of questions about ICS architecture and place. CT to respond to JS advising a response to his paper would be prepared and would co-ordinate that with SP. 19/92 - Urgent and Emergency Care The AEDB met yesterday. A rigorous management approach and a demand management plan linking in with the financial recovery plan and LOS work are in place and all were being given the highest profile. CT advised WLCCG had been running a major incident approach to urgent care and holding daily review phone calls. A stock take would happen tomorrow. CT was taking part in an urgent care escalation call today with NHSEI. MP also advised that Dr Rizvi, GP was dedicating his clinical sessions to support CT on this. DB reported a Transforming Care Programme submission had been sent on Friday. More work was needed to close the gaps. DB would bring the work plan to the October SLT meeting.

CT SP DB

SLT 19/105 NHS Long Term Plan LLR Five Year Financial Plan – presentation (Spencer Gay) The system had been informed of five years’ worth of allocations from 19/20 to 23/24. The modelling had been done as a system response across the organisations. Historic spend had been used as a baseline and inflation added for pay, non-pay and demographic need and local priorities, the LTP ‘must dos’ and the efficiencies LLR needed to make had been taken into account. There was a deficit in some of the years of the plan and that would need to be agreed with NHSEI. Funding was being asked through various sources; financial recovery fund, provider support fund, commissioner support fund. The system has accessed those funds historically to support the bottom line. Assumptions had been made but there was no guarantee of support. Growth had been assumed locally as 0.7+ on demographic, 1.3% on community and 2.7% on acute. Demographic growth had not been applied to mental health because there had been significant investment into the plan already (£10m for 2020/21). SG had checked against a number of investment areas and believed all were covered with the exception of two; Community CHC and PC investment standard was being checked as to how that

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would be measured but it was believed the investment had been met. Long Term Plans must demonstrate maintaining or returning to financial balance and not all organisations at present show a balance. SG believed NHSEI would question if the system was working quickly enough to achieve balance. 2019/20 had a £30m in year problem to address and SG was identifying the extent to which the solutions were recurrent/non recurrent. Agreement of the plan needed to go alongside agreement of contractual arrangements with all parties. 2019/20 identified a £9m planned deficit and for 2020/21 a £82m planned deficit. The full amount of external support would be requested for 2020/21. SG advised the system was receiving £40m of central funding support in 2019/20 so the £9m was artificial. The plan had been set to achieve financial balance by 2023/24. JA noted most of the system deficit sat with UHL. SG responded there was quite a lot of investment in UHL that was not funded by usual contractual mechanisms and so the contractual arrangements and pattern of spend needed to change. The current construct meant that UHL internal savings were a benefit to them but any system-wide transformation or demand management was currently modelled to take income out of the provider. The reward and benefit of collective work needed to be considered. PT recognised £82m as the deficit for 2020/21 but the split across organisations was still for debate. He agreed more work was needed to understand the transformation projects and who would share the benefit. SG said the aim was to get every organisation to an even position regardless of the split. JA queried the status of the numbers and SG said they would be submitted with the draft LTP. JA warned the numbers would need to be heavily caveated because as they stood support would not be given from the UHL board. DB asked if there were any unidentified savings and SG said there were none for 2020/21 and he believed all options had been explored. DB felt the regulators would push back as there were six months until 2020/21 and they would say more could be done to bring down the deficit. SG said this set framework for people to go away and work up the plans in detail for example, £10m had been put aside for the MH investment standard but there was a work-up to be done on how it would be spent within the identified areas. SG reported a 4% growth average with the exclusion of targeted funding which the system would bid for. SG believed the LLR share would be £30m and if successful would be used to deliver some of the system priorities earlier. SG reported over the next five years there would be enough funding to make the investments and meet pay and non-pay growth. Activity growth was not an option and therefore redesign of services to be more effective or demand management would be required. Some additional funding for LPT had been funded from the baseline £44m, a fair share allocation nationally for STP of £31.5m and targeted funding for some areas of priority in LPT which was being held centrally and would be bid for. £50m of investment was anticipated for 2020/21. Narrative and evidence to support the plan will be key to receiving approval from the regulator. SG wanted to be honest about the scale of deficit so that achieving balance would be deliverable. Benchmarking did not show LLR as an outlier. LLR had found it difficult to deliver transformational work in previous years but the five year view was helpful in setting out the ambitions early. It would take time for new ways of working and contracting to work through the system. CT acknowledged that UHL didn’t want to hold the risk for deficit but the CCGs didn’t want to be in a position of holding an excess. It would be important to get NHSEI to understand that the current split needed to be remodelled. SG would talk to the regional team before submitting the numbers.

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PT noted PSF was not in the modelling and getting back to balance by 2023/24 without PSF would not be easy. He expected push back on a worsening position for 2020/21. JA said UHL would have little choice but to increase its prices to reduce its deficit if the current split and the current contracting remained unchanged. Therefore the way in which LLR traded would need to change otherwise the futile efforts of UHL increasing prices and the CCGs challenging that would continue. SG assured the narrative in the body of the plan would state that LLR was looking to change and there would be a different contractual approach to sharing the risk. SG understood it would be difficult for UHL to sign up to the plan with the deficit sitting with them. MA made the point that UHL were being put in a position of risk to invest in other parts of the system that had not always been able to deliver the transformational change. MA didn’t feel these discussions represented an emerging ICS and the whole system owning the risks and was not surprised that UHL felt uncomfortable. DB didn’t feel the CCGs would be comfortable either with this either as the deficit moved to the CCGs; 100% of the deficit sat with in UHL in 2019/20 and 75% in 2020/21 with the other 25% shifting to the CCGs. DB was clear the ICS needed to own the total deficit. PT said the transformation work and creating a model with shared benefits would represent and deliver genuine partnership. SG asked if the boards would be less nervous if they were clear that a different contractual form was being moved into. ML noted that both financial and clinical strategies would be needed to meet the requirements of the five year plan including the reshaping of primary and community care and contracting opportunities. Professor Farooqi commented that the numbers felt abstracts and clinicians would want to see some real examples of what the finances would mean for transformation of services. JA felt UHL board would support the plan if the deficit risk was evenly balanced across the organisations and there was agreement for a new contractual form that facilitated the delivery of the objectives. As a trust in deficit UHL were nationally required to take out 1.6% in the absence of a CIP. SP advised the draft would be submitted on 27 September 2019 and between then and 8 October 2019, NHSEI regional team, programme team and finance team would review. The LLR feedback meeting was diarised for 9 October 2019. Between 9 October 2019 and 15 November LLR would go through a reiterative process with the region and the plan revised in light of the feedback. The plan would be taken through trust boards at the end of October/early November 2019. The contractual principles would need to be in there. SP and SG would work on the narrative to reflect what had been discussed today. SLT agreed that a new approach to contracting, particularly the UHL contract was required and committed to work on this for inclusion in the LPT papers to boards in November 2019. LLR Five Year Plan The narrative had been revised since presented to SLT in August 2019. The narrative describes how the LLR system will meet the LTP commitments through structural and services changes, ICS development and achieving financial balance. The plan builds on existing BCT work, the community services redesign and LTP transformation programmes. SP had been balancing the strategic and operational requirements of NHSEI. The region had increasingly been issuing KLOEs about what needed to be in the plan resulting in a lot of detail therefore SP was trying to deliver a balance of answering the questions at a reasonable level but still ensuring the plan was strategic. There was more work to do on workforce. Region was providing some support which LPT and UHL workforce leads would link into. More work was also needed on the health inequalities chapter. The plan narrative would come to boards at the end of October/early November 2019. The draft plan narrative has been to CCB, the planning and operational group and CLG. SP invited comments bearing in mind there was one week before submission. CT was pleased NHSEI were helping with the workforce area and it was agreed the two workforce

SG SP

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leads would be asked to attend SLT to provide an overview on risks. A chief officer lead needed to be identified. It was agreed to discuss that with SL. SP would send out a final copy of what was submitted. MP had talked to the 25 PCN leads about how they would want to interface with the system. MP and AFa proposed 2 PCN ACDs from each current CCG footprint to join the SLT membership. AFu wanted assurance they would be empowered by the other 19 PCN ACDs and AFa affirmed they would be speaking on the others’ behalf. SP was mindful of their time commitment as they needed to get involved in the care alliance discussions which she felt was of more benefit. AF suggested starting with 6 PCN ACDs to begin with and then revisit the number in due course. MA felt 6 was a lot and one per place was more sensible. MA felt a discussion about how to properly integrate at a local level was needed and bringing the LAs into the alliance discussion to better integrate resources across LAs and health. JA agreed PCN attendance on that scale was a lot but could be tried as a starting point. It was agreed to include them on the SLT at present and see what other groups opened up to them, such as the CLG and care alliance. JA asked if there was anything else to feedback on PCNs such as work stream interface. AFa advised the PCNs has established an LLR forum and the next meeting would look at representation on work streams alongside looking governing body GPs alignment to work streams. The CCGs would put together a development programme for PCNs and £800k a year was available across LLR for their development needs. MP noted the level of recruitment for ANPs, pharmacists, social prescribers, physios etc. and with a limited pool of these skills it was important to think about how these roles could be recruited to so as not to destabilise other providers in the system. MP asked if there was capacity and capability in the system to provide HR support to PCNs for job descriptions and recruitment. A number of different streams of work were happening that needed bringing together; Helen Mather was working on a training passport, UHL Chief Pharmacist had raised the issue of staff movement, Tim Sacks was leading on PC workforce. SP would speak to Tim Sacks to ensure UHL pharmacy, EMAS and LPT were invited to the next session. SP would talk to Tim Sacks about mapping out all the meetings and to see if PCNs wanted to be involved. SP requested that CEOs and AOs read the forward she had written on their behalf. SP would add EMAS and DHU into the forward if they wanted that.

SP All

SLT 19/106 Financial Recovery Plan FRP was submitted at the end of July and was due for resubmission on Friday 20 September. The figures were still based on month 4 and no major changes were expected. The overarching message is that system is primacy. Individual organisations have got control totals and are receiving their PSF. The financial recovery plan had been split into several areas; demand management, cost control, managing capacity, budgetary review and flexibilities. CCB went through the ‘no go’ FRP areas last week; cancer, clinically urgent, 52ww, 26 week rebook, anything that would be detrimental to ED performance, MHIS. The month 4 FRP position reported a £28.9m problem across the system. Elective and non-elective care are areas of focus. £5m for elective had been built in but heavily caveated that work needed to be done and £8.8m for the urgent care target. There is currently a £11.7m gap and NHSEI will want to know what else is being looked at. There is potentially £750k of overseas visitors income opportunities based on national benchmarking. The system submitted a balanced plan but that position had deteriorated. An escalation meeting was taking place next week. UHL and LPT internal pressures were recognised. A move to sharing the

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financial risks and benefits and contracting differently would indicate to NHSEI the change of intent. PT said despite the efforts over the next few months the elective and non-elective gains would be small and the sooner the system moved into proper transformation the better. Date, time and venue of next meeting 9am-12pm Thursday 17 October 2019, 4th Floor Conference Room, St John’s House. CT would chair SLT from October to December.

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Documents

Chair’s Report able Officer’s Corporate Report12ibcm2f1hm941gh4lrvpwk1-wpengine.netdna-ssl.com/wp-content/u… · 10/12/2019 · - Dr Girish Purohit asked that the word ‘refusing’