Item: 13 - ealingccg.nhs.uk

APPROVED 280319

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Minutes of the NW London Finance Committee Held on Thursday 21 February 2019, 11:15 – 12:45hrs

Rooms 1.1 & 1.2, 87-91 Newman Street, W1T 3EY

Members in Attendance

Lindsey Wishart (LW) Lay Member and CCG Finance Committee Chair, Brent CCG (Chair)

Richard Smith (RS) Lay Member and CCG Finance Committee Chair, Harrow CCG

Philip Young (PY) Lay Member and CCG Finance Committee Chair, Ealing CCG

Allison Seidlar (AS) Lay Member and CCG Finance Committee Chair, Hillingdon CCG

Dr Andrew Steeden (ASte) CCG Finance and Activity Committee Chair, West London CCG

Dr Fabio Conti (FC) CCG Finance Committee Chair, Hounslow CCG

Mark Easton (ME) Accountable Officer, NW London CCGs

Paul Brown (PB) Chief Finance Officer, NW London CCGs

Caroline Morison (CM) Managing Director, Hillingdon CCG

Mary Clegg (MC) Managing Director, Hounslow CCG

Tessa Sandall (TS) Managing Director, Ealing CCG

Louise Proctor (LP) Managing Director, West London CCG

Javina Sehgal (JS) Managing Director, Harrow CCG

Janet Cree (JC) Managing Director, Hammersmith & Fulham CCG

Non-Members in Attendance

Dr Shazia Siddiqi (SS) Clinical Director and Governing Body member, Brent CCG

Dr Raj Chandok (RC) Vice Chair, Ealing CCG

Dr Nicola Burbidge (NB) Chair, Hounslow CCG

Dr Neville Purssell (NP) Chair, Central London CCG

Dr James Cavanagh (JCav) Vice Chair, Hammersmith & Fulham CCG

Dr Genevieve Small (GS) Chair, Harrow CCG

Ben Westmancott (BW) Director of Compliance

Jo Ohlson (JO) Interim Director of Commissioning

Jonathan Wise (JW) Finance Team Support

Jonathan Tymms (JT) Deputy Chief Finance Officer, Hillingdon CCG

Alex Stiles (AStil) Deputy Chief Finance Officer, Harrow CCG

Huw Wilson-Jones (HWJ) Deputy Director of Contracts

Alex Harris (AH) NWL Corporate Governance Officer (Minutes)

Apologies

Jules Martin Managing Director, Central London CCG

Dr Tim Spicer Chair, Hammersmith & Fulham CCG

Sheik Auladin Managing Director, Brent CCG

Para no.

Business Items Action

1. Welcome/Apologies

Apologies received are noted above.

Item: 13.3

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2. Declaration of Interests

There were no Declarations of Interest in addition to those previously recorded on the Registers of Interests.

3. Minutes of the Previous Meeting held on 24 January 2018

The Minutes of the Finance Committee Meeting held on Thursday 24 January 2019 were agreed as an accurate record.

4. Action Log as at February 2019

4.1

4.2 4.3

The Committee reviewed the outstanding actions and agreed the following:

Actions to be closed:

Act.0305

NHS England had been briefed. There was as yet no resolution, therefore the GP

at Hand cost had been included in the M10 financial position for Hammersmith and

Fulham.

Act. 0309

This is still being considered by Chairs and MDs. To be brought to the next

meeting.

Act. 0322

This would go to governing bodies in March. BW had recommended an approach,

but the scrutiny and assurance of this approach still needed to be described.

Act.0247

This was included in all existing contracts and would also be included in medicines

management next year.

4.1 Position regarding rent reimbursement

PB provided an update to the committee, noting that there would not be any

unforeseen liabilities. MCP added that a lot of member practices had not had rent

reviews for at least six years. There would need to be more clarity on the process

applied at NHS England for these reviews.

PB

5. Report from the Business Planning Recovery Group

5.1 5.2

PB introduced the report, and noted that all CCGs are invited to be part of BPRG. There was no further discussion. The Committee noted the update report.

6. Reporting items

6.1.1

6.1 2018/19 NW London CCGs financial position – M10

PB introduced the item. He noted that GP at Hand had been included into the M10 forecast.

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6.1.2 6.1.3 6.2.1 6.3.1 6.3.2 6.4.1 6.4.2

PB updated on issues further to finalising M10. Prescribing forecasts from PPA were being revised, and there was an outstanding issue with ChelWest support where NW London CCG’s were proposing to provide support to help them meet their control total. PY asked how many other providers were at the edge of their control totals. PB responded that there were no others. The Committee noted the report. 6.2 2018/19 NW London CCGs QIPP report – M10 There were no issues not covered by the previous item, and this item was not discussed further. The Committee noted the report. 6.3 2018/19 NW London CCGs Contract Report – M9 JO introduced the item, noting that assessing the underlying reasons for contract over-performance was still being worked on. Possible reasons were that there may have been under-commissioning, QIPP may not have mitigated the growth in the way it was originally anticipated, and growth may have been higher than planned. We also may have genuinely new activity or flows and some trusts may be better at recording activity than others. It was agreed that there would be an integrated finance, activity & QIPP report for 2019/20. JO also noted that NW London was an outlier from the rest of London with respect to two-week referrals. MCP explained that GPs may refer urgent patients via two-week referrals in order that they are seen promptly. The Committee noted the variance analysis and next steps. 6.4 NW London CCGs 2018/19 System-wide financial position – M9 PY noted that a large proportion of the underlying deficit was located in outer NW London (London NW University Healthcare NHS Trust (LNWHT) plus the three CCGs). JO responded that in terms of LNWHT PFI was part of the issue, as well as the site being under-utilised. There may also be operational running issues as well as estate issues which SOC could have addressed. ME stated that it was still to be determined if the system recovery plan would contain several elements The Committee noted the report.

7. Planning items

7.1 7.2 7.3

Update on contracts, QIPP and financial position

JW introduced the item. MP asked if we would be able to draw-down on the accumulated surplus. PB responded that he had made a request but had been told by NHS England that this was not currently possible.

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7.4 7.5 7.6 7.7 7.8

PY added that we were going to be faced with unbalanced plans and therefore ther needed to be a form of words that would explain this. PB agreed that if members felt that numbers were unachievable they would be less likely to work towards them. PY also added that QIPP numbers were largely driven bottom-up by CCGs, and questioned whether transformation plans were linked to CIP plans. PB agreed that QIPP was largely bottom-up. JO noted that the areas that we have developed a NW London-wide narrative were around UEC based on our UEC strategy and planned care. JO also stressed the need to plan earlier each year. ME suggested that we should identify in the next pack the areas that we should be working on collectively. LW stressed the need to consider system-wide changes that have mutual benefit for everyone, such as Integrated Care Systems, risk and gain shares. JO stated that there were two issues with QIPP – one was that it was very large, and the other was that in order to secure the blended tariff, the trusts would require a realistic baseline. ME added that the third element of difficulty was that QIPP was differentially distributed across trusts. The Committee noted the report, and the next steps set out in it.

8. 2019/20 system draft operating plan

8.1 8.2 8.3 8.4

ME & PB introduced the item. AS stated that three things had been discussed, these were: 1) Harrow 2) London NW and 3) repatriation. Those issues have a material impact on our financial position. There was a need for programmes to address those within the FC that people are working on those collaboratively. ME stated that London NW position would be a fundamental component of the recovery plan. PY suggested a review of the papers that go to the Finance Committee to ensure that the committee did not receive too high a volume of technical papers, so that the committee’s time could be better spent honing in on key issues. The Committee noted:

The draft STP operating plan submitted on 19 February 2019

The date for submission of the final STP alignment submission on 11 April

9. Financial recovery items

9.1 9.2

Harrow CCG recovery plan – update Alex Stiles introduced the item. LW asked if there was any way we could use the external support to move towards a system recovery plan covering LNWHT and the CCGs. JS responded that it was a good opportunity, this was the fourth wave and we were the last of them. The CCG self-assessment would be shared with NHSE.

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9.3

GS added that Harrow’s FRP could be developed as a plan that other CCGs could learn from. Also that the ICS would be part of a wider NW London programme as part of the recovery. The Committee noted the update of the Harrow CCG FRP.

10. Any other business

10.1

There was none.

Meeting Closed at 13.00 hours

APPROVED 230519

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Minutes of the NW London Finance Committee Held on Thursday 25 April 2019, 11:15 - 12:45hrs

Rooms 1.1 & 1.2, 87-91 Newman Street, W1T 3EY

Members in Attendance

Lindsey Wishart (LW) Lay Member and CCG Finance Committee Chair, Brent CCG (Chair)

Richard Smith (RS) Lay Member and CCG Finance Committee Chair, Harrow CCG

Philip Young (PY) Lay Member and CCG Finance Committee Chair, Ealing CCG

Allison Seidlar (AS) Lay Member and CCG Finance Committee Chair, Hillingdon CCG

Nick Martin (NM) Lay Member and CCG Finance Committee Deputy Chair, Hammersmith & Fulham CCG

Alex Johnstone (AJ) Lay Member & CCG Audit Committee Chair, Brent, Harrow & Hillingdon CCGs

Mark Easton (ME) Accountable Officer, NW London CCGs

Paul Brown (PB) Chief Finance Officer, NW London CCGs

Caroline Morison (CM) Managing Director, Hillingdon CCG

Javina Sehgal (JS) Managing Director, Harrow CCG

Mary Clegg (MC) Managing Director, Hounslow CCG

Sheik Auladin (SA) Managing Director, Brent CCG

Jules Martin (JM) Managing Director, Central London CCG

Tessa Sandall (TS) Managing Director, Ealing CCG

Louise Proctor (LP) Managing Director, West London CCG

Janet Cree (JC) Managing Director, Hammersmith & Fulham CCG

Non-Members in Attendance

Dr Nicola Burbidge (NB) Chair, Hounslow CCG

Dr Neville Purssell (NP) Chair, Central London CCG

Dr Tim Spicer (TS) Chair, Hammersmith & Fulham CCG

Dr Genevieve Small (GS) Chair, Harrow CCG

Jonathan Wise (JW) Finance Team Support

Jonathan Tymms (JT) Deputy Chief Finance Officer, Hillingdon CCG

Huw Wilson-Jones (HWJ) Deputy Director of Contracts

Chris Hoult (CH) Hoult Consulting Ltd (item 9)

Ben Westmancott (BW) Director of Compliance

Alex Harris (AH) NWL Corporate Governance Officer (Minutes)

Apologies

Dr Fabio Conti (FC) CCG Finance Committee Chair, Hounslow CCG

Dr M C Patel (MCP) Chair, Brent CCG

Business Items Action

1. Welcome/Apologies

1.1 Apologies received were noted above.

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2.Declaration of Interests

2.1 There were no Declarations of Interest in addition to those previously recorded on the Registers of Interests.

3. Minutes of the Previous Meetings

3.1 The Minutes of the previous meeting held on 28 March 2019 were approved as an accurate record of the proceedings.

4. Action Log as at 25 April 2019

4.1 The Committee reviewed the outstanding actions and agreed the following:

Actions to remain open:

Act.0342: Item 6.4 - PB to reflect net opportunity within the "Risk & Opportunities -

by CCG" slide

Act.0343: Item 7.9 - JO to provide more detail to show statistics with regard to

reductions in waiting lists.

Act.0348: Item 7.27 - PB to prepare text to indicate the agreement of the use of

CCG funds pending formal agreement of final budgets. (April update: PB to double

check this is completed).

Act.0349: Item 7.28 - Strategically primary care budgets would be monitored

closely to respond to any dictated changes on the use of delegated budgets.

Act.0350: Item 7.31 - Clarification of the items which would be classified as new

investment would be provided alongside the process.

Act.0351: Item 7.34 - Any future investment (defined as any expenditure not

contractually committed) would be paused, with a process for agreeing exceptions

which would be devised and circulated post-meeting. (April update: PB to provide

regular schedule of approvals to FC).


Act.0344: JO to hold rebasing conversation with JM re Central London CCG.

Act.0345: PB to review key assumption variation.

Act.0346: Discussion around delegated budgets to be conducted outside of

meeting.

Act.0347: PB to report any changes in budgets to CCGs.

5. Report from Business Planning Recovery Group (incl. action log)

5.1 PB introduced the report and action log, noting that the substance of the report was covered by other items further down on the agenda.

The Committee noted the update.

6. Reporting items

6.0.1 PB noted that there was a deterioration of £12m in the financial figures from

the M11 report as NHS England agreed that additional accruals could be put on the

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balance sheet, subject to approval from auditors. The accounts had now been re-

done and submitted.

6.1 2018/19 NW London CCGs financial position – M12

6.1.1 There was a discussion about how the extra £12m of accruals would be

explained to the public. It was agreed that a consistent form of wording would be

used across the eight CCGs to explain this, which would be circulated outside of the

meeting. Action: PB would draft a paragraph to be circulated outside of the

meeting

6.1.2 There had been an independent review of our forecasting commissioned from

Grant Thornton to identify lessons learned. The output would be brought to the June

Finance Committee.

The Committee noted the report.

6.2 M12 QIPP 6.2.1 There was nothing more to add on this item that had not been covered by the previous item.


6.3 M12 contract report 6.3.1 HWJ introduced the item. There was a discussion around the out-of-sector overperformance figures, particularly in relation to GP at Hand. JC noted that this had been discussed at Hammersmith & Fulham’s Finance and Performance Committee and there had been concern at the rate of growth. PB noted that the GP at Hand issues were subject to ongoing discussions with NHS England.


6.4 2018/19 System wide financial position M11 6.4.1 This item was submitted for information.


PB

Planning items

7. Proposed NW London CCG initial budgets / operating plans for 2019/20

7.1 The item was introduced by PB. He reported that proposals had been discussed with the F&P Committee or Governing Body of each CCG. He asked the Finance Committee to recognise the improvement that had been made to the plan, noting that a balance needed to be struck between improving the numbers whilst being realistic. He explained that these initial budgets were still not agreed with Regulators, however colleagues from NHS London had been working with his team and this was helpful in ensuring that they were sighted on the issues. It was therefore likely that there will need to be a further update to the plan at the next meeting.

7.2 PY asked if there had been any KPIs put into the contracts in relation to RTT. PB responded that the simple metric was that there should be no 52 week waits.

7.3 It was noted that London North West were so far the only trust which had come

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forward with a request for RTT although Imperial had also indicated that there would be a requirement. HWJ stated he was working with both Trusts to agree how this could be monitored. Action: HWJ to provide an update on this at the next meeting.

7.4 ME stated that one of the main issues was that costs were uncertain. Whilst it was clearly not acceptable to have approx. 90 people waiting 52 weeks for treatment, there should be a realistic plan for achieving this ambition.

7.5 It was noted that London was currently the only area in the country that had 52 week waiters.

7.6 AS added that in order to tackle 52 week waiters they would need to be flagged within the Month 8 figures. It was suggested that consultants perhaps come up with suggestions to enable us to get an earlier handle on this. Action: HWJ stated he would look into this and bring an answer back to the next meeting.

7.7 AS added that there were savings that would need to be made in year two but they had not yet been fully identified and it would be a challenge to deliver them in two years. ME added that there would be conclusions reached for the 12 individual recovery streams of the CCG. There was a financial recovery group and a schedule of provider savings. This would need to be pushed further and we needed to be more mindful of consolidation.

7.8 ME also added that if we did not have a convincing story on demand management this would be an issue.

Recommendations:

1) To agree updated opening budgets based on the update assumptions. 2) To agree the ongoing recovery actions, however noting that Central

London’s would be discussed at the recovery board. 3) To further agree to hold more detailed discussions about recommendation

2), particularly in relation to the 12 recovery streams and CCG savings. 4) To note the risks and opportunities. 5) To agree the conclusions and next steps. 6) To note that the current recovery plan was necessary but not sufficient.

Substantial further work would be done and reported back to the Finance Committee.

HWJ HWJ

8. Update on system position / system recovery plan

8.1 The item was introduced by PB. Points raised included the following: 8.2 AJ stated that this talked about the recovery programme board driving changes

and the need for simplicity but it was not yet clear how the Health and Care Partnership fit into it. There was therefore a need for a more clarified accountability structure.

8.3 ME noted that at the moment the Partnership Operations Group reported to the Joint Committee via the Health and Care Partnership report but that report could in future contain financial arrangements. AJ stated he was content with this response. The Committee noted the update. It was agreed that there was a lot to

do before the plan is completed by the end of June, and therefore a

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comprehensive update would be required for the May and June meetings.

9. QIPP Assurance Report

9.1 The item was introduced by CH. PY expressed the view that there needed to be more identifiable actions arising from the report and stated that he was dissatisfied with the report which he felt did not bring new ideas to the CCGs. PB advised that the author had been asked to give a view on the QIPP schemes that were put forward and that it had provided assurance on those schemes where there was underpinning analysis and plans, which was helping the management team assess the risk of the plan and implement remedies.


10. Finance strategic objectives & risks

10.1 The item was introduced by BW. LW stated that she would email BW outside of the meeting to discuss adjustments to the paper.

The Committee agreed to note the strategic objective for finance and the outcomes and associated risks, and comment on them prior to presentation to the Joint Committee in May.

11. Counter-fraud risks

The Committee agreed to note the report.

12. HMRC Update

12.1 No actions arising from this item.

Any other business

There were no items raised for discussion.

APPROVED 210319

NW LONDON CLINICAL COMMISSIONING GROUPS Shadow Quality & Performance Committee

Thursday 14 February 2019, 11:30 – 13:00 87-91 Newman Street, W1T 3EY

Members in attendance Diane Jones (DJ) Chief Nurse and Director of Quality NWL CCG’s (acting Chair) Mark Easton (ME) Chief Officer, NWL CCG’s Dr Afsana Safa (ASa) Chair of Quality Committee, Central London CCG Carmel Cahill (CC) Chair of Quality Committee, Ealing CCG Hiten Shah (HS) Chair of Quality Committee, Harrow CCG Dr Andrew Steeden (ASt) Chair of Quality Committee (Deputy), West London CCG Dr Vanessa Andreae (VA) Chair of Quality Committee, Hammersmith & Fulham CCG Dr Annabel Crowe (AC) Chair of Quality Committee, Hounslow CCG (obo) Jo Ohlson (JO) Director of Commissioning (interim), NWL CCG’s (and item xx) Ben Westmancott (BW) Director of Compliance, CWHHE CCG’s Tessa Sandall (TS) Managing Director, Ealing CCG Javina Sehgal (JS) Managing Director, Harrow CCG Sheikh Auladin (SA) Managing Director, Brent CCG Non-members in attendance Dr Genevieve Small (GS) Chair, Harrow CCG

Dr Mohini Parmar (MP) Chair, Ealing CCG Ben Westmancott (BW) Director of Compliance

Sue Pascoe (SP) Deputy Director for Quality, Nursing and Safeguarding (item 4.1)

Jennifer Roye (JR) Deputy Director Quality, BHH CCG’s (item 4.1)

Mary Mullix (MM) Deputy Director of Quality, Nursing & Patient Safety, CWHHE CCG’s (items 4.1 and 5)

Ruth Sheridan (RS) Assistant Director of Quality Improvement & Clinical Assurance (Hounslow) on behalf of Mary Clegg

Jonathan Pearson (JP) Head of Performance Acute and Urgent Care (items 9 and 10) Sarah Galbraith (SG) Performance Lead – Elective Pathways, NW London CCG’s

(item 7)

Ian Leigh (IL) Urgent and Emergency Care (UEC) Programme, NW London CCG’s

Seher Barrell (SB) Programme Delivery Lead, NW London Performance team (item 9) on ‘phone

Cathy Bowyer (CB) Corporate Governance Officer, NW London CCGs (minutes)

NWL CCGs’ is a collaboration between the Brent, Central London, Ealing, Hammersmith & Fulham, Harrow,

Hillingdon, Hounslow and West London Clinical Commissioning Group Page 1 of 5

APPROVED 210319

Minutes

Business Items Action 1. Welcome & Apologies 1.1

Apologies were received from the members below:

• Lizzy Bovill, Director of Performance – NW London CCG’s • Dr Ian Goodman, Chair of Quality Committee – Hillingdon CCG • Dr M C Patel, Chair of Quality Committee – Brent CCG • Dr Nicola Burbidge, Chair of Quality Committee – Hounslow CCG

2. Declaration of interests 2.1 No further interests were declared other than those previously identified.

3. Minutes from the previous meeting 3.1

The minutes of the meeting held on 6 December 2018 were agreed as a true and accurate record.

4. Action log 4.1 4.2

Actions to remain open:

• 0318 – ongoing (in development) • 0319 – ASafa had provided an update and it was agreed to wait for the full NW

London guidance. • 0278 – ongoing (in development) • 0280 – expected at the March meeting


• 0320 – further meeting dates have been set and distributed to members

4.3 4.4 4.5 4.6 4.7

4.1 Terms of Reference (v9) and governance MM introduced the report which addressed the aims, roles and responsibilities at both local CCG and NWL wide levels. It provided detail in regard to the function and frequency of different meetings as well as the strategic and operational functions. The paper outlined the work of the quality directorate and how this was undertaken on behalf of the NWL CCG’s. The paper also outlined a proposed way forward for safeguarding reporting to reflect the coming together of safeguarding teams under a single directorate as of March 2019. Whilst the paper gave an overview of the quality structure, it failed to give a comprehensive overview of the Local Quality Committees and NW London Quality and Performance Committee remit in relation to the Clinical Quality Groups (CQG). The Committee agreed for a smaller group to convene and map out the governance around assurance from CQG to each committee. In discussion, the following matters were raised:

• Clarification was requested in regard to issues raised at a CCG Primary Care Committee and whether they would be presented at this committee, albeit as a

NWL CCGs’ is a collaboration between the Brent, Central London, Ealing, Hammersmith & Fulham, Harrow, Hillingdon, Hounslow and West London Clinical Commissioning Group

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APPROVED 210319

4.8 4.9 4.10 4.11

Part II agenda item.

• The quality issues across the CCGs should be brought to this committee, there should be no ambiguity. This would include the centrally contracted providers, private providers and smaller NHS organisations.

• Work was being carried out to line up the strategic objectives and assist the

providers in achieving a good or outstanding status. The review and alignment of processes were also necessary to achieve an optimum and consistent quality of care for patients.

• JO would work with quality colleagues to carry out a mapping exercise to

ensure continuity and consistency re clinical input to Clinical Quality Groups. Following discussion with the designated professionals, a revised reporting plan was outlined. The Committee noted the Quality Assurance paper.

5. SI and NE - NE 2017/18 and 2018/19 up to December 2018 5.1 5.2 5.3

MM presented the report which was to inform the committee on total numbers and trends of serious incidents (SI), including never events (NE) reported by all providers commissioned by North West London CCGs. The detail was from the financial years of 2017/18 and 2018/19 up to, and including December 2018. There were issues highlighted in that there were some providers who were not forthcoming in discussing their SI/NE reporting mechanisms. Additionally, during a review, there may be a difference of opinion, where a provider may not agree with the quality team labelling something as a Serious Incident; this would be resolved by inviting NHSE to comment on such cases. Looking at the benchmarking outside of NW London could possibly add value; there is a London patient safety forum that is attended by the patient safety team where London level data was shared as well as any learning. The Committee noted the report.

6. Primary Care - Quarterly Report (Q2) NRLS GP Incidents (Jul-Sep18) 6.1 6.2

The Committee was asked to note the report compiled by the NHS England, London Region Patient Safety Team. It presented data on all the incidents reported on the GP e-form by GPs across the London Region between 01/07/2018 and 30/09/2018 (quarter 2 2018/19) There was guidance regarding GP reporting on the National Reporting and Learning System (NRLS), DJ would disseminate to all following the meeting. The Committee noted the report.

DJ332

7. Cancer - 28 day faster diagnosis 7.1

The purpose of the paper was to inform the committee of a new ’28 day faster diagnosis’ waiting time standard. The CCG would be working with stakeholders to develop the operating plan to meet the requirement from 2020/21, but running in shadow form from 2019/20.


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APPROVED 210319

7.2 7.3 7.4 7.5

The committee discussed the challenges in meeting this standard and where the areas were which required focus. The work would be led by the alliance with a working group set up to develop the plan. There would be representation from primary and secondary care providers, as well as Business Intelligence (BI) advisors. Administration and queuing issues would be worked through by the Cancer Clinical Oversight Group (COG). Providers had raised concerns around diagnostic capacity and other aspects, patient initiated delays were expressed as a concern and would have an impact on the new standard, noting they were to be avoided where at all possible. AS stated that the NW London was the best performing alliance in the country. There had been £8-£10 million pounds of funding received for transformation work; service delivery and diagnostics were a large part of this as well as screening. The Committee noted the report and welcomed an update once the project detail had been decided.

8. Cancer presentation from RAPID (ICHT) 8.1

Imperial College Healthcare NHS Trust had sent their apologies due to preparatory requirements for a CQC inspection.

9. UEC – winter performance 9.1 9.2 9.3 9.4 9.5

SG introduced the item and the following points were reported:

• Accident and Emergency (A&E) performance in 2018-19 had improved from 2017-18 by an average of 1.2%.

• While North West London was not yet meeting the 95% target, half of the four acute trusts performed at above 90% in December despite increased attendances as part of winter pressures.

• North West London A&E performance was on average better than London and National A&E performance, also the best performing STP in London for A&E performance in August, September, October and November.

The Committee expressed the issues below in regard to the report:

• there was a lack of problem areas identified, • the standards set out by NHSE had not been covered; • there were no comments regarding diverted patients; and • patient experience was not evidenced, data was made available but was not

included as it was after the committee paper deadline. The Committee noted the report, also that this had been presented at the Joint Committee in February.

10. NW London performance briefing 10.1

The report provided a 2018/2019 performance overview of Acute, Mental Health and the Improvement and Assessment Framework as well as the NWL STP performance in relation to Operating and Constitutional Standards in order to allow for the committee to review and monitor as well as take action accordingly.


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APPROVED 210319

10.2

Members were asked to note the following risk areas:

• Ambulance delays and Serious Incidents (SI’s); • Close monitoring of handover times to continue via daily escalation calls; • ICHT – Following a Serious Incident in ophthalmology, the Trust would

continue validation of identified cases. Assurance was given that all dormant email accounts were being reviewed (and deleted as applicable) to eliminate any further risk; and

• Cancer 62 day performance - there was a risk to delivery in January 2019 due to lower treatment activity, increased patient initiated delays (due to seasonal period) and capacity challenges. All providers assessing and increasing provision to meet demand.

The Committee noted the report and risks highlighted therein.

11. AOB 11.1

No items were raised. <Meeting closed at 12:56>


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APPROVED 16 MAY 2019

NW LONDON CLINICAL COMMISSIONING GROUPS Minutes

Shadow Quality & Performance Committee Thursday 21 March 2019, 12:00 – 14:00

87-91 Newman Street, W1T 3EY Members in attendance Lizzy Bovill (LB) Director of Performance, NW London CCG’s (acting Chair) Mark Easton (ME) Chief Officer, NW London CCG’s Dr Afsana Safa (ASa) Chair of Quality Committee, Central London CCG Carmel Cahill (CC) Chair of Quality Committee, Ealing CCG Dr Ian Goodman (IG) Chair of Quality Committee, Hillingdon CCG Dr Andrew Steeden (ASt) Chair of Quality Committee (Deputy), West London CCG Dr Nicola Burbidge (NB) Chair of Quality Committee, Hounslow CCG Dr MC Patel (MCP) Representative for Quality Committee, Brent CCG Dr Martin Lees (ML) Secondary Care Clinician Ben Westmancott (BW) Director of Compliance Tessa Sandall (TS) Managing Director, Ealing CCG Mark Jarvis (MJ) Head of Governance and Engagement, Hammersmith &

Fulham CCG (obo Janet Cree)

Javina Sehgal (JS) Managing Director, Harrow CCG Sheikh Auladin (SA) Managing Director, Brent CCG Non-members in attendance Dr Mohini Parmar (MP) Chair of Ealing CCG and NW London STP clinical lead Ben Westmancott (BW) Director of Compliance

Jennifer Roye (JR) Deputy Director Quality, BHH CCG’s (item 4.1)

Mary Mullix (MM) Deputy Director of Quality, Nursing & Patient Safety, CWHHE CCG’s (items 4.1 and 5)

Molly Larkin (ML) Assistant Director of Quality Improvement & Clinical Assurance (Central London) on behalf of Jules Martin

Sarah Galbraith (SG) Performance Lead – Elective Pathways, NW London CCG’s (item 9)

June Farquharson (JF) Associate Director, NW London CCG’s (item 6) Chakshu Sharma (CS) Senior Business Development Manager, NW London CCG’s

(item 6)

Cathy Bowyer (CB) Corporate Governance Officer, NW London CCGs (minutes) Annet Gamell (AG) Lay member (observer)


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Minutes

Business Items Action 1. Welcome & Apologies 1.1

Apologies were received from the members below:

• Diane Jones, Chief Nurse and Director of Quality NWL CCG’s • Hiten Shah, Chair of Quality Committee, Harrow CCG • Dr Vanessa Andreae, Chair of Quality Committee, Hammersmith & Fulham

CCG • Jo Ohlson, Director of Commissioning NWL CCG’s • Dr Lyndsey Williams, Chair of BCCG Integrated Governance Committee, Brent

CCG

2. Declaration of interests 2.1 No further interests were declared other than those previously identified.

3. Minutes from the previous meeting 3.1

The minutes of the meeting held on 14 February 2019 were agreed as a true and accurate record.

4. Action log 4.1 4.2 4.3

The Committee reviewed the action log as presented and the following was agreed: Actions to remain open: 0278 Actions to be closed: 0280, 318, 319 and 332

5. Committee Terms of Reference (v9) and governance 5.1 5.2 5.3 5.4 5.5

JR introduced the item and welcomed comments from the Committee. Points raised included:

• Further detail was required; greater coverage of the scope for primary care, mental health and acute trusts, also an illustration of the mechanisms for feeding matters through the CCG and NW London committees.

• Rather than receiving minutes of meetings, CCG committees would welcome a

full set of papers.

• Further thought should be given to the frequency of the meetings as well as responsibility as there were other primary care committees in operation.

• There was confirmation that feedback from the Clinical Quality Group (CQG)

meetings would be brought to this committee and it was recognised that due to the local relationships CCG’s hold with providers, there would be difficulties in avoiding duplication.


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5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15

• The wording in section 5.2 of the Quality Governance arrangements required revising as it appeared to be describing the scope.

• Clarity was required within the TOR of the Committee around Never Events

and the learning from them.

• Exception reporting from a CQG to this committee would be helpful with key headlines, this would enable this committee to understand what concerns had been highlighted in order to address them.

• There did not seem to be a risk stratifying approach to address any Central

Contracts issues; this is needed to provide assurance that the quality concerns about providers were addressed.

• A Committee view on how to manage the risk in contracts differently against

their quality schedules was required; one that assured members that any issues picked up would be addressed.

• Members agreed Primary Care, Central Contracts and Safeguarding concerns

should be at the forefront of the Committee responsibilities.

• Safeguarding plan and route on the agenda at a future meeting, to be determined through the work-plan.

• Action: A work plan for the Quality and Performance Committee was to be

produced and circulated to members, following review by both DJ and LB.

• Development of a working group would be discussed and members would be invited.

The Committee noted the report and had made recommendations as above to be considered and reflected where appropriate in the next iteration of the documents.

6. NHSE Policy review 6.1 6.2 6.3 6.4

JF and CS introduced the item. The Committee was asked to: • Endorse the recommendations and process undertaken before the final

decision at the Joint Committee in April 2019. • Agree whether any stakeholder engagement needed to take place before Joint

Committee decision. • Identify any additional assurance needed before Joint Committee decision

making Following a query raised about the volume of accompanying papers, JF informed members that the large amount of papers for this item was to provide the Committee with the papers that were reviewed by the Policy Development Group (PDG). This was to ensure that committee members had all of the references. This was in the context of ensuring due diligence and due regard as the papers were in reference to National and London wide policies – some of which the PDG made recommendations not to adopt. The reference papers provided full detail of the rationale. JF presented the key highlights of the PDG review. The PDG looked at both sets of policies independently as it was important to review the evidence base. There was


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6.5 6.6 6.7 6.8 6.9 6.10 6.11

also at the end alignment process. For the LCW policies, the PDG initially agreed to recommend adopting both the cataracts and varicose veins policy but during the alignment exercise, agreed to adopt the EBI varicose vein policy based on the evidence base and that it would cover a wider population spread. It was noted that the LCW policy for cataracts had a modelled commissioning impact of an increase of 9% activity and associated spend, equating to excess of £500k. With regards to the EBI policies, the PDG noted that there was already close alignment to the evidence base of the current PPwT policies and therefore there was not significant change for patients. However there were two policies that the PDG recommending deviating away from the national EBI policies:

1. The Low Back Pain policy – as it was deemed that the current NWL PPwT had more detail post implementation and provided more clarity around parameters to treat. This was post local clinical engagement and external validation.

2. The PDG also felt that there were elements of the EBI benign skin lesions

policy in relation to spider naevi treatment, which would be inequitable with other cosmetic procedures that NWL did not fund. The PDG therefore made a recommendation to adopt the broader benign skin lesion policy but not this element.

Members were invited to comment and the following points were noted:

• Low back pain – concern was expressed as to whether a policy could be agreed which stated a three month target with the large Refer to Treatment (RTT) lists. There would need to be clarity on our grounds for the variance.

• The adoption of Choosing Wisely policies would always be reviewed from a

patient perspective rather than the commissioners.

• As highlighted previously, adoption of the LCW cataract policy may have an adverse commissioning impact. Whilst the proposal was based on the rationale that the LCW policy was more aligned to NICE guidance than the current PPwT policy, it was estimated that it may involve a 9% increase in activity (£495k FYE) which would represent a significant adverse financial impact across NWL.

• However, it was suggested that this would need to be balanced with assuring

patients that the commissioning was patient focused. There was a wider discussion around the cataract policy in particular, the updated NICE evidence vs the financial implications. It was also highlighted the deviation away from the NICE policy could be challenged by stakeholders. Moreover, it was suggested that an option would be the additional thresholds be covered by IFR in the first instance. It was agreed by ME that there would be a continued discussion regarding all the elements of the LCW cataract policy outside of the meeting. Until this was undertaken it was agreed that the decision regarding the portfolio of policies would be put on hold until this discussion had taken place. The Committee agreed to suspend the decision regarding this portfolio of


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policies pending the outcome of the discussion concerning the many elements of the LCW cataract policy.

7. Quality schedules 7.1 7.2 7.3 7.4 7.5 7.6 7.7

There had been district nursing challenges to the reporting but each of the community contract teams had worked to develop local quality schedules. As future transformation changes would indicate a move to one NW London CCG, this would provide the opportunity to provide consistency and equity when providing care for our patients. The Quality Schedule would hold the providers to account which was in the Committee Terms of Reference; further, the detail contained had been through various edits and was about to be agreed with the providers. Consequences had been included where performance was not within the expected parameters. In regard to the format, it was suggested that a template be worked up which would be easier to understand; LB mentioned that the Integrated Urgent Care Board had produced similar detail. Considering the development of the ICP this could be picked up in the future at a different forum The Committee noted the document and recognised the work which had been carried out over the last two to three years.

8. CONFIDENTIAL – NWL Performance briefing 8.1 8.2 8.3 8.4

The detail had been reviewed by the members and it was noted that: It would be helpful to report the 62 day standard as actual days taken to treatment, ie. 30 or 55 etc. The tumour groups which attracted multiple investigations inevitably resulted in a delay to treatment. The Committee requested that the 62 day tumour pathway be shared at the next meeting.

LB353

9. CONFIDENTIAL – NWL Performance assurance briefing 9.1 9.2 9.3

The Committee were informed that the Secondary Care Board had discussed improvement of screening numbers at a recent meeting. The Hillingdon Hospitals NHS Foundation Trust and Chelsea and Westminster Hospital NHS Foundation Trust had revised trajectories and those would be received in coming week. The Committee noted the briefing.

10. Safeguarding position regarding CCG implementation of the Wood Report 10.1

MM presented the item in the absence of Sue Pascoe, Deputy Director of Safeguarding.


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10.2

The Wood review had produced recommendations which were addressed in a report relevant to each CCG. The reports would be presented at the local Governing Bodies.

11. BAF 11.1 11.2 11.3

The Committee were assured that a conversation had been held at the NW London CCG’s Joint Committee regarding the BAF review group. Relating to the three areas of focus, AoF2, AoF3 and AoF4, the Committee was asked to reflect on:

a) was the Committee satisfied that the quality and performance risks were being adequately managed; and

b) were there any questions we would like the leads to answer prior to it being represented at this Committee.

It was noted that the mitigations should reflect the actions rather than plans; the suggestion was to add an outcomes column for the next year’s BAF.

12. AOB 11.1 There were no items raised.


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Documents

Item: 13 - ealingccg.nhs.uk