Governing Body Meeting Supplement, 26 October 2016

Document Page

1 Governing Body 26 October Public Agenda 22 317 16 Risk and Performance FS 43 317 16 Risk and Performance Minutes 121016 7

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Chair: Dr Hugh Porter Enquiries to: Kim Pocock (Governance Co-ordinator) 0115 8839251 kim.pocock@nottinghamcity.nhs.uk

GOVERNING BODY

Meeting Agenda

Wednesday 26 October 2016, 9.30 am – 12.00 pm Community Suites A & B, Clifton Cornerstone, Southchurch Drive, Clifton,

Nottingham, NG11 8EW

Introductory Items

9.30am 1. Welcome HP GB 301/16 – Oral 2. Apologies for absence HP GB 302/16 – Oral 3. Governing Body Etiquette HP GB 303/16 – Oral 4. Declarations of interest for any item on the

agenda HP GB 304/16 – Oral

5. Agreement of how any real or perceived

conflicts of interest are required to be managed

HP GB 305/16 – Oral

6. Questions from the Public HP GB 306/16 – Oral 7. Minutes of the meeting held on 28

September 2016 HP GB 307 /16

8. Action log and matters arising from the

meeting held on 28 September 2016 HP GB 308/16

Strategy and Leadership

9.35am 9. Chair and Chief Officer Update HP/DS GB 309 /16 10. NHS Operational Planning Guidance for

2017/18 and 2018/19 LBa GB 310/16

11. Commissioning Priority Area: Cancer GB 311/16 a) Patient Story SS b) Delivery Update MP 12. Clinical Council Report AM GB 312/16

Financial Stewardship

13. Finance Report LBa GB 313/16 14. Resource Allocation and Prioritisation

Panel Report DS GB 314/16

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11.00am BREAK

Quality Improvement

15. Quality Improvement Committee Report RT GB 315/16 16. Annual Assurance Report: Serious

Incidents SS GB 316/16

Corporate Assurance and Performance

17. Risk and Performance Committee Report SC GB 317/16 18. Performance Report LBa GB 318/16 19. Governing Body Assurance Framework LBr Deferred to

November

Closing Items

20. Any Other Business HP GB 320/16 21. Date of Next Meeting - Wednesday 30

November 2016, 9.30am – 12.00pm, The Boardroom, Standard Court

HP GB 321/16

Confidential Meeting Motion The Governing Body will resolve that representatives of the press and other members of the public be excluded from the remainder of this meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section 1[2] Public Bodies [Admission to Meetings] Act 1960)

Minutes Presented to the Committee: Last Meeting On

Agenda Next Meeting

Sub-Committees:

Primary Care Commissioning Panel 1 September - 3 November

Clinical Council 21 September 16 October

Audit Committee 6 September - 22 November

Resource Allocation and Prioritisation Panel 21 September 2 November

Quality Improvement Committee 12 October 9 November

Risk and Performance Committee 12 October 9 November

People’s Council 26 October - 9 November

Partnerships: (within Chair and Chief Officer Report)

Crime and Drugs Partnership Board 20 June 26 September

Health and Wellbeing Board 28 September 30 November

Childrens Partnership Board 13 July - 31 October

If you are aware that you have an interest or you need any advice on declaring an interest in any item on the agenda, please contact the Governance Officer shown at the top of the agenda, if possible before the day of the meeting.

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GOVERNING BODY

Title: Report of the Risk and Performance Committee

Presenter: Sue Clague - Lay Member, Planning and Performance

Purpose of the Paper: To inform the Governing Body of the work undertaken by the Risk and Performance Committee at the meeting held on 12 October 2016.

Key Issues and Recommendations: The Committee received the Organisational Risk Register as at October 2016, which informed the Committee of new risks that had been added since the last meeting and ongoing high risks. An update on progress of the organisation’s ongoing major risks was also received (shown at Appendix 1). The Committee received a verbal update on the findings of a recent evaluation of the Early Intervention and Psychosis Service, and was reassured by the positive impact of subsequent implementation of agreed actions. The Committee received a paper, which detailed the interim position of the 2016/17 Governing Body Assurance Framework, and was reassured that sufficient levels of assurance and a robust system for assurance are in place in relation to the CCG’s strategic risks. The Committee received a QIPP report update, and expressed concerned about the efficiency measures being taken in relation to the prescribing budget, together with the increasing difficulty in reaching agreement with County CCGs. There was also concern that, although previously identified QIPP schemes are on track, it has not been possible to identify any additional QIPP schemes. The Committee received an updated Performance Report, and expressed concerned that, in light of the impact on A & E performance in August of the implementation of a new computer system at Nottingham University Hospitals Trust, providers should have in place sufficient system resilience and robust contingency plans to mitigate for unforeseen events.

Action required by the Governing Body: To note the work of the Risk and Performance Committee.

GB 317/16

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Appendix 1 - Major Risks on the Organisational Risk Register at October 2016

Risk

Ref Risk and progress update

Risk

Score

(I x L)

240 Risk:

Due to factors that are specific to Nottingham City GP practices (the high

percentage of GPs aged over 55, high levels of deprivation and patient list

size and high number of single handed practices) there is a risk that any

practice failure/closure could have a detrimental impact on Primary Care in

the City, due to the possibility of practices not being able to accommodate

displaced patients and also in enabling the CCG to successfully deliver its

strategy.

Actions and Progress Update:

Under review by the Primary Care Quality Steering Group and Clinical

Council

Primary Care Panel initiating Health Needs Assessments for Care

Delivery Groups where practices have requested list closures (as

appropriate)

Participation in the Health Education East Midlands (HEEM) GP

Fellowship Scheme

Ongoing discussions with HEEM and GP Education and Training Board

Primary Care Offer (which will increase resources to practices in order to

support them in providing high quality care)

Primary Care Estates Strategy (which will support infrastructure of

practices)

CCG support in establishing the GP Alliance

Recognition of national issue in the GP Forward View (Dr McLachlan is

currently summarising this locally)

Work is ongoing vis the General Practice Staff Education Training Board

to Health Education England on any strategies that will support improved

recruitment into General practice

There is a section on this issue on Members concerns that is considered

at the bi annual Members meeting.

Risk Owner: Dr Alastair McLachlan, Corporate Medical Lead

16

(4 x 4)

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Risk

Ref Risk and progress update

Risk

Score

(I x L)

265 Risk:

There is a risk that the pace of delivery against partnership transformation

plans across the Nottinghamshire health and social care system, including the

lack of detailed plans for meeting the identified financial gap, are insufficient,

particularly in the context of the change in geographic footprint and the need

to align existing plans.

Action and progress update:

Additional investment in PMO arrangements has been agreed and there are

plans in place to implement these arrangements.

Risk Owner: Dawn Smith, Chief Officer

15

(5 x 3)

267 Risk:

EMAS remains within CQC domain of 'inadequate' for safety and have been

issued a Section 29 Notice, therefore are subject to the delivery of a Quality

Improvement Plan within agreed timescales.

Action and progress update:

The oversight group met on 29 September 2016. The CQC Quality

Improvement Plan has been updated to include action identified through an

internal audit. All actions identified in the CQC Quality Improvement Plan

have been completed or are on track, with one exception which is related to a

time in lieu policy update. A strategic demand and capacity review has been

commissioned and will report in January 2017

Risk Owner: Helen Jones, Head of Urgent Care

16

(4 x 4)

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GB 317/16

RISK AND PERFORMANCE COMMITTEE

Unratified Minutes of Meeting held on Wednesday 12 October 2016 at Standard Court

Present: Sue Clague Lay Member, Planning and Performance Lead (Chair) Mindy Bassi Assistant Director of Medicines Management Dr Marcus Bicknell GP Cluster Lead (Norcomm) Lucy Branson Director of Corporate Development Peter Burnett Assistant Director of Planning, Performance and QIPP Isobel Scoffield Deputy Chief Finance Officer Dr Om Sharma GP Lead Sue Sunderland Associate Lay Member Hazel Wigginton Assistant Director of Commissioning, Community Services Apologies: Janet Champion Associate Lay Member In attendance: Simon Castle Assistant Director of Commissioning - Mental Health, Cancer and Acute

Contracts Emily Fleming Interim Head of Corporate Assurance Paul Gardner Head of Information Governance Kelvin Langford Principal Anti-Crime Specialist, 360 Assurance Maureen Welch-Dolynskyj

Governance Officer (minute taker)

ITEM ACTION

Opening Items RP 121/16 Welcome

Sue Clague welcomed everyone to the meeting.

RP 122/16 Apologies for absence Apologies were received from Janet Champion.

RP 123/16 Declarations of interest for any item on the agenda No interests were declared in relation to items on the agenda.

Cumulative Record of Members Attendance (2016/17):

Member Possible Actual Member Possible Actual

Mindy Bassi 5 5 Sue Clague 5 4

Dr Marcus Bicknell 5 4 Isobel Scoffield 5 4

Lucy Branson 5 5 Dr Om Sharma 5 5

Peter Burnett 5 5 Sue Sunderland 5 5

Janet Champion 5 3 Hazel Wigginton 5 4

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ITEM ACTION Sue Clague reminded members of their responsibility to declare any interests should they become apparent as a result of discussions during the course of the meeting. She also drew members’ attention to the recently issued guidance on the category definitions in relation to conflicts of interest.

RP 124/16 Agreement of how any real or perceived conflicts of interest are

required to be managed

As no interests in relation to items on the agenda were declared, this item

was not required.

RP 125/16 Minutes of the Risk and Performance Committee Meeting held on 14

September 2016

The Committee considered the minutes of the meeting held on 21 September 2016, which were confirmed as an accurate record.

RP 126/16 Action log and matters arising from meeting held on 14 September

2016

The Committee reviewed the action log from the meeting held on 14 September 2016 and updates were provided as follows: (a) RP 097/16 – Organisational Risk Register

Work is ongoing between Dr Alastair McLachlan, Corporate Medical Lead, and Maria Principe, Director of Contracting and Transformation, to quantify the resource gap in primary care. Risk 240 relates to the potential for City practice closures due to factors specific to Nottingham including the high percentage of GPs aged over 55, high levels of deprivation, patient list size and high number of single handed practices. A more detailed update is scheduled to be presented at the November 2016 meeting.

(b) RP/116/16 – Briefing on the Review of Access Targets

Liaison is taking place with the CCG’s Engagement and Communications Team in relation to proposed patient engagement. The paper is also scheduled to be presented to next week’s Clinical Council to obtain further feedback; a decision will then be taken on how best to proceed. At the moment, it is still planned to implement the changes in early 2017 via contract variation. Hazel Wigginton agreed to liaise with Kathryn Brown to ascertain the value of presenting a further update to the Committee’s at its November meeting.

(c) RP 113/16 – Performance Report

The five Emergency Care Improvement Programme (ECIP)-mandated actions were noted: - Streaming at the front door. - NHS 111 call disposition - Ambulance turnaround - Enhanced flow through the department - Discharge to assess

HW

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ITEM ACTION ECIP had also highlighted three areas that leadership needs to drive: - Access to admit - Doing today’s work today - Home first

The A & E Delivery Board action plan and the NHS Improvements “Rapid Implementation Guidance for Local Systems” document were also noted.

The revised NHS 111 contract, awarded to a consortium comprising Derbyshire Health United and East Midlands Ambulance Service, is scheduled to commence this month.

Colleagues from the Urgent Care Centre (UCC) and A & E are working together to try to ensure that patients are directed appropriately. The Committee feels that further assurance is required in terms of the remit and usage of the UCC, which appears to be currently running on a clinic-type basis, together with a more general overview of joined-up working across urgent care including, EMAS, NHS 111, A & E and the UCC. It was suggested that this could be incorporated into the A & E deep-dive scheduled for November and that that Nikki Pownall would be contacted in this regard. It was felt that the focus of the deep-dive should therefore include remit, utilisation and patient education with regard to the Urgent Care Centre, the role of NHS 111, and the impact of both services on the A & E four-hour wait performance.

(d) RP 064/16 – East Midlands Ambulance Service Recovery Plans

The Committee’s attention was drawn to Appendix C to the action log, which outlined the results of a quarterly audit recently carried out at EMAS. It was noted that it was Linda Shipman, Head of Quality Governance, and not Helen Jones, Head of Urgent Care, who had taken part in the review. The aim of the audit had been: - To understand the performance of standard response to calls

within Nottinghamshire during April 2016 - To determine whether the correct response and care was

provided - To determine whether the outcome would have been different if

the response target had been achieved - To determine if the initial disposition (either through 111 or 999)

was appropriate - To identify any learning arising and recommend actions for

agreement through EMAS and CCG urgent care arrangements

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ITEM ACTION Unfortunately, it had not been possible to audit any real-time calls on this occasion, but it is anticipated that the next audit will include actual calls, together with a specific definition of “harm”. The Committee was not reassured by the results of the audit. It was highlighted that no associated themes had been identified but that the focus had been on quality, which the Quality Improvement Committee is reviewing. It was noted that there had been no identified negative patient outcomes. The Committee was not confident that the audit was adequately scrutinising the element of performance, but it was noted that NHS Hardwick CCG is aware of this lack of scrutiny, which will be addressed during the next audit which is due shortly. It was suggested that an appendix of anonymised calls could be attached the next audit to provide more context.

Simon Castle joined the meeting at 2.35 pm. Lucy Branson agreed to feed back the Committee’s comments on the audit and to liaise with Sally Seeley, Director of Quality and Personalisation, in terms of next steps. It was noted that Lucy Anderson is leading on this issue on behalf of the Quality and Personalisation Directorate.

Risk Management and Corporate Assurance

RP 132/16 Update on the External Evaluation of the Early Intervention and

Psychosis Service

The Committee welcomed Simon Castle, who provided an update on the findings of a recent evaluation of the Early Intervention and Psychosis Service (EIP). The following points were highlighted: (a) A number of operational issues had been identified, but associated

actions have now been implemented:

The Nottinghamshire Healthcare Trust (NHT) is now tracking the waiting list on a daily basis.

A clinical review of current patient caseloads is being undertaken.

Improvements have been made in relation the accuracy of recorded data.

There is more flexibility in terms of moving resources into Nottingham City.

Fortnightly meetings between the CCG and NHT to discuss the recovery action plan have been instigated.

(b) There was an improvement in performance during September, with

the forecast rate anticipated to be at 27% during that month. (c) The number of referrals from Nottingham City is continuing to

increase, but the referral-to-treatment rates and conversion rates are

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ITEM ACTION good. Referrals are being received from the usual practices.

(d) A contract performance notice was issued at Quarter 1 and a

meeting was held with NHT to discuss how improvements could be made. It was highlighted that it may be difficult to get performance up to the required standard of 50% without additional resources, but that a funding request is scheduled to be discussed by the CCG’s Executive Management Team shortly.

The following points were made in discussion: (a) There are on average 10 – 12 referrals made to the service per

week; the recommended practitioner caseload is 15 patients, and current caseloads are currently averaging 30 patients. Owing to pressure on resources, efforts are currently being concentrated on treatment rather than assessment.

(b) The review has expedited the easing of a backlog of cases and a

number of discharges to be made. It has also facilitated a redistribution of some funding from treatment to assessment, but additional resource is still required.

(c) The key things that have contributed to the significant changes are

the service review; the redistribution of funding; the addition of a new team manager; a review of policies; and the provision of some non-recurrent funding.

(d) There are plans to incorporate best practice, and associated

learning, from recently revised substance misuse services into the EIP service.

(e) There is a perception that mental health treatment is slower than that

provided for physical health issues. Although it was acknowledged that substantial progress has been made in a relatively short time, it was felt that more review work could be undertaken in relation to the current model and that a more aspirational approach could be adopted.

(f) DNA rates do not impact on when the clock stops and restarts on

the treatment pathway.

(g) The next steps are to continue with the current bi-weekly meetings between the CCG and NHT; pursue the application for additional funding; and to track progress via the performance report.

The Committee thanked Simon for his presentation and noted the update on the Early Intervention in Psychosis service. Simon Castle left the meeting at 3.00 pm.

RP 127/16 Organisational Risk Register Emily Fleming presented the Organisational Risk Register (ORR) as at

October 2016, explaining that all members had access to either the full register or a redacted version relevant to their declared interests.

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ITEM ACTION The following points were highlighted: (a) Two new risks have been added to the ORR and two risks have

been requested for archive as follows:

Risk 156 – this is around the risk of unexpected closure of care homes at short notice, and archiving is requested because robust controls are now in place for any unexpected closures. This risk has now been replaced by new Risk 268, which is around the financial pressures in the care home sector that may lead to closures and resulting gaps in care provision. It also more accurately reflects the current situation in the sector.

Risk 237 – this is around the external focus on the consistent non-achievement of the four-hour wait standard and the impact it may have on the CCG’s assurance status with respect to leadership. This is requested for archive because the NHS England assurance process has now been completed and a new A & E Delivery Board has now been established. The only outstanding element is the performance against the four-hour waiting time target, but this will be reviewed via performance reporting and will also be scrutinised by the newly-established A & E Delivery Board.

Risk 269 – this is a new risk highlighting that the current financial environment within the health market brings an increased risk of provider failure and risk of disruption to services, workforce instability and the need for emergency service provision, and the impact on the CCG’s ability to deliver its objectives and duties. There is also a risk in terms of horizon-scanning of providers. This risk has been identified from the Governing Body Assurance Framework as a gap.

(b) In relation to Risk 161, around a lack of assurance of the completion

of appropriate levels of statutory and mandatory training, the new e-learning system has now been launched. However, the current risk score of 12 will be kept for the time being and then reviewed when the system has been in use for a period of time.

(c) In relation to Risk 162, around the breakdown of central monitoring

systems regarding staff appraisals, a new system was rolled out in April 2016, but insufficient data is currently available; a workforce report is scheduled to be presented to the November meeting, which will include updated information.

(d) In relation to Risk 240, a red risk which relates to the potential for

City practice closures due to factors specific to Nottingham including the high percentage of GPs aged over 55, high levels of deprivation, patient list size and high number of single handed practices, it was reported that initiatives are in process and that a progress update is scheduled for the November meeting.

(e) In relation to Risk 251, around the processes and systems in place

D

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ITEM ACTION to demonstrate the CCG’s clinical engagement activity, work is continuing in liaison with Dawn Smith, Chief Officer, with a review being carried out at all senior levels across the CCG. Lucy Branson suggested that Emily Fleming could liaise with Dr Alastair McLachlan, Corporate Medical Lead, to ensure that a clear distinction is made between membership engagement and clinical engagement. Lucy also highlighted that the evidencing of clinical engagement could be factored into the prioritisation process work being carried out by Peter Burnett.

(f) In relation to Risk 263, around the financial pressures being

experienced by the CCG’s main providers, it was confirmed that the Data Policy doesn’t negate the risk, but does ensure that progress is reported. Lucy queried how this risk differed from risk 269 and Emily clarified that Risk 269 refers more to the internal risk and the internal management of it, but she agreed to liaise with Isobel Scoffield make the wording in relation to each risk more distinct and explicit.

(g) In relation to Risk 267, a red risk around the Care Quality

Commission’s (CQC) rating for EMAS of “inadequate”, Emily confirmed that she has liaised with Sally Seeley, Director of Quality and Personalisation, and the risk has now been reworded so that it can be more accurately scored in terms of likelihood and impact. The Committee felt that the CQC rating is not a risk for the CCG, but agreed to check with Sally Seeley.

Sue Clague thanked Emily for presenting the Organisational Risk Register. The Committee noted the Organisational Risk Register and agreed that Risk 156 and Risk 237 could be archived.

EF

EF

EF

RP 128/16 Governing Body Assurance Framework Emily Fleming presented a paper, which detailed the interim position of

the 2016/17 Governing Body Assurance Framework (GBAF). She explained that its purpose is to provide the Governing Body with assurance that the CCG has identified its strategic risks and has robust and effective systems in place in order to deliver its objectives. The following points were highlighted: (a) The GBAF has been aligned to the NHS England CCG Improvement

and Assessment Framework 2016/17 and the risks have been identified as high-level, potential risks that are unlikely to be fully mitigated unless there are significant changes to the external environment.

(b) The document describes the scrutiny and review processes of the

various risks within the GBAF; the Risk and Performance Committee has delegated responsibility for monitoring and scrutinising the GBAF, focussing on progress against identified actions.

(c) Within the current residual risk profile of 24 risks, there are currently

six red risks.

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ITEM ACTION

(d) In terms of controls and assurances, a recent review has indicated that the overall split of internal and external assurances against identified controls is 62% internal and 38% external, which are perceived to be acceptable levels.

(e) In terms of reporting, a six-monthly action plan will be presented to

the Risk and Performance Committee prior to presentation at the Governing Body. Any risks rated above amber/green will be added to the Organisational Risk Register. Any newly identified risks will always be presented to the Risk and Performance Committee and will be cross-referenced with the Organisational Risk Register.

(f) Lucy Branson suggested that an external assurance needs to be

added to the sustainability risk.

(g) Lucy noted that, the outstanding actions within the recovery action plan are deemed to be low-level risks, and, although limited progress has been made in that regard, visibility is maintained via the Risk and Performance Committee.

Sue Clague thanked Emily for presenting the Governing Body Assurance Framework. The Committee noted the current position of the Governing Body Assurance Framework and was assured that sufficient levels of control and a robust system for assurance are in place in relation to the CCG’s strategic risks.

Performance Management and QIPP

RP 129/16 QIPP Report

Isobel Scoffield presented a report that summarised the CCG’s QIPP position for the current financial year as at 31 August 2016 (month 5). The following points were highlighted: (a) The financial position for the CCG is currently on plan, with a

forecast to deliver the £5,533k planned surplus. The surplus position is currently forecast to be achieved but there is significant activity and financial pressure on a number of contracts and service lines.

(b) The main overspend relates to acute care activity. This is covered

by existing reserve funds and mitigating action will be taken as necessary. Reserve funds may also be required for the current risks identified in mental health activity, prescribing activity and general QIPP under-delivery.

(c) The QIPP plan has an identified target of £12.42m savings to be

achieved; £7.42m is related to cash-releasing schemes and £5m relates to cost avoidance schemes.

(d) £1,489m of all schemes are currently rated as high risk and a further

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ITEM ACTION £3.152m is rated as medium risk. All cost avoidance schemes have been rated as Green.

(e) Although no additional QIPP schemes have been identified, the

CCG will be able to confirm with NHS England that all identified deliverables remain on track. However, Nottingham City CCG’s financial position now has similar pressure to County CCGs and it was agreed that it would therefore be mutually beneficial for all of the CCGs to work together to identify any further efficiencies where possible.

(f) The full value of Amber and Red-rated schemes relates to cash-

releasing and the current risk of under-delivery stands at £4,641m; this includes £1.5m of QIPP which was agreed to be transacted from the contract with Nottingham University Hospitals Trust from 1 April 2016.

The following points were made in discussion: (a) There is concern about the efficiency measures being taken in

relation to the prescribing budget, together with the increasing difficulty in reaching agreement with County CCGs. A joint QIPP working group has been established to facilitate discussions. It was suggested that patients’ expectations will need to be managed, via extensive patient engagement, to make them aware of potential changes to medication prescriptions. It was noted that this will also apply to proposed changes to procedures of limited clinical value.

(b) There is concern about the subtle difference between identified

QIPP saving schemes and actual service disinvestment, which could impact significantly on elective care.

Sue Clague thanked Isobel for her presentation. The Committee noted the QIPP plan and financial position for 2016/17.

RP 130/16 Performance Report

Peter Burnett presented the Performance Report as at October 2016, and indicated that he would highlight matters by exception. The following points were highlighted: (a) A & E waiting times performance dropped to 69.4% in August, but

members were reminded that this was due in part to the implementation of a new computer system which had been implemented at that time, and had caused a number of significant issues. However, the performance for September improved to 80.4%; this has still missed the planned trajectory, but is moving in the right direction. The Urgent Care Centre’s performance remains consistently high and was at 98.9% in August 2016.

Members were reminded that performance is now reported by combining figures for A & E and the Urgent Care Centre, and the

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ITEM ACTION combined representative performance rate for August was 82.2%. Peter assured the Committee that the new A & E Delivery Board will be made aware of any future potential issues within the A & E Department and it is expected that contingency plans will be put in place.

(b) The regional Red 1, Red 2 and A19 targets for East Midlands

Ambulance Service (EMAS) are still being missed, but are improving; it was noted that the activity rate has also dropped. The targets for Nottinghamshire in August was for EMAS to achieve 75% for Red 1 and they achieved 79%. For Red 2 calls the target was 61.5% and they achieved 62.3%. The A19 the target was 92% and they achieved 92.7%. EMAS is reporting that Nottingham City currently has the highest level of Red 2 referrals from healthcare professionals to EMAS, but the reason for this has not yet been investigated.

(c) In August, the performance for cancer: 31 days from diagnosis to

treatment activity improved to 95.7%, with only one breach recorded in relation to the CCG. The main areas of concern remain as head and neck and urology services, but an associated action plan is in place.

(d) In relation to cancer: 31 days to subsequent treatment – surgery,

performance fell to 84.6% in August. Head and neck and urology surgery capacity is the primary cause, but this is also being addressed via the action plan.

(e) In relation to cancer: 31 days to subsequent treatment – drugs,

performance fell to 95.5%; one breach was recorded, but this is deemed to be an isolated incident with little likelihood of recurrence.

(f) In relation to cancer: 62 days from urgent referral to treatment, a

performance figure of 70% was recorded for August. Nottingham University Hospitals Trust believes that this relates to a national data submission issue, which is currently being investigated. There is an overall fluctuating trend, but a recovery action plan is now in place to review identified issues. New consultants have recently been appointed in relation to head and neck and urology services, which should result in improvements in all associated activity. It is also hoped that three to four months of consistent performance can now be achieved.

(g) In relation to the Early Intervention in Psychosis service, although

current data is unavailable, the target is expected to be met. (h) There have been two breaches in the number of 52-week referral-to-

treatment pathways, which occurred in August 2016, but these have subsequently been identified as NHS England directly-commissioned services, and are therefore not actual CCG-related breaches.

(i) It was noted that, of 21,600 calls made to NHS 111 by Nottingham

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ITEM ACTION City patients, approximately a quarter of these were directed to A & E.

(j) The cancer: 31 days from diagnosis to treatment performance figure

of 87% at Nottingham Circle is thought to be largely due to skin cancer activity. Associated data is being analysed to ascertain the reason why.

Sue Clague thanked Peter for his presentation. The Committee noted the Performance Report as at October.

RP 131/16 Performance Deep Dive Plan Peter presented the revised deep dive plan which had been redrafted

following discussion at the last meeting. The following points were highlighted during the ensuing discussion: (a) It was mooted that the deep-dives for A & E and the Better Care

Fund (BCF) should occur more than once a year, particularly as the BCF is not featured in the Performance Report. It was agreed that the frequency of BCF deep dives be discussed further after the first scheduled report.

(b) It was noted that specific topics would be identified for the proposed deep dives around community services nearer the scheduled times.

(c) It was noted that presenters will need to be notified of the

requirements of the Committee, but should at least include details of the highest risks and current challenges.

(d) It was agreed that the issues of primary care and prescribing are

sufficiently address via the Quality and Improvement Committee and the Primary Care Performance and Quality Steering Group, and it is not therefore necessary to include them on the deep-dive programme.

(e) It was agreed that previous presentations made to the Committee

should be reviewed to ascertain the level of scope and brief that presenters could be asked to provide.

Sue Clague thanked Peter for his presentation. The Committee noted the revised deep dive plan.

Information Governance and Data Quality

RP 133/16 Information Governance Update: Quarter One and Quarter Two

Update

The Committee welcomed Paul Gardner, who presented an update in relation to the reporting requirements as per the Information Governance agenda. The paper also provided an update with regard to national developments and initiatives that are specifically related to the CCG.

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ITEM ACTION The following points were highlighted: (a) The CCG made a submission of Level 2 in relation to version 13 of

the Information Governance Toolkit, which resulted in the CCG receiving an overall rating of “satisfactory”. Work for completion of project work relating to version 14 has already commenced in all of the key areas. The 2016/17 proposed submission will be reviewed by internal audit during week commencing 23 January 2017, focussing on six identified criteria.

(b) In terms of compliance around staff training, the current figure is

67%, but it is anticipated that the required figure of 90% will be reached by the end of March 2017. Face-to-face training sessions are held bi-monthly in addition to online training; all sessions are promoted via Quick Connect.

(c) There have been no information governance incidents reported

during Quarter 1. One incident was reported during Quarter 2; remedial action has been taken.

(d) In terms of Freedom of Information Requests, there was 98.8%

compliance in Quarter 1 and 100% compliance in Quarter 2.

(e) No subject access requests were received during Quarters 1 or 2.

(f) Two queries were received in relation to requests for medical records; advice on where to obtain them was provided in each case.

(g) In terms of national updates, all CCGs are in the process of updating

privacy notices.

(h) A review is currently underway regarding this CCG’s accredited safe haven arrangements.

(i) The National Data Guardian Report and the Care Quality

Commission Review of Approaches to Security across the NHS Reports have been released and a summary paper produced by internal audit will be shared with the CCG’s Audit Committee. Finalised recommendations are awaited. There is a clear indication from the Care Quality Commission that information governance will form a bigger part of inspections and the Information Governance Toolkit will be used as a risk indicator for non-compliance.

The following points were noted in discussion: (a) Lucy requested that the detailed IG Toolkit action plan be included

with the Quarter 3 update. (b) It was acknowledged that, in terms of staff training, there is

sometimes a lull at this time of the year, but that compliance is usually achieved by the end of the financial year.

Sue Clague thanked Paul for his presentation.

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ITEM ACTION The Committee noted the updates in relation to Quarter 1 and Quarter 2.

Policy Approval

RP 134/16 Data Quality Policy Paul Gardner presented the Data Quality Policy which detailed the quality

requirements of the CCG in terms of maintaining and increasing high levels of data quality. Paul noted that this is a new policy as a result of identification by internal audit that a separate policy was required in terms of scope, principles and the assurance process. This policy therefore included information on data quality principles, roles and responsibilities together with details of data validation and quality assurance. Paul clarified that data disposal is covered in the Records Management Policy. Sue Clague thanked Paul for his presentation. The Committee approved the Data Quality Policy.

RP 135/16 Security Annual report 2015/2016 and Security Quarter 1 Update

2016

The Committee welcomed Kelvin Langford, who presented the Security Annual Report for 2015/16, which detailed the work carried out by the 360 Assurance Security Management Service which provides security management support to the CCG. Kelvin highlighted that the standards have now changed, and that a meeting is scheduled for 20 October 2016 with commissioners to discuss the changes. Appendix A to the paper listed the standards, standard requirements and when the associated work was completed. Appendix B to the paper provided details of NHS Protect security alerts. Emily Fleming noted that the annual report is not normally presented to the Risk and Performance Committee, and that next year’s report will contain more detail and will also incorporate the recent changes. Kelvin noted that the Quarter 1 report provided an update of work related to the standards, and standard requirements for the period 1 April to 30 June 2016. It was noted that the CCG is in the process of finalising its Security Policy. Sue Clague thanked Kelvin for his presentation. The Committee noted the Security Annual report 2015/2016 and the Security Quarter 1 Update 2016.

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ITEM ACTION RP 136/16 Security Programme Review Update – Self-Review Tool Progress Kelvin Langford explained that the self-review tool (SRT) enables the

organisation to produce a summary of the security management work conducted over the previous 12 months. Organisations are required to complete the SRT annually. The SRT also covers the key areas of activity outlined in the standards. Upon completion, the SRT provides a red, amber or green (RAG) rating for each of the key areas and an overall RAG rating. Sue Clague thanked Kelvin for his presentation. The Committee noted the Security Programme Review Update – Self-Review Tool Progress.

Closing Items

RP 137/16 Any Other Business

There was no further business.

RP 138/16 Key issues and recommendations to be raised with the Governing

Body

The Committee agreed to highlight the following to the Governing Body:

In relation to QIPP issues, there is concern about the efficiency measures being taken in relation to the prescribing budget, together with the increasing difficulty in reaching agreement with County CCGs. Although previously identified QIPP schemes are on track, it has not been possible to identify any additional QIPP schemes.

In light of the impact on A & E performance in August of the implementation of a new computer system at Nottingham University Hospitals Trust, members expressed concern that providers should have in place sufficient system resilience and robust contingency plans to mitigate for unforeseen events.

Members recognised the recent and ongoing improvements to the Early Intervention Psychosis service.

RP 139/16 Date, time and venue of next meeting Wednesday 9 November 2016, 2.00 pm – 4.30 pm, The Boardroom,

Standard Court.

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