Meeting of the NHS Newark and Sherwood Commissioning Group ... · Yes Approve Dr Amanda S ullivan ... Mr Cawley gave a resume of the information contained within the report, asking

Meeting of the NHS Newark and Sherwood Commissioning Group Governing Body

Thursday 2 August 2018 at 2.00pm Ashfield Health Village PUBLIC AGENDA

Public Session

Administration 2.00pm Reference Title Paper

Included Action Presenter

JGB/18/85 Welcome and Introductions

Yes Note Chair

JGB/18/86 Apologies for absence and Quoracy

No Note Chair

JGB/18/87 Declarations of interest

Yes Note Chair

JGB/18/88 Questions submitted from members of the public

No Discuss Chair

JGB/18/89 Minutes of the Mansfield and Ashfield CCG Governing Body meeting held on Thursday 5 July 2018

Yes

Approve

Chair

JGB/18/90 Matters Arising – Governing Body Actions Yes Note

Chair

For Approval 2.10pm JGB/18/91 Rates of Smoking at the Time of Delivery Yes Approve Mrs Elaine Moss

Planning, Strategy and Commissioning Developments 2.25pm JGB/18/92 Chief Officer’s Report

Yes Note Dr Amanda Sullivan

Quality, Performance, Finance and QIPP 2.40pm JGB/18/93 CCG Annual Ratings 2017/18 Yes Discuss Dr Amanda Sullivan

JGB/18/94 Integrated Performance Report

Yes Approve Dr Amanda Sullivan

Patient and Public Engagement Committee Feedback 3.30pm JGB/18/95 Progress Report from the Patient and Public

Engagement Committee

Yes Note Mr Peter Robinson

Governance 3.40pm JGB/18/96 Progress reports from the following CCG

committees: • Clinical Effectiveness Committee of 12 July • Primary Care Commissioning Committee of

12 July • Quality, Risk and Safeguarding Committee of

28 June

Yes Yes Yes

Note Note Note

Dr Peter Macdougall Mr Jon Towler Mrs Eleri de Gilbert

1

Meeting Conclusion JGB/18/97 Identification of:

• Risks in light of agenda item discussions • Key areas to be fed back to the member

practices

No Agree Chair

Meeting Close 3.45pm

2

Minutes of the meeting of the NHS Newark and Sherwood Clinical Commissioning Group

Governing Body (Meeting in common with Mansfield and Ashfield CCG Governing Body)

Thursday 5 July 2018 Ashfield Health Village

Present: Dr Thilan Bartholomeuz, Clinical Chair (from item JGB/18/79) Dr Kerrie Wilkins, Governing Body GP Dr Kerri Sallis, Governing Body GP Mr Michael Cawley, Chief Finance Officer Mr Peter Robinson, Interim Lay Member, Patient and Public Engagement Committee (from item JGB/18/81) Mrs Sandy Hogg, Director of Turnaround Mr David Ainsworth, Director of Primary Care Professor Rachel Munton, Lay Member and Meeting Chair Mr Peter Clay, Chair of Audit Committee Dr Ben Pearson, Secondary Care Advisor Mrs Elaine Moss, Chief Nurse and Director of Quality and Governance In Attendance: Mr Jon Towler, Lay Chair of Primary Care Commissioning Committee Mrs Sue Batty, Service Director, Adult Social Care and Health, Nottinghamshire County Council Ms Dawn Jenkin, Designate Director, Nottinghamshire Public Health Mrs Eleri de Gilbert Lay Chair, Quality, Risk and Safeguarding Committee Dr Gavin Lunn, Clinical Chair, Mansfield and Ashfield CCG Dr Peter Macdougall, Governing Body GP, Mansfield and Ashfield CCG Dr Hilary Lovelock, Governing Body GP, Mansfield and Ashfield CCG Dr Milind Tadpatrikar, Governing Body GP, Mansfield and Ashfield CCG Mrs Rosa Waddingham, Associate Director of Quality and Governance Mr Neil Moore, Associate Director of Procurement and Market Development Mrs Sarah Carter, Consultant Director, Organisational Development Mrs Rachel Whitaker, Interim Board Secretary Mrs Diane Butcher, Head of Information and Performance (item JGB/18/79 only) Ms Sue Wass, Corporate Governance Officer (minutes)

Apologies: Dr Amanda Sullivan, Chief Officer Mrs Lucy Dadge, Chief Commissioning Officer Mr Shaun Beebe, Chair of Remuneration and Terms of Service Committee Apologies, Mansfield and Ashfield CCG: Dr Carter Singh, Governing Body GP

JGB/18/72 Welcome and Introductions

The Chair welcomed members to the meeting and a round of introductions was undertaken.

JGB/18/73 Apologies for absence and Quoracy Apologies were noted above and the meeting was declared quorate.

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JGB/18/74 Declarations of interest No interests in addition to those detailed in the register of interests were noted on any of the agenda items. Dr Tadpatrikar wished members to note that he had recently been appointed Chair of the Mansfield South Locality Hub and would update his register of interests accordingly. • Action: Dr Tadpatrikar to update his register of interests prior to the next meeting.

JGB/18/75 Questions submitted from members of the public

No questions had been received.

JGB/18/76 Minutes of the Mansfield and Ashfield CCG Governing Body meeting held on Thursday 7 June 2018 The minutes were approved as an accurate record of discussions with the inclusion of ‘Mrs Hogg gave further detail on the QIPP position as at month one, which was behind target at £0.9m against a target of £1.1m Headroom schemes were being developed, which would be brought to the next meeting for approval. This represented a significant risk for the CCGs’.

JGB/18/77 Matters Arising – Governing Body Actions Regarding actions JGB/18/37 and 40, Mr Cawley noted that an iterative approach was being taken towards the development of the Integrated Performance Report and members would see modifications month by month. Actions closed. Regarding item JGB/18/67, Mrs Butcher clarified that the assessment of recovery was the opinion of the provider and would make this clear in future reports. Action closed. Regarding action JGB/18/70, Mr Cawley noted that this piece of work also needed to include commentary on the current financial position and undertook to ensure the action was completed by the August meeting. Action to remain open. All other actions were noted as completed. The Chair asked that going forward all actions would include a timeline of ‘not later than…’ and this was agreed.

JGB/18/78 Chief Officer’s Report Mr Cawley gave an overview of the information contained within the report, which noted that mid Nottinghamshire had been mentioned in the Prime Minister’s NHS 70th birthday speech for the work the CCGs has undertaken to reduce hospital admissions; the announcement of a new Director of Nottinghamshire Public Health; and CCG approval of the merger of Harwood close and Ashfield Medical Centre. Dr Lovelock also noted that the CCGs had been mentioned in an article within in the Daily Telegraph in relation to the Assist Programme Mr Towler queried what the long term funding settlement meant for mid Nottinghamshire. Mr Cawley noted that the full detail of the settlement would not be available until the autumn, but estimated a figure of £16-17m, the release of which would be subject to a number of conditions being met.

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Mr Towler noted that it was Mrs Hogg’s last meeting and queried the CCGs’ plans for a replacement Turnaround Director. Mr Cawley noted that a recruitment process was due to commence shortly, with an appointment likely in the autumn, but cautioned that skilled Turnaround specialists were highly sought after and in the meantime, interim arrangements were being put in place. Mr Clay noted his concern; and as Chair of the Audit Committee, he would keep a watching brief on the situation. He also asked that he be involved in the interview process, which was agreed. On behalf of the Governing Bodies Dr Tadpatrikar wished to formally thank Mrs Hogg for her work as Turnaround Director. The Chief Officer’s Report was noted.

JGB/18/79 Integrated Performance Report Mr Cawley gave a resume of the information contained within the report, asking members to note that the report included a full financial report for the first time. In summary, Mr Cawley noted areas of strong performance with Newark and Sherwood diagnostic waiting times; IAPT recovery; Mansfield and Ashfield Dementia targets; e-referrals; complaints and A&E 4 hour waiting times. Areas indicating a deteriorating position were noted as 52+ week waits; Newark and Sherwood Dementia targets; and rates of smoking at the time of delivery. Regarding the financial position, the CCGs were still forecasting a break-even position at the end of the financial year; however, increased acute activity, partly due to technical issues regarding the phasing of QIPP and partly due to above plan outpatient and non-elective activity, had been seen. The principle reason for this was the impact of the winter pressures; however, the overall position had been mitigated with underspend in primary care and prescribing activity. Mr Cawley asked members to note that the Turnaround Board had discussed activity, and had referenced GP referral rates, which were higher than plan. Although there was some inconsistency, there remained an overall downward trend. Dr Tadpatrikar raised the need to look at secondary care referrals and Mr Ainsworth noted that a deep dive would be undertaken on other referrals, specifically consultant-to-consultant referrals in both acute trusts. Dr Macdougall noted that ‘one stop shops’ to prevent patients being seen multiple times was one solution and Mr Ainsworth agreed this was a feature of the move towards locality working. Dr Lovelock noted that practices that were ‘under-doctored’ had higher rates of referral and Mr Ainsworth noted that the CCGs’ Referral Management Group was closely monitoring demand patterns and supporting practices to use tools such as peer to peer support and the Ardens decision support tool to tackle any unwarranted clinical variation. Mr Cawley noted that the CCGs were currently investigating the issue, which could be in relation to GP extended hours opening. Regarding the QIPP plan, £2.8m of savings had been delivered against a plan of £3.2m. Mrs Hogg noted that the Turnaround Board had reviewed plans that had been put in place to mitigate the slippage. The risk in the plan related to a small number of schemes that had not yet been signed off by providers and a number of schemes that had not moved at the intended pace. Dr Bartholomeuz and Dr Lunn had led a discussion at the recent Better Together Leadership Board regarding the need to move forward with these schemes. The Chair queried the PMO BRAG rating within the QIPP delivery risks, which was noted as being an analysis of confidence of delivery, taking into account progress regarding both financial and delivery performance. The Chair queried whether there was the same level of risk within the overall programme as at last month, and Mrs Hogg confirmed that it was.

3

Dr Sallis noted the impact on individual patients of the slippage in QIPP schemes, referencing the End of Life scheme, which was at significant risk of not delivering its objectives. She gave an example of a patient requiring palliative care, who had been passed back and forth between different specialities. Mrs Moss noted that this was a distressing case and the Deputy Chief Nurse would meet with Dr Sallis outside of the meeting to discuss it further. Mr Ainsworth noted that this case proved the need to move to a more generic workforce model. Mrs Hogg noted that the case gave context for the QIPP Programme, which aimed to improve outcomes for patients by transforming care. Mrs de Gilbert reported that the Quality, Risk and Safeguarding Committee had rejected a large number of Equality and Quality Impact Assessments as they had failed to identify adequately the risk to patients, which could potentially slow the pace of implementation. Mrs Moss noted that the Quality Team was working with project managers to support the delivery of more robust assessments. Mrs de Gilbert noted that performance data from Nottingham University Hospitals had recently proved difficult to obtain from public sources and Mrs Moss responded that the Quality Team was working with the lead commissioner to ensure timely data was received. Dr Macdougall noted concern regarding the increase in rates of smoking at the time of delivery, particularly as the trend had decreased in previous months. Ms Jenkin noted that public health campaigns had not had sufficient traction in Mansfield and Ashfield, which had one of the highest rates in the country and was due in the main to it being an area of high deprivation. It was agreed that a report on actions to reduce the rates of smoking at the time of delivery should be brought to the next meeting. • ACTION: Mrs Moss to bring a report on actions to reduce the rates of smoking at the

time of delivery to the August meeting.

Dr Pearson requested further information on East Midlands Ambulance Trust, particularly regarding how staff were supported and what changes were being made to clinical pathways. Mr Cawley agreed to bring a report to the September meeting. • ACTION: Mr Cawley to bring a report on EMAS to the September meeting. The Chair asked whether the Quality, Risk and Safeguarding Committee had undertaken a deep dive on staff indicators and Mrs de Gilbert noted this was due to be presented to their August meeting. The Chair reminded Mr Cawley to ensure that within the Integrated Performance Report an anticipated recovery date was always specified. The Integrated Performance Report was noted.

JGB/18/80 Patient Story Mrs Waddingham detailed the journey of a patient with significant physical disabilities who had used Integrated Personal Commissioning (IPC) to purchase an assistance dog. The dog had helped the patient to manage her disabilities to the extent that it was estimated to have prevented more than sixty ambulance trips, which would have cost circa £17k. The ethos of Integrated Personal Commissioning was described as being care focused around individual need in order to enhance quality of life.

4

Dr Bartholomeuz asked that IPC be more widely publicised within General Practice and Mrs Waddingham described the criteria for receipt of IPC. Dr Wilkins noted the need for GPs to understand the referral process. Mrs Hogg queried plans for the future of IPC. Mrs Moss noted that this area was a pilot site to examine how to commission services in a more individual way and there was already numerous examples of more effective care being delivered to patients accessing IPC. It was agreed that a report should be brought to the October meeting to detail progress to date and how IPC was driving quality and savings. • ACTION: Mrs Waddingham to bring a report to the October meeting to detail

progress to date and how IPC was driving quality and savings. The patient story was noted.

JGB/18/81 Assurance Framework Mrs Moss introduced the report, which identified the key risks to the delivery of the CCGs’ objectives. Analysis had been undertaken on the risks, as detailed in the report, which demonstrated a high level of internal assurance, as opposed to external assurance of the risks. However, there was further work to be undertaken on what was assurance and what was re-assurance. It also demonstrated a high number of system-level risks. Mr Clay noted that the Audit Committee had requested that Committees recorded a full discussion of the risks overseen by them. Mrs Moss asked the Governing Bodies to approve the inclusion of a new risk 25, relating to the primary care workforce and to close risk 2, relating to primary care strategy. Mr Towler considered that risk 25 somewhat duplicated risk 5 relating to the wider workforce and it was agreed that this should be discussed further at the next meeting of the Primary Care Commissioning Committees. Mr Robinson queried whether practices were aware of the risk and who in the CCGs led on practice engagement. Mr Ainsworth confirmed he was lead and agreed to send Mr Robinson the latest Primary Care Team structure. • ACTION: Mr Ainsworth to send Mr Robinson the latest Primary Care Team structure. Mr Towler queried whether risk 3 relating to activity should have its risk rating raised in light of the discussion that had taken place during item JGB/18/79. It was agreed to raise the likelihood rating for the risk from 3 to 4. With the uplift of the rating of risk 3; and the inclusion of risk 25 and closure of risk 2, subject to the agreement of the Primary Care Commissioning Committees, the Assurance Framework was approved.

JGB/18/82 Progress Report from the Patient and Public Engagement Committee (PPEC) Mr Robinson reported that the core membership of the PPEC was now in place, with arrangements made for the chair and vice chair to be elected at the August meeting. The PPEC had held a development session and the inaugural meeting had taken place

5

on 25 June where members provided input into a number of engagement and communication plans. The development of the Committee’s work plan was underway. The report was noted.

JGB/18/83 Progress reports from the following CCG committees: Clinical Effectiveness Committee of 17 May Dr Bartholomeuz asked members to note that Mansfield and Ashfield was likely to miss the Quality Premium requirements for E.coli and a report would be discussed at the next meeting. Audit Committee of 14 June Mr Clay reported that the CCGs had reached 90% compliance regarding stage one of the conflicts of interests training. Primary Care Commissioning Committee of 14 June Mr Towler wished to record his thanks to the staff at Harwood Close, Ashfield Medical Centre and the CCGs for their hard work to ensure a successful merger of the GP practices. Quality, Risk and Safeguarding Committee of 28 June Mrs de Gilbert highlighted two issues of concern for the Committee relating to non-achievement of the deadline for some responses to Freedom of Information requests and low levels of compliance with mandatory and statutory training. The Committee undertook to write formally to staff on these matters and would review the CCGs’ Training Policy at its next meeting.

JGB/18/84 Identification of: • Risks in light of agenda item discussions • Key areas to be fed back to the member practices Concern raised over the high number of system level risks; the increasing levels of smoking at the time of delivery. To feedback to the membership the work around Integrated Personal Commissioning and the comments regarding mid Nottinghamshire in the Prime Minister’s speech.

6

ACTION LOG Agenda Ref

Item Action Name Progress

JGB/18/70 (June meeting)

Progress Report from the Audit Committee

With input from Dr Lunn and Dr Bartholomeuz, Dr Sullivan to lead on the drafting of a narrative to explain to the membership the opinion in the accounts and to detail the financial recovery journey.

AS

JGB/18/79

Integrated Performance Report

Mrs Moss to bring a report on actions to reduce the rates of smoking at the time of delivery to the August meeting.

EM On this agenda

JGB/18/79

Integrated Performance Report

Mr Cawley agreed to bring a report on EMAS to the September meeting.

MC Scheduled for the September Meeting

JGB/18/80

Patient Story Mrs Waddingham to bring a report to the October meeting to detail progress to date and how IPC was driving quality and savings.

RW Scheduled for the October Meeting

JGB/18/81

Assurance Framework

Mr Ainsworth to send Mr Robinson the latest Primary Care Team structure.

DA Action completed

MEETING IN COMMON OF NHS MANSFIELD AND ASHFIELD CCG

AND NHS NEWARK AND SHERWOOD CCG GOVERNING BODIES

TITLE: Smoking At Time Of Delivery (SATOD) rates DATE OF MEETING: 2 August 2018 PAPER REF: JGB/18/91 AUTHOR: Sue Bateman / Rosa

Waddingham PRESENTER: Elaine Moss

PURPOSE OF REPORT: To provide detail on the SATOD rates and the work being undertaken in relation to maternal smoking rates within mid-Nottinghamshire. RECOMMENDATION:

To endorse To approve To receive the recommendation (see details below) To discuss This paper is for information as requested by the Governing Bodies on 5th July 2018, there is also a recommendation to: Adopt the Local Maternity System (LMS) SATOD targets, and report against the agreed local trajectory moving forwards. The national target is 6% by 2021/22 The Nottingham LMS targets are 10% in Mansfield & Ashfield and 8% in Newark & Sherwood. EXECUTIVE SUMMARY (OVERVIEW): In Quarter 1 2017/18, Mansfield & Ashfield CCG SATOD rates were 23.8% making them the third highest CCG nationally. Newark and Sherwood CCG had a better position with a rate of 18.1%. Improvement has been made with Q1 2018/19 SATOD rates at 20.6% for Mansfield and Ashfield CCG and 17.8% for Newark and Sherwood CCG both remain at a concerning level. We recognise;

• Smoking in pregnancy is a national priority and for the Nottinghamshire Local Maternity System (LMS) particularly in view of the exceptionally high rates in Mansfield and Ashfield, Newark and Sherwood and Nottingham City.

• Smoking in pregnancy leads to a number of negative effects and it is the single most important modifiable risk factor in pregnancy.

• Reducing smoking during pregnancy is one of the three national ambitions in the Tobacco Control Plan (DOH 2017), with an aim of “reducing smoking amongst pregnant women (measured at time of giving birth) to 6% by the end of 2022”.

In 2017:

• Sherwood Forest Hospitals Foundation Trust was the first trust in the region to introduce the “Risk Perception Model”. This is a hard hitting intervention delivered by a midwife with an individual mother and her family. The intervention graphically explains the effects of smoking on a fetus.

• Public Health supported an evaluation of the risk perception model at Sherwood Forest Hospitals Foundation Trust, which demonstrated that the intervention is effective in reducing Smoking at Time of Delivery; previously only 57% of pregnant smokers had received the intervention.

• All midwives who deliver the Risk Perception needed to be trained and updated annually with adequate staffing in the antenatal clinic to increase coverage.

• Need to integrate work around SATOD into wider population approaches and a Making Every Contact Count (MECC) approach was relaunched.

Building on Actions Into 2018:

• Bi-monthly Mid Nottinghamshire SATOD focus group has been established • An additional midwife has been trained to deliver Brief Intervention Interviews for

women accessing services in Newark. • All women who are identified as smokers are referred to a smoking cessation service

via electronic referral. The service then contacts women by telephone to offer various types of support.

• Smoking status at booking is now communicated to GPs via an electronic letter. • The smoking cessation provider has undertaken wider work with the early pregnancy

unit, ward 24 and the neonatal unit to improve uptake. • The Local Maternity System (LMS) has set timescales for the development of a

community hub model and the revised Nottinghamshire local maternity offer for 2020 will integrate SATOD and maternal smoking into a wider population focussed approach.

REPORT: Background

In Quarter 1 2017/18, Mansfield & Ashfield CCG SATOD rates were 23.8% making them the third highest CCG nationally. Newark and Sherwood CCG had a slightly better position with a rate of 18.1%. Improvement has been made Q1 2018/19 SATOD rates 20.6% for Mansfield and Ashfield CCG and 17.8% for Newark and Sherwood CCG both remain at a concerning level. We recognise;

• Smoking in pregnancy is a national priority and for the Nottinghamshire Local Maternity System (LMS) particularly in view of the exceptionally high rates in Mansfield and Ashfield, Newark and Sherwood and Nottingham City.

• Smoking in pregnancy leads to a number of negative effects and it is the single most important modifiable risk factor in pregnancy.

• Reducing smoking during pregnancy is one of the three national ambitions in the Tobacco Control Plan (DOH 2017), with an aim of “reducing smoking amongst pregnant women (measured at time of giving birth) to 6% by the end of 2022”.

SATOD has been a priority for a number of years and some long term improvement has been made, but rates remain higher than the England average.

Source: NHS Digital "Smoking Status at time of delivery" Data collection

Local Targets As part of the Better Births Maternity Transformation the current target is 11%. The Local Maternity System (LMS) has instead developed some local targets, for agreement. These targets remain challenging. The targets have been developed with provider, commissioner, regulator and public health input. LMS Nottinghamshire Targets

Smoking at Time of Delivery

2018-19

2019-20

2020-21

2021-22

National IAF Target

- - - 6% Mansfield & Ashfield CCG

18.0

15.0

12.

<10. Newark & Sherwood CCG

16.0

13.5

11.

<8.

Actions to Date:

Work between December 2017 and June 2018 has delivered a number of changes:

• SFHFT was the first trust in the East Midlands to roll out the risk perception smoking cessation model following the first dating scan for pregnant smokers. The model is a motivational interviewing consultation focusing on the effects that smoking has on the baby, includes visual aids and a Carbon Monoxide (CO) reading. A mandatory smoking cessation referral is then made following the consultation. However as previously reported, the trust had struggled to offer this intervention to all pregnant smokers due to staffing issues. In the last 6 Months the CCG’s have supported the training of an additional midwife to offer the intervention at Newark Hospital.

• Working with Nottingham University, SFHFT developed and displayed posters at two conferences relating to successes achieved to date with the Brief Intervention model (Annex A)

• SFHFT has implemented the NICE guidance relating to smoking in pregnancy. CO2 breath testing is offered to all women at pregnancy, 16 weeks if missed or still smoking, and at 36 weeks. Additional ad hoc readings are performed if a woman needs to attend pregnancy day care unit.

• All women who are identified as smokers are referred to a smoking cessation service via electronic referral. The service then contacts women by telephone to offer various types of support.

• Smoking status at booking has been added to the letter sent to GPs following a booking appointment.

• Known smokers are invited to specific scan appointments; smoking cessation advisors are present at these clinics and offer interventions directly to women and their wider families. This is when risk perception is also offered.

• As part of the Saving Babies Lives Care Bundle women who choose to continue to smoke are put onto a care pathway which increases the fetal surveillance.

• The smoking cessation provider offers NRT treatments as well as offering advice and support information relating to e- cigarettes.

• The smoking cessation provider has now undertaken some wider work with the early pregnancy unit, ward 24 and the neonatal unit.

Mid-Nottinghamshire and Greater Nottinghamshire CCGs planned for the development of a website and linked support materials to provide information about the harms of smoking in pregnancy and how to access support. However a decision by Nottingham City Council to decommission all smoking cessation services saw the withdrawal of Greater Nottinghamshire CCGs from the planned scheme and this has currently been suspended.

Next Steps

• A joint trust and CCG audit is planned for July 2018 to gain assurance that midwives are following the Trust’s Smoking in Pregnancy Guidelines.

• Work is underway to improve access to the brief intervention interview by some changes the organisation of staff within the antenatal clinic and pregnancy day care unit.

• Community midwives will be asked to attend a meeting delivered by the smoking cessation service, this will update them on the maternity transformation plans and provide an opportunity for midwifes to feedback their views.

• Two community maternity hubs are currently being scoped for Kirkby-in- Ashfield and Newark. The hubs will incorporate access to smoking cessation support.

• IT developments have been requested to support midwives being able to record C02 readings electronically.

QIPP Assurance and connection

Whilst this work will not realise any QIPP in itself it is an enabler to achieve reductions in non-elective admissions and the development of long term conditions in both adults and children. Financial Impact and Risks

Services are paid for via Maternity Tariff. Payments are made in the antenatal period at three rates:

Code Name Tariff (£)

n/a Standard 1,019

n/a Intermediate 1,630

n/a Intensive 2,713 Smoking in pregnancy triggers an intermediate payment and would be a factor considered in deciding if the intensive tariff applies. Additional payment is made for the care given during the birth, costs increase if the birth is complicated. A fetus that is compromised by maternal smoking is more likely to require and emergency, and complex, delivery. Reducing maternal smoking would have a positive impact in reducing costs for maternity services. Risk Implications, Assessment and Mitigations

Consultation, Involvement and Engagement

Not applicable

Equality Impact

Not applicable

Evidence and Research (include where this informs why the paper is presented to Governing Bodies Not applicable

HOW DOES THIS CONTRIBUTE TO THE OUTCOMES AND OBJECTIVES OF THE CCG:

Quality Health Financial Clinical Performance (tick as appropriate)

CONFLICTS OF INTEREST:

This is a recommended action to be agreed by the Chair at the beginning of the item. No conflict identified Conflict noted, conflicted party can participate in discussion but not decision (see below) Conflict noted, conflicted party can remain but not participate (see below) Conflicted party is excluded from discussion (see below)

CONFIDENTIALITY:

Is the information in this paper confidential?

No Yes

Claire Allison: Sherwood Forest Hospitals NHS Foundation Trust and Dr Seamus Allison: Nottingham Trent University

Successes in reducing smoking in pregnancy at SFHFT: Supporting NHS Saving Babies’ Lives

Background Smoking in pregnancy is a major public health concern and the current national ambition rate has been set to reduce smoking at time of birth to ≤6% at time of birth by 2020.

Smoking is a modifiable risk factor in pregnancy. It is known that smoking or smoke exposure during pregnancy can cause serious health problems and has further implications throughout childhood. Smoking is strongly associated with several adverse socio-economic and educational indicators

1.

NHS England recently set a national ambition to halve the rates of stillbirths by 2030, with a 20% reduction by 2020. ‘Saving Babies’ Lives’ will help maternity services meet this aspiration. Reducing the incidence of maternal smoking during pregnancy forms one of the evidence based four elements of the NHS England ‘Saving Babies’ Lives’ care bundle

2.

The total annual cost to the NHS of smoking during pregnancy is estimated to range between £8.1 and £64 million for treating the resulting problems for mothers and between £12 and £23.5million for treating infants (aged 0–12 months)

3.

Smoking cessation pathway development

2011 Community midwives had Brief Intervention education 2013 University of Nottingham ‘Opt out’ study: introduction

of a CO reading at 12 weeks of pregnancy4

2014 Risk Perception Intervention commenced (Motivational Interviewing based intervention)

5

2017 CO readings at first contact commenced6,7

Care pathway for women who smoke 2017 1. CO reading at first contact2. Risk Perception with a repeat CO reading for women

continuing to smoke3. Discussion about smoking raised at every subsequent

antenatal contact4. Serial growth scans for women who continue to smoke at

28, 32, 36, 39 and 41 weeks to detect fetal growth restriction and small for gestational age babies to reduce the term still birth rate: NHS England Saving Babies’ Lives (2016)

8

5. Smoking status recorded at 25 weeks and 34 weeks6. CO repeated at 36 weeks for all pregnant women7. SATOD question on admission in labour

9

8. NRT provided for in-patients.

9. Electronic referral to (local SSS) at any time.

Multidisciplinary approach 1. Close working relationship with Smokefreelife, Public

Health Nottinghamshire and the CCG.2. Embedding smoking cessation in antenatal care provision

ensures it is everyone’s responsibility 3. Collaborative working with the University of Nottingham.

SATOD and Stillbirth %: Q1 14/15 to Q3 17/18

10.00%

12.00%

14.00%

16.00%

18.00%

20.00%

22.00%

24.00%

26.00%

14 15

Q1

14 15

Q2

14 15

Q3

14 15

Q4

15 16

Q1

15 16

Q2

15 16

Q3

15 16

Q4

16 17

Q1

16 17

Q2

16 17

Q3

16 17

Q4

17 18

Q1

17 18

Q2

17 18

Q3Quarters

0.00%

0.20%

0.40%

0.60%

0.80%

1.00%

1.20%

Local SATOD data Stillbirth % of births Linear (Stillbirth % of births) Linear (Local SATOD data)

Post Risk Perception likelihood of setting a quit date n=22 (2017)

6

5

6

3

11

unsure

very likely

likely

unlikely

very unlikely

already

stopped

Results Impact of ‘opt-out’ referrals with CO identification

• Increased the numbers of referrals for smoking cessation support

received by Smokefreelife.

• Twice the number of women engaged with SSS support afterimplementation of the programme.

• Doubling of the proportion of women who reported abstinencefrom smoking at one month.

• 6% statistically significant increase in successful cessationamong women who used SSS in the intervention period.

Impact of Risk Perception Intervention

• Further 3% increase in successful smoking cessation.

• Increase in birth weight centile amongst women who reducedtheir cigarette consumption, but who didn’t quit.

• Women have reported that the direct approach of Risk Perceptionis what they required. The women didn’t previously know why smoking is harmful to the pregnancy and the baby.

• Chart 2 opposite shows that 50% of women reported they werelikely to quit smoking following the Risk Perception. It is acknowledged that the sample is small n=22.

References 1. Department of Health and Social Care (2017): Towards a smoke-freegeneration: tobacco control plan for England (Online). https://www.gov.uk/government/publications/towards-a-smoke-free-

generation-tobacco-control-plan-for-england [Accessed 7.2.18] 2. NHS England Saving babies’ Lives: a care bundle for reducing stillbirth(2016) https://www.england.nhs.uk/wp-content/uploads/2016/03/saving-babies-lives-car-bundl.pdf [accessed 17.2.18] 3. Godfrey C, Pickett KE, Parrot S et al. (2010) Estimating the costs tothe NHS of smoking in pregnancy for pregnant women and infants. York: Department of Health Sciences, The University of York4. Campbell, K. A., Cooper, S., Fahy, S. J., Bowker, K., Leonardi-Bee, J.,McEwen, A., Whitemore, R., and Coleman, T., (2017). ‘Opt-out’ referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support. Tobacco Control. May 2017, 26 (3) 300-306. 5.Fendall, L., Griffith. W, Iliff, W., Lee, A., and Radford, J., (2012).Integrating a clinical model of smoking cessation into routine antenatal care. British Journal of Midwifery. 20:4 6. NICE PH 26. (2010) Smoking: stopping in pregnancy and afterchildbirth. (Online). https://www.nice.org.uk/guidance/ph26 [accessed 17.2.18] 7. NICE PH48 (2013). Smoking: Acute, maternity and mental healthservices. (Online) https://www.nice.org.uk/guidance/ph48 [accessed 17.2.18. 8. Perinatal Institute (2007). Confidential enquiry into stillbirths with fetalgrowth restriction http://www.pi.nhs.uk/rpnm/CE_SB_Final.pdf [accessed 17.2.18] 9. SATOD data. (Online). https://digital.nhs.uk/catalogue/PUB24222[accessed 17.2.18] 10. Allison, S., Hiller, A., and Allison, C. 2011. Amy’s Story: A ResearchAgenda for Smoking Cessation in Pregnancy. Conference Paper Prepared for the Academy of Marketing Annual Conference: July 2011.

Reflection and Discussion Seeing the baby for the first time and receiving CO readings coupled with learning that high CO levels are harmful to the fetus, could have been an additional motivator for the women

10.

At SFHFT ‘opt-out’ referrals were implemented by a small group of healthcare staff who were trained to national standards and received support afterwards; staff training and ongoing support may be necessary to ensure that new referral processes are effectively introduced. The ’opt out’ pathway was implemented in addition to existing ‘opt in’ referrals, repeated referrals may have enhanced smokers’ motivation leading to improved cessation outcomes (Campbell et al 2017). SFHFT redesigned the smoking in pregnancy pathway, embedding intensive specialist smoking cessation advice into routine antenatal care. Motivational Interviewing is a powerful technique and must be conducted by appropriately qualified personnel to achieve a consistent outcome that empowers women to quit smoking.

Chart 2: Risk Perception evaluation Public Health, Nottinghamshire

2017

A CORREL analysis of chart 1

data indicated a

correlation coefficient of

0.47 for the full date range,

suggesting a moderate

relationship between SATOD

and % stillbirth for the full

period. There was a score of

0.75 for Q1 16/17 onwards,

indicating the two variables

are strongly related in the

latter quarters. The small

numbers associated with

still births contributed to the

volatility in the data.

Chart 1: SFHFT monthly reported SATOD data from the electronic maternity pathway ‘ORION’.

Annex A

CHIEF OFFICERS REPORT NHS 70 CELEBRATIONS

Eleven members of staff represented the mid Nottinghamshire CCGs at national services marking the seventieth anniversary of the NHS in July. Staff were selected to join special services taking place at York Minster and Westminster Abbey on Thursday 5 July after being nominated for their outstanding service by colleagues.

Colleagues at Birch House marked the anniversary by taking part in celebration events coordinated by NHS England. The Guest of hour was John Corrigan who was the first baby born in Nottinghamshire after the foundation of the NHS seventy years ago.

Meanwhile, the CCG Engagement Team were out and about Mid Nottinghamshire ASDA Stores to raise awareness of the NHS 70 Birthday and also raising awareness of local NHS Services, including GP Access, Diabetes Prevention Programme, supported by the Community and Voluntary Sector at the events.

KINGS MEDICAL CENTRE OPENS IN SUTTON IN ASHFIELD

A new medical practice serving more than 9000 patients opened in Sutton in Ashfield on 2 July.

The Kings Medical Practice has been formed as the result of a merger between Harwood Close Surgery and Ashfield Medical Centre, and is located on King Street in Sutton in Ashfield.

The change follows a period of extensive engagement with local patients, carried out by the CCG’s Patient Engagement Team. As a result of the practice merger patients will experience:

• Increased availability of doctors and nurses • Improved accessibility of premises • Access to a wider range of services and treatments on site

The Kings Medical Practice plans to expand following the merger and will include a large multidisciplinary team consisting of three full time GPs; two nurse practitioners; three nurses and three health care assistants.

A further review of patient experience is planned following the merger to understand the impact of the changes after three months.

The practice held an official opening ceremony on Wednesday 25 July.

PATIENT AND PUBLIC ENGAGEMENT EVENT – NEWARK URGENT TREATMENT CENTRE

NHS Newark and Sherwood CCG are hosting a further engagement event for members of the public and patients to consider plans for the new NHS Urgent Treatment Centre at Newark.

The event will describe national core standards for Urgent Treatment Centres; review feedback; and provide the local community with an opportunity to discuss the proposed design for Newark Urgent Treatment Centre.

The aim of the event is to ensure people in Newark are involved in key discussions about future urgent care arrangements at the hospital.

CCGS GET BEHIND HYDRATION CAMPAIGN FOLLOWING LOCAL RISE IN E.COLI BLOODSTREAM INFECTION

Dr Thilan Bartholomeux has written an opinion piece for the Mansfield Chad backing a campaign by NHSE to promote awareness of hydration. The piece, which can be viewed online at the link below, highlights a rise in E.coli bloodstream infections which can be caused by UTIs and poor hydration.

In a 12 month period last year there were 44 cases of E.coli in Mansfield. But this year there have already been 55 cases since the beginning of April, which could be linked to the hot summer we’re having and more people getting dehydrated. The piece has been widely circulated on social media by members of the public as well as health professionals.

https://www.chad.co.uk/lifestyle/keeping-yourself-healthily-hydrated-is-as-easy-as-1-2-3-1-9259208=

PUBLIC ENGAGEMENT UPDATE

FARNSFIELD PUBLIC MEETING

Over 100 people attended a follow up meeting at St. Michael’s Church of England School, Farnsfield. The meeting delivered in partnership by the CCG, Sherwood Medical Partnership and PPG provided an opportunity to respond to the many issues raised at an earlier meeting held on 24 April 2018. Chaired by Dr. Amanda Sullivan, an initial presentation delivered by Cathy Quinn, Deputy Director of Primary Care summarised the key issues arising from the earlier event and outlined the CCGs role in practice performance. Michelle Barksby, Practice Manager responded on behalf of the practice sharing information about the services and clinical cover provided at Farnsfield and progress already made to deliver improvement. The event concluded with a question and an answer session. Further clarification was provided during the question and answer session and notably feedback from patients confirmed that they are already observing positive change. An ongoing dialogue will continue with patients through the PPG and a report of the engagement will be produced and shared widely with Farnsfield patients.

UNDERWOOD BRANCH SURGERY CLOSURE

An extensive communication plan has been delivered to inform patients of the closure of Underwood Branch Surgery. This will be followed up by an opportunity for patients to find out more about the closure through a period of engagement. This will allow the practice and the CCG to understand the impact on patients in order to offer possible solutions.

PROTECTED LEARNING TIME

The Engagement Team were initially asked to attend three Non Clinical PLT Sessions to discuss “What it is like to be a patient arriving at a GP surgery”. The Engagement Team developed the scope of the brief to consider what it is like for the underserved communities to visit a GP surgery. Three members of the public from underserved communities were sourced and asked to attend to present to the audience around barriers that people from specific communities, could face. The presenters all had lived experience of being profoundly deaf, having a disability and also from the Black/Ethnic Minority Community. Following the sessions all staff was asked to make a pledge to take back to their practice around one thing that they could do differently to make their service more accessible. The session was well received and evaluated well. Staff took away some

https://www.chad.co.uk/lifestyle/keeping-yourself-healthily-hydrated-is-as-easy-as-1-2-3-1-9259208

easy and changeable ways to reduce the barriers for some communities including looking at people and smiling rather than face down in work and also having a text message or email system in place for the deaf community to make contact around appointments.

MATERNITY HUB WORKSHOP

In line with the National Better Births Programme and the Local Maternity Service Transformation, a workshop was held in Ashfield Health and Wellbeing Centre on the 25 June 2018 to look at what a local Maternity Community Hub could look like and what this should contain. The workshop was well attended from Health Care Professionals, Service Users, Charities and Members of the Community and Voluntary Sector. The aim of the session was to look at what should be included to meet the needs of the local community and how this will be taken forward. A session is planned in Newark for the 25 July 2018 to replicate the work. Further updates will be provided.

MANSFIELD CVS VOLUNTEER AWARDS 2018

On the 7 June 2018 the Mansfield Volunteer Awards took place at the John Fretwell Centre. This event was well attended from organisations and representatives across all community and voluntary sectors. The event started with a performance from a local children’s choir who demonstrated the strength in which they have grown since the previous years with the help and support of volunteers. There was also an emotional presentation from the Suicide Support Group who helps and support people who have been affected by suicide. The volunteers have been affected by suicide, depression and anxiety and they established the group to put something back into the community to provide a support mechanism to local residents.

ANNUAL PUBLIC MEETING AND CELEBRATING SUCCESS AWARDS

The dates have been set for the Annual Public Meetings. Newark and Sherwood will be taking place on Wednesday 5 September 2018 from 4.30pm – 7.30pm with Mansfield and Ashfield taking place on Monday 17 September 2018 from 4.30pm – 7.30pm. Invitations will be circulated shortly. We have also launched our Celebrating Success Awards recognising the work at our GP Practices. The awards recognise people who go the extra mile to plan or deliver exceptional health and care services through their contribution to engagement, leadership, partnership and innovation or an act of kindness. The awards will be presented at our Annual Public Meetings.

PATIENT PARTICIPATION GROUPS (PPGS)

PPG Chairs from across Mansfield and Ashfield met on the 12 July 2018. This meeting was supported by Mansfield CVS and also Ashfield Voluntary Action. Discussions at the meeting surrounded GP Extended Access and the importance of cascading the information out to patients to ensure that the appointments are utilised, raising the issue of Bowel Screening and also a presentation from the CVS about supporting PPGs in their work. The latest issue of Network News was also disseminated. This is a newsletter distributed to all PPGs across Mid Nottinghamshire.

NATIONAL UPDATE

NHS – Ten Year Plan THE KINGS FUND

The government has announced increases in NHS funding over five years, beginning in 2019/20, and has asked the NHS to come up with a 10-year plan for how this funding will be used. After eight years of austerity, growing financial and service pressures within the NHS and the damaging and distracting changes brought about by the Health and Social Care Act 2012, there is now an opportunity to tackle the issues that matter most to patients and communities and to improve health and care. Read more here

High intensity user programme - reducing A&E pressures NHS ENGLAND

A senior paramedic’s idea that has cut A&Es visits from “frequent callers” by up to 90 per cent is being rolled out across the country.

The High Intensity User programme was the brainchild of Rhian Monteith, who was working as an advanced paramedic in Blackpool when she noticed that a very small group of people took up a great deal of NHS resources and staff time.

Rhian decided to tackle their problems by meeting for coffee and a chat. Through personal mentoring and one-to-one coaching, as well as getting them involved with community activities, and encouraging them to phone her rather than call 999, Rhian helped A&E attendances, 999 calls and hospital admissions drop by about 90 per cent among the group. Eventually the patients were able to cope for themselves and came to call Rhian less often.

The scheme was then scaled up to cover about 300 patients in Blackpool over the following three years, saving the NHS more than £2million. It has now been rolled out to around a fifth of the country with 36 local heath teams adopting the scheme.

NHS England announce £10million fund to retain GP’s NHS ENGLAND

NHS England has announced a new £10 million fund to support and retain GPs. Some £7 million will be made available through regional-based schemes to help GPs to stay in the workforce, by promoting new ways of working and by offering additional support through a new Local GP Retention Fund.

A further £3 million will also be made available to establish seven intensive support sites across the country in areas that have struggled most to retain GPs. Details on these sites and plans for retention efforts there will be announced next month.

The fund will support local health services focusing on supporting newly qualified GPs or those within their first five years of practice, who are seriously considering leaving general practice or who are no longer clinically practicing in the NHS in England but remain on the National Performers List (Medical).

NHS LAUNCHES PLAN TO IMPROVE PATIENT CARE BY CUTTING LONG HOSPITAL STAYS NHS ENGLAND

The NHS has announced plans to improve patient care by cutting long stays in hospitals. Speaking at the annual NHS Confederation conference at Manchester Central, Simon Stevens and Ian Dalton, the Chief Executives of NHS England and NHS Improvement, set out the plans which will also help to free up thousands of hospital beds and ease pressures next winter.

Shorter stays will benefit patients who would otherwise be stuck in hospital when they are well enough to leave as well as freeing up beds for those who are sicker. Many older people, particularly those who are frail

https://www.kingsfund.org.uk/publications/nhs-10-year-plan?gclid=CjwKCAjw7vraBRBbEiwA4WBOn9LiKlG4lM39ELkrZngIDoH8ZU9LU0aPWPZ-OxYXFl5MLCInB7HxMRoCJWwQAvD_BwE

and may have dementia, actually deteriorate while in hospital – a stay of more than 10 days leads to 10 years’ muscle ageing for people most at risk.

PRIME MINISTER SETS OUT 5-YEAR NHS FUNDING PLAN DEPARTMENT OF HEALTH AND SOCIAL CARE

The NHS will receive increased funding of £20.5bn in real terms per year by the end of the 5 years compared to today – an average 3.4% per year overall – in a move to secure the future of the health service as it approaches its 70th birthday, the Prime Minister has announced.

The increase will mean the NHS can regain core performance and lay the foundations for service improvements. The funding will be front-loaded with increases of 3.6% in the first 2 years, which means £4.1 billion extra next year.

This long-term funding commitment means the NHS has the financial security to develop a 10-year plan. The plan will be developed by the NHS, working closely with government and be published later this year.

Nearly 350,000 patients spend more than three weeks in a hospital each year. That is around a fifth of beds, or the equivalent of 36 hospitals. Some patients need to be there for medical reasons but many do not. The NHS, working with local authorities, aims to reduce the number of long staying patients by around a quarter, freeing up more than 4,000 beds in time for the winter surge.

PLANS TO STRENGTHEN NHS CYBER SECURITY ANNOUNCED DEPARTMENT OF HEALTH AND SOCIAL CARE

A new multi-million pound Microsoft package will ensure NHS systems have the most up-to-date software with the latest security settings. The deal with Microsoft will ensure all health and care organisations are using the latest Windows 10 software with up-to-date security settings to help prevent cyber-attacks.

Since 2017 the government has invested £60 million to address cyber security weaknesses. A further £150 million will be spent over the next 3 years to improve the NHS’s resilience against attacks. This will include setting up a new digital security operations centre to prevent, detect and respond to incidents.

NHS MET UNPRECEDENTED PATIENT DEMAND LAST YEAR NHS IMPROVEMENT

NHSI has published a report on performance of NHS providers in 2017/18.

Despite experiencing the worst winter in a decade, frontline NHS staff and managers have risen to the challenge and cared for more patients than ever before. However, this surge in demand has affected the NHS’s performance in key areas, such as waiting times and its reliance on temporary workers.

More than 5.87 million people went to A&E in January, February and March 2018 – that’s over 220,000 more than the same period last year. During January, February and March alone, there were 1.1 million people who attended A&E who needed to be admitted for treatment – 70,000 more than the same period last year.

However, performance against the four hour standard slipped nationally – 88.4% of patients were seen within four hours in A&E, compared to 89.1% the year before. The national target is 95%.

While the provider sector was in deficit during 2017-18, viewed as a whole the NHS was broadly in balance. Last month, NHS England provisionally reported a £955m underspend for the healthcare commissioning sector in 2017-18.



TITLE: CCG Annual Ratings DATE OF MEETING: 2 August 2018 PAPER REF: JGB/18/93 AUTHOR: Amanda Sullivan PRESENTER: Amanda Sullivan PURPOSE OF REPORT: This report sets out the CCG Annual Ratings for 2017/18, alongside local comparators. RECOMMENDATION:

To endorse To approve To receive the recommendation (see details below) To discuss To DISCUSS the CCG Annual Ratings for 2017/18.

EXECUTIVE SUMMARY (OVERVIEW): The CCG Annual Ratings have improved in 2017/18 and both CCGs are rated as Requires Improvement.

REPORT: The CCG ratings have improved in 2017/18, largely because the assessment of CCG leadership has improved and this moves the CCGs into a more favourable category. The CCGs have undertaken significant work in 2017/18 to address the very significant financial challenges across mid-Nottinghamshire and this work has been recognised by NHS England. It is also noteworthy that the CCGs are rated as Outstanding for dementia early diagnosis and Good for mental health. However, Mansfield and Ashfield CCG is rated as Inadequate for cancer early diagnosis and diabetes management. This in part reflects the local demographic challenges, but the work that is on-going in both of these areas must maintain momentum and impact on health outcomes. The scale of financial challenge for 2018/19 is reflected in the ratings. QIPP Assurance and connection

The CCGs’ financial leadership rating has improved.

Financial Impact and Risks

The scale of the financial challenge for 2018/19 is noted in the ratings.

Identify links to known risks on the Assurance Framework and the impact of the paper’s content and also to ensure it is clear for the Governing Body’s consideration in relation to the risk score and future mitigation There is a clear need to remain very focused on the health outcome indicators that need to be improved. There is an on-going risk to the CCG financial position.

Legal Impact

N/A

Risk Implications, Assessment and Mitigations

As above


N/A

Equality Impact

N/A

Evidence and Research (include where this informs why the paper is presented to Governing Bodies


X Quality X Health X Financial X Clinical X Performance (tick as appropriate)



Please state rationale for decision

CONFIDENTIALITY:

Is the information in this paper confidential?

No Yes

ANNEXES: Annex 1 CCG 17-18 Assessment and comparators

CCG Performance Assessment 2017-18 (based on Q4 2017-18)

NHS Mansfield and Ashfield CCG

NHS Newark and Sherwood CCG

NHS NNE CCG NHS North Derbyshire CCG NHS Hardwick CCG NHS Notts City CCG NHS Nottingham West CCG NHS Bassetlaw CCG NHS Rushcliffe CCG

Overall 2017/18 Assessment Requires Improvement Requires Improvement Good Inadequate Requires Improvement Requires Improvement Good Outstanding Good

Better CareCancer Q4 2017-18 CCG IAF Assessment - Cancer Inadequate Good Requires Improvement Requires Improvement Requires Improvement Inadequate Requires Improvement Inadequate Good

Cancer Diagnosed at an Early Stage 39.4% 50.0% 52.7% 49.3% 44.9% 50.5% 52.8% 51.0% 60.4%

People with Urgent GP referral having 1st definitive treatment for cancer within 62 days of referral 89.8% 83.2% 90.2% 84.1% 82.5% 84.8% 85.1% 74.3% 83.9%

One year survival of cancer 70.1% 73.7% 72.3% 72.1% 69.8% 69.4% 72.3% 71.4% 73.0%

Cancer patient experience 8.7 8.5 8.9 8.7 8.8 8.4 8.6 8.40 8.50

Care Ratings Provision of high quality care - hospitals 54 55 60 59 57 61 61 59 61

Provision of high quality care - primary medical services 66 66 66 70 67 60 73 72 71

Provision of high quality care - Adult Social Care 63 55 63 63 62 62 61 61 62

Dementia Q4 2017-18 CCG IAF Assessment - Dementia Outstanding Outstanding Outstanding Outstanding Outstanding Outstanding Outstanding Good Outstanding

Estimated diagnosis rate for people with dementia 77.4% 66.4% 71.7% 68.1% 74.5% 84.2% 82.6% 80.6% 74.1%

Dementia care planning and post-diagnostic support 79.5% 75.7% 81.5% 76.5% 80.4% 80.0% 77.7% 79.4% 81.7%

Elective Access Patients waiting 18 weeks or less from referral to hospital treatment 89.5% 89.6% 93.3% 91.4% 90.5% 93.5% 92.8% 89.9% 93.2%

7 Day Services 4 out of 4 clinical standards met the 90% threshold

3 out of 4 clinical standards met the 90% threshold








Learning Disability Reliance on specialist inpatient care for people with a learning disability and/or autism 72 72 72 50 50 72 72 72 72

Proportion of people with a learning disability on the GP register receiving an annual health check 61.6% 49.20% 54.20% 57.6% 52.7% 44.6% 56% 73.60% 58.20%

Completeness of the GP learning disability register 0.7% 0.7% 0.5% 0.5% 0.7% 0.5% 0.5% 0.5% 0.4%

Maternity Smoking at Time of Delivery 20.8% 14.6% 13.0% 12.8% 20.3% 18.9% 12% 13.6% Performing Well

Neonatal mortality and stillbirths 6.5 3.3 4.8 6 11.7 4.4 3.3 3.1 2.8

Women's experience of maternity services 86.8 83.6 80.7 82.6 86.3 80.7 85.5 88.6 77.4

Choices in maternity services 59 66.4 62.8 59 65.5 60.2 66.5 66.8 64.8

Mental Health Q4 2017-18 CCG IAF Assessment - Mental Health Good Good Good Outstanding Outstanding Requires Improvement Good Outstanding Good

Improving Access to Psychological Therapies Recovery Rate 53.1% 57.8% 57.7% 57.5% 54.4% 51.0% 57.8% 60.3% 71.6%

Improving Access to Psychological Therapies Access Rate 3.0% 3.6% 3.1% 6.3% 4.5% 4.1% 4.2% 5.6% 80.0%

People with 1st episode starting NICE - recommended treatment within 2 weeks of referral 66.7% 91.7% 85.0% 97.1% 100.0% 70.3% 50.0% 75.0% 100.0%

Out of Area Placements (bed days per 100,000 GP registered population 140 per 100,000 46 per 100,000 164 per 100,000 75 per 100,000 0 per 100,000 383 pewr 100,000 105 per 100,000 180 per 100,000 87.5%

NHS Continuing Care % of NHS CHC full assessments in an acute setting 30.7% 13.3% 26.7% 13.3% 6.7% 16.7% 10% 5.1% 20.50%

Patient Safety Evidence sepsis awareness raising amongst healthcare professionals has been prioritised by the CCG Green + Green + Amber Amber Amber Amber Amber Green + Green +

Primary Medical Care Patient experience of GP services 84.8% 85.1% 83.6% 87.0% 85.9% 83.7% 91.1% 92.2% 88.20%

General practice extended access 0.0% 0.0% 0.0% 6.7% 0.0% 100.0% 0.0% 0.0% 25%

Primary care workforce 0.9 0.9 1 1.3 1.2 1 1.1 1.1 1.3

End of Life Care % of deaths with 3 or more emergency admissions in last months of life 5.3% 5.9% 5.4% 5.8% 6.1% 4.3% 3.2% 6.8% 3.5%

Urgent and Emergency Care Emergency admissions for urgent care sensitive conditions 2959 2167 2194 2769 3259 2642 2147 2667 1774

Percentage of patients admitted, transfer Inadequate or discharged from A&E within 4 hours 88.9% 86.9% 79.6% 85.8% 87.6% 78% 78.3% 93.3% 78.0%

Delated transfers of care per 100,000 population 10.5 12.1 11.1 6.8 6 16.4 8.8 10.7 11.8

Population use of hospital beds following emergency admissions 505 456 499 471 461 492 472 388 480

Better HealthChild Obesity Percentage of children aged 10-11 classified as overweigh or obese 34.7% 31.6% 31.1% 30.8% 36.0% 38.3% 29.7% 33.3% 21.7%

Diabetes Initial Assessment - Diabetes Inadequate Requires Improvement Good Requires Improvement Requires Improvement Requires Improvement Outstanding Outstanding Good

Diabetes patients that have achieved all the NICE - recommended treatment targets 36.4% 37.9% 37.1% 35.6% 35.7% 34.8% 40.8% 46.1% 38.30%

People with diabetes diagnosed less than a year who attended a structured Inadequate education course 5.5% 4.3% 9.7% 6.3% 5.5% 7.9% 10.4% 18.5% 10.30%

Falls Injuries from falls in people aged 65 and over 1,709 per 100,000 1,646 per 100,000 2,191 per 100,000 2,268 per 100,000 2,111 per 100,000 2.339 per 100,000 2,209 per 100,000 2,647 per 100,000 1,709 per 100,000

Personalisation and choice Personal Health Budgets 176 per 100,000 232 per 100,000 192 per 100,000 24.9 per 100,000 18.3 per 100,000 88.7 per 100,000 211.2 per 100,000 47.4 per 100,000 184 per 100,000

% of deaths with 3 or more emergency admissions in last months of life 5.3% 5.9% 5.4% 5.8% 6.1% 4.3% 3.2% 6.8% 45.40%

Anti-microbial resistance Anti-microbial resistance: Appropriate prescribing of antibiotics in primary care 1.235 above target 1.161 1.06 below target of 1.161 1.018 below target of 1.161 1.14 below target of 1.161 1.165 below target of 1.161 0.955 below target of 1.161 0.894 below target of 1.161 1.109 below target of 1.161 0.883 below target of 1.161

Anti-microbial resistance: Appropriate prescribing of broad spectrum antibiotics in primary care 7.5% below target of 10% 8.3% below target of 10% 9% below target of 10% 7.7% below target of 10% 6.9% below target of 10% 7.8% below target of 10% 7.3% below target of 10% 4.2% below target of 10% 7.6% below target of 10%

Carers % of carers with an LTC who feel supported to manage their condition 63% 68.8% 70% 67.2% 61.9% 68.1% 70.6% 63.5% 72.2%

Health Inequalities Quality of life of carers An absolute gradient of 2545.1 on an underlying CCG mean value of 6521.8. This CCG is

similar to the average for other CCGs.

An absolute gradient of 2160.4 on an underlying CCG mean value of 4774. This CCG is similar to the average for

other CCGs.

An absolute gradient of 1978 on an underlying CCG mean value of 4840.7. This CCG is similar to the

average for other CCGs.

An absolute gradient of 3266.2 on an underlying CCG mean value of 6021.8. This CCG is amongst the CCGs with the

most inequality.

An absolute gradient of 2434.9 on an underlying CCG mean value of 7050.2. This CCG is similar to

the average for other CCGs.

An absolute gradient of 2603.4 on an underlying CCG mean value of 5613.2. This

CCG is similar to the average for other CCGs.


least inequality.

An absolute gradient of 2389.4 on an underlying CCG mean value of 5804.9. This

CCG is similar to the average for other CCGs.


least inequality.

SustainabilitySustainability Financial plan - assessment of whether the CCG is likely to meet the plan Red Red Green Red Amber Amber Green Green Green

Utilisation of the NHS e-Referrals Service to enable choice at first routive elective referral 96.2% above target of 80% 90.8% above target of 80% 88.5% above target of 80% 81.7% above target of 80% 86.4% above target of 80% 87.7% above target of 80% 91.1% above target of 80% 66.9% above target of 80% 88% above target of 80%

Well-ledProbity and corporate governance Fully compliant Fully compliant Fully compliant Fully compliant Fully compliant Fully compliant Fully compliant Fully compliant Fully compliant

Staff engagement index (engagement index on a 1 to 5 scale (5 good)) 3.8 3.8 3.8 3.8 3.8 3.8 3.8 3.7 3.8

Progress against workforce and race equality standard (higher scores indicate higher differences, 0 indicates equality) 0.05 0.062 0.118 0.138 0.122 0.125 0.126 0.121 0.119

Effectiveness of working relationships in the local system 67.2 66.2 72.8 57.5 68.6 67.5 75.8 77.5 83

Quality of CCG leadship Amber Amber Amber Red Amber Amber Amber Outstanding Amber

Compliance with statutory guidance on patient and public participation in commissioning health care Amber (7 out of 15) Amber (8 out of 15) Green (11 out of 15) Green (10 out of 15) Green (13 out of 15) Green (12 out of 15) Green (10 out of 15) Amber (6 out of 15) Green (10 out of 15)

CCG Performance Assessment 2016-17

NHS Mansfield and Ashfield CCG

NHS Newark and Sherwood CCG

NHS NNE CCGNHS North

Derbyshire CCGNHS Hardwick CCG NHS Notts City CCG

NHS Nottingham West CCG

NHS Bassetlaw CCG NHS Rushcliffe CCG

Overall 2016/17 Assessment Inadequate Inadequate Good Inadequate Requires Improvement Good Good Outstanding Good

Better CareCancer 2016-17 CCG IAF Assessment - Cancer Inadequate Good Requires Improvement Requires Improvement Requires Improvement Inadequate Requires Improvement Inadequate Good

Cancer Diagnosed at an Early Stage 47.20% 51.80% 53.50% 51.90% 52.80% 48.70% 52.70% 47.80% 52.80%

People with Urgent GP referral having 1st definitive treatment for cancer within 62 days of referral 84.20% 75.00% 77.50% 76.20% 72.30% 76.60% 75.90% 92.30% 84.30%

One year survival of cancer 67.00% 72.10% 70.60% 70.40% 68.80% 67.50% 70.70% 68.60% 71.50%

Cancer patient experience 8.6 8.5 8.9 8.7 8.6 8.8 8.7 8.60 8.70

Care Ratings Provision of high quality care - hospitals 52 54 62 56 54 62 62 61 62

Provision of high quality care - primary medical services 63 66 66 71 63 65 74 70 71

Provision of high quality care - Adult Social Care 61 59 59 62 60 60 61 60 63

Dementia 2016-17 CCG IAF Assessment - Dementia Outstanding Outstanding Outstanding Outstanding Outstanding Outstanding Outstanding Good Outstanding

Estimated diagnosis rate for people with dementia 69.1% 71.2% 70.5% 72.0% 70.4% 88.9% 74.8% 76.7% 79.0%

Dementia care planning and post-diagnostic support 81.1% 80.2% 81.5% 79.9% 79.7% 81.3% 80.3% 76.0% 80.8%

Elective Access Patients waiting 18 weeks or less from referral to hospital treatment 92.7% 92.3% 96.1% 93.8% 93.1% 96.1% 95.4% 90.7% 95.3%

Learning Disability Initial Assessment: Learning Disability Needs Improvement Needs Improvement Needs Improvement Performing Well Needs Improvement Needs Improvement Needs Improvement Needs Improvement Performing Well

Reliance on specialist inpatient care for people with a learning disability and/or autism 86 86 86 73 73 86 86 86 86

Proportion of people with a learning disability on the GP register receiving an annual health check 45.0% 37.0% 34.0% 36.0% 32.0% 28.0% 42.0% 46.0% 35.0%

Maternity Initial Assessment: maternity Needs Improvement Performing Well Performing Well Performing Well Needs Improvement reatest Need for Improvemen Needs Improvement Needs Improvement Performing Well

Neonatal mortality and stillbirths 8.9 4.8 5.8 6.1 2.3 9.5 4.2 11.3 2.8

Women's experience of maternity services 83.9 82.5 82.2 84.6 85.4 78.6 77.4 81.9 77.4

Choices in maternity services 68.4 61.2 62.8 67.8 69.9 67.7 61.6 66.9 64.8

Mental Health 2016-17 CCG IAF Assessment - Mental Health Good Good Good Outstanding Outstanding Requires Improvement Good Outstanding Good

Improving Access to Psychological Therapies Recovery Rate 50.5% 60.0% 56.3% 56.8% 56.0% 47.5% 60.0% 59.4% 71.6%

People with 1st episode starting NICE - recommended treatment within 2 weeks of referral 57.4% 69.2% 55.6% 93.1% 82.1% 43.6% 52.2% 100.0% 80.0%

Children and Young People's Mental Health Services - Transformation 100.0% 100.0% 100.0% 95.0% 95.0% 50.0% 100.0% 100.0% 100.0%

Crisis Care and Liaison Mental Health Service - Transformation 50.0% 50.0% 52.5% 100.0% 100.0% 55.0% 52.5% 82.5% 52.5%

Out of Area Placements 87.5% 87.5% 87.5% 100.0% 100.0% 87.5% 87.5% 100.0% 87.5%

NHS Continuing Care People eligible for standard NHS Continuing Healthcare 45.2 47.6 46.6 56.1 54.4 35.7 36.3 21.5 44

Primary Medical Care Management of long term conditions 1120 825 868 932 1165 1276 827 1021 639

Patient experience of GP services 84.70% 84.80% 84.30% 89.90% 86.00% 84.70% 89.90% 88.40% 88.20%

General practice extended access 0.00% 0.00% 0.00% 0.00% 0.00% 3.60% 0.00% 0.00% 25%

Primary care workforce 0.9 1 1 1.2 1.2 1 1 1 1.3

Urgent and Emergency Care Emergency admissions for urgent care sensitive conditions 3301 2533 2212 2811 3352 2731 2160 2909 1734

Percentage of patients admitted, transfer Inadequate or discharged from A&E within 4 hours 95.20% 93.40% 84.20% 91.50% 93.00% 81.60% 92.60% 92.60% 82.40%

Delated transfers of care per 100,000 population 7.9 8.5 8.1 9.5 7.5 9.2 8 8 8.5

Population use of hospital beds following emergency admissions 548.9 503.6 520.2 479.3 512.4 512.5 412.3 412.3 505.7

Delivery of an Integrated Urgent Care service 3 3 5 7 7 5 5 4 5

Better HealthSATOD Maternal smoking at delivery 18.6% 14.9% 12.0% 11.0% 17.4% 15.9% 12.6% 16.1% 4.6%

Child Obesity Percentage of children aged 10-11 classified as overweigh or obese 33.3% 31.6% 31.4% 30.6% 34.0% 36.9% 31.1% 34.2% 23.5%

Diabetes Initial Assessment - Diabetes Needs Improvement Needs Improvement Needs Improvement Needs Improvement Needs Improvement Needs Improvement Top Performing Top Performing Performing Well

Diabetes patients that have achieved all the NICE - recommended treatment targets 36.70% 38.30% 37.40% 38.20% 36.10% 34.60% 39.50% 45.60% 38.70%

People with diabetes diagnosed less than a year who attended a structured Inadequate education course 0.80% 1.30% 12.00% 5.30% 7.70% 9.20% 10.40% 19.70% 6.30%

Falls Injuries from falls in people aged 65 and over 2018 1844 2259 2131 2108 2452 2543 3042 1892

Personalisation and choice Utilisation of the NHS e-referral service to enable choice at first routine elective referral 107.10% 102.50% 94.60% 70% 75.70% 82.90% 88.20% 54.30% 100.10%

Personal Health Budgets 130.80 157.70 114.50 2.10 4.90 61.30 112.30 20.90 0.95

Percentage of deaths which take place in hospital 46.50% 45.9 50.4 43.8 44.8 56.7 50.7 44.4 45.40%

People with a long term condition feeling supported to manage their condition(s) 61.6% 66.1% 66.1% 68.3% 63.2% 64.6% 70.1% 73.0% 65.4%

Health Inequalities Inequality in avoidable emergency admissions

An absolute gradient of 1236 on an underlying

CCG mean value of 1008. This CCG is amongst the

CCGs with the most inequality.

An absolute gradient of 941 on an underlying CCG mean value of 748. This CCG is similar to the average for other CCG.

An absolute gradient of 882 on an underlying CCG mean value

of 770. This CCG is similar to the average for other CCG.


CCG mean value of 842. This CCG is similar

to the average for other CCG.

An absolute gradient of 1003 on an underlying CCG mean value of 1047. This

CCG is similar to the average for other CCG.


CCG mean value of 1085. This CCG is

amongst the CCGs with the most inequality.


CCG is amongst the CCGs with the least inequality.

An absolute gradient of 824 on an underlying CCG mean value of

904. This CCG is similar to the average for

other CCG.

An absolute gradient of 855 on an underlying CCG mean value of

576. This CCG is similar to the average for

other CCG.

Inequality in unplanned hospitalisation for chronic ambulatory care sensitive conditions



CCGs with the most inequality.


CCG mean value of 2307. This CCG is similar to the average for other CCG.

An absolute gradient of 1704 on an underlying CCG mean value of 1983. This CCG is similar to

the average for other CCG.





CCG is similar to the average for other CCG.






CCGs with the least inequality.






amongst the CCGs with the least inequality.

Anti-microbial resistance Anti-microbial resistance: Appropriate prescribing of antibiotics in primary care 1.3 1.1 1 1.1 1.2 1 0.9 1.1 0.9

Anti-microbial resistance: Appropriate prescribing of broad spectrum antibiotics in primary care 7.7% 8.3% 10.0% 7.7% 6.9% 7.7% 8.2% 4.6% 8.0%

Carers Quality of life of carers 0.78 0.77 0.82 0.8 0.78 0.78 0.79 0.84 0.84

SustainabilitySustainability Financial plan Good Good Good Good Good Good Good Requires Improvement Good

Digital interactions between primary and secondary care 78.9% 80.6% 72.3% 65.3% 71.5% 70.7% 68.2% 54.3% 68.8%

Local strategic estates plan (SEP) in place In place In place In place In place In place In place In place In place In place

In year financial performance

Expenditure in areas with identified scope for improvement (Wave One CCGs only) CCG not included in wave

1CCG not included in wave

1 CCG not included in wave 1 75.0% 70.0%CCG not included in

wave 1CCG not included in wave

1CCG not included in

wave 1CCG not included in

wave 1

Outcomes in areas with identified scope for improvementCCG not included in wave

1CCG not included in wave

1 CCG not included in wave 1 50.0% 49.6%CCG not included in

wave 1CCG not included in wave

1CCG not included in

wave 1CCG not included in

wave 1

Local digital roadmap in place? Y Y Y Y Y Y Y Y Y

New Models of Care Adoption of new care models

Y The CCG is leading the

development of a population health

vanguard

YThe CCG is leading the


vanguard

NThe CCG is leading the

development of a population health vanguard



vanguard



vanguard



vanguard



vanguard



vanguard



vanguard

Well-ledSustainability and Transformation Plan Good Good Good Good Good Good Good Good Good

Probity and corporate governance Fully compliant Fully compliant Fully compliant Fully compliant Partially compliant Partially compliant Fully compliant Fully compliant Fully compliant

Staff engagement index 3.8 3.8 3.8 3.8 3.8 3.8 3.8 3.7 3.8

Progress against workforce and race equality standard 0.2 0.2 0.1 0.1 0.1 0.1 0.1 0.1 0.1

Effectiveness of working relationships in the local system 74.2 71.4 73.9 62.3 72.2 72.5 75.3 77.4 90.8

Quality of CCG leadship Inadequate Inadequate Requires Improvement Inadequate Requires Improvement Good Requires Improvement Outstanding Requires Improvement



TITLE: July Integrated Performance Report (IPR) - Summary DATE OF MEETING: 2nd August 2018 PAPER REF: JGB/18/94 AUTHOR: Directors Team PRESENTER: Amanda Sullivan PURPOSE OF REPORT: o The July report sets out the latest position for Performance, Quality, Finance, QIPP and

Activity, based on the information available at the time of writing. In that regard certain performance and quality indicators are based on information only up to May.

o The IPR has been considered and scrutinised by the Turnaround Board at its meeting on 26th July; any matters arising will be reported to the Governing Bodies.

RECOMMENDATION:

To endorse To approve To receive the recommendation (see details below) To discuss The Governing Bodies are recommended to:

(1) Note the latest position for Performance, Quality, Finance, QIPP and Activity delivery. (2) Consider for approval any recommendations proposed by the Turnaround Board

following its review of the IPR. EXECUTIVE SUMMARY (OVERVIEW): Performance against all constitutional standards is set out in the full report. Areas of notable, strong performance include:

Key Achievements (1 of 2) Position

since last month

Diagnostic Waiting Times

Both M&A CCG and N&S CCG achieved the 6+ week standard at the end of May. M&A CCG was at 0.7% and N&S CCG was at 0.65%.

Audiology Waiting Times

Across Mid-Nottinghamshire, more than 98% of patients were waiting less than 18 weeks for audiology at the end of May.

Cancer Waiting Times

In May, M&A CCG achieved 7 out of 9 standards (+1). N&S CCG achieved 8 out 9 standards (-).

IAPT Access The Q1 forecast shows that, at 4.4%, N&S CCG is achieving the 4.2% standard for IAPT Access.

IAPT Recovery

The Q1 forecast shows that both CCGs are continuing to achieve the 50% standard for IAPT Recovery. M&A is at 52.1% and N&S CCG is at 57.8%.

EIP Waiting Times

In May, M&A CCG achieved the target that at least 53% of patients should receive a NICE-recommended package within 2 weeks (N&S CCG had no activity).

Dementia Both M&A CCG and N&S CCG achieved the 66.7% dementia diagnosis target in May. M&A CCG is at 77.4% and N&S CCG is at 66.7%.

e-Referrals All practices continue to be high users of the e-Referrals (e-RS) system to SFHFT in May. For N&S CCG, 100% of referrals were sent via e-RS.

Extended Access

All Mid-Nottinghamshire practices are offering extended access at weekends & evenings.

HCAIs There have been no cases of MRSA for May YTD, and levels of C-Difficile were within trajectories.

Continued on the next page

Key Achievements (2 of 2) Position

since last month

CHC The level of CHC referrals concluded in 28 days remains above the 80% target. For Q1, M&A CCG was at 87% and N&S CCG was at 93%.

CHC DSTs The level of Decision Support Tools (DSTs) performed in an acute setting was within the 15% target for both CCGs in Q1 18/19. M&A CCG had 2%, and N&S CCG had none in an acute setting.

Complaints All complaints were acknowledged within 3 working days. A&E 4-Hour wait SFHFT achieved the 4-Hour standard in June at 97.2%.

Conversely areas of poor performance are in relation to:

Key Issues Position

since last month

RTT 92% Both the Mid-Nottinghamshire CCGs and SFHFT continued to breach the standard at the end of May.

52+ weeks At the end of May, both CCGs had breaches of this standard, the majority coming out of the process for validating open pathways at SFHFT.

Cancer Waiting Times

In May, M&A CCG breached 2 out of 9 standards as follows: 62-Day from referral to treatment 2ww Breast

N&S CCG breached 1 out of 9 standards as follows: 62-Day from referral to treatment

IAPT Access The Q1 forecast shows that, whilst there has been an improvement, M&A CCG is currently failing the Q1 standard of 4.2%.

Smoking at Delivery

At Q4 17/18, both CCGs had levels higher than the national target of 11%. The CCG awaits the final Q1 data.

Waiting Times for Children’s Wheelchairs

At Q4, both CCGs were significantly below the national target of 92%.

Patient Online Access (POA)

This relates to the proportion of patients registered with their practice to receive online services, including appointment booking and the ordering of repeat prescriptions. The NHSE has recently advised the CCGs of a new 30% target, and both CCGs are below this recommended level. However, all Mid-Nottinghamshire practices are above the minimum requirement of 10% and registration continues to increase. The latest figures show that M&A CCG is at 25.5%, and N&S CCG is at 27.7%

DTOCs Delayed Transfers of Care (DTOCs) remain above the national 3.5% target at SFHFT.

EMAS Response Times

EMAS failed 5 out of 6 targets as a total Trust and 4 out of 6 targets for Nottinghamshire.

Actions taken to address deteriorating performance along with an assessment of when performance will get back on track is set out in the accompanying pages and the full Integrated Performance Report (IPR).

Page 2 of 11

REPORT: Performance Significant variances to the agreed performance standards are highlighted below. RTT waits over 52 weeks (Zero Standard) Issues & Actions Taken o At the end of May, the Mid-Nottinghamshire CCGs had the following breaches:

Number Provider

M&A CCG 17 All breaches are at SFHFT and came out of validation. 10 patients had dates in June or July. Other patients are being progressed.

N&S CCG 19

17 patients are at SFHFT – 16 coming out of validation and 1 Patient Choice. 13 patients had dates in June or July. Other patients are being progressed. 1 patient at NUH and 1 at Derby Hospitals Foundation Trust.

o SFHFT’s validation exercise continues and breaches will continue to occur until it is

complete. All specialties have been risk-assessed to prioritise validation and the Trust is concentrating on the higher risk specialties. A large proportion of the May breaches at SFHFT were under the specialties of ENT and Urology – which are in the latest phase of validation.

o Patient pathways found to require a review are escalated to the Trust's Divisional Teams to identify immediate capacity for an OP appointment. Patients found to require a review will trigger the Harm Review Process immediately and a full review takes place at the OP appointment.

o The CCGs receive weekly local information from SFHFT and this is used to track long-wait patients and to progress-chase provision of treatment dates.

o The Quality Team work with SFHFT to ensure that where patients have had long waits quality impacts are assessed and, when necessary, formal visits to review services would be undertaken.

Anticipated Recovery: SFHFT to have no 52+ breaches from March 2019 once validation complete and outstanding long-waits treated. RTT 92% Standard (total of all specialties) Issues & Actions Taken o The May position for the Mid-Nottinghamshire CCGs was as follows:

May 2018 Level RAG M&A CCG 90.4% R N&S CCG 90.6% R

o Several Trusts contributed to the CCGs’ failure to achieve the standard, but the CCGs’

position was mainly impacted by SFHFT. Issues relate mainly to vacancies, unexpected absence and emergency pressures.

o SFHFT has provided the CCG with first-cut specialty recovery plans. SFHFT continues to work through the actions to be taken and is aiming for September 2018 delivery (aggregate for all specialties). There is still a gap to deliver by September but the Trust is progressing this. Actions include:

o General Surgery: Additional theatre lists and OP sessions are being arranged. Agency staff are being utilised to cover gaps in staffing.

o Urology: Additional lists and clinics are being arranged. An additional consultant is joining the Trust in July.

o T&O: Additional capacity is being sought. o Cardiology: Additional clinics were arranged for June. System-wide working is ongoing

between SFHFT and a GPWSI who will be able to carry out 1 session per week to review

Page 3 of 11

and triage new referrals. o Gastroenterology: Additional clinics have been set up for July. Tele-clinics have been set

up between June to August. Anticipated Recovery: SFHFT to recover total bottom-line for September 2018. Cancer Waiting Times Standards – 62-Day Standard (standard = 85%) Issues & Actions taken. o Both Mid-Nottinghamshire CCGs failed the 62-Day standard in May as follows:

May 2018 Level RAG M&A CCG 83.1% R N&S CCG 70.0% R

o Most of the breaches were related to diagnostics – either due to complexity or because of

delays in the pathway. A small proportion of delays were due to Patient Choice. o SFHFT failed the standard at 79.7% in May, and this is impacting on the CCG’s

performance. o The Trust had an unusually high level of referrals for Urology in March leading to

approximately a third more treatments than average in May, which impacted on the Trust's performance. It should be noted that numbers have not continued at this level.

o SFHFT has provided the CCG with a refreshed Remedial Action Plan (RAP) and the CCG has met with the Trust to review. SFHFT has provided a trajectory which indicates that the Trust will achieve in July 2018.

o SFHFT has been working with the Intensive Support Team (IST) and recommendations have been fed into the refreshed recovery plan.

o The actions being taken under the 62-Day to Treatment Recovery Plan will impact positively on all CWT standards.

o The Quality Team work with SFHFT to ensure that, where patients have had long waits, quality impacts are assessed and, when necessary, formal visits to review services would be undertaken.

Anticipated Recovery: SFHFT to achieve for July 2018. Cancer Waiting Times Standards – 2 Week Wait Breast Symptoms (standard = 93%) Issues & Actions taken. o M&A CCG failed the 2ww Breast in May as indicated in the following table.

May 2018 Level RAG M&A CCG 90.3% R N&S CCG 100% G

o SFHFT also failed the standard at 90.5% in May. o All breaches were due to Patient Choice. Improved Access to Psychological Therapies (IAPT) (target = 4.2% for Q1 18/19) Issues & Actions taken. o The expectation is that a minimum of 19% patients suffering anxiety and/or depression will

be able to access IAPT services by the end of 2018/19. In order to deliver this, the CCGs have a target of 4.2% for Q1 18/19.

o Whilst both Mid-Nottinghamshire CCGs increased their achievement in Q1, current forecasts show M&A CCG at 3.71%. The forecast for N&S CCG shows achievement at 4.4%.

o Let’s Talk Well Being (LTWB) has been working to an agreed recovery plan and was successful in the recruitment of CBT Workers (3 agency) and Counsellors (2 permanent, 1 agency), together with increased in-house capacity. However, 2 x CBT workers have now finished their contract. The Trust recently advertised for 7 CBT trained staff, but the Trust

Page 4 of 11

was only able to recruit to one post. o LTWB is introducing 2 new ways of increasing their service. A live text-based service which can be utilised out-of-hours. There have been delays in

implementing this due to the new GDPR rules. Once all issues are resolved, the contract between LTWB and the software company will be finalised.

Silvercloud - a web-based direct-referral service without the need for pre-assessment. A 3-month pilot is taking place in Leicester from 16th July. Once testing is successful, it will be rolled-out to Nottinghamshire (current plan = Oct/Nov 2018).

o The CCG is reviewing the patient information card to ensure that the location of clinics is clear for patients, as this is thought to be a reason for non-attendance.

o The Mid-Nottinghamshire CCGs are currently undertaking a transformation of Mental Health services. The main focus of the transformation is to increase the integration of physical and mental health and the development of Primary Care Hubs. IAPT will be included in this work given that it is at the forefront of the integrating physical health and psychological therapies. This should lead to an increase in the access rates from those with a LTC and/or Older Adults

Anticipated Recovery: Q3 2018/19 for the CCGs – but this remains under review due to the complexity of forecasting achievement. Waiting Times for Children’s Wheelchairs (target = 92%) Issues & Actions Taken o This service is provided by SFHFT and reasons for delay are capacity and Patient Choice. o SFHFT has provided the CCGs with a Recovery Plan. Actions include: SFHFT held additional all-day paediatric clinics in March and April 2018 to address the

backlog, together with an additional half day clinic in May. The Trust reduced appointments to 30 minutes to maximise the number of patients seen.

A new protocol has been implemented at SFHFT to offer cancelled appointments to paediatric patients first.

Now that the clinical workforce is back at full capacity, the Trust is able to offer additional domiciliary assessment appointments where appropriate to increase capacity.

To ensure best utilisation of clinics and to reduce DNAs, all parents are called prior to their child’s appointments. To support this and improve efficiency the option of a text messaging service is being explored.

A new database is in place which supports extra efficiencies. o SFHFT served notice on the CCGs for the Wheelchair Contract in 2017. Anticipate Recovery: SFHFT has advised that it will be at 92% for Q2 2018/19. It should be noted that the service will transfer to the new provider from the 1st September 2018. Delayed Transfers of Care (DToCs) (target = 3.5%) Issues & Actions taken. o As previously reported, the level of DTOCs at SFHFT is above the level of 3.5%. There

was an improvement in May when SFHFT was at 3.9%. However, local data shows that levels have increased again in June.

o The Intensive Recovery Roadmap Work Stream has pulled together a system-wide Recovery Plan and this has been ratified by the A&EDB. Progress against the Recovery Plan is overseen by the Intensive Recovery Roadmap Programme Board and issues escalated to the A&E Delivery Board.

o The first-cut Recovery Plan was completed in April 2018, together with a trajectory to reach 3.5% by September 2018. Actions include:

Ensure coding & reporting of DTOCs accurately reflects national guidance. The Health Community is inviting ECIST back to carry out a review of previous work.

Review of Discharge Policy (which also has a positive impact on the 95% A&E standard) and having clear documented escalation process in place across the system.

Increase proportion of discharges before 11:00am. Implementation of Trusted Assessor (anticipated Go-Live in July). Page 5 of 11

o The good performance of May is being reviewed by the Task & Finish Group to ensure that learning and improvements are embedded.

Anticipated Recovery: September 2018 for SFHFT. EMAS Performance Issues & Actions taken. o As a total Trust, EMAS achieved only 1 standard out of 6 in May 2018: CAT 1: 90th Percentile Response Time 15 minutes.

o For the Nottinghamshire Division, 2 out of 6 standards were achieved: CAT 1: 90th Percentile Response Time 15 minutes (this was achieved for M&A CCG) CAT 4: 90th Percentile Response Time 3 hours.

o There have been no Category (CAT) response times were achieved for NHS Newark & Sherwood CCG; however 2 Health Care Professional (HCP) time frames were achieved for the area.

o Because both STF and a trajectory to deliver performance are in place to achieve national ARP standards, commissioners are unable to pursue core contracting mechanisms for non-achievement in 2018/19.

o In 2018/19, performance will be monitored against quarterly trajectories developed by the consultancy “Operational Research in Health” (ORH). This will be delivered at a county level, with national performance standards being delivered quarterly at a county level from April 2019 onwards. They will be in place from Q2, with the £9m being apportioned equally over the 3 quarters during 2018/19. Each quarterly value will then be apportioned equally over the six standards.

o It was agreed that if the trajectories are not achieved, and pre-hospital handover delays within that county exceed the modelled baseline for that quarter, EMAS will ask ORH to re-model the trajectories for that quarter, for the relevant county.

o Further work needs to take place to develop and agree the mechanism to manage handover delays. A paper went to the June A&E Delivery Board (A&EDB) regarding this and, as requested, an action plan addressing handover delays will be delivered to the next A&EDB meeting.

o EMAS are participating in High Volume Service User conversations across the STP in an attempt to align services and pathways for those patients who pose a high demand to services due to frequent calls/presentations etc.

Anticipated Recovery: Full recovery not anticipated until Q1 2018/19. Quality o Escherichia Coli (E.Coli) targets have been breached in M&A CCG. As at the end of May,

there were 34 cases against a target of 30. Of the 34 cases, 29 were community acquired and 5 were hospital acquired. E.Coli BSI is complex and multifactorial, and there is no single reason to explain the high numbers seen in May. Clear themes are not being identified despite 100% completion of case reviews. Not all of the cases have accessed healthcare prior to the episode, 48% are linked to UTI which is the main source locally and nationally. The majority of cases appear to be unavoidable with few reviews identifying any clear areas for improvement. Nationally, cases rose again last year by 1% and our local findings are similar to the national findings.

o Smoking at the Time of Deliver (SATOD) rates continue to be of significant concern. A paper outlining actions is on the Governing Body agenda.

o Staffing metrics continue to be poor and this has been investigated by the Quality & Risk Committee. A paper will be presented to the Governing Bodies in September 2018. However all providers have improved sickness and absence rates in May, with the exception of NUH.

o There has been a significant rise in complaints at SFHT in May. The CCG is investigating this with the Trust.

Finance

Page 6 of 11

o The financial position of the CCGs as reported at Month 3 is set out below:

o The combined year-to-date (YTD) in-year surplus of £0.016m, is a small favourable movement to plan. This comprises of:

o The main drivers of the YTD overspend position on acute activity are: Technical issues associated with phasing of the in-year QIPP, which has the impact of

overstating the year-to-date adverse variance. An adverse variance on QIPP delivery compared to plan. An adverse variance on acute activity. Increased outpatient follow-ups and non-elective activity above financial plan.

Increased activity at month 3 is mitigated by contingency reserves set aside within the plan.

o The CCG continues to take steps to strengthen and improve the delivery confidence associated with the existing QIPP schemes. However, there remains a risk to the delivery of the agreed QIPP schemes. Where there are significant risks to delivery of specific schemes, the Executive Team is focussing on developing schemes to address that risk. This will be articulated through a detailed action plan for consideration by the July Turnaround Board and August Governing Body meeting.

QIPP o The CCG QIPP programme for 2018/19 is required to deliver financial savings of £31m

(6%). There is a full year effect (FYE) of the 2017/18 schemes in 2018/19 of £10.4m. o £5m (16%) of QIPP financial savings are phased to deliver in Q1 and £7.5m (24%) in Q2. o At Month 3, the CCG’s QIPP plan has delivered £4.2m against a £5.1m plan, an adverse

variance of £0.9m (18%). o FYE schemes have delivered £3m against a plan of £3.6m, an adverse variance of £0.6m

(17%). o New QIPP schemes have delivered £1.2m against a plan of £1.5m, an adverse variance of

£0.3m (20%). o Mitigation actions are in place for all schemes where there is a QIPP delivery risk. o The Turnaround Board is reviewing the QIPP Programme, Month 2 delivery and progress

against the agreed QIPP Action Plan on 26th July. An update will be provided to the Governing Bodies.

Activity The following narrative is based on comparing actual activity (from the latest information available) with a re-phased SUS activity plan. [Rationale behind re-phasing adjustment. The CCG has identified two issues in its activity

Page 7 of 11

profile: o A technical issue in the way that QIPP has been recorded in the original activity plan

trajectories. It relates specifically to activity QIPP schemes from 2017/18 that continue to have an impact in 2018/19;

o The 2018/19 QIPP scheme for elective outpatients requires re-phasing. Both issues have the effect of overstating the level of activity reductions in the earlier part of the financial year with a corresponding understatement in the latter part of the year. In order to compensate and smooth out these “technical artefacts”, a manual adjustment has been made to arrive at a re-phased SUS activity plan. The table below shows variances against the re-phased SUS activity plan]

M&A N&S GP Referrals +4.4% +5.9% Other Referrals +16.3% +17.2% 1st Outpatients -0.4% +1.3% F/Up Outpatients -0.1% +1.0% Non-elective Admissions -6.2% -3.9% A&E Attendances +2.7% +6.0%

GP Referrals: o The level of Mid-Nottinghamshire GP referrals against both the submitted SUS activity plan

and the re-phased SUS activity plan can be seen in Chart (1) below.

Chart (1)

o Chart (2) below shows the average number of GP referrals per working day. An

adjustment has been made from April 2018 to take account of the additional sessions now taking place in Mid-Nottinghamshire under GP Extended Access on Saturday mornings and in the evenings. This is being investigated further by the CCG.

Chart (2)

Page 8 of 11

o Since April 2016, there has been a downward trend in GP referrals (after adjustments have

been made for working days and GP Extended Access). o There has been an increase in 2ww referrals when comparing May YTD to the previous

year. This is mainly in the 2ww specialties of breast screening, urology and clinical haematology.

Other Referrals o The average number of “other” referrals per working day can be seen in Chart (2) above. o “Other” referrals comprise of referrals from consultants, opticians, Allied Health

Professionals and other community staff. Table (3) shows the proportion of 1st outpatient attendances by source of referral where the source would be recorded under “other” within the national return. The majority of “other” referrals relate to those from consultants.

o The CCG is looking to reduce consultant referrals with the following schemes: A new policy is being implemented from the 1st September that provides Acute

Providers with guidance as to when it is appropriate that a consultant-to-consultant referral takes place. The adherence to policy will be audited by the CCG at regular intervals throughout the year. The audit results will be shared with the providers and any areas of non-adherence to policy will be discussed. The Sustainability & Transformation Partnership (STP) is looking to develop a Nottinghamshire-wide agreed policy.

Within the Outpatient Transformation Workstream, one element is to reduce 1st outpatients by 3.9% across Mid-Nottinghamshire. This will impact on consultant-to-consultant referrals.

Table (3)

Source OP Attends % of TotalConsultant referrals (any type - including post A&E attend)

22,706 70.37%

Referral from A&E 4,935 15.29%Optometrist 477 1.48%Allied Health Professional 310 0.96%Specialist Nurse 248 0.77%Self Referral 634 1.96%Other 2,957 9.16%Total 32,267 100.00%

1st OP Attendances where Source of Referral = "Other"

Mid-Nottinghamshire CCG patients at all providers 12-month period of June 2017 to May 2018

Source of data = SUS Non-elective Admissions: o There is a favourable variance against the re-phased SUS activity plans for non-elective

Page 9 of 11

admissions. o However, when comparing May YTD to the previous year, across all providers, there has

been an increase of +2.9% acute non-elective admissions across Mid-Nottinghamshire. Chart (4) shows the average number of non-elective admissions per calendar day. As can be seen, whilst there is a downward trend, levels are increasing. Chart (4)

o The top 5 over-performing specialties for non-electives within the contracts are Acute Internal Medicine, Geriatric Medicine, Stroke, Cardiology and Paediatrics. Lobar pneumonia, Urinary Tract Infections and Falls are amongst the top over-performing HRGs.

A&E Attendances: o Chart (5) shows the level of Mid-Nottinghamshire A&E Attendances against both the

submitted SUS activity plan and the re-phased SUS activity plan.

Chart (5)

o Levels increased significantly in May and this increase was seen at both SFHFT and NUH. This is believed to be due to the hot weather, and this is being investigated further by the CCG.

QIPP Assurance and Governance

The report is governed by a process involving the CCGs’ PMO and its Financial Recovery Group and is overseen by the CCG’s Turnaround Board. Financial Impact and Risks

The CCG must deliver the Control Totals agreed with NHS England.

Page 10 of 11

Legal Impact

N/A

Risk Implications, Assessment and Mitigations

N/A


N/A

Equality Impact

N/A

Evidence and Research (include where this informs why the paper is presented to Governing Bodies) N/A


Quality Health Financial Clinical Performance (tick as appropriate)



CONFIDENTIALITY:

The CCGs are required to conduct the majority of their business in open session, as an accountable body for the use of public funds. Where a paper is to be accepted onto the confidential agenda, this is to be agreed with the Chief Officer. Is the information in this paper confidential? No

Page 11 of 11

Mid-Nottinghamshire CCGs Full Integrated Performance Report

July 2018

Page

Executive Summary Overview of RAG ratings 3

Executive Summary Overview QIPP BRAG rating 5

Executive Summary - Narrative on CCG RED rated indicators 6

Executive Summary - Narrative on Trust RED rated indicators 9

Full CCG Summary by Indicator - Latest Position 11

Total Trust Summary for Key Indicators - Latest Position 14

Performance Trends - CCG Level 15

Performance Trends - Total Trust Level 17

Quality Indicators for CCGs & Trusts 18

Finance Summary 23

QIPP Finance Summary 27

QIPP Summary - Mid-Nottinghamshire 28

QIPP Red Schemes - Mid-Nottinghamshire 29

QIPP Delivery Risks and Recovery Actions 30

Finance Full Report 35

CCG IAF - Q3 17/18 49

Mid-Nottinghamshire CCGs

Full Integrated Performance Report

July 2018

Table of Contents

Executive Summary - Overview of RAG rating

July 2018 Report

Activity - Level 1 Finance - Level 1

Quality - Level 1 Performance - Level 1

Mansfield & Ashfield CCG

Key

Green Indicator achieving

Red Indicator failing

Level Red Indicators (submitted)

GP Referrals

Other Referrals

Total Referrals

Outpatient 1st

Outpatient F/Up

Total Outpatients

Nonelective spells

A&E attendances

Level Red Indicators (rephased)

GP Referrals (acute)

Other Referrals (acute)

Total Referrals (acute)

Total A&E attendances (acute)

Level Red Indicators - SLAM

A&E attendances

Elective IP Admissions

Non-Elective Admissions

Out-Patient First Attendances

Out-Patient Follow-Up Attendances

Out-Patient Procedure

Non-PBR

Level Red Indicators

RTT Incomplete

52+ Week Waits

62-Days from urgent referral to

treatment

2 WW– Breast symptoms

IAPT % Access

Transforming Care

% Smokers at the Time of Delivery

Waiting Times for Wheelchairs

Patient Online Access


Number of cases of e-coli (March)


Year to Date In Year (surplus) /

Deficit

QIPP - Year to Date Delivery

Year to Date Cumulative Position

(surplus) / Deficit

Page 3 of 50

Executive Summary - Overview of RAG rating

July 2018 Report

Activity - Level 1 Finance - Level 1

Quality - Level 1 Performance - Level 1

Newark & Sherwood CCG

Key

Green Indicator achieving

Red Indicator failing


No Red indicators for June Report

Level Red Indicators (submitted)

GP Referrals

Other Referrals

Total Referrals

Outpatient 1st

Outpatient F/Up

Total Outpatients

Nonelective spells

A&E attendances

Level Red Indicators (rephased)

GP Referrals (acute)

Other Referrals (acute)

Total Referrals (acute)

Total A&E attendances (acute)

Level Red Indicators - SLAM

A&E attendances

Elective IP Admissions

Non-Elective Admissions

Out-Patient First Attendances

Out-Patient Follow-Up Attendances

Out-Patient Procedure

Non-PBR


RTT Incomplete

52+ Week Waits

62-Days from urgent referral to

treatment

Transforming Care

% Smokers at the Time of Delivery

Waiting Times for Wheelchairs

Patient Online Access


QIPP - Year to Date Delivery

Cash Position Year to Date (%

drawn down)

Page 4 of 50

Executive Summary - Overview of QIPP BRAG rating

5 of 50

Executive Summary: Narrative on RED rated indicators (Level 2)

Mid Nottinghamshire CCGs

Indicator CCG Period Plan Actual Diff RAG Trend Comments & Actions to be taken

M&A

CCGMay-18 0 17 17 R

N&S

CCGMay-18 0 19 19 R

M&A

CCGMay-18 92% 90.4% -1.6% R

N&S

CCGMay-18 92% 90.6% -1.4% R

M&A

CCGMay-18 85% 83.1% -1.9% R

N&S

CCGMay-18 85% 70.0% -15.0% R

CWT: 2ww

from GP to

1st OP –

Breast

M&A

CCGMay-18 93% 90.3% -2.7% R

Issue: M&A CCG breached this standard for May month. All breaches were due to Patient Choice.

Actions being taken: Actions being taken relating to pathways under the 62-Day to Treatment

Recovery Plan will impact positively on this standard.

CWT: 62-

Day (all

cancers)

RTT

Incomplete

Waiting

Times

Issues: At the end of May, M&A CCG and N&S CCG both continue to breach the standard with 17 and

19 breaches respectively. M&A's breaches all occurred at SFHFT. For N&S, all but 2 breaches

occurred at SFHFT - the other 2 occurred at out of area hospitals.

Is a remedial action plan in place? Yes - this has been formalised via a Contract Performance

Notice and the serving of General Condition 9 of the contract.

Actions being taken:

Validation will continue until December 2018. The Trust cannot guarantee that no further breaches will

occur until validation is complete.

SFHFT had 40 breaches at the end of May. 39 of these breaches were as a result of the Trust's

validation of open pathways, and 1 breach was due to Patient Choice. 26 patients were given dates in

June and July, 9 are awaiting responses from patients, 3 patients required no further treatment and 2

were for other reasons.

The Trust is prioritising the higher risk specialties in its validation. A large proportion of the May

breaches were under Urology and ENT, although several specialties had breaches.

Patient pathways found to require a review are escalated to the Trust's Divisional Teams to identify

immediate capacity for an OP appointment within 2 weeks. Patients found to require a review will

trigger the Trust's Harm Review Process immediately and a full review takes place at the OP

appointment.

The CCG tracks progress of all 40+ week waiters at SFHFT using weekly information provided by

SFHFT, progress-chasing treatment/appointment dates where possible.

Anticipated Recovery: March 2019 once validation is complete and outstanding long-wait patients are

treated.

Issues: At the end of May, both M&A CCG and N&S CCG breached the standard at 90.4% (April was

89.7%) and 90.6% (was 89.9%) respectively. For both CCGs, this was mainly due to SFHFT.

Is a remedial action plan in place? Yes - SFHFT has an overall Trust recovery plan in place and a

trajectory has been submitted to NHSI indicating achievement of the standard at the end of July 2018.

However, the Trust has advised that it will now not achieve the standard until September 2018 at the

earliest. The Trust has provided the CCG with first cut specialty level recovery plans and the CCG has

met with the Trust to review.

Issues: vacancies, unexpected absence and emergency pressures.

Actions being taken include:

General Surgery: Additional theatre lists and OP sessions being arranged. Utilising agency to cover

gaps in staffing.

Urology: Additional lists and clinics. Additional consultant joining in July.

T&O: Additional capacity being sought.

Cardiology: Additional clinics arranged for June. System-wide working between SFHFT and GPWSI

who will be able to carry out 1 session per week to review and triage new referrals.

Gastroenterology: Additional clinics set up for July. Tele-clinics set up between June to August.

Anticipated Recovery: September 2018 for bottom-line at SFHFT.

52+ week

waits

Issue: Both M&A CCG and N&S CCG breached this standard for May month.

Actions being taken: SFHFT has provided the CCG with a refreshed recovery plan and a meeting

has taken place to go through this. The Trust has provided the CCG with a trajectory which indicates

that the Trust will achieve in July 2018.

The Trust had an unusually high level of referrals for Urology in March which led to approximately a

third more treatments than average in May - which impacted on the Trust's performance. It should be

noted that numbers have not continued at this level.

SFHFT has been working with the IST and recommendations have been fed into the refreshed

recovery plan. The Trust is pulling together a revised Cancer Strategy.

Actions being taken relating to pathways under the 62-Day to Treatment Recovery Plan will impact

positively on this standard.

Anticipated Recovery: The Trust anticipates sustaining a recovery for July 2018.

Improvement since previous month

No significant change in performance

Deterioration in performance since previous month

Key

Page 6 of 50







Key

M&A

CCGQ4 17-18 92% 45.0% -47.0% R

N&S

CCGQ4 17-18 92% 52.9% -39.1% R

Issues: The Q1 forecast for M&A CCG is 3.71%. Whilst this is not achieving the 4.2% target, this is an

improvement on the previous quarter. The Q1 forecast for N&S CCG is 4.4% which is achieving the

standard. Reasons for breaching include waiting times, high levels of patient cancellations/DNA rates

and staffing levels/capacity.

Is a remedial action plan in place? The CCGs and Let’s Talk Well Being (LTWB) agreed a recovery

trajectory to reduce the waiting times, improve flow through the service, and to increase capacity.

Actions taken:

• LTWB was successful in the recruitment of CBT Workers (3 agency) and Counsellors (2 permanent,

1 agency), together with increased in-house capacity. However, 2 x CBT workers have now finished

their contract. The Trust recently advertised for 7 CBT trained staff, but the Trust was only able to

recruit to one post. LTWB is looking to address the workforce issue by utilising counsellors more.

• LTWB is introducing 2 new ways of increasing their service. (1) a live text-based service which can

be utilised out-of-hours. There have been delays in implementing this due to the new GDPR rules.

However, once this is sorted, the contract between LTWB and the software company will be finalised.

(2) Silvercloud - a web-based direct referral service without the need for pre-assessment. A 3-month

pilot is taking place in Leicester from 16th July. Once testing is successful, it will be rolled-out to

Nottinghamshire (current plan = Oct/Nov 2018).

• The CCG has now distributed the new IAPT Information Card to all Mid-Nottinghamshire practices.

This contains provider contact numbers and referral information for patients. The CCG is reviewing

this to ensure location of clinics is clear for patients as this is thought to be a reason for non-

attendance.

• The Kings Mill Hospital Long Term Conditions pilot involves IAPT clinics being included in the Pain

and Cancer pathway. Discussions are taking place with regards to the expansion of IAPT into other

LTCs such as diabetes.

• Discussions are also taking place to increase the number of referrals from patients who have

experienced sexual violence; this will involve closer working between the IAPT and specialist sexual

violence services.

• The Mid-Nottinghamshire CCGs are currently undertaking a transformation of Mental Health services.

The main focus of the transformation is to increase the integration of physical and mental health and

the development of Primary Care Hubs. IAPT will be included in this work given that it is at the forefront

of the integrating physical health and psychological therapies. This should lead to an increase in the

access rates from those with a LTC and /or Older Adults.

• The CCG is re-procuring the service from April 2019.

• The CCG is in discussion with Health Education England (HEE) to reduce the training course to 18

months for IPAT trainees to put it in line with other Universities.

• The CCG is in discussion with victims of sexual violence organisations to see if we can include their

activity.

Issues: This service is provided by SFHFT and reasons for delay are capacity and Patient Choice.

SFHFT served notice on the CCGs for the Wheelchair Contract in 2017

Actions being taken: SFHFT has provided the CCGs with a Recovery Plan. Actions include:

• SFHFT held additional all day paediatric clinics in March and April 2018 to address the backlog,

together with an additional half day clinic in May. The Trust reduced appointments to 30 minutes to

maximise the number of patients seen.

• A new protocol has been implemented at SFHFT to offer cancelled appointments to paediatric

patients first (as opposed to the next patient on the waiting list)

• Now that the clinical workforce is back at full capacity, the Trust is able to offer additional domiciliary

assessment appointments where appropriate to increase capacity.

• A new database is in place which allows for:

o Introduction of E-Referrals – on trial with the Amputee Service and this is progressing well.

o Direct issue of stock - allowing for quicker processing of stock from a live stock list.

• To ensure best utilisation of clinics and to reduce DNAs, all parents are called prior to their child’s

appointments. To support this and improve efficiency the option of a text messaging service is being

explored.

Anticipate Recovery: SFHFT has advised that it will be at 92% for Q2. This is a regular agenda item

at the monthly performance meeting with SFHFT.

The CCG is looking to re-procure the service and a revised service specification containing a set of

KPIs has been developed in readiness for a new provider. Within this service specification, there are a

number of standards to be met including waiting times for different stages of the pathway.

IAPT %

Access

Waiting

Times for

Children

Wheelchair

M&A

CCG

Q1 draft

(May)4.20% 3.71% -0.49% R

Page 7 of 50







Key

M&A

CCGQ4 17/18 11% 24.9% 13.9% R

N&S

CCGQ3 17/18 11% 17.1% 6.1% R

M&A

CCG3rd July 30% 25.5% -4.6% R

N&S

CCG3rd July 30% 27.7% -2.3% R

Number of

cases of e-

coli

M&A

CCGMay-YTD 30 34 4 R

Issues: M&A CCG was over plan in May 2018. E.coli BSI is complex and multifactorial. There is no

single reason to explain the high numbers seen in May. Clear themes are not being identified despite

100% completion of case reviews. Not all of the cases have accessed healthcare prior to the episode,

48 % are linked to UTI which is the main source locally and nationally.The recent hot weather may be a

contributory factor as dehydration is an increased risk factor and many of these patients are elderly.

The majority of cases appear to be unavoidable with few reviews identifying any clear areas for

improvement. Nationally cases rose again last year by 1% and our local findings are similar to the

national findings.

Is a remedial action plan in place? Yes

Actions being taken: The IPC team continue to search for common themes, cases are discussed

with Microbiology and sepsis leads at the Nottinghamshire RCA group. A UTI focused workshop is

planned to scope for next actions to take.

Anticipated Recovery: Q2

Year to

Date In

Year

(surplus) /

Deficit

M&A

CCGJun-YTD 0 0.006 0.01 R

The CCG is slightly overspent at month 3 by £6,000. There is an overspend on acute services in

month, which is currently being offset by non recurrent underspends in primary care prescribing. The

position is also offset using contingency reserves set aside in the plan.

M&A

CCGJun-YTD -3.19 -2.76 0.44 R

YTD Delivery is below the forecast outturn target at month 3 by £0.44m. The shortfall is seen in urgent

and elective care programmes due to the slippage of planned schemes.

N&S

CCGJun-YTD -1.86 -1.42 0.44 R

YTD Delivery is below the forecast outturn target at month 3 by £0.436m. The shortfall is seen in

urgent and elective care programmes due to the slippage of planned schemes.

Year to

Date

Cumulative

Position

(surplus) /

Deficit

M&A

CCGJun-YTD 2.11 2.12 0.01 R

The CCG is slightly overspent at month 3 by £6,000. There is an overspend on acute services in

month, which is currently being offset by non recurrent underspends in primary care prescribing. The

position is also offset using contingency reserves set aside in the plan.

Cash

Position

Year to

Date (%

drawn

down)

N&S

CCGJun-YTD 48.41 49.54 1.13 R

The CCGs cash drawdown at month 3 is above the level expected by £1.1m when compared to a

profile where cash is drawn down in equal twelfths. The savings targets are set to deliver savings later

in the year and therefore should reduce the future cash outgoings.

QIPP - Year

to Date

Delivery

Issues: SATOD levels are historically high in Mid-Notts due to socio-economic factors. M&A CCG in

Q2 local data showed some improvement in smoking rates however these were not sustained in Q3 or

Q4.

Actions being taken: The CCGs are continuing to focus on SATOD using the local maternity system

Transformation Working Group as the key forum to deliver change across the system.

• SFHFT has developed revised guidelines for all maternity and obstetric staff around smoking in

pregnancy.

• Co2 Monitoring is offered to all pregnant women at booking.

• Opt-out electronic referral to smoking cessation for all smokers - this is initiated at booking.

• Letter to GP to advise smoking status following booking appointment. If a smoker, a dating scan

booked for “smokers clinic”. A further CO2 testing offered to smokers at dating scan.

• Risk perception model – the CCGs have funded an additional midwife training place.

• Smoking cessation collocated with hospital antenatal clinics.

• Serial growth scans for all smokers.

• NRT offered.

• Co2 reading at 36 weeks – all women.

• Referral to smoking cessation offered at all points of antenatal pathway

The National Target has been confirmed as 30% per practice - but with a minimum requirement of

10%. Both M&A and N&S CCGs continue to see an increase in take up. As at the 3rd July, M&A was

at 25.5% and N&S was at 27.7%. The level was 26.4% across the whole of Mid-Nottinghamshire. All

Mid-Nottinghamshire practices are above the minimum requirement of 10%.

Actions being taken:

• Distributing information to GP practices and providing links to order national POA promotional

materials. This includes information such as FAQs, local case studies and "tips", together with a "time

saved" calculator. Fresh communications relating to benefits is being pulled together.

• The NHIS Project Manager is providing practices with training, support & advice as required, and

raising awareness in PLTs & meetings.

• Support GP practices to send SMS text messages to patients re POA.

• Monthly information continues to be published in the CCGs’ Primary Care Dashboard.

• The NHSE have now recruited Nurse Clinical Champions for each Region who will be able to help

with local & regional events.

• The Steering Group remains in place and will be looking for opportunities to increase coverage.

Going forward, this group will cover Online Consultations as well.

Delivering the March 2019 target = All Mid-Nottinghamshire practices are above the minimum

requirement of 10%. For M&A, the achievement varies across practices ranging from 13.79% to

44.02% (with 24/28 practices below 30%). For N&S, the achievement ranges from 16.07% to 38.54%

(with 9/15 practices below 30%). There has been continual improvement for both CCGs each month.

% of

Smokers at

the Time of

Delivery

GP Access:

Patient

Online

Access

Page 8 of 50

Executive Summary: Narrative on RED rated indicators (Level 2)Trust KPIs

Indicator Period Plan Actual Diff RAG Trend Comments & Actions to be taken

Sherwood Forest Hospitals Foundation Trust

52+ week waits May-18 0 40 40 R

Issues: SFHFT continues to report breaches of the 52+ week standard. The cause of the breaches

has been mainly due to Data Quality and incorrect clock-stops. SFHFT had 40 breaches at the end

of May. 39 of these breaches were as a result of the Trust's validation of open pathways, and 1 breach

was due to Patient Choice. 26 patients were given dates in June and July, 9 are awaiting responses

from patients, 3 patients required no further treatment and 2 were for other reasons. Please see CCG

sections for update and actions being taken relating to SFHFT.

Anticipated Recovery: March 2019 once validation is complete and outstanding long-wait patients

are treated.

RTT Incomplete

Waiting TimesMay-18 92% 90.0% -2.0% R

Issues: This is the 9th consecutive month that SFHFT has failed the RTT 92% standard bottom-line.

An overall recovery plan is in place and a trajectory has been provided. The Trust has draft specialty

level recovery plans and the CCG has met with the Trust to review. SFHFT continues to work through

the actions to be taken and is aiming for September 2018 delivery. There is still a gap to deliver by

September but the Trust is progressing this. Please see CCG section for further details.

Anticipated Recovery: September 2018 for bottom-line.

CWT: 62-Day (all

cancers)May-18 85% 79.7% -5.3% R

Actions being taken: SFHFT has provided the CCG with a refreshed recovery plan. The Trust has

provided the CCG with a trajectory which indicates that the Trust will achieve in July 2018.

Please see CCG section for further details.

Actions being taken relating to pathways under the 62-Day to Treatment Recovery Plan will impact

positively on this standard.

Anticipated Recovery: The Trust anticipates sustaining a recovery for July 2018.

CWT: 2ww from GP

to 1st OP – BreastMay-18 93% 90.5% -2.5% R

Issue: SFHFT breached this standard for May month. The breaches were due to Patient Choice.

Actions being taken: The actions being taken under the 62-Day to Treatment Recovery Plan will

impact positively on this standard.

31-Day Subsequent

Treatment - SurgeryMay-18 94% 55.6% -38.4% R

Issue: SFHFT breached this standard for May month.

Actions being taken: The actions being taken under the 62-Day to Treatment Recovery Plan will

impact positively on this standard.

DTOCs Level of days

delayedMay-18 3.5% 3.9% 0.4% R

Issue: Level of Delayed Transfers of Care (DTOCs) are higher than the current 3.5% target. There

was an improvement in May when SFHFT was at 3.9%. However, local data shows that levels have

increased again in June.

Is a remedial action plan in place? The Intensive Recovery Roadmap Work Stream has pulled

together a System-wide Recovery Plan and this has been ratified by the A&EDB.

Delivery Actions:

• The CCGs are leading a system-wide work-stream referred to as The Intensive Recovery Roadmap

and DTOCs (and the related work) will be part of that. Progress against the Recovery Plan is

overseen by the Intensive Recovery Roadmap Programme Board and issues escalated to the A&E

Delivery Board.

• The first-cut Recovery Plan was completed in April 2018, together with a trajectory to reach 3.5% by

September 2018. Actions include:

• Ensure coding & reporting of DTOCs accurately reflects national guidance. The Health Community is

inviting ECIST back to carry out a review of previous work.

• Review of Discharge Policy (which also has a positive impact on the 95% A&E standard) and having

clear documented escalation process in place across the system.

• Increase proportion of discharges before 11:00am.

• Implementation of Trusted Assessor (anticipated Go-Live in July).

• The good performance of May is being reviewed by the Task & Finish Group to ensure that learning

and improvements are embedded.

Anticipated Recovery: September 2018.




Key




Key




Key

9 of 50

Executive Summary: Narrative on RED rated indicators (Level 2)Trust KPIs

Indicator Period Plan Actual Diff RAG Trend Comments & Actions to be taken




Key




Key




Key

East Midlands Ambulance Service

EMAS Total -

Category 1: Average

Response Time

7mins

May-18 00:07:00 00:08:06 00:01:06 R

EMAS Total -

Category 2: Average

Response Time

18mins

May-18 00:18:00 00:30:45 00:12:45 R

EMAS Total -

Category 2: 90th

Percentile Response

Time 40mins

May-18 00:40:00 01:04:35 00:24:35 R

EMAS Total -

Category 3: 90th

Percentile Response

Time 2hrs

May-18 02:00:00 02:53:55 00:53:55 R

EMAS Total -

Category 4: 90th

Percentile Response

Time 3hrs

May-18 03:00:00 02:42:50 00:17:10 R

Notts - Category 1:

Average Response

Time 7mins

May-18 00:07:00 00:07:46 00:00:46 R

Notts - Category 2:

Average Response

Time 18mins

May-18 00:18:00 00:28:16 00:10:16 R

Notts - Category 2:

90th Percentile

Response Time

40mins

May-18 00:40:00 00:58:26 00:18:26 R

Notts - Category 3:

90th Percentile

Response Time 2hrs

May-18 02:00:00 02:32:27 00:32:27 R

Issues: Overall continued non-achievement of national ARP standards at a trust level, with the

exception of CAT 4. In May 2018 EMAS achieved the national ARP Standard for NHS Mansfield &

Ashfield CCG for CAT 1 for both Mean & 90th Centile measures. No CAT response times were

achieved for NHS Newark & Sherwood CCG, however 2 Health Care Professional (HCP) time frames

were achieved for the area. Trust-wide EMAS achieved the 90th Centile measure for the Cat 1

standard, and the CAT 4 Standard which is only measured at the 90th Centile. Because both STF and

a trajectory to deliver performance are in place to achieve national ARP standards, commissioners are

unable to pursue core contracting mechanisms for non-achievement in 18/19

The protocol extending the auto trip of calls from DHU111 to EMAS for Cat 3 & 4 calls from 15 minutes

to 30 minutes has been approved for business as usual.

Actions include:

• The 18/19 contract deed of variation has now been signed following contract negotiations over recent

weeks & involvement from NHSE/I.

• Agreement has been reached to pay EMAS an additional £9.086m across the contract in 2018/19,

with payment being made retrospectively based on achievement of county level performance

trajectories.

• County level trajectories have now been received by Commissioners and we are awaiting milestone

action plans which will drive achievement of the trajectories.

• The additional investment for 2018/19 will be apportioned to CCG Level based on 2018/19 contract

shares.

• Deloittes will undertake a further contract pricing review during 2018 to provide the correct tariff price

for the 19/20 contract. This will incorporate and take account of any initiatives in relation to demand

and handover delays.

• In 2018/19, performance will be monitored against quarterly trajectories developed by ORH, and

delivered at a county level, with national performance standards being delivered quarterly at a county

level from April 2019 onwards. They will be in place from Q2, with the £9m being apportioned equally

over the 3 quarters during 2018/19. Each quarterly value will then be apportioned equally over the six

standards.

• Full payment will be made each quarter by each CCG if EMAS achieve all six of the quarterly

performance trajectories for the county within which each CCG resides. If any of the six performance

trajectories are not achieved at a county level, then the payment made by each CCG within that

county will be reduced by an equal share (i.e. one sixth) for each trajectory missed in the quarter

• The Mid-Notts proportion of the £9m uplift for 18/19 is £638,289.

• It was agreed that if the trajectories are not achieved, and pre-hospital handover delays within that

county exceed the modelled baseline for that quarter, EMAS will ask ORH to re-model the trajectories

for that quarter, for the relevant county. This remodelling will take into account 50% of any pre-hospital

handover delay over and above the baseline figure. This could then result in payment being made for

that quarter by the respective county. Further work needs to take place to develop and agree the

mechanism to manage handover delays. A paper went to the June A&E Delivery Board regarding this

and as requested, an action plan addressing handover delays will be delivered to the next board

meeting. Implementation of new rotas and operating model, along with the new urgent care tier

commenced in April 2018.

The local experience of the new Urgent Tier and its impact upon Notts CC colleagues will be reviewed

at the next A&EDB meeting, with regards to previous long waits for sectioned patients.

• Work continues to take place on an STP Footprint between Commissioners, EMAS and other system

partners to focus on reducing conveyance activity across the County by 3%.

• EMAS are participating in High Volume Service User conversations across the STP in an attempt to

align services and pathways for those patients who pose a high demand to services due to frequent

calls/presentations etc.

• Deep Dive meetings will continue to take place with Dale Bywater & coordinating commissioners

• NHSI have not currently approved the EMAS county level trajectories which equate to reduced

performance against ARP standards for the 18/19 financial year.

Anticipated Recovery: Improvement expected in Q3/4 18/19, but full recovery not anticipated until Q1

2018/19

10 of 50

Level 3: Full CCG Summary by Indicator - Latest Position

Domain Level Area Indicator Period Plan Actual Diff RAG Trend Plan Actual Diff RAG Trend

Finance CCG Finance Year to Date In Year (surplus) / Deficit Jun-YTD 0.00 0.01 0.01 R 0.00 -0.02 -0.02 G

Finance CCG Finance Forecast Outturn (surplus) / Deficit Jun-YTD 0.00 0.00 0.00 G 0.00 0.00 0.00 G

Finance CCG Finance Commissioning Spend - Forecast Outturn Jun-YTD 293.81 293.81 0.00 G 191.19 191.19 0.00 G

Finance CCG Finance Running Costs - Forecast Outturn Jun-YTD 4.12 4.12 0.00 G 2.79 2.79 0.00 G

Finance CCG Finance QIPP - Year to Date Delivery Jun-YTD -3.19 -2.76 0.44 R -1.86 -1.42 0.44 R

Finance CCG Finance QIPP - Forecast Outturn Delivery Jun-YTD -19.37 -19.37 0.00 G -11.68 -11.68 0.00 G

Finance CCG Finance Net Risk to Plan Forecast Outturn Jun-YTD 0.00 0.00 0.00 G 0.00 0.00 0.00 G

Finance CCG Finance Year to Date Cumulative Position (surplus) / Deficit Jun-YTD 2.11 2.12 0.01 R 0.35 0.33 -0.02 G

Finance CCG Finance Forecast Cumulative Position (surplus) / Deficit Jun-YTD 8.46 8.46 0.00 G 1.40 1.40 0.00 G

Finance CCG Finance Underlying Recurrent Position (surplus) / Deficit Jun-YTD 5.55 5.55 0.00 G 0.70 0.70 0.00 G

Finance CCG Finance Cash Position Year to Date (% drawn down) Jun-YTD 74.36 73.25 -1.12 G 48.41 49.54 1.13 R

Finance CCG Finance BPPC (% paid - value) Jun-YTD 95.0% 99.5% 4.9% G 95.0% 99.1% 4.9% G

GAP GAP GAP GAP GAP GAP GAP GAP GAP GAP GAP GAPActivity CCG NHSE SUS Plan - Submitted GP Referrals (acute) May-YTD 5749 6298 9.5% R 4350 4776 9.8% R

Activity CCG NHSE SUS Plan - Submitted Other Referrals (acute) May-YTD 2589 2896 11.9% R 1784 2030 13.8% R

Activity CCG NHSE SUS Plan - Submitted Total Referrals (acute) May-YTD 8338 9194 10.3% R 6134 6806 11.0% R

Activity CCG NHSE SUS Plan - Submitted Outpatient 1st (acute) May-YTD 9414 9665 2.7% R 6982 7252 3.9% R

Activity CCG NHSE SUS Plan - Submitted Outpatient F/Up (acute) May-YTD 20289 24216 19.4% R 13066 16011 22.5% R

Activity CCG NHSE SUS Plan - Submitted Total Outpatients (acute) May-YTD 29703 33881 14.1% R 20048 23263 16.0% R

Activity CCG NHSE SUS Plan - Submitted Total Elective IP & DC spells (acute) May-YTD 5207 4452 -14.5% G 3787 3409 -10.0% G

Activity CCG NHSE SUS Plan - Submitted Total Nonelective spells (acute) May-YTD 3765 3843 2.1% R 2162 2242 3.7% R

Activity CCG NHSE SUS Plan - Submitted Total A&E attendances (acute) May-YTD 10317 10855 5.2% R 7582 8235 8.6% R

GAP GAP GAP GAP GAP GAPActivity CCG NHSE SUS Plan - Rephased GP Referrals (acute) May-YTD 6035 6298 4.4% R 4512 4,776 5.9% R

Activity CCG NHSE SUS Plan - Rephased Other Referrals (acute) May-YTD 2490 2896 16.3% R 1732 2,030 17.2% R

Activity CCG NHSE SUS Plan - Rephased Total Referrals (acute) May-YTD 8319 9194 10.5% R 6102 6806 11.5% R

Activity CCG NHSE SUS Plan - Rephased Outpatient 1st (acute) May-YTD 9701 9665 -0.4% G 7159 7,252 1.3% G

Activity CCG NHSE SUS Plan - Rephased Outpatient F/Up (acute) May-YTD 24239 24216 -0.1% G 15857 16011 1.0% G

Activity CCG NHSE SUS Plan - Rephased Total Outpatients (acute) May-YTD 33940 33881 -0.2% G 23016 23263 1.1% G

Activity CCG NHSE SUS Plan - Rephased Total Elective IP & DC spells (acute) May-YTD 5245 4452 -15.1% G 3810 3409 -10.5% G

Activity CCG NHSE SUS Plan - Rephased Total Nonelective spells (acute) May-YTD 4096 3843 -6.2% G 2333 2,242 -3.9% G

Activity CCG NHSE SUS Plan - Rephased Total A&E attendances (acute) May-YTD 10570 10855 2.7% R 7766 8,235 6.0% R

GAP GAP GAP GAP GAP GAP GAP GAP GAP GAP GAP GAP GAP

Mansfield & Ashfield CCG Newark & Sherwood CCG




Key

Page 11 of 50







Key

Activity CCG at SFHFT SLAM Contract at SFHFT A&E attendances May-YTD 9049 9925 9.7% R 5767 6694 16.1% R

Activity CCG at SFHFT SLAM Contract at SFHFT Day Case admissions May-YTD 2855 2536 -11.2% G 1777 1550 -12.8% G

Activity CCG at SFHFT SLAM Contract at SFHFT Elective In-Patient Admissions May-YTD 296 457 54.4% R 231 347 50.3% R

Activity CCG at SFHFT SLAM Contract at SFHFT Non-Elective Admissions (Full Tariff) May-YTD 2568 3280 27.7% R 1201 1553 29.3% R

Activity CCG at SFHFT SLAM Contract at SFHFT Non-Elective Excess Bed Days (ALL TYPES) May-YTD 407 367 -9.8% G 187 102 -45.4% G

Activity CCG at SFHFT SLAM Contract at SFHFT Non-Elective Non-Emergency (Births and transfers) May-YTD 544 501 -7.9% G 237 219 -7.7% G

Activity CCG at SFHFT SLAM Contract at SFHFT Maternity Pathway (non delivery events) May-YTD 683 663 -2.9% G 355 346 -2.6% G

Activity CCG at SFHFT SLAM Contract at SFHFT Out-Patient First Attendances May-YTD 5483 6470 18.0% R 3667 4258 16.1% R

Activity CCG at SFHFT SLAM Contract at SFHFT Out-Patient Follow-Up Attendances May-YTD 9730 21688 122.9% R 5813 12662 117.8% R

Activity CCG at SFHFT SLAM Contract at SFHFT Out-Patient Procedure May-YTD 4784 4826 0.9% R 2521 2678 6.2% R

Activity CCG at SFHFT SLAM Contract at SFHFT Non-PBR May-YTD 145810 153722 5.4% R 94899 98880 4.2% R


Activity CCG Total SLAM Contract Total A&E attendances May-YTD 9604 10480 9.1% R 7033 7873 11.9% R

Activity CCG Total SLAM Contract Total Day Case admissions May-YTD 3613 3331 -7.8% G 2637 2547 -3.4% G

Activity CCG Total SLAM Contract Total Elective In-Patient Admissions May-YTD 494 602 21.9% R 431 547 26.9% R

Activity CCG Total SLAM Contract Total Non-Elective Admissions (Full Tariff) May-YTD 2778 3537 27.3% R 1565 2025 29.4% R

Activity CCG Total SLAM Contract Total Non-Elective Excess Bed Days (ALL TYPES) May-YTD 608 377 -38.0% G 336 220 -34.6% G

Activity CCG Total SLAM Contract Total Non-Elective Non-Emergency (Births and transfers) May-YTD 615 596 -3.05% G 351 353 0.6% R

Activity CCG Total SLAM Contract Total Maternity Pathway (non delivery events) May-YTD 689 667 -3.2% G 376 361 -4.1% G

Activity CCG Total SLAM Contract Total Out-Patient First Attendances May-YTD 6667 7728 15.9% R 5365 5993 11.7% R

Activity CCG Total SLAM Contract Total Out-Patient Follow-Up Attendances May-YTD 12593 24678 96.0% R 9533 16529 73.4% R

Activity CCG Total SLAM Contract Total Out-Patient Procedure May-YTD 5556 5641 1.5% R 3844 4031 4.8% R

Activity CCG Total SLAM Contract Total Non-PBR May-YTD 148172 157851 6.5% R 130969 135437 3.4% R


Page 12 of 50







Key

Performance CCG Waiting Times RTT Incomplete May-18 92% 90.4% -1.6% R 92% 90.6% -1.4% R

Performance CCG Waiting Times 52+ week waits May-18 0 17 17 R 0 19 19 R

Performance CCG Waiting Times Audiology May-18 N/A 98.0% N/A N/A 98.5% N/A

Performance CCG Waiting Times Diagnostics May-18 1% 0.7% -0.3% G 1% 0.65% -0.3% G

Performance CCG Cancer Waits 2 Weeks from GP referral to 1st OP appointment May-18 93% 96.6% 3.6% G 93% 93.2% 0.2% G

Performance CCG Cancer Waits 31-Days from diagnosis (decision to treat) to treatment - all cancers May-18 96% 99.2% 3.2% G 96% 97.6% 1.6% G

Performance CCG Cancer Waits 62-Days from urgent referral to treatment - all cancers May-18 85% 83.1% -1.9% R 85% 70.0% -15.0% R

Performance CCG Cancer Waits 2 Weeks from GP referral to 1st OP appointment – Breast symptoms May-18 93% 90.3% -2.7% R 93% 100.0% 7.0% G

Performance CCG Cancer Waits 62 Day Upgrade Standard (admitted & non-admitted) May-18 N/A 82.4% N/A N/A 100.0% N/A

Performance CCG Cancer Waits 62-Day Screening Standard (admitted - breast) May-18 90% 100.0% 10.0% G 90% 100.0% 10.0% G

Performance CCG Cancer Waits 62-Day Screening Standard (admitted - all types) May-18 90% 90.0% 0.0% G 90% 100.0% 10.0% G

Performance CCG Cancer Waits 31-Day Subsequent Treatment - Surgery May-18 94% 100.0% 6.0% G 94% 100.0% 6.0% G

Performance CCG Cancer Waits 31-Day Subsequent Treatment - Drug May-18 98% 100.0% 2.0% G 98% 100.0% 2.0% G

Performance CCG Cancer Waits 31-Day Subsequent Treatment - Radiotherapy May-18 94% 100.0% 6.0% G 94% 100.0% 6.0% G

Performance CCG MH IAPT % Access Q1 draft (May) 4.20% 3.71% -0.49% R 4.20% 4.40% 0.20% G

Performance CCG MH IAPT % Recovery Q1 draft (May) 50% 52.1% 2.1% G 50% 57.8% 7.8% G

Performance CCG MH Early Intervention - % patients waiting LESS than 2 weeks May-18 53% 100.0% G 53% No activity G

Performance CCG MH Early Intervention - number of patients waiting MORE than 2 weeks May-18 0 N/A N/A No activity N/A N/A

Performance CCG MH Dementia - % of patients 65+ with a diagnosis May-18 66.70% 77.4% 10.7% G 66.70% 66.7% 0.0% G

Performance CCG MH Transforming Care (Nottinghamshire Total) May-18 53 65 12 R 53 65 12 R

Performance CCG Maternity % of Smokers at the Time of Delivery Q4 17-18 11% 24.9% 13.9% R 11% 17.1% 6.1% R

Performance CCG Wheelchairs Waiting Times for Children Wheelchairs Q4 17-18 92% 45.0% -47.0% R 92% 52.9% -39.1% R

Performance CCG E-Referrals % e-Referrals to SFHFT (as part of the national pilot) May-18 80% 99.92% 19.9% G 80% 100.0% 20.0% G

Performance CCG GP Access Practices with Extended Access May-18 100.0% 100.0% 0.0% G 100.0% 100.0% 0.0% G

Performance CCG GP Access Patient Online Access (Vanguard target rather than national 20%) 3rd July 30% 25.5% -4.6% R 30% 27.7% -2.3% R

GAP GAP GAP GAP GAP GAP GAP GAP GAP GAP GAP GAP GAPQuality CCG HCAIs Number of cases of MRSA May-YTD 0 0 0 G 0 0 0 G

Quality CCG HCAIs Number of cases of C-difficile May-YTD 16 12 -16 G 6 6 0 G

Quality CCG HCAIs Number of cases of e-coli May-YTD 30 34 4 R 20 13 -7 G

Quality CCG CHC % of DSTs performed in an acute setting Q1 18/19 15% 2.0% -13.0% G 15% 0.0% -15.0% G

Quality CCG CHC % of referrals concluded in 28 days Q1 18/19 80% 87.0% 7.0% G 80% 93.0% 13.0% G

Quality CCG Organisational Number of formal complaints received May-YTD 13 N/A 5 N/A

Quality CCG Organisational Acknowledge written complaints within 3 working days May-YTD 100% 100.00% 0.0% G 100% 100.00% 0.0% G

Quality CCG Organisational Number of serious incidents May-YTD 14 N/A 9 N/A

Quality CCG Organisational Number of PHBs (CHC and wider) Q1 18/19 74 94 20 G 49 100 51 G

Quality CCG Organisational GAP GAP GAP GAP

Page 13 of 50

Level 3: Total Trust Summary for Key Indicators - Latest Position


Performance Total Trust Waiting Times RTT Incomplete May-18 92% 90.0% -2.0% R 92% 94.0% 2.0% G

Performance Total Trust Waiting Times 52+ week waits May-18 0 40 40 R 0 5 5 R

Performance Total Trust Waiting Times Audiology May-18 95% 98.0% 3.0% G 95% 100.0% 5.0% G

Performance Total Trust Waiting Times Diagnostics May-18 1% 0.9% -0.1% G 1% 0.5% -0.5% G

Performance Total Trust Cancer Waits 2 Weeks from GP referral to 1st OP appointment May-18 93% 99.8% 6.8% G 93% 96.0% 3.0% G

Performance Total Trust Cancer Waits 31-Days from diagnosis (decision to treat) to treatment - all cancers May-18 96% 99.3% 3.3% G 96% 95.0% -1.0% G

Performance Total Trust Cancer Waits 62-Days from urgent referral to treatment - all cancers May-18 85% 79.7% -5.3% R 85% 85.1% 0.1% R

Performance Total Trust Cancer Waits 2 Weeks from GP referral to 1st OP appointment – Breast symptoms May-18 93% 90.5% -2.5% R 93% 98.6% 5.6% G

Performance Total Trust Cancer Waits 62 Day Upgrade Standard (admitted & non-admitted) May-18 N/A 87.5% N/A N/A 88.9% N/A

Performance Total Trust Cancer Waits 62-Day Screening Standard (admitted - breast) May-18 90% 100.0% 10.0% G 90% 100.0% 10.0% G

Performance Total Trust Cancer Waits 62-Day Screening Standard (admitted - all types) May-18 90% 100.0% 10.0% G 90% 91.7% 1.7% G

Performance Total Trust Cancer Waits 31-Day Subsequent Treatment - Surgery May-18 94% 55.6% -38.4% R 94% 88.5% -5.5% G

Performance Total Trust Cancer Waits 31-Day Subsequent Treatment - Drug May-18 98% 100.0% 2.0% G 98% 98.6% 0.6% G

Performance Total Trust Cancer Waits 31-Day Subsequent Treatment - Radiotherapy May-18 94% N/A N/A 94% 99.4% 5.4% G

Performance Total Trust Cancer Waits Patients waiting 104+ days. Weekly position w/e 24/06/18 0 6 6 R

Performance Total Trust A&E 4-Hours to admission, discharge or transfer Jun-18 95% 97.2% 2.2% G 95% 85.9% -9.1% R

Performance Total Trust DTOCs Level of days delayed (NHSE reported figure) May-18 3.5% 3.9% 0.4% R 3.5% 3.2% -0.3% G

Performance Total Trust VTEs % of VTE Risk Assessments Q4 Final 95.0% 95.5% 0.5% G

Performance Total Trust Ambulance Handover Ambulance Pre-handover times - Main Site (in minutes) May-18 00:15:00 00:18:08 00:03:08 R 00:15:00 00:15:36 00:00:36 R

Performance Total Trust Ambulance Handover Ambulance Pre-handover times - 2nd Site (in minutes) May-18 00:15:00 00:11:22 -00:02:29 G 00:15:00 00:20:23 00:05:23 R


Quality Total Trust HCAIs MRSA – all patients at Trust May-YTD 0 0 0 G 0 1 1 R

Quality Total Trust HCAIs C-Diff levels – all patients at Trust May-YTD 8 5 -3 G 14 15 1 R

Quality Total Trust Complaints Number of formal complaints received May-YTD 47 N/A 111 N/A

Quality Total Trust Serious Incidents Number of serious incidents May-YTD 7 N/A 4 N/A

Quality Total TrustStaff Sickness &

AbsenceLevel of staff sickness/absence trust total (3.5% is SFHT internal target) May-YTD 3.50% 3.2% -0.3% G 3.60% 3.90% 0.30% R

Quality Total Trust Staff Appraisals Number of staff with in date appraisals May-YTD 95% 95% 0.0% G 90% 87% -3.00% R

Quality Total Trust Never Events Number of Never Events May-YTD 0 0 0.0% G 0 0 0.00% G

Quality Total Trust MSA breaches Number of MSA breaches May-YTD 3 0 -300.0% G 0 0 0.00% G

Quality Total Trust Mandatory Training Number of staff with all mandatory training in date May-YTD 90% 92% 2.0% G 90% 86% -4.00% R

Quality Total Trust Friends & FamilyInpatient - % of patients who would recommend the service to their friends and

familyMay-YTD 96% 98% 2.1% G 90% 97% 7.40% G

GAP GAP GAP GAP GAP GAP GAP GAP GAP GAP GAP GAP GAP GAP GAP

Domain Level Area Indicator Period Plan Actual Diff RAG Trend

Performance EMAS Total Response Times Category 1: Average Response Time 7mins May-18 00:07:00 00:08:06 00:01:06 R

Performance EMAS Total Response Times Category 1: 90th Percentile Response Time 15mins May-18 00:15:00 00:14:36 00:00:24 G

Performance EMAS Total Response Times Category 2: Average Response Time 18mins May-18 00:18:00 00:30:45 00:12:45 R

Performance EMAS Total Response Times Category 2: 90th Percentile Response Time 40mins May-18 00:40:00 01:04:35 00:24:35 R

Performance EMAS Total Response Times Category 3: 90th Percentile Response Time 2hrs May-18 02:00:00 02:53:55 00:53:55 R

Performance EMAS Total Response Times Category 4: 90th Percentile Response Time 3hrs May-18 03:00:00 02:42:50 00:17:10 R

Performance Notts Division Response Times Category 1: Average Response Time 7mins May-18 00:07:00 00:07:46 00:00:46 R

Performance Notts Division Response Times Category 1: 90th Percentile Response Time 15mins May-18 00:15:00 00:13:25 00:01:35 G

Performance Notts Division Response Times Category 2: Average Response Time 18mins May-18 00:18:00 00:28:16 00:10:16 R

Performance Notts Division Response Times Category 2: 90th Percentile Response Time 40mins May-18 00:40:00 00:58:26 00:18:26 R

Performance Notts Division Response Times Category 3: 90th Percentile Response Time 2hrs May-18 02:00:00 02:32:27 00:32:27 R

Performance Notts Division Response Times Category 4: 90th Percentile Response Time 3hrs May-18 03:00:00 02:21:38 00:38:22 G

SFHFT NUH

EMAS




Key

Page 14 of 50

Level 4: Performance Trends for Constitutional & Key Performance Targets

Total CCG

Area Indicator/Target Target To be met May-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18

Performance

shift prev

month

Q

4

1

6

Q1 17/18 Q2 17/18Q3

17/18

Q4

17/18

Performance

shift prev

quarter

ICP RTT: 92% of patients should wait <= 18 weeks while waiting for treatment. 92.0% Monthly 93.2% 92.2% 90.9% 91.1% 90.4% 89.5% 89.7% 90.4%

52+ Week Waiters: patients waiting 52+ weeks should be zero. zero Monthly 3 4 7 8 9 9 14 17

Audiology: 95% of audiology patients wait <= 18 weeks from GP referral to

treatment (incomplete)95.0% Monthly 100.0% 100.0% 99.2% 99.3% 99.0% 99.3% 97.7% 98.0%

Diagnostic Waiting Times: % waiting 6+ weeks for a key-15 test at the end of each

month. <=1% Monthly 0.5% 0.6% 0.7% 1.3% 1.2% 2.1% 1.2% 0.7%

2 Weeks from GP referral to first OP appointment 93.0% Quarterly 95.3% 95.8% 98.1% 96.7% 98.1% 97.6% 98.1% 96.6% 94.8% 96.6% 96.8% 97.5%

31-Days from diagnosis (decision to treat) to treatment, for all cancers 96.0% Quarterly 96.8% 97.2% 97.1% 98.9% 98.7% 97.8% 98.0% 99.2% 96.4% 95.6% 97.3% 98.5%

62-Days from urgent referral to treatment for all cancers 85.0% Quarterly 70.6% 83.7% 89.4% 100.0% 75.0% 93.8% 82.9% 83.1% 79.1% 67.4% 84.2% 89.7%

2 Weeks from GP referral to first outpatient appointment – Breast symptoms 93.0% Quarterly 100.0% 100.0% 100.0% 95.8% 92.9% 100.0% 95.5% 90.3% 96.9% 98.0% 98.6% 96.4%

62 Day Upgrade Standard (admitted & non-admitted) N/A N/A 75.0% 78.6% 78.9% 100.0% 90.9% 81.0% 100.0% 82.4% 92.0% 90.2% 77.1% 89.6%

62-Day Screening Standard (admitted - breast) 90.0% Quarterly 100.0% 80.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 93.8% 85.7% 92.9% 100.0%

62-Day Screening Standard (admitted - all types) 90.0% Quarterly 100.0% 75.0% 100.0% 75.0% 100.0% 75.0% 100.0% 90.0% 88.9% 83.3% 89.5% 84.6%

31-Day Subsequent Treatment - Surgery 94.0% Quarterly 93.8% 92.9% 71.4% 81.8% 100.0% 91.7% 81.8% 100.0% 95.1% 86.2% 89.7% 91.9%

31-Day Subsequent Treatment - Drug 98.0% Quarterly 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 90.9% 100.0% 100.0% 100.0% 100.0% 100.0%

31-Day Subsequent Treatment - Radiotherapy 94.0% Quarterly 100.0% 93.3% 100.0% 100.0% 95.0% 100.0% 100.0% 100.0% 98.6% 95.5% 96.6% 97.6%

Access: % of people who have who enter treatment for psychological therapies. 4.20% Quarterly N/A 3.34% 3.41% 3.30% 3.37%

Recovery: % of people who have depression and/or anxiety disorders who achieve

recovery. 50.0% Quarterly N/A 51.33% 49.00% 51.3% 55.7%

Waiting Times: % of referrals that finish a course of treatment, receiving their first

treatment appointment within 6 weeks of referral75% Quarterly N/A 91.0% 85.0%


treatment appointment within 18 weeks of referral95% Quarterly N/A 100.0% 100.0%

% of patients waiting LESS than 2 weeks 50.0% Quarterly 100.0%No

Activity100% 100% 100%

No

Activity

No

Activity100% N/A 75.0% 71.4% 100.0% 100.0%

Number of patients waiting MORE than 2 weeks 0No

Activity0 0 0 0

No

Activity0 N/A 2 2 0 0

MH: Dementia

DiagnosisProportion of dementia patients aged 65+ years with a diagnosis 66.7% Monthly 74.4% 78.7% 78.1% 77.7% 77.1% 69.1% 77.2% 77.4% N/A

SATOD % of women who were recorded as smokers at the time of delivery 11.0% Quarterly 23.7% 18.2% 20.7% 24.9%

Number of practices with Extended Access 100%End of

Year29.6% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% N/A

% of GP referrals to a consultant-led service via electronic e-Referral system at

SFHFT. National target = 80% & 100% by October 2018

Pilot =

100%

End of

Year95.7% 99.8% 99.9% 99.91% 99.95% 99.9% 99.9% 99.9% N/A

Level of patients with Online Access. National target for March 2018 = 25%. National

target for March 2019 = 30% but with a minimum of 10%

Mar 2019

min 10%

End of

Year20.2% 22.0% 23.7% 24.8% 25.0% 25.2% N/A

Childrens

WheelchairsWaiting Times for Children Wheelchairs 92.0% Quarterly 50.0% 33.3% 56.3% 45.0%

Mansfield & Ashfield CCG - patients at any hospital

Waiting Times

Cancer WTs

MH: IAPT

MH: Early

Intervention

GP Access




Key

Page 15 of 50


Total CCG


Performance

shift prev

month

Q

4

1

6

Q1 17/18 Q2 17/18Q3

17/18

Q4

17/18

Performance

shift prev

quarter




Key





Diagnostic Waiting Times: % waiting 6+ weeks for a key-15 test at the end of each

month. <= 1% Monthly 0.6% 0.4% 1.0% 1.3% 1.1% 2.0% 1.0% 0.7%

2 Weeks from GP referral to first OP appointment 93.0% Quarterly 94.2% 95.5% 97.6% 92.8% 96.4% 94.6% 94.5% 93.2% 94.3% 95.0% 96.9% 94.6%

31-Days from diagnosis (decision to treat) to treatment, for all cancers 96.0% Quarterly 98.4% 98.4% 96.8% 98.7% 98.3% 98.6% 100.0% 97.6% 97.5% 97.6% 98.4% 99.0%

62-Days from urgent referral to treatment for all cancers 85.0% Quarterly 75.9% 75.9% 82.4% 76.7% 85.3% 86.1% 86.7% 70.0% 81.1% 83.7% 82.4% 83.0%

2 Weeks from GP referral to first outpatient appointment – Breast symptoms 93.0% Quarterly 95.7% 95.5% 88.2% 95.2% 94.1% 81.3% 72.7% 100.0% 95.6% 100.0% 95.2% 90.7%

62 Day Upgrade Standard (admitted & non-admitted) N/A N/A 71.4% 91.7% 100.0% 75.0% 83.3% 90.0% 92.9% 100.0% 83.3% 74.1% 85.7% 85.7%

62-Day Screening Standard (admitted - breast) 90.0% Quarterly 100.0% 100.0% 100.0% 100.0% 100.0%No

Activity

No

Activity100.0% N/A 100.0% 100.0% 100.0% 100.0%

62-Day Screening Standard (admitted - all types) 90.0% Quarterly 100.0% 100.0% 100.0% 85.7% 75.0% 100.0% 87.5% 100.0% 100.0% 85.7% 100.0% 80.0%

31-Day Subsequent Treatment - Surgery 94.0% Quarterly 93.8% 100.0% 100.0% 66.7% 95.0% 90.0% 100.0% 100.0% 92.6% 90.6% 100.0% 85.7%

31-Day Subsequent Treatment - Drug 98.0% Quarterly 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

31-Day Subsequent Treatment - Radiotherapy 94.0% Quarterly 92.3% 91.7% 95.2% 95.5% 100.0% 100.0% 100.0% 100.0% 97.7% 98.3% 95.5% 98.6%

Access: % of people who have who enter treatment for psychological therapies. 4.20% Quarterly 3.94% 3.99% 3.60% 4.12%

Recovery: % of people who have depression and/or anxiety disorders who achieve

recovery. 50.0% Quarterly 51.7% 50.00% 58.7% 61.3%


treatment appointment within 6 weeks of referral75% Quarterly 91.0% 88.0%


treatment appointment within 18 weeks of referral95% Quarterly 100.0% 98.0%

% of patients waiting LESS than 2 weeks 50.0% Quarterly No activity 100.0% 100.0% 100.0%No

Activity

No

Activity100.0%

No

ActivityN/A 100.0% 80.0% 100.0% 100.0%

Number of patients waiting MORE than 2 weeks 0 0 0 0No

Activity

No

Activity0

No

ActivityN/A 0 1 0 0

MH: Dementia

DiagnosisProportion of dementia patients aged 65+ years with a diagnosis 66.7% Monthly 67.3% 68.6% 68.2% 67.3% 66.4% 71.2% 66.4% 66.7% N/A

SATOD % of women who were recorded as smokers at the time of delivery 11.0% Quarterly 19.3% 16.5% 14.5% 17.1%

Number of practices with Extended Access 100%End of

Year0.0% 43.0% 43.0% 43.0% 100.0% 100.0% 100.0% 100.0% N/A

% of GP referrals to a consultant-led service via electronic e-Referral system at

SFHFT. National target = 80% & 100% by October 2018

Pilot =

100%

End of

Year94.7% 99.7% 99.9% 100.00% 100.0% 99.8% 99.9% 100.0% N/A

Level of patients with Online Access. National target for March 2018 = 25%. National

target for March 2019 = 30% but with a minimum of 10%

Mar 2019

min 10%

End of

Year24.6% 25.7% 26.1% 27.0% 27.1% 27.4% N/A

Childrens

WheelchairsWaiting Times for Children Wheelchairs 92.0% Quarterly 42.9% 11.1% 42.9% 52.9%

Newark & Sherwood CCG - patients at any hospital

Waiting Times

Cancer WTs

MH: IAPT

MH: Early

Intervention

GP Access

Page 16 of 50


Total Trust

Area Indicator/Target Target To be met Apr-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18

Performance

shift prev

month

Q4 16/17 Q1 17/18 Q2 17/18Q3

17-18

Q4

17-18

Performance

shift prev

quarter





Diagnostic Waiting Times: % waiting 6+ weeks for a key-15 test at the end of

each month. <= 1% Monthly 1.2% 0.3% 0.9% 1.2% 1.0% 3.4% 1.4% 0.9%

2 Weeks from GP referral to first OP appointment 93.0% Quarterly 92.4% 95.7% 98.1% 95.6% 97.7% 96.3% 97.5% 99.8% 96.6% 94.9% 96.3% 96.8% 96.5%

31-Days from diagnosis (decision to treat) to treatment, for all cancers 96.0% Quarterly 99.0% 99.2% 100.0% 99.1% 97.0% 98.3% 99.2% 99.3% 97.3% 98.6% 98.2% 99.5% 98.2%

62-Days from urgent referral to treatment for all cancers 85.0% Quarterly 86.3% 83.5% 88.3% 90.4% 83.8% 91.9% 87.6% 79.7% 86.2% 84.6% 78.2% 85.0% 88.8%

2 Weeks from GP referral to first outpatient appointment – Breast symptoms 93.0% Quarterly 91.7% 97.8% 97.6% 96.1% 95.7% 96.4% 95.7% 90.5% 94.2% 96.2% 99.2% 97.8% 96.1%

62 Day Upgrade Standard (admitted & non-admitted) N/A N/A 100.0% 91.1% 92.9% 93.6% 94.4% 88.9% 95.4% 87.5% 89.4% 88.5% 86.5% 87.3% 92.0%

62-Day Screening Standard (admitted - breast) 90.0% Quarterly 100.0% 75.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 93.8% 85.7% 92.3% 100.0%

62-Day Screening Standard (admitted - all types) 90.0% Quarterly 100.0% 71.4% 100.0% 63.6% 90.9% 77.8% 100.0% 100.0% 87.5% 90.0% 80.0% 88.9% 77.4%

31-Day Subsequent Treatment - Surgery 94.0% Quarterly 100.0% 90.0% 100.0% 70.0% 100.0% 66.7% 100.0% 55.6% 100.0% 96.6% 95.7% 94.7% 78.6%

31-Day Subsequent Treatment - Drug 98.0% Quarterly 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 91.7% 100.0% 96.1% 100.0% 100.0% 100.0% 100.0%

31-Day Subsequent Treatment - Radiotherapy 94.0% Quarterly N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Number of patients waiting 104+ days (based on last week of the month)

(both with and without a decision to treat)zero

Monthly

w/e 24th

June

1 7 7 7 10 1 2 6

A&E Percentage of patients meeting 4 hour maximum wait in A&E 95.0% Monthly 95.9% 91.9% 86.4% 87.2% 89.0% 88.8% 92.4% 95.7% 94.0% 96.0% 94.19% 90.7% 88.3%

DTOCsTotal reportable days delayed (S1 & S2) as a % of the total occupied beddays

DTOCs should be at a minimum level. Based on NHSE data.

To be at 3.5% for September 2018

Apr18 = 5.0%

May18 = 4.7%

Jun18 = 4.3%

Jul18 = 4.0%

Aug18 = 3.8%

Monthly 4.1% 4.4% 4.1% 4.6% 5.8% 5.3% 5.1% 3.9%

VTE % of VTE Risk Assessments 95.0% Quarterly 92.0% 95.95% 95.1% 95.5% 95.7% 95.4% N/A N/A 94.9% 94.1% 95.2% 95.8% 95.5%





Diagnostic Waiting Times: % waiting 6+ weeks for a key-15 test at the end of

each month. <= 1% Monthly 0.4% 0.5% 0.7% 0.6% 0.3% 0.5% 0.8% 0.5%

2 Weeks from GP referral to first OP appointment 93.0% Quarterly 93.2% 97.4% 94.6% 90.0% 97.6% 95.1% 93.1% 96.0% 95.0% 93.9% 97.1% 96.9% 94.3%

31-Days from diagnosis (decision to treat) to treatment, for all cancers 96.0% Quarterly 96.1% 96.7% 96.5% 97.1% 98.4% 96.3% 96.9% 95.0% 96.5% 96.3% 97.4% 96.9% 97.3%

62-Days from urgent referral to treatment for all cancers 85.0% Quarterly 78.5% 81.3% 82.1% 81.4% 81.2% 86.7% 84.1% 85.1% 74.9% 77.1% 79.3% 83.7% 83.3%

2 Weeks from GP referral to first outpatient appointment – Breast symptoms 93.0% Quarterly 88.7% 100.0% 96.5% 100.0% 97.5% 97.5% 94.3% 98.6% 93.7% 94.0% 98.1% 99.1% 98.3%

62 Day Upgrade Standard (admitted & non-admitted) N/A N/A 82.6% 87.1% 77.1% 79.3% 81.5% 69.4% 86.5% 88.9% 79.5% 79.3% 85.9% 80.8% 75.1%

62-Day Screening Standard (admitted - breast) 90.0% Quarterly 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 98.4% 100.0% 100.0% 100.0% 100.0%

62-Day Screening Standard (admitted - all types) 90.0% Quarterly 95.7% 97.9% 100.0% 85.2% 98.0% 95.4% 100.0% 91.7% 95.5% 88.2% 92.1% 95.1% 91.5%

31-Day Subsequent Treatment - Surgery 94.0% Quarterly 94.1% 95.0% 94.6% 93.0% 96.3% 96.0% 100.0% 88.5% 91.3% 96.9% 95.0% 95.3% 94.8%

31-Day Subsequent Treatment - Drug 98.0% Quarterly 98.8% 99.3% 99.3% 98.8% 100.0% 99.4% 99.4% 98.6% 99.5% 98.4% 98.7% 98.8% 99.3%

31-Day Subsequent Treatment - Radiotherapy 94.0% Quarterly 97.9% 97.3% 97.4% 98.8% 99.4% 99.0% 99.0% 99.4% 98.5% 98.0% 97.9% 97.6% 99.1%

A&E Percentage of patients meeting 4 hour maximum wait in A&E 95.0% Monthly 81.6% 84.7% 77.8% 79.8% 75.5% 76.6% 82.4% 84.3% 82.0% 80.9% 83.3% 82.4% 77.5%

NUH - any CCG patients at the Trust

SFHFT - any CCG patients at the Trust

Waiting Times

Cancer WTs

Waiting Times

Cancer WTs




Key

Page 17 of 50

Level 4: Quality Indicators for CCGs and TrustsTotal CCG and Total Trust


Performance

shift prev

month

Q1

17-18

Q2

17-18

Q3

17-18

Q4

17-18

Q1

18-19

Performance

shift prev

quarter

MRSA – CCG patients at any hospital. zero Annual 0 0 0 0 0 0 0 0 0 0 0 0

C-Diff levels – CCG patients at any hospital. NB: the

target is the 2nd

figure in each box.Actual/Plan Annual 4/8 7/8 6/8 7/7 5/8 8/8 7/7 5/8 12/24 23/23 23/24 20/23

E-Coli levels – CCG patients at any hospital. NB:

the target is the 2nd


Complaints Number of formal complaints received Monthly 4 6 0 6 3 1 7 6 12 18 10 10

Serious Incidents Number of serious incidents Monthly 8 8 8 7 2 4 7 7 23 14 18 3

Personal Health

BudgetsNumber of PHBs (CHC and wider)

as per

trajectoryQuarterly 190 221 281 338 94

MRSA – CCG patients at any hospital. zero Annual 0 0 0 0 0 0 0 0 0 0 0 0

C-Diff levels – CCG patients at any hospital. NB: the

target is the 2nd


E-Coli levels – CCG patients at any hospital. NB:

the target is the 2nd




Personal Health

BudgetsNumber of PHBs (CHC and wider)

as per

trajectoryQuarterly 164 198 259 310 100

Number of GP practices with an Intense Level of

SupportMonthly 1 3 3 3 3 4 3 5

Number of GP practices with an Intermediate Level

of SupportMonthly 7 2 2 2 2 3 4 3

Number of GP practices with an Routine Level of

SupportMonthly 19 22 22 22 22 20 20 19



Number of GP practices with an Intense Level of


Number of GP practices with an Intermediate Level

of SupportMonthly 5 6 6 5 5 3 2 0

Number of GP practices with an Routine Level of




CCG Level of

Support Ratings

CCG Level of

Support Ratings

Primary Care Newark & Sherwood CCG

HCAIs

HCAIs

Mansfield & Ashfield CCG - patients at any hospital

Newark & Sherwood CCG - patients at any hospital

Primary Care Mansfield & Ashfield CCG




Key

Page 18 of 50


Performance

shift prev

month

Q1

17-18

Q2

17-18

Q3

17-18

Q4

17-18

Q1

18-19

Performance

shift prev

quarter

Number of Care Homes with an High Level of

SupportMonthly 4 5 5 5 5 8 7

Number of Care Homes with an Moderate Level of


Number of Care Homes with an Low Level of




Number of Care Homes with an High Level of


Number of Care Homes with an Moderate Level of


Number of Care Homes with an Low Level of




MRSA – all patients at Trust zero Annual 0 1 0 0 0 0 0 0 0 1 1 0

C-Diff levels – all patients at Trust. NB: the target is

the 2nd


Complaints Number of complaints received Monthly 21 19 13 24 22 31 18 29 57 42 48 77

Serious IncidentsNumber of serious incidents (including Never

Events)Monthly 4 1 5 3 4 2 3 4 6 7 8 9

Sickness & AbsenceLevel of staff sickness/absence trust total. SFHFT

internal target = 3.5%.Internal 3.5% Monthly 3.7% 4.0% 4.2% 4.7% 4.23% 3.4% 3.2% 3.2%

Appraisal Rates Number of staff with in date appraisals Internal 95% Monthly 92% 95% 94% 94% 95% 95% 96% 95%

Never Events Number of Never Events zero Monthly 0 0 1 0 0 0 0 0 0 0 2 0

Number of Grade 2 Avoidable Acquired Pressure

Ulcers

36 per

annumMonthly 5/3 0/3 1/3 1/3 1/3 1/3 0/3 1/3 11/9 3/9 2/9 3/9


Ulcerszero Monthly 1/0 0/0 1/0 0/0 0/0 0/0 0/0 0/0 1/0 0/0 1/0 0/0


Ulcerszero Monthly 0/0 0/0 0/0 0/0 0/0 0/0 0/0 0/0 0/0 1/0 0/0 0/0


Ulcers per 1000 OBD Monthly 0.28 0.00 0.05 0.05 0.06 0.05 0.00 0.05





Mixed Sex

AccommodationNumnber of MSA breaches zero Monthly 0 0 0 0 0 0 0 0 0 0 0 0

Mandatory Training Number of staff with all mandatory training in date 90% Monthly 91% 93% 93% 94% 95% 94% 92% 92%

Friends & FamilyInpatient - % of patients who would recommend the

service to their friends and family96% Monthly 98% 98% 99% 99% 99% 97% 98% 98%

CCG Level of

Support Ratings

HCAIs

Pressure Ulcers

Care Homes Newark & Sherwood CCG

Sherwood Forest Hospitals Trust (Total Trust - any patient)

CCG Level of

Support Ratings

Care Homes Mansfield & Ashfield CCG

Page 19 of 50


Performance

shift prev

month

Q1

17-18

Q2

17-18

Q3

17-18

Q4

17-18

Q1

18-19

Performance

shift prev

quarter

MRSA – all patients at Trust zero Annual 0 0 0 0 1 0 1 0 1 0 0 1

C-Diff levels – all patients at Trust. NB: the target is

the 2nd


Complaints Number of complaints received 45 59 40 63 53 53 59 52 143 170 155 169

Serious Incidents

Number of serious incidents per 1000 occupied ned

dates. Change of indicator in 2017/18 - Number

of serious incidents

Monthly 4 5 7 5 3 2 1 3 13 12 21 10

Sickness & AbsenceLevel of staff sickness/absence trust total. Target =

3.6%3.60% Monthly 3.64% 3.68% 3.70% 3.70% 3.70% 3.70% 3.83% 3.90%

Appraisal Rates Number of staff with in date appraisals 90% Monthly 91% 89% 89% 88% 87% 87% 88% 87%



Ulcers per 1000 OBD 0.33 Monthly 0.38 0.35 0.39 0.40 0.32 0.42 0.24 0.24


Ulcers per 1000 OBD 0.05 Monthly 0.00 0.05 0.00 0.11 0.05 0.07 0.05 0.05


Ulcers per 1000 OBD zero Monthly 0 0 0 0 0 0 0 0

Mixed Sex

AccommodationNumnber of MSA breaches zero Monthly 0 0 0 0 1 0 0 0 0 0 0 1

Mandatory Training Number of staff with all mandatory training in date 90% Monthly 86% 87% 88% 87% 87% 87% 87% 86%


service to their friends and family90% Monthly 98% 96% 98% 98% 97% 98% 97% 97%

MRSA – all patients zero Annual 0 0 0 1 0 0 0 0 1 0 0 1

C-Diff levels – all patients . NB: the target is the 2nd


Complaints Number of complaints received Monthly 51 65 43 79 79 56 56 162 197 166 201

Serious Incidents Number of serious incidents Monthly 25 27 16 15 26 10 22 77 74 65 51

Sickness & AbsenceLevel of staff sickness/absence trust total - target =

4.5%4.50% Monthly 4.3% 4.9% 4.8% 5.3% 5.6% 4.5% 4.8% 4.7%

Appraisal Rates Number of staff with in date appraisals 95% Monthly 79% 79% 79% 81% 77% 80% 80% 79%


Number of Grade 2 Acquired Pressure Ulcers 28 per month Monthly 55/28 41/28 44/28 50/28 42/28 5/28 126/84 105/84 129/84 92/48

Number of Grade 3 Acquired Pressure Ulcers zero Monthly 3/0 6/0 8/0 1/0 5/0 7/0 1/0 10/0 13/0 22/0 13/0

Number of Grade 4 Acquired Pressure Ulcers zero Monthly 2/0 2/0 2/0 5/0 0/0 2/0 1/0 7/0 4/0 5/0 7/0

Mixed Sex

AccommodationNumnber of MSA breaches zero Monthly 0 2 1 1 2 0 0 0 3 5 3

Mandatory TrainingNumber of staff with all mandatory training in date

(Target = 85% in 2016/17)95% Monthly 91% 91% 91% 91% 91% 90% 83% 92%


service to their friends and family90% Monthly 93% 88% 91% 90% 90% 90% 91%

Pressure Ulcers

HCAIs

Pressure Ulcers

HCAIs

NUH (Total Trust - any patient)

United Lincoln Hospitals Trust (Total Trust - any patient)

Page 20 of 50


Performance

shift prev

month

Q1

17-18

Q2

17-18

Q3

17-18

Q4

17-18

Q1

18-19

Performance

shift prev

quarter

MRSA – all patients zero Annual 0 0 0 0 0 0 0 0 0 0 0 0

C-Diff levels – all patients NB: the target is the 2nd

figure in each box.Actual/Plan Annual 1 0 0 0 0 1 0 0 2 2 0 1

Complaints

Number of complaints received. Change of indicator

in 2017/18 - Number of complaints is Total NHCT,

not just LP

Monthly 80 70 40 65 60 78 63 66 198 200 180 203

Serious Incidents

Number of serious incidents. Change of indicator in

2017/18 - Number of serious incidents is Total

NHCT, not just LP

Monthly 32 25 20 20 22 20 37 32 77 74 76 62

Sickness & Absence

Level of staff sickness/absence trust total. Change

of indicator in 2017/18 - Number of sickness is Total

NHCT, not just LP

3.50% Monthly 5.0% 5.5% 6.1% 6.4% 5.40% 5.00% 4.80% 4.70%

Appraisal Rates

Number of staff with in date appraisals. Change of

indicator in 2017/18 - Number of appraisal is Total

NHCT, not just LP

95% Monthly 85% 83% 82% 80% 83% 83% 82% 83%


Pressure Ulcers Number of Avoidable Acquired Pressure Ulcers Monthly 18 24 15 23 20 23 19 17 77 56 59 66

Mixed Sex

Accommodation

Numnber of MSA breaches. Change of indicator in

2017/18 - Number of MSA is Total NHCT, not just LPzero Monthly 0 0 0 0 0 0 0 0 0 0 0 0

Mandatory Training

Number of staff with all mandatory training in date.

Change of indicator in 2017/18 - Number of training

is Total NHCT, not just LP

90% Monthly 91% 91% 91% 90% 90% 90% 91% 91%

Friends & Family

% of patients who would recommend the NHS

services to their friends and family who need similar

treatment or care.

90% Monthly 96% 97% 94% 94% 95% 95% 95% 96%

Complaints Number of complaints received Monthly 11 19 8 9 11 16 8 8 48 51 43 20


Sickness & AbsenceLevel of staff sickness/absence trust total. Change

of target in 2017/18 = 5.3%Internal 5.3% Monthly 5.6% 6.4% 7.2% 6.5% 6.36% 4.87%

Appraisal Rates Number of staff with in date appraisals 95% Monthly 69% 73% 73% 73% 75% 80%


Mandatory Training Number of staff with all mandatory training in date 90% Monthly

Friends & Family

% of staff who would recommend the NHS services

they work in to friends and family who need similar

treatment or care

80% Quarterly 87% 85%

HCAIs

Local Partnerships/NHCT (Total Trust - any patient)

EMAS - East Midlands Abulance Service (Total Trust - any patient)

Page 21 of 50


Performance

shift prev

month

Q1

17-18

Q2

17-18

Q3

17-18

Q4

17-18

Q1

18-19

Performance

shift prev

quarter

Complaints Number of complaints received Monthly 0 1 2 4 0 4 1 2 4 5 8

Serious Incidents Number of serious incidents Monthly 0 0 0 0 0 0 0 0 0 0 0

Sickness & Absence Level of staff sickness/absence trust total Internal 4% Monthly 3.5% 3.3% 5.0% 3.7% 6.8% 2.8% 1.2%

Appraisal Rates Number of staff with in date appraisals Internal 95% Quarterly 77.6% 74.0% 72.0% 67.4% 74.0%


MandatoryTraining Number of staff with all mandatory training in date 90% Monthly N/A N/A 51.0% 71.1% 78.8% 78.2% 85.8%

Vacancy Rate Number of staff vacancies (clinical & non-clinical) 0% Quarterly 13.4% 20.9% 26.9% 26.9% 13.4%

Turnover Rate Number of staff leaving organisation Monthly N/A 4.2% 4.4% 2.2% 0.0% 3.6% 2.2%

Staff Friends and

Family Test


they work in to friends and family who need similar

treatment or care

Monthly N/A N/A N/A N/A N/A N/A

Staff Friends and

Family Test


they work in to friends and family as a place to workMonthly N/A N/A N/A N/A N/A N/A

NQR 1 NEMS to report regularly to CCG Monthly

NQR 2NEMS to send details of OOH Consultations to GP

PracticesMonthly

NQR 3 Providing care to patients with pre-defined needs Monthly

NQR 4 Review of clinical performance of individuals Monthly

NQR 5 Sample of patient experiences Monthly

NQR 6 Complaints Process Monthly

NQR 7 Matching of capacity to demand Monthly

NQR 11 Clinician appropriate to patient's need - GP available Monthly

Emergency - commence < 1 hour 90% Monthly 0% 100% 100% 100% 67% 100% 100% 100%

Urgent - commence < 2 hours 90% Monthly 95% 95% 90% 94% 100% 94% 100% 97%

Less urgent - commence < 6 hours 90% Monthly 100% 98% 100% 100% 100% 100% 100% 100%

Emergency - commence < 1 hour 90% Monthly 100% 100% 100% 100% 100% 100% 100% 100%

Urgent - commence < 2 hours 90% Monthly 91% 93% 92% 100% 88% 90% 89% 100%

Less urgent - commence < 6 hours 90% Monthly 97% 100% 91% 94% 94% 91% 94% 98%

NQR 13Provision for patients with special communication

needsMonthly

NQR 12 Primary

Care Centre

Consultations

NQR 12 Home Visit

Consultations

NEMS Community Benefit Services Limited (Mid-Notts patients)

Page 22 of 50

Level 4: Finance Mid-Notts CCGs

2018/19 Plan /

Target

2018/19 Actual

/Forecast

2018/19

Variance

April 2018 - June 2018 : Month 3 £'m £'m £'m

Year to Date In Year (surplus) / Deficit 0.00 -0.02 -0.02

Forecast Outturn (surplus) / Deficit 0.00 0.00 0.00

Commissioning Spend - Forecast Outturn 485.00 485.00 0.00

Running Costs - Forecast Outturn 6.92 6.92 0.00

QIPP - Year to Date Delivery -5.05 -4.18 0.87

QIPP - Forecast Outturn Delivery -31.05 -31.05 0.00

Net Risk to Plan Forecast Outturn 0.00 0.00 0.00

Year to Date Cumulative Position (surplus) / Deficit 2.46 2.44 -0.02

Forecast Cumulative Position (surplus) / Deficit 9.86 9.86 0.00

Underlying Recurrent Position (surplus) / Deficit 6.25 6.25 0.00

Cash Position Year to Date (% drawn down) 122.78 122.79 0.01

BPPC (% paid - value) 95.0% 99.4% 4.9% The CCGs have met the target to pay 95% invoices within 30 days.

The CCGs cash drawdown at month 3 is above the level expected by £11k when compared to a profile where cash is drawn down in equal twelfths. The savings

targets are set to deliver savings later in the year and therefore should reduce the future cash outgoings.

This is the planned EXIT underlying position of the CCG at the end of 2018/19. As the CCG is currently forecasting breakeven this is also reported as breakeven to

plan at month 3. With the increase in costs at month 3 on acute services, supported by non recurrent prescribing underspends, this position will be need to be

monitored closely.

At month 3 the CCG is reporting a breakeven forecast position. The risk from slippage in the delivery of the QIPP savings programme is offset by the use of

contingency and the development of headroom schemes.

The CCGs are slightly underspent at month 3 by £16,000. There is however an overspend on acute services in month, which is currently being offset by non

recurrent underspends in primary care prescribing. The position is also offset using contingency reserves set aside in the plan.

The net delivery risk remains at of nil at month 3. See below for further detail.

At month 3 the CCG is reporting a forecast delivery of £31m QIPP programme. A review is underway to de-risk all the current delivery plans and develop

headroom schemes to underpin any slippage in delivery.

YTD Delivery is below the forecast outturn target at month 3 by £0.87m. The shortfall is seen in urgent and elective care programmes due to the slippage of

planned schemes.

Running costs are currently forecasting a breakeven position at year end. This is under review as any interim cost pressures arising which will need to be

mitigated in year.

Although the position on Acute services is £3,942,000 overspent at month 3, this is being offset by underspends in prescribing and the use of contingency to

date. There is a process in place to identify headroom schemes which impact 2018/19 and therefore the forecast is currently breakeven to plan.

The overspend to date largely reflects the requirement to mitigate the QIPP delivery risk highlighted to NHSE of £8m for the full year and also non elective

activity above plan for which cost containment actions will be required.



The CCG is slightly underspent at month 3 by £16,000. There is however an overspend on acute services in month, which is currently being offset by non


Financial Assurance Dashboard

Commentary

LEVEL 1

April 2018 - June 2018 : Month 3 Joint Mid-Nottinghamshire Position

Page 23 of 50

Level 4: Finance Mid-Notts CCGs April 2018 - June 2018 : Month 3 Joint Mid-Nottinghamshire Position

As at month 3, the Mid-Nottinghamshire CCGs have slightly underspent against the planned year to date budget by £0.02m. The year to date variance comprises of :

o NHS Mansfield and Ashfield CCG - 04E £0.006m YTD variance at month 3 (Previously reported £0.2m)

o NHS Newark and Sherwood CCG - 04H -£0.02m YTD variance at month 3 (Previously reported -£0.2m)

The year to date position estimate includes an adverse variance on Acute Activity seen in the early month 3 activity reporting. It should be noted however that this largely reflects the requirement to mitigate the QIPP delivery risk highlighted to NHSE of £8m

for the full year. A full and complete validation of the £8m QIPP risk is being undertaken urgently at the CCGs to identify mitigating actions.

In addition to this there has been further increased non-elective and outpatient activity above plan. This is mitigated at month 3 by contingency reserves set aside within the plan and also a favourable variance from prescribing and activity estimates in

2017/18.

The CCG is currently actively generating headroom QIPP schemes to mitigate the risk in the plan and also undertaking a full review to de-risk the current delivery plans. This work covers:-

• Reducing demand by removing unwarranted clinical variation

• Decommissioning further services through service benefit reviews

• Increasing areas of restricted and not routinely funded procedures

• Pursuit of clinical transformation opportunities highlighted through Right Care and other benchmarking information

In addition to this the CCG continues to strengthen and improve the delivery confidence of agreed QIPP schemes.

The above position has been notified to NHS England.

Risks reported at month 3 highlight £12.8m of risk. This comprises of £8.0m relating to QIPP delivery and £4.8m relating to other risks of activity above plan. This is mitigated to an overall net risk of nil through use of the contingency budget set aside at plan

stage and additional QIPP headroom saving schemes which will impact 2018/19.

The CCGs cash drawdown at month 3 is above the level expected by just £11k when compared to a profile where cash is drawn down in equal twelfths. The savings targets are set to deliver savings later in the year and therefore should reduce the future

cash outgoings.

Finance Executive Summary

MID-NOTTINGHAMSHIRE POSITION - FINANCIAL PERFORMANCE REPORT

Page 24 of 50


2018/19 Plan /

Target

2018/19 Actual

/Forecast

2018/19

Variance


Year to Date In Year (surplus) / Deficit 0.00 0.01 0.01







Year to Date Cumulative Position (surplus) / Deficit 2.11 2.12 0.01



Cash Position Year to Date (% drawn down) 74.36 73.25 -1.12

BPPC (% paid - value) 95.0% 99.5% 4.9% The CCGs have met the target to pay 95% invoices within 30 days.

The CCGs cash drawdown at month 3 is under plan by £1.1m when compared to a profile where cash is drawn down in equal twelfths.

This is the planned exit underlying position of the CCG at the end of 2018/19. As the CCG is currently forecasting breakeven this is also reported as breakeven to


monitored closely.



The CCG is slightly overspent at month 3 by £6,000. There is an overspend on acute services in month, which is currently being offset by non recurrent

underspends in primary care prescribing. The position is also offset using contingency reserves set aside in the plan.

The net delivery risk remains at of nil at month 3.

At month 3 the CCG is reporting a forecast delivery of £31m QIPP programme across Mid Nottinghamshire. A review is underway to de-risk all the current

delivery plans and develop headroom schemes to underpin any slippage in delivery.


planned schemes.


mitigated in year.

Although the position on Acute services is £2,086,000 overspent at month 3, this is being offset by underspends in prescribing and the use of contingency to

date. There is a process in place to identify headroom schemes which impact 2018/19 and therefore the forecast is currently breakeven to plan.

The overspend to date largely reflects the requirement to mitigate the QIPP delivery risk highlighted to NHSE of £8m across Mid Nottinghamshire for the full

year and also non elective activity above plan to date for which cost containment actions will be required.



The CCG is slightly overspent at month 3 by £6,000. There is an overspend on acute services in month, which is currently being offset by non recurrent

underspends in primary care prescribing. The position is also offset using contingency reserves set aside in the plan.


MANSFIELD & ASHFIELD CCGCommentary

Page 25 of 50


2018/19 Plan /

Target

2018/19 Actual

/Forecast

2018/19

Variance


Year to Date In Year (surplus) / Deficit 0.00 -0.02 -0.02







Year to Date Cumulative Position (surplus) / Deficit 0.35 0.33 -0.02



Cash Position Year to Date (% drawn down) 48.41 49.54 1.13

BPPC (% paid - value) 95.0% 99.1% 4.9%

(G = on plan or better, R = off plan)

The CCGs have met the target to pay 95% invoices within 30 days.

The CCGs cash drawdown at month 3 is above the level expected by £1.1m when compared to a profile where cash is drawn down in equal twelfths. The savings

targets are set to deliver savings later in the year and therefore should reduce the future cash outgoings.

This is the planned exit underlying position of the CCG at the end of 2018/19. As the CCG is currently forecasting breakeven this is also reported as breakeven to


monitored closely.



The CCG is slightly underspent at month 3 by £22,000. There is however an overspend on acute services in month, which is currently being largely offset by non


The net delivery risk remains at of nil at month 3.

At month 3 the CCG is reporting a forecast delivery of £31m QIPP programme across Mid Nottinghamshire. A review is underway to de-risk all the current

delivery plans and develop headroom schemes to underpin any slippage in delivery.


planned schemes.


mitigated in year.

Although the position on Acute services is £1,856,000 overspent at month 3, this is being offset by underspends in primary care and prescribing as well as the

use of contingency to date. There is a process in place to identify headroom schemes which impact 2018/19 and therefore the forecats is currently breakeven to

plan.

The overspend to date largely reflects the requirement to mitigate the QIPP delivery risk highlighted to NHSE of £8m across Mid Nottinghamshire for the full

year and also non elective activity above plan to date for which cost containment actions will be required.



The CCG is slightly underspent at month 3 by £22,000. There is however an overspend on acute services in month, which is currently being largely offset by non



NEWARK & SHERWOOD CCGCommentary

Page 26 of 50

Level 4: QIPP Finance Summary - Mid-Nottinghamshire CCGs Month 3

Total Mid-Nottinghamshire CCGs

Delivery Board QIPP Reporting SRO Plan FOT Variance Plan Actual Variance Plan Actual VarianceIn-

MonthYTD

£k £k £k £k £k £k £k £k £k £k £k

Urgent & Proactive Care Lucy Dadge 6,073 6,073 1,992 1,535 (456) 641 467 (173) Red Amber

Elective Care David Ainsworth 11,168 11,168 1,608 892 (717) 536 227 (309) Red Red

Community Lucy Dadge 4,620 4,620 157 157 52 52 Green Green

Mental Health Lucy Dadge 2,554 2,554 237 262 25 79 90 11 Green Green

Maternity, Paediatrics and Children Lucy Dadge 1,508 1,508 146 203 58 52 77 25 Green Green

CHC Elaine Moss 2,500 2,000 (500) 240 240 80 80 Green Green

Primary Care and Prescribing Lucy Dadge 2,555 3,055 500 635 887 252 208 340 132 Green Green

Other CCG Lucy Dadge 72 72 36 (36) 12 (12) Red Red

Headroom Schemes Grey GreyTotal Mid Notts CCGs 31,050 31,050 0 5,051 4,177 (874) 1,660 1,333 (327) Amber Amber

Mansfield & Ashfield CCG


MonthYTD

£k £k £k £k £k £k £k £k £k £k £k

Urgent & Proactive Care Lucy Dadge 3,797 3,797 1,242 1,006 (236) 408 297 (112) Red Amber

Elective Care David Ainsworth 7,064 7,064 1,024 621 (403) 345 170 (175) Red Red


Mental Health Lucy Dadge 1,437 1,437 146 177 31 49 55 6 Green Green

Maternity, Paediatrics and Children Lucy Dadge 879 879 87 143 55 31 42 11 Green Green

CHC Elaine Moss 1,546 1,237 (309) 150 150 50 50 Green Green

Primary Care and Prescribing David Ainsworth 1,543 1,852 309 384 521 137 126 202 76 Green Green


Headroom Schemes Grey Grey

Total CCG 19,372 19,372 0 3,193 2,756 (437) 1,063 862 (201) Amber Amber

Newark & Sherwood CCG


MonthYTD

£k £k £k £k £k £k £k £k £k £k £k

Urgent & Proactive Care Lucy Dadge 2,276 2,276 750 530 (220) 232 171 (62) Red Red

Elective Care David Ainsworth 4,104 4,104 584 270 (314) 191 57 (135) Red Red


Mental Health Lucy Dadge 1,117 1,117 91 86 (5) 30 35 4 Green Amber

Maternity, Paediatrics and Children Lucy Dadge 629 629 58 61 2 21 35 14 Green Green

CHC Elaine Moss 954 763 (191) 90 90 30 30 Green Green

Primary Care and Prescribing David Ainsworth 1,012 1,203 191 250 366 115 82 139 57 Green Green


Headroom Schemes Grey Grey

Total CCG 11,679 11,679 0 1,858 1,421 (436) 597 471 (126) Amber Amber

April 2018 - June-18 : Month 3 2018/19 Programme 2018/19 YTD QiPP Delivery 2018/19 QiPP Delivery Finance RAGs

April 2018 - June-18 : Month 3 2018/19 Programme 2018/19 YTD QiPP Delivery 2018/19 QiPP Delivery Finance RAGs

April 2018 - June-18 : Month 3 2018/19 Programme 2018/19 YTD QiPP Delivery 2018/19 M03 QiPP Delivery Finance RAGs

Page 27 of 50

Level 4: QIPP Summary - Mid-Nottinghamshire CCGs

Financial Summary For 3 Months to June-18

FYE/NEW SRO Plan FOT Variance Plan Actual Variance Plan Actual Variance In-Month YTD

£k £k £k £k £k £k £k £k £k £k £k

Urgent & Proactive CareCall for Care 1819-003 FYE Lucy Dadge 427 427 266 134 (132) 89 38 (50) Red Red

Frailty 1819-013 FYE Lucy Dadge 1,771 1,771 664 419 (245) 221 95 (126) Red Red

Intensive Home Support (Phase 2) 1819-012 FYE Lucy Dadge 43 43 12 10 (1) 4 (4) Red Amber

High Volume Service Users 1819-014 FYE Lucy Dadge 365 365 122 110 (11) 41 18 (23) Red Amber

Enhanced Care Homes Service 1819-004 FYE Lucy Dadge 85 85 21 90 69 7 38 31 Green Green

GP Access 1819-006 FYE Lucy Dadge 412 412 152 39 (113) 51 22 (29) Red Red

ECP EMAS 1819-007 FYE Lucy Dadge 42 42 42 42 Grey Green

HRG4+ Price Review 1819-009 FYE Lucy Dadge 739 739 370 370 123 123 Green Green

Integrated Discharge Service 1819-017 FYE Lucy Dadge 225 225 111 111 37 37 Green Green

SFH Non Core Service Review 1819-011 FYE Lucy Dadge 290 290 145 145 48 48 Green Green

End of life 1819-008 FYE/NEW Lucy Dadge 253 253 28 44 16 33 33 Green Green

GU Clinical Pathways (NELs) 1819-001 NEW Lucy Dadge 365 365 Grey Grey

Ambulatory Emergency Care 1819-015 NEW Lucy Dadge 203 203 6 6 6 6 Green Green

Newark Urgent Treatment Centre 1819-016 NEW Lucy Dadge 386 386 Grey Grey

EMAS Non Conveyance 1819-080 NEW Lucy Dadge 467 467 59 15 (44) 20 9 (11) Red Red

Urgent & Proactive Care Total 6,073 6,073 0 1,992 1,535 (456) 641 467 (173) Red Amber

Elective CareIntegrated MSK Model 1819-032 FYE David Ainsworth 2,568 2,568 639 421 (218) 213 163 (50) Amber Red

Non NHS Further Service Review 1819-020 FYE David Ainsworth 241 241 135 135 45 45 Green Green

In patient Sleep Studies 1819-022 FYE David Ainsworth 42 42 18 15 (3) 6 6 0 Green Amber

Gynaecology 1819-019 FYE David Ainsworth 118 118 39 50 11 13 13 0 Green Green

Community Ophthalmology 1819-029 FYE/NEW David Ainsworth 347 347 87 93 6 29 35 6 Green Green

Community Dermatology Service 1819-025 NEW David Ainsworth 140 140 47 45 (2) 16 20 5 Green Green

Diagnostic Opportunities 1819-021 NEW David Ainsworth 560 560 84 (84) 28 (28) Red Red

Compliance with BADS 1819-026 NEW David Ainsworth 255 255 38 121 83 13 13 0 Green Green

Gastroenterology – Implementation of Primary Care Triage 1819-036 NEW David Ainsworth 17 17 6 11 5 2 3 1 Green Green

Elective Care Transformation 1819-028 NEW David Ainsworth 6,880 6,880 516 (516) 172 (172) Red Red

MSK Prescribing FYE 1819-107 David Ainsworth (72) (72)

Elective Care Total 11,168 11,168 0 1,608 892 (717) 536 227 (309) Red Red

CommunityCommunity Services Contract 1819-050 FYE/NEW Lucy Dadge 2,766 2,766 38 38 13 13 Green Green

Intermediate Care Services 1819-052 NEW Lucy Dadge 328 328 82 82 27 27 Green Green

Intensive Recovery 1819-047 NEW Lucy Dadge 1,013 1,013 Grey Grey

Local Integrated Care Teams 1819-046 NEW Lucy Dadge 150 150 38 38 13 13 Green Green

Chatsworth Unit – Neuro - rehabilitation 1819-048 NEW Lucy Dadge 173 173 Grey Grey

Mid Nottinghamshire Wheelchair Service 1819-044 NEW Lucy Dadge 190 190 Grey Grey

Community Total 4,620 4,620 0 157 157 0 52 52 0 Green Green

Mental HealthMental Health Contract 1819-051 FYE/NEW Lucy Dadge 2,101 2,101 124 155 31 41 73 32 Green Green

Mental Health Core 24 (NHT) QIPP 1819-040 FYE Lucy Dadge 250 250 62 56 (6) 21 (21) Red Amber

Mental Health Placements 1819-049 FYE Lucy Dadge 203 203 51 51 17 17 Green Green

Mental Health Total 2,554 2,554 0 237 262 25 79 90 11 Green Green

Maternity, Paediatrics and Children Children's Community Nursing and Therapy Contract 1819-054 FYE/NEW Lucy Dadge 294 294 41 15 (26) 14 5 (9) Red Red

Reducing ED Attendances & Admission Avoidance 1819-058 FYE/NEW Lucy Dadge 946 946 39 134 95 13 23 10 Green Green

Newborn Opportunities 1819-060 NEW Lucy Dadge 20 20 5 9 4 5 9 4 Green Green

Cows Milk Protein Allergy Prescribing 1819-059 NEW Lucy Dadge 100 100 25 (25) 8 (8) Red Red

Reducing Outpatient Activity and Elective Admissions 1819-056 NEW Lucy Dadge 148 148 36 45 9 12 40 28 Green Green

Maternity, Paediatrics and Children Total 1,508 1,508 0 146 203 58 52 77 25 Green Green

1819

Scheme

ID

2018/19 Annual Programme 2018/19 YTD QiPP Delivery 2018/19 M03 QiPP Delivery Finance RAGs

Page 28 of 50

Level 4: QIPP RED Schemes - Mid-Nottinghamshire CCGs

Financial Summary For 3 Months to June-18

RED : FINANCE RAG FYE/NEW SRO Plan FOT Variance Plan Actual Variance Plan Actual Variance In-Month YTD

£k £k £k £k £k £k £k £k £k £k £k

Urgent & Proactive CareCall for Care 1819-003 FYE Lucy Dadge 427 427 266 134 (132) 89 38 (50) Red Red

Frailty 1819-013 FYE Lucy Dadge 1,771 1,771 664 419 (245) 221 95 (126) Red Red

Intensive Home Support (Phase 2) 1819-012 FYE Lucy Dadge 43 43 12 10 (1) 4 (4) Red Amber

High Volume Service Users 1819-014 FYE Lucy Dadge 365 365 122 110 (11) 41 18 (23) Red Amber

GP Access 1819-006 FYE Lucy Dadge 412 412 152 39 (113) 51 22 (29) Red Red

EMAS Non Conveyance 1819-080 NEW Lucy Dadge 467 467 59 15 (44) 20 9 (11) Red Red

Urgent & Proactive Care Total 3,485 3,485 0 1,275 728 (547) 425 182 (243) Red Red

Elective CareIntegrated MSK Model 1819-032 FYE David Ainsworth 2,568 2,568 639 421 (218) 213 163 (50) Amber Red

Diagnostic Opportunities 1819-021 NEW David Ainsworth 560 560 84 (84) 28 (28) Red Red

Elective Care Transformation 1819-028 NEW David Ainsworth 6,880 6,880 516 (516) 172 (172) Red Red

Elective Care Total 10,008 10,008 0 1,239 421 (818) 413 163 (250) Red Red

Mental HealthMental Health Core 24 (NHT) QIPP 1819-040 FYE Lucy Dadge 250 250 62 56 (6) 21 (21) Red Amber

Mental Health Total 250 250 0 62 56 (6) 21 0 (21) Red Amber

Maternity, Paediatrics and Children Children's Community Nursing and Therapy Contract 1819-054 FYE/NEW Lucy Dadge 294 294 41 15 (26) 14 5 (9) Red Red

Cows Milk Protein Allergy Prescribing 1819-059 NEW Lucy Dadge 100 100 25 (25) 8 (8) Red Red

Maternity, Paediatrics and Children Total 394 394 0 66 15 (51) 22 5 (17) Red Red

Primary Care and PrescribingMid Nottinghamshire Diabetes Development 1819-071 FYE/NEW David Ainsworth 205 205 53 29 (24) 9 21 12 Green Red

Core Plus All 1819-073 FYE/NEW David Ainsworth 805 805 175 7 (168) 70 (70) Red Red

Primary Care and Prescribing Total 1,010 1,010 0 228 36 (192) 79 21 (58) Red Red

Other CCGCSU Changes 1819-090 Lucy Dadge Lucy Dadge 72 72 36 (36) 12 (12) Red Red

Other CCG Total 72 72 0 36 0 (36) 12 0 (12) Red Red

SUB TOTAL 15,219 15,219 0 2,906 1,256 (1,650) 972 371 (601) Red Red

GRAND TOTAL 15,219 15,219 0 2,906 1,256 (1,650) 972 371 (601) Red Red

1819

Scheme

ID

2018/19 Annual Programme 2018/19 YTD QiPP Delivery 2018/19 M03 QiPP Delivery Finance RAGs

Page 29 of 50

Level 4: PMO summary of QIPP delivery risks and recovery actions Month 3

Scheme ID Scheme Name

FYE/New YTD

Planned

Savings

YTD

Actual

Savings

YTD

Variance

Financial

BRAG in

month

Financial

BRAG YTD

Milestone

BRAG

PMO

Confidence

BRAG

Summary Comment

Urgent & Proactive Care £'000 £'000 £'000

1819-003 Call for Care FYE £266 £134 -£132 Red Red Green Amber

Currently scheme is underperforming however exception report provides

confidence of full recovery through the mitigating actions.

1819-013 Frailty FYE £664 £419 -£245 Red Red Amber Amber



1819-012 Intensive Home Support (Phase 2) FYE £12 £10 -£1 Red Amber Red Green

1819-014 High Volume Service Users FYE £122 £110 -£11 Red Amber Amber Amber



1819-004 Enhanced Care Homes Service FYE £21 £90 £69 Green Green Green Green

1819-006 GP Access FYE £152 £39 -£113

Red Red Blue Red

Currently scheme is underperforming. Recovery plan in place however a risk

to full recovery remains. Possible shortfall to be mitigated through

headroom schemes.

1819-007 ECP EMAS FYE £42 £42 £0 Grey Green Green Green

1819-009 HRG4+ Price Review FYE £370 £370 £0 Green Green Green Green

1819-017 Integrated Discharge Service FYE £111 £111 £0 Green Green Blue Green

1819-011 SFH Non Core Service Review FYE £145 £145 £0 Green Green Blue Green

1819-008 End of life FYE £28 £44 £16

Green Green Amber Red

Proposal for new service model is still being finalised and will not mobiliise

asplanned. Plan in place for resolution but full recovery not expected.

Savings to be replaced through headroom.

1819-001 GU Clinical Pathways (NELs) NEW £0 £0 £0

Grey Grey Red Red

Scheme under revision based on outcome and recommendations of audit.

However full recovery is not expected. Shortfall to be replaced through

headroom.

1819-015 Ambulatory Emergency Care NEW £0 £6 £6 Green Green Green Green

1819-016 Newark Urgent Treatment Centre NEW £0 £0 £0

Grey Grey Amber Red

Revised plan developed but re-evaluation of current and proposed service

costs required. Full recovery not expected. Savings to be replaced through

headroom.

1819-080 EMAS Non Conveyance NEW £59 £15 -£44 Red Red Green AMber



Urgent & Proactive Care Total £1,992 £1,535 -£456

Page 30 of 50


Scheme ID Scheme Name FYE/New

YTD

Planned

Savings

YTD

Actual

Savings

YTD

Variance

Financial

BRAG in

month

Financial

BRAG YTD

Milestone

BRAG

PMO

Confidence

BRAG

Comment

Elective Care £'000 £'000 £'000

1819-032 Integrated MSK Model FYE £639 £421 -£218 Amber Red Amber Amber



1819-020 Non NHS Further Service Review FYE £135 £135 £0 Green Green Blue Green

1819-022 In patient Sleep Studies FYE £18 £15 -£3 Green Amber Blue Green

1819-019 Gynaecology FYE £39 £50 £11 Green Green Green Green

1819-029 Community Ophthalmology NEW £87 £93 £6 Green Green Red Green

1819-025 Community Dermatology Service NEW £47 £45 -£2 Green Green Green Green

1819-021 Diagnostic Opportunities NEW £84 £0 -£84

Red Red Red REd

CCG unable to pursue savings related to DEXA scans. Savings to be replaced

through headroom.

1819-026 Compliance with BADS NEW £38 £121 £83 Green Green Blue Green

1819-036 Gastroenterology – Implementation of Primary Care TriageNEW £6 £11 £5 Green Green Green Green

1819-028 Elective Care Transformation NEW £516 £0 -£516

Red Red Red Red

Delays to commencing project, slippage to mid July/early August. Activity

and savings have been reprofiled. Recovery plan in place but full recovery

not expected. Savings to be replaced through headroom.

1819-107 MSK Prescribing FYE £0 £0 £0 Grey Grey Grey Grey

Elective Care Total £1,608 £892 -£717

Page 31 of 50



YTD

Planned

Savings

YTD

Actual

Savings

YTD

Variance

Financial

BRAG in

month

Financial

BRAG YTD

Milestone

BRAG

PMO

Confidence

BRAG

Comment

Community £'000 £'000 £'000

1819-050 Community Services Contract FYE £38 £38 £0

Green Green Amber REd

No schemes identified for £1.5m gap. Plan in place to identify further

opportunities but full delivery is not expected. Savings to be replaced

through headroom.

1819-052 Intermediate Care Services NEW £82 £82 £0 Green Green Blue Green

1819-047 Intensive Recovery NEW £0 £0 £0

Grey Grey Red Red

No agreement to deliver bed reductions. Demand for beds impacting on

ability to reduce bed numbers. Plan in place to review bed requirement but

full delivery is not expected. Savings to be replaced through headroom.

1819-046 Local Integrated Care Teams NEW £38 £38 £0 Green Green Green Green

1819-048 Chatsworth Unit – Neuro -

rehabilitation

NEW £0 £0 £0

Grey Grey Red Red

Currently milestones are not being met. Provider response received and

business case developed based on this feedback; the financial envelop has

been increased. Full recovery is not expected; headroom schemes required

for shortfall.

1819-044 Mid Nottinghamshire Wheelchair

Service

NEW £0 £0 £0

Grey Grey Red Red

Confirmed saving less than target. Full recovery Is not expected. Savings to

be delivered through headroom schemes.

Community Total £157 £157 £0


YTD

Planned

Savings

YTD

Actual

Savings

YTD

Variance

Financial

BRAG in

month

Financial

BRAG YTD

Milestone

BRAG

PMO

Confidence

BRAG

Comment

Mental Health £'000 £'000 £'000

1819-051 Mental Health Contract FYE £124 £155 £31

Green Green Amber Red

Schemes required for the identified £0.9m gap. Plan in place to identify

further opportunities but full delivery is not expected.

1819-040 Mental Health Core 24 (NHT) QIPP FYE £62 £56 -£6 Red Amber Green Green

1819-049 Mental Health Placements FYE £51 £51 £0 Green Green Amber Green

Mental Health Total £237 £262 £25

Page 32 of 50



YTD

Planned

Savings

YTD

Actual

Savings

YTD

Variance

Financial

BRAG in

month

Financial

BRAG YTD

Milestone

BRAG

PMO

Confidence

BRAG

Comment

Maternity, Paediatrics and Children £'000 £'000 £'000

1819-054 Children's Community Nursing

and Therapy Contract

FYE £41 £15 -£26

Red Red Amber Red

Currently scheme is underperforming. Plan in place to address delays in

identified schemes however there is a shortfall in profiled savings. Full

recovery is not expected; headroom schemes required.

1819-058 Reducing ED Attendances &

Admission Avoidance

NEW £39 £134 £95

Green Green Green Red

Contracted part of the scheme is delivering above plan. However approx.

£400k remains to be identified through headroom. Full delivery of savings is

not expected. Headroom required.

1819-060 Newborn Opportunities NEW £5 £9 £4

Green Green Red Red

Due to high intensity of maternity services changes project to be re-scoped.

Plan in place to achieve this. Full delivery of savings is not expected. Savings

to be replaced through headroom.

1819-059 Cows Milk Protein Allergy Prescribing NEW £25 £0 -£25 Red Red Amber Amber



1819-056 Reducing Outpatient Activity and Elective AdmissionsNEW £36 £45 £9 Green Green Amber Amber



Maternity, Paediatrics and Children Total £146 £203 £58


YTD

Planned

Savings

YTD

Actual

Savings

YTD

Variance

Financial

BRAG in

month

Financial

BRAG YTD

Milestone

BRAG

PMO

Confidence

BRAG

Comment

CHC £'000 £'000 £'000

1819-079 Continuing Health Care FYE FYE £240 £240 £0 Green Green Green Green

1819-068 CHC Recommissioning NEW £0 £0 £0 Grey Grey Amber Green

CHC Total £240 £240 £0

Page 33 of 50



YTD

Planned

Savings

YTD

Actual

Savings

YTD

Variance

Financial

BRAG in

month

Financial

BRAG YTD

Milestone

BRAG

PMO

Confidence

BRAG

Comment

Primary Care and Prescribing £'000 £'000 £'000

1819-083 Prescribing FYE FYE £183 £188 £5 Green Green Blue Green

1819-070 CCG Commissioned High Cost DrugsFYE £60 £117 £57 Green Green Green Green

1819-071 Mid Nottinghamshire Diabetes DevelopmentNew £53 £29 -£24 Green Red Green Amber



1819-073 Core Plus All New £175 £7 -£168 Red Red Green Amber



1819-069 Cost effective prescribing NEW £142 £460 £318 Green Green Green Green

1819-081 Optimal Use of Medicine NEW £13 £31 £18 Green Green Green Green

1819-072 Direct Supply Wound Management ProductsNEW £0 £0 £0 Grey Grey Green Green

1819-074 Repeat Prescriptions - Self Care NEW £9 £55 £46 Green Green Green Green

Primary Care and Prescribing Total £635 £887 £252


YTD

Planned

Savings

YTD

Actual

Savings

YTD

Variance

Financial

BRAG in

month

Financial

BRAG YTD

Milestone

BRAG

PMO

Confidence

BRAG

Comment

Other CCG £'000 £'000 £'000

1819-090 CSU Changes FYE £36 £0 -£36

Red Red Red Red

The scheme requires a detailed recovery plan. Full recovery is not expected

as further delays to go live are expected as it is likely notice will have to be

served on services. Savings to be replaced through headroom.

Other CCG Total £36 £0 -£36


YTD

Planned

Savings

YTD

Actual

Savings

YTD

Variance

GRAND TOTAL M01 to M03 £5,051 £4,177 -£874

Page 34 of 50

Finance Report: Month 3 - June 2018

(1) Introduction The report sets out the mid Nottinghamshire CCG’s financial performance and net risk position as at 30th June 2018. The CCG has submitted a 2018/19 plan to NHS England which achieves an in-year breakeven position across Mid Nottinghamshire. In-year financial performance will be measured against this plan. In summary, the expenditure in 2018/19 must not exceed the resource allocation set for the year. [It should also be noted that the CCGs will be required to make good cumulative deficits, arising from 2017/18, by building up sufficient financial headroom over future financial years to return to a 1% cumulative surplus. The timescale of which will be agreed with NHS England.] At month 3 the Mid Nottinghamshire CCGs are reporting achievement of this breakeven control total. This is based on:

a) Achieving £31m QIPP savings programme. b) Ensuring demand for services is contained within agreed contract levels.

A summary of the year to date key performance indicators at month 3 are shown below: [“+” means favourable/surplus] [“-“ means adverse/deficit]

A summary of the resource allocations position at month 3 is shown below:

Performance Measure/Duty Report

Section

Target YTD

(£'000)

Actual YTD

(£'000)

Achievement

%

RAG

Rating

Control Total 2 0 16 100% G

Savings/QIPP against £31.0m plan 3 5,051 4,177 83% G

Net Risk Position at Month 3 4 0 0 100% G

Cash Drawdown 7 122,778 122,789 100% G

Running Costs against allocation 11 1,710 1,482 100% G

Table 1.1 Mid Nottinghamshire Year to Date Finance Performance

Headlines as at 30th June 2018

Table 1.2 Resource Allocations 2018-19

CCG 2018/19 As at

M2 £'000

2018/19 As at

M3 £'000

M3 Allocations

£'000

Mansfield and Ashfield 293,965 293,812 -153

Newark and Sherwood 191,283 191,189 -94

Total Programme 485,248 485,001 -247

Running Costs 6,855 6,915 60

Total - In Year Allocations 492,103 491,916 -187

Page 35 of 50


The overall adverse variance month 2 compared to month 3 on in-year Resource Allocations is £187k. The allocations have been adjusted in month 3 to predominantly take account of a high cost prescribing patient with Nottingham West CCG .There is a long term funding risk share agreement in place with the Nottinghamshire CCGs, where a single patient care costs in excess of £100k are risk shared. This is fully accounted for in the financial plans, and does not affect the forecast outturn position. (2) Summary Financial Position The summary financial position at month 3 is set out in the table below. The year to date expenditure position is based on two months of data for acute providers with the exception of SFH where an early sight of month 3 data has been used to inform the reported position. The CCG is reporting a year to date (YTD) underspend of £16k. This small underspend is consistent with a full year breakeven forecast. The forecast is breakeven to plan and is based on delivering QIPP savings of £31m in 2018/19, and ensuring demand for services remains within planned levels.

The summary financial position is consistent with that of the CCG’s original 2018/19 plan submission. The CCG’s full operating cost statement is set out in Appendix 1. The main drivers of the YTD overspend position on acute activity are:

o Technical issues associated with phasing of the in year QIPP, which has the impact of overstating the year to date adverse variance.

o An adverse variance on QIPP delivery compared to plan.

o Increased outpatient follow-ups and non-elective activity above financial plan. Increased activity at month 3 is mitigated by contingency reserves set aside within the plan.

Table 2.1 Summary Financial Position Mid-Nottinghamshire CCG's

Area Annual

Budget

YTD

Budget

YTD

Actual

YTD

Variance

Year End

Forecast

Variance

Year End

Variance

against

QIPP

plan

Year End

Variance

Other

Month

on

Month

Change

in Year

Forecast

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000Programme Acute Services 228,074 57,678 61,621 3,942 0 0 0 0

Mental Health Services 46,648 11,307 11,305 -3 0 0 0 0

Community Services 38,729 9,988 10,005 17 0 0 0 0

Primary Care 106,673 26,032 24,887 -1,145 0 0 0 0

Continuing Health Care 36,632 8,922 8,901 -21 118 0 118 118

Operational Costs 19,772 4,936 4,934 -2 103 0 103 103

Running Costs 6,915 1,710 1,482 -228 0 0 0 0

Sub-Total 483,443 120,574 123,134 2,560 221 0 221 221

Reserves 8,473 2,576 0 -2,576 -221 0 -221 -221

Total In Year Position 491,916 123,150 123,134 -16 0 0 0 0

Variance expla ined by

Page 36 of 50


The CCG continues to take steps to strengthen and improve the delivery confidence associated with the existing QIPP schemes. However, there remains risk to delivery. Where there are significant risks to specific schemes, the Executive Team is focussing on developing mitigations to address that risk. This will be articulated through a detailed action plan for consideration by the July Turnaround Board and August Governing Body. (3) Savings Target The profile and delivery to date of the savings plan is set out in Graph 3.1. (4) Risk and Mitigations As at month 3 the Mid Nottinghamshire CCGs level of risk remains unchanged on last month at £12.8m, £8m of which is attributable to delivery of the QIPP programme with £4.1m being associated with potential price and/or activity pressures. The CCG is currently developing additional mitigations that will address these risks if they materialise, most notably from additional QIPP pipeline schemes delivery. The CCGs are undertaking a full review to de-risk the existing delivery plans and to develop additional mitigations that will have a positive impact on the 2018/19 position.

Monthly April May June July August SeptemberOctober NovemberDecemberJanuary February March Total

Plan £31m 1,701 1,689 1,660 2,371 2,578 2,628 3,150 3,201 3,014 3,011 3,001 3,046 31,050

Actual Achieved 1,422 1,422 1,333 4,177

Variance Against £31m Plan (279) (268) (327) (26,873)

Cumulative April May June July August SeptemberOctober NovemberDecemberJanuary February March Total

Plan £31m 1,751 3,391 5,051 7,422 9,999 12,627 15,777 18,979 21,993 25,003 28,005 31,050 31,050

Actual Achieved to Date 1,422 2,844 4,177

Variance Against £31m Plan (329) (547) (874)

Page 37 of 50

Finance Report: Month 3 - June 2018 (5) Reporting to the Regulator CCGs are membership organisations of NHS England and as such are required to fulfil a number of obligations, including formal reporting of their financial position and performance each month. The month 3 position contained in this report, including the YTD and FOT overspend along with the level of net risk is consistent with the position as reported to NHS England. (6) Detailed Financial Position Narrative by Commissioning/Service Line 6.1 Acute Services Table 6.1 summarises the YTD and forecast outturn (FOT) position for acute services. The overall YTD position is overspent by £3.9m. This remains subject to further scrutiny and validation between the CCG and the Trusts. The full year forecast remains as per the plan. The most notable variances and movements are detailed below:

Table 4.1 - Risk and Mitigations as at June 2018

Area Contract QIPP Prescribing Other TOTAL

RISKS

Contingency

Held

Further QIPP

Extensions

Non-

Recurrent

Measures

Delay /

Reduce

Investment

Plans

Other

Mitigations

TOTAL

MITIGATIONS

Total Net

Risk

£m £m £m £m £m £m £m £m £m £m £m £m

Acute Services -4.1 -5.2 0.0 0.0 -9.3 3.2 6.1 0.0 0.0 0.0 9.3 0.0

Mental Health Services 0.0 -0.9 0.0 0.0 -0.9 0.9 0.0 0.0 0.0 0.0 0.9 0.0

Community Health Services 0.0 -1.9 0.0 0.0 -1.9 1.9 0.0 0.0 0.0 0.0 1.9 0.0

Continuing Care Services 0.0 0.0 0.0 -0.3 -0.3 0.3 0.0 0.0 0.0 0.0 0.3 0.0

Primary Care Services 0.0 0.0 -0.4 -0.0 -0.4 0.4 0.0 0.0 0.0 0.0 0.4 0.0

Primary Care Co-Commissioning Services 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Other Programme Services 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Commissioning Services Total -4.1 -8.0 -0.4 -0.3 -12.8 6.7 6.1 0.0 0.0 0.0 12.8 0.0

Running Costs 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

TOTAL CCG NET EXPENDITURE -4.1 -8.0 -0.4 -0.3 -12.8 6.7 6.1 0.0 0.0 0.0 12.8 0.0

Risks Mitigations

Table 6.1 Summary Financial Position - AcuteAnnual

Budget

YTD Budget YTD Actual YTD

Variance

Year End

Forecast

Variance

Month on

Month

Change in

Forecast

Variance

£'000 £'000 £'000 £'000 £'000 £'000

Sherwood Forest Hospitals FT 167,268 42,452 46,440 3,987 0 0

Nottingham University Hospitals Trust 27,206 6,731 7,329 598 0 0

East Midlands Ambulance Service 11,977 2,943 2,994 51 0 0

United Lincolnshire Hospitals Trust 4,709 1,167 1,239 72 0 0

Doncaster & Bassetlaw Hospitals FT 3,141 779 782 4 0 0

Derby Hospitals FT 2,000 497 443 -54 0 0

University of Leicester Hositals FT 492 122 76 -46 0 0

Chesterfield Royal Hospital FT 1,042 259 306 47 0 0

Sheffield Teaching Hospital FT 734 182 119 -63 0 0

Sheffield Children's Hospital FT 88 22 40 18 0 0

Other Acute Providers - NHS 2,706 672 225 -447 0 0

Other Acute Providers - Non NHS 7,972 1,985 1,635 -349 0 0

Acute Risk Share 0 0 -8 -8 0 0

Acute Activity Reserve / QIPP / FRP -2,841 -498 0 498 0 0

Activity Reserve 1,580 364 0 -364 0 0

228,074 57,678 61,621 3,942 0 0

Page 38 of 50


Sherwood Forest Hospitals NHS Foundation Trust – The acute section of the contract is showing a year to date plan variance of £4.0m at month 3. This is based on month 3 (currently not validated) information received from the trust and excludes the Community element of the contract contained in section 6.3 below. The main drivers of the variance are: o Re-phasing on current QIPP saving programmes relating to elective schemes affecting

outpatient appointments and outpatient follow ups. This has the effect of overstating the adverse year to date position by £808k.

o A technical issue has been identified regarding the phasing of the contract plan in

relation to full year effect QIPP schemes. The impact of this at month 3 is to overstate the adverse year to date position by £594k.

The main drivers of the remaining variance of £2.5m are:

o Lower than the planned performance on schemes relating to admission avoidance

affecting A&E activity £168k

o Increased A&E and non-elective activity above plan currently valued at £1,661k. Contract queries have been raised and the CCG is working through these jointly with the trust.

o Additional activity over plan for outpatient follow ups (£321k), Critical Care Activity

(£203k) & additional pass through costs relating to High cost drugs (£250k).

The above is subject to further scrutiny and validation and this is ongoing as part of a jointly owned programme between Sherwood Forest Hospitals NHS Foundation Trust and the CCGs.

Nottingham University Hospitals NHS Trust - The contract is currently stating £598k variance to plan at month 3. This is based on month 2 information received from the trust and an estimate for month 3. The main drivers of the variances to plan are:

o Additional adult critical care activity above plan contributing to £149k of the variance.

o Increased non-elective activity above plan of £311k.

o Elective activity over plan relating to T and O (Trauma and Orthopaedics) activity £138k.

This has been identified as a planning issue across the total consortia plan with Nottingham University Hospitals NHS Trust and is being investigated.

Page 39 of 50


6.2 Mental Health Table 6.2 summarises the year to date and forecast position on Mental Health at month 3.

6.2.1 Mental Health The cost pressures contained within the position are relating to increased high observation costs and out of area psychiatric intensive care. Both of these services are being reviewed to manage the additional costs. The above reported position is in line with the planned delivery of the Mental Health Investment Standard which is a national requirement to ensure that mental health expenditure increases in line with allocation growth as a minimum. 6.3 Community Services Community Services are broadly in line with plan year-to-date and are forecasting a balanced position at year end.

Table 6.2 Summary Financial Position - Mental HealthAnnual

Budget


Variance

Year End

Forecast

Variance

Month on

Month

Change in

Forecast

Variance

£'000 £'000 £'000 £'000 £'000 £'000

Nottinghamshire Healthcare Trust - Mental Health 33,732 8,260 8,265 5 0 0

Other Mental Health Providers - NHS 2,213 538 538 0 0 0

Other Mental Health Providers - Non NHS 3,341 811 871 60 0 0

S117 Placements 6,281 1,630 1,630 0 0 0

Mental Health QIPP not transacted -768 32 0 -32 0 0

Mental Health Reserve 1,850 37 0 -37 0 0

46,648 11,307 11,305 -3 0 0

Table 6.3 Summary Financial Position - Community ServicesAnnual

Budget


Variance

Year End

Forecast

Variance

Month on

Month

Change in

Forecast

Variance

£'000 £'000 £'000 £'000 £'000 £'000

Nottinghamshire Healthcare Trust - General Health 28,227 6,854 6,850 -4 0 0

Sherwood Forest Hospitals FT 10,436 2,696 2,696 -0 0 0

Other NHS - Community 1,895 453 459 7 0 0

Other Non NHS - Community 0 0 0 0 0 0

Community QIPP not transacted -1,846 -17 0 17 0 0

Community reserve 17 3 0 -3 0 0

38,729 9,988 10,005 17 0 0

Page 40 of 50

Finance Report: Month 3 - June 2018 6.4 Primary Care The most notable areas of variance are:

6.4.1 Primary Care Contracting

The underspend £594k on Primary Care Contracting is made up of underspends as a result of over accruals in 2017/18. 6.4.2 Practice Prescribing and QIPP The table below explains the £414k year to date favourable variance actual compared to budget on Prescribing at month 3:

The CCG is in receipt of one month PPA (Prescriptions Pricing Authority) data for 2018/19 which has been used to estimate expenditure for May to June. The £414k Prescribing underspend reported at month 3 is as a result of a benefit of £939k due to lower than estimated actuals for month 11 and 12 in 2017/18. This prior year benefit was mainly relating to the estimate for No Cheaper Stock Obtainable (NCSO) issue reported in 2017/18. This benefit is non-recurrent in nature. The prior year benefit was offset by an overspend in the current year to date of £525k. This is mainly relating to practice level drug prescribing in Mansfield & Ashfield CCG.

Table 6.4 Summary Financial Position - Primary CareAnnual

Budget


Variance

Year End

Forecast

Variance

Month on

Month

Change in

Forecast

Variance

£'000 £'000 £'000 £'000 £'000 £'000

Primary Care Contracting 44,547 10,809 10,215 -594 0 0

Prescribing 53,000 12,937 12,918 -19 0 0

Prescribing - QIPP -1,459 -372 -767 -395 0 0

Medicine Management - Clinical 914 231 222 -9 0 0

CCG Pathways 0 0 0 0 0 0

EH - Primary Care 351 88 -18 -106 0 0

EH - GP Forward View 1,936 484 484 -0 0 0

Enhanced Services 1,383 355 378 23 0 0

Practice Transformation fund 967 242 206 -36 0 0

GPIT 948 237 228 -9 0 0

Out of Hours 4,086 1,021 1,021 0 0 0

Primary Care Reserve 0 0 0 0 0 0

106,673 26,032 24,887 -1,145 0 0

Favourable variance Practice Prescribing Month 3 Actual v. Budget £k

Prescribing -19

Prescribing-QIPP -395

Favourable ytd variance v. budget -414

Explained by:

Underspend accruals release 17/18 NCSO (No Cheaper Stock Available) -939

Overspend on Practice level drug Prescribing 525

-414

Page 41 of 50

Finance Report: Month 3 - June 2018 6.5 Continuing Health Care (CHC)

6.5.1 Continuing Health Care and Funded Nursing Care

At month 3 the actual growth is within planned levels. Work continues in developing the trend forecasts to inform the position going forward.

(7) CCG Cash Management The Mid Nottinghamshire CCGs have to operate within a maximum cash drawdown envelope to pay for its commitments. This currently stands at £491.1m. As at 30th June 2018 the CCGs have drawn down £122.7m of its cash limit which equates to 25.0% of the available cash. This is in line to the profile where cash is drawn down in equal twelfths. The Mid Nottinghamshire CCGs held a cash balance at 30th June 2018 above the NHS England cash target. This will be brought into line going forward. (8) Statement of Financial Position The Statement of Financial Position as at the end of June 2018 is shown in Appendix 2 and shows the movement from the previous month. In month net liabilities have increased by £1.6m due to a rise in current payables partially offset by a rise in current receivables and cash at the bank. (9) Better Payments Practice Code The Mid Nottinghamshire CCGs have a responsibility to meet the Better Payments Practice Code (BPPC). This focuses on the timeliness at which the CCGs pays its invoices to the private sector and to other NHS organisations. The target is to pay 95% of invoices, in terms of value and volume, within 30 days. The Mid Nottinghamshire CCGs have met all four cumulative targets. (10) Aged Debt Table 10.1 shows the level of debt owed to the CCGs and the length of time this debt has been outstanding.

Table 6.5 Summary Financial Position - Continuing Health CareAnnual

Budget


Variance

Year End

Forecast

Variance

Month on

Month

Change in

Forecast

Variance

£'000 £'000 £'000 £'000 £'000 £'000

Continuing Care & Free Nursing Care 35,855 8,728 8,730 3 0 0

City Care CHC Assessment 777 194 171 -24 118 118

36,632 8,922 8,901 -21 118 118

Page 42 of 50

Finance Report: Month 3 - June 2018 The majority of Non NHS aged debt over 30 days is with Solutions 4 Health £31k and Central Nottinghamshire Clinical Services £30k (CNCS). The CCGs are engaged in ongoing dialogue to recoup the monies owed. The CNCS outstanding debt is currently with the administrators; a bad debt provision has been set aside for this debt. For the NHS debts over 30 days, the majority are held with NHS England and Nottinghamshire Healthcare NHS Foundation Trust. (11) Running Costs The CCG has a running cost allocation in 2018/19 of £6.9m. The CCG running costs establishment for 2018/19 has been budgeted at £6.9m, after taking into account a QIPP savings target of £72k. (12) Contingencies and Reserves to meet Business rules The CCG has set aside the following contingencies and reserves:

Table 11.1 Running Costs Year to Date and Forecast Position

Operational (Running Costs) Annual

Budget

YTD

Budget

YTD

Actual

YTD

Variance

Year End

Forecast

Variance

Variance

Change

Month

on

Month

£'000 £'000 £'000 £'000 £'000 £'000

Running Costs - Chief Officer 769 194 177 -17 0 0

Running Costs - Chief Finance Officer 3,327 823 788 -34 587 587

Running Costs - Chief Commissioniong Officer 48 12 1 -11 0 0

Running Costs - Chief Nurse 459 116 98 -17 93 93

Running Costs - Director of Primary Care 632 160 119 -41 0 0

Running Costs - Director of Transformation 359 91 146 56 16 16

Running Costs - Estates 626 158 151 -7 0 0

Running Cost Reserves 694 156 0 -156 -695 -695

Total Operational (Running Costs) 6,915 1,710 1,482 -228 0 0

Page 43 of 50

Finance Report: Month 3 - June 2018 * The above reserves are included with the programme areas in the operating cost statement and the summary operating cost statements. (13) Virements In month 3, virements have been transacted moving from the opening plan submitted to NHS England on the 30th April 2018 to align with the opening budgets agreed with budget managers as part of the opening budgets process. As additional allocations are received in future months and virements are agreed between budget holders, all movements will be reported in Appendix 4 and will report changes between detailed budget lines.

Page 44 of 50

Finance Report: Month 3 - June 2018 Appendix 1 – Operating Cost Statement

Page 45 of 50

Finance Report: Month 3 - June 2018 Appendix 1 – Operating Cost Statement - continued

Running Costs

Running Costs 6,221 6,916 695 1,554 1,482 (72) 518 561 43

Running Cost Reserves 694 (1) (695) 156 0 (156) 49 0 (49)

TOTAL AVAILABLE RESOURCE - ADMIN 6,915 6,915 0 1,710 1,482 (228) 567 561 (6)

491,916 491,916 0 123,150 123,134 (16) 40,857 40,886 28

Cumulative Deficit (9,855) 0 9,855 (2,464) 0 2,464 (814) 0 814

482,061 491,916 9,855 120,686 123,134 2,448 40,043 40,886 843

TOTAL NET OPERATING EXPENDITURE AGAINST IN YEAR

RESOURCE ALLOCATION

TOTAL NET OPERATING EXPENDITURE AGAINST CUMULATIVE

RESOURCE ALLOCATION

Page 46 of 50

Finance Report: Month 3 - June 2018 Appendix 2 - Statement of Financial Position

Closing Balance

30 June 2018

Closing Balance

31 May 2018

Movement In

Period

£'000 £'000 £'000

Non Current Assets

Plant, Property and Equipment 64 67 -2

Intangible Assets 0 0 0

Total Non Current Assets 64 67 -2

Current Assets

Inventories 0 0 0

Receivables 5,010 3,368 1,642

Cash at Bank / OPG 3,126 1,625 1,500

Total Current Assets 8,136 4,993 3,143

Current Liabilities (Due within 1 year)

Payables -28,917 -24,201 -4,716

Provision for Liabilities and Charges -1,559 -1,559 -0

Borrowings

Total Current Liabilities -30,476 -25,760 -4,716

Net Current Assets / (Liabilities) -22,276 -20,700 -1,576

Non Current Liabilities

Non Current Payables 0 0 0

Non Current Provision for Liabilities and Charges 0 0 0

Total Non Current Liabilities 0 0 0

Total Assets / (Liabilities) -22,211 -20,633 -1,578

Tax Payers Equity

General Fund -22,276 -20,700 -1,576

Revaluation Reserve 0 0 0

Total Tax Payers Equity -22,276 -20,700 -1,576

Mid Nottinghamshire CCGs - Statement of Financial Position - June 2018

Page 47 of 50

Finance Report: Month 3 - June 2018 Appendix 3 – Cumulative Revenue Resource Position Appendix 4 – Virements agreed in Month 3 No budget virements between budget lines took place.

2017-18

£'000

2018-19

£'000

Cumulative Brought Forward 1,595 -9,855

In-Year Surplus / (Deficit) -11,450 0

Cumulative Carried Forward -9,855 -9,855

Page 48 of 50

CCG Improvement & Assessment Framework Q3

Page 49 of 50

CCG Improvement & Assessment Framework Q3

Page 50 of 50

Progress report from Patient and Public Engagement Committee July 2018

Key Messages

Patient and Public Engagement Committee Lucy Dadge, Chief Commissioning Officer, attended the second meeting of the PPEC and delivered an extremely informative presentation that covered:

• Integrated Care Systems and Integrated Care Partnerships • Financial challenges and Quality, Innovation, Productivity and Prevention (QIPP) schemes • Commissioning Intentions 2018/19 and highlighting opportunities for PPEC involvement in the

development of the Commissioning Intentions for 2019/2020 • Locality Integrated Care Partnerships

The presentation was really helpful to PPEC members and helped them to understand the context within which they are working. The information will be used to inform the development of the PPEC’s work plan. Key areas that emerged for inclusion within the work plan were:

• Planned care focusing on shared decision-making and patient choice • Social prescribing/self-care • Locality Integrated Care Partnerships, access and community transport provision • Mental health services • Cancer pathway • Commissioning Intentions • Preventative health care • Restricted and not routinely funded procedures

The election of the PPEC Chair and Vice-Chair will take place at the August meeting. The Chair will represent PPEC at meetings of the joint Governing Bodies and the Vice-Chair will represent PPEC on the Quality, Risk and Safeguarding Committee.

1

Minutes of the meeting of the Patient and Public Engagement Committee (PPEC) on

Monday 25 June 2018 in Meeting Room 2, Birch House, Southwell Road West, Mansfield, NG21 0HJ

Present: Julie Andrews, Engagement Manager in the Chair Nickie Anthony, Newark & Sherwood Community & Voluntary Service Jim Barrie, Newark Patient Participation Groups Val Brownley, Ashfield North Patient Participation Groups Gilly Hagen, Sherwood Patient Participation Groups Mary Hodgeon, Newark Patient Participation Groups Jean Kirk, Cancer Patient & Carer Group Ann Mackie. Disability Special Interest Group Julie McIntyre, Mansfield South Patient Participation Groups Peter Robinson, Governing Body Lay Member Di Roffe, Healthwatch Nottinghamshire Katie Swinburn, Engagement Officer Sarah Taylor, Ashfield Voluntary Action Lesley Watkins, Mansfield Community & Voluntary Service PPEC/01/06/18 Welcome and Introductions

Julie Andrews opened the inaugural meeting of the PPEC and led a round of introductions. Members were reminded that it was agreed that during the transition period and prior to the election of the Chair and Vice-Chair, Julie Andrews would chair the meetings. Peter Robinson agreed to support the committee and carry out a handover with the chair once appointed. It was also noted and recorded that links would be made with the Chair and Vice Chair of the Citizens Council to ensure that sufficient representation is appointed to represent PPEC on the Citizens Council meetings.

PPEC/02/06/18 Apologies for Absence Apologies for absence were received from; Pat Kelsey Cllr. Barry Answer Not in Attendance; Cllr. Neil Mison Cllr. David Staples

PPEC/03/06/18 Declarations of Interest Julie Andrews confirmed that the Conflict of Interest Policy and declaration of interest form had been circulated to all members for completion. This information would be compiled into a register for PPEC that would be

1

published on the CCGs website and will be a standing agenda item. No interests were declared in relation to any of the agenda items.

PPEC/04/06/18 Patient and Public Engagement Committee (PPEC)Terms of Reference The PPEC Terms of Reference were virtually agreed by the members of NHS Mansfield and Ashfield CCG and NHS Newark and Sherwood CCG Governing Bodies and were fully ratified at a meeting of the joint Governing Bodies held on 7 June 2018. Mary Hodgeon requested clarification regarding the statement of confidentiality and the sharing of information with parties prior to meetings. As per the Code of Conduct, any information shared in confidence or any information believed to be of a confidential nature should not be disclosed without prior consent. It is the responsibility of the author or speaker to be explicit around the status of information shared. It was confirmed that a full meeting schedule had been prepared to reflect sufficient time to allow feedback following the publication of the CCGs Governing Body papers. Lesley Watkins queried the PPEC diagram that was an appendix to the Terms of Reference. It was noted that the Citizen’s Council had been omitted from the diagram when it had been agreed that this should be included. It was agreed that this would be amended and included. Mary Hodgeon requested clarification regarding the role and function of the Citizen’s Council. Peter Robinson explained that this group comprised patient representatives of both commissioners and providers of the Alliance/Better Together Programme.

PPEC/05/06/18 Code of Conduct A copy of the Code of Conduct had been circulated prior to the meeting. It was agreed that as the Nolan Principles had been included in the Terms of Reference they should also be contained in the Code of Conduct. An error was noted on page 2 stating where it should state “Lay Members”. It was also noted that it should state “CCGs” throughout the document. Action; An updated copy of the Code of Conduct would be brought back to the next meeting of PPEC for approval.

PPEC/06/06/18 Development Needs/Actions A copy of the follow up actions from the Development Session held on the 18 June 2018 had been circulated for information with the meeting papers. Comments on the actions were as follows:- Action 1 Julie Andrews confirmed that Lucy Dadge had been invited to attend the PPEC Meeting in July 2018 to talk about the following: -

2

• Sustainability and Transformation Plan/Integrated Care System • Financial Challenges • Commissioning Priorities • Primary Care Developments e.g. Locality Hubs

The meeting would need to be altered to accommodate Lucy Dadge’s attendance and would now be taking place from 11.30am – 1.30pm at Birch House in Meeting Room 2. The meeting scheduled would be amended and circulated to reflect this. It was discussed and agreed that there should also be discussions in the session around what the CCGs role is in commissioning. Discussions took place around the evolving Integrated Care Systems and Integrated Care Partnerships which Lucy Dadge would be able to provide further clarity at the next PPEC meeting. It was agreed that a link would be circulated with the minutes to the STP website to provide an overview to members prior to the meeting. Here is the link to the website Action 2 PPG Networking Event in July/August for Newark and Sherwood – Nickie Anthony confirmed that this would be planned with Mary Hodgeon, Jim Barrie Pat Kelsey and Gilly Hagen. Val Brownley and Julie McIntyre also offered support to the working group. A link would also be made to National Association of Patient Participation (NAPP) who have useful resources and also an approach to Paul Devlin, Chief Executive to attend. Action; It was agreed that a meeting would be arranged with the working group to take this piece of work forward. Action 3 It was agreed that the mapping of networks across the community and voluntary sector would be undertaken and would also include community transport. This would be carried out by Lesley Watkins, Sarah Taylor and Nickie Anthony. Di Roffe also offered support to this piece of work representing Healthwatch. Action 4 Consent had been received from the majority of PPEC members to circulate email addresses to facilitate networking and communication. Action 5 All information following the development session has been circulated including a jargon buster and the PPG Charter. Julie McIntyre mentioned that there is also an APP that can be downloaded around acronyms Action 6 & 7 Katie Swinburn confirmed that an internal communication will be developed to circulate to all CCG staff clarifying the role and

3

http://www.stpnotts.org.uk/

responsibilities of PPEC and this would also include a biography of the members to showcase areas of interest and expertise. All members were requested to send a biography to Katie Swinburn by close of play on the 30 June 2018. A website page will also be developed to promote the PPEC and will include copies of the minutes to evidence the work that the PPEC are doing. Action 8 – Completed as Development Needs was added as an Agenda Item for the meeting on the 25 June 2018. Action 9 Work is ongoing to explore options for the wider Health and Wellbeing Forum. Peter Robinson has undertaken some preparatory work around the wider membership and how this can link into the PPEC. Mary Hodgeon confirmed to the group that she will be attending the Patients for Patients meeting to talk about the work of PPEC and to consider the linkages between the two groups going forward. Julie Andrews offered for a member of the Engagement Team to attend to offer support if required.

PPEC/07/06/18 Communication and Engagement Plans GP Extended Access Katie Swinburn explained that there has been a phased approach to the introduction of GP Extended Access since October 2017. There is now full coverage supported by a full communication and engagement plan. Information has been cascaded widely to advertise the service across mid Nottinghamshire with further work ongoing to cascade the key messages. PPGs have been instrumental in disseminating information through practices and have been part of meetings with practice staff. Katie Swinburn confirmed that she is attending Lombard Street PPG to talk about the service and what this means for the practice. An offer was made to attend other PPG meetings to provide information about GP extended access. The service has also been an agenda item at PPG Events. Evaluations of the GP extended access service are being carried out and will be rolled out across all practices. End of Life Care Katie Swinburn is currently working with Caren Rice, Transformation Manager, to develop a communication and engagement plan for end of life care. Jean Kirk referenced previous work around end of life care carried out with Carolyn Bennett at Sherwood Forest Hospitals (SFH) which may provide some useful insight to further inform the plan. Katie Swinburn agreed to make contact to ask if Carolyn Bennett can provide this information. Caren Rice and Carl Ellis from Sherwood Forest Hospitals Foundation Trust would be attending the Citizens Council on 6 July 2018 to talk about the programme of work. The invitation had also been extended for a

4

presentation to the PPEC to provide an overview. Newark Urgent Treatment Centre Julie Andrews explained that previous public engagement events had taken place in Newark to provide residents and patients with information about the Urgent Care Centre transforming into an Urgent Treatment Centre. This is a National Programme from NHS England. Julie Andrews confirmed that work is currently ongoing to plan a further public engagement event in July 2018 to provide updates. A full communication and engagement plan is being developed. Further information would be circulated providing details of future events in order that members can cascade throughout their networks. Underwood Branch Surgery Closure Julie Andrews explained that the branch surgery at Underwood had now closed, because the tenancy on the building had ended at short notice. A full communications and engagement plan was prepared together with a communications toolkit. A letter was sent out to head of households informing them of the closure and confirming that the closure would not affect any of the medical services currently provided at Jacksdale Medical Centre. Additional appointments would be provided at Jacksdale Medical Centre to meet additional demand. Frequently asked questions were prepared and circulated together with posters to inform local residents of the decision. A report was prepared and presented to the Joint Primary Care Commissioning Committee on the 16 June 2018. Following that meeting it was agreed that a post-closure communication and engagement plan should be put in place to ensure that views and comments were received from local residents around any issues that may have transpired following the closure. A public engagement event is currently being arranged. In response to a request for further information, Julie Andrews confirmed that during previous engagement on the proposed closure the main issues raised were around transport and how vulnerable people could access services at Jacksdale. Following the closure bus timetables had been printed and circulated to the practice for patient information and further information was being obtained to around community transport services and also what other services may be available in the vicinity. Val Brownley asked about local pharmacies and whether any were within Underwood or nearby. Julie Andrews confirmed that there is a pharmacy adjacent to Jacksdale Medical Centre This also provided a useful resource in respect of self-care. It was also confirmed that for anyone requiring social care support, Nottinghamshire County Council could be contacted through their golden number and a range of information was provided on the Notts. Help Yourself website.

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Harwood Close/Ashfield Medical Centre A full communication and engagement plan had been put in place and sessions have been held in both surgeries to obtain feedback about plans for Harwood Close Surgery and Ashfield Medical Centre to merge and deliver services from one building – Ashfield Medical Centre. A survey was produced and completed and embedded into the full engagement report that was presented to the Joint Primary Care Commissioning Committee. The outcome of considerations by the Joint Primary Care Commissioning Committee was that services should transfer from Harwood Close Surgery to Ashfield Medical Centre from 1 July 2018. The practice would be renamed “Kings Medical Centre”. The PPEC Members confirmed that they found the information provided useful, however suggested that a short report should be provided outlining plans and key messages for future meetings. Local Issues Ann Mackie enquired about the process to report and feedback issues raised by patients. Julie McIntyre advised of the availability of a template that could be completed and reported into the PPEC going forward. Action; Circulate a copy of the patient feedback reporting template to PPEC members. Ann Mackie also raised the issue about the Patient Experience Team and was not aware that there was such a team at the CCG. It was agreed that going forward it would be useful to have a report presented by the Patient Experience Team in order that trends could be looked into and consider how the PPEC could provide support. It was agreed this would be incorporated into the agenda of future PPEC meetings. Action: Confirm reporting schedule for Patient Experience reports and incorporate into PPEC Forward Programme. Julie McIntyre raised an issue around text messages from the surgeries to patients around the friends and family tests and that this is not currently covered around the General Data Protection Regulations (GDPR) that came into force on the 25 May 2018. Katie Swinburn explained that there had been a successful PPG Networking Event on the 5 June 2018 covering Mansfield and Ashfield Practices. The event had evaluated very well and the presentations and resources are available on the CCG website.

PPEC/08/06/18 Key Messages to Joint Meeting of CCGs’ Governing Bodies

• The group had been established and held its inaugural meeting. • Recruitment to gaps in the membership would be advertised and

applications invited shortly. • The group should be utilised appropriately by the CCGs in relation

to specific programmes and projects. • The group are working together in partnership across mid

Nottinghamshire. • There is a challenge to equip PPEC members with information and

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http://www.mansfieldandashfieldccg.nhs.uk/get-involved/patient-participation-groups/

resources to enable them to fulfil their role effectively of two-way communication with their groups and networks

• Early discussions of the group will focus on social prescribing/self care, understanding Integrated Care Systems and the financial challenges currently faced by the CCGs and what is working and what isn’t around projects and Quality, Innovation, Productivity and Prevention (QIPP) schemes.

PPEC/09/06/18 Any Other Business The group asked to be informed in advance of any information Lucy Dadge would require from them at the next meeting on 24 July 2018.

PPEC/10/06/18 Agenda Items for next meeting

• Presentation from Lucy Dadge, Chief Commissioning Officer • Citizens Council – PPEC representation, role and responsibilities • Highlight Report for Joint Meeting of Governing Bodies • Communication and Engagement Plans highlight report

PPEC/11/06/18 Date of next meeting:

Tuesday 28 August 2018 from 4 pm to 6 pm at Balderton Primary Care Centre, Lowfield Road, Balderton, NG24 3HJ Apologies for the meeting were received from Lesley Watkins.

. . .

• . .

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Progress Report from the Clinical Effectiveness Committee

Date of committee: 12 July 2018

Key Achievements • APPROVED the attendance of clinical leads at the Clinical Effectiveness Committee as non-voting

members. This ensured valuable clinical input and would strengthen clinical engagement within the CCGs. There would be no additional cost to the CCG as attendance at the committee would be part of the revised job specification for the clinical leads.

• APPROVED the concept of the Diabetes Clinics to provide a single standardised Nottinghamshire-wide diabetes pathway.

• APPROVED the Hypercalcaemia Pathway for the management of Hypercalcaemia for use across primary and secondary care. The pathway was designed to shorten patient waiting times for definitive treatment and avoid unnecessary referrals to Endocrinology.

• APPROVED the Cancer Care in Primary Care: A Quality Toolkit for General Practice as a direction of travel for mid-Nottinghamshire. The toolkit aimed to develop high quality cancer care, including screening, early diagnosis, identification and care of patients living with and beyond cancer.

• NOTED the CCGs feedback, featuring an update on the financial position.

Issues Actions Ongoing concerns continued in relation to 52+ week waits, RTT, diagnostic waiting times, the cancer 62 day standard, IAPT access; the A&E 4 hours wait and delayed transfers of care.

Robust monitoring and scrutiny required via the Turnaround Board to ensure delivery of the financial surplus.

Mid-Nottinghamshire identified as an outlier in respect of diabetic foot amputations. Significant variation in achievement of diabetic treatment targets. Recent improvements had been noted around structured education and self-care, but uptake was still poor. In respect of the NHSE Assessment Framework, Mansfield and Ashfield CCG had been given an overall rating of inadequate and Newark and Sherwood CCG required improvement.

Diabetes was now being monitored on a monthly basis via the QIPP programme and diabetes performance dashboard. A Notts-wide Diabetes Task and Finish Group had been established. The Hypoglycaemia pathway was in place and benefits were now being seen. The Amputation Improvement Programme was progressing well and 35/41 practices had attended Foot Care Management training sessions. The Elective Care programme was reviewing performance and trying to understand the increasing follow up activity into acute services and implementing % reductions. Work was underway with STP colleagues to align pathways across Nottinghamshire. Meeting to take place to agree critical steps to move the implementation of the Diabetes Clinics forward.

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Risks Actions No risks to raise.

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Minutes of the Joint Meeting of the NHS Mansfield and Ashfield and NHS Newark & Sherwood Clinical Commissioning Group

Clinical Effectiveness Committee

Held on Thursday 17 May 2018, 2.00 – 5.00pm

Meeting Rooms 2/3, Birch House Present: David Ainsworth Director of Primary Care Dr Thilan Bartholomeuz Clinical Chair, Newark and Sherwood CCG (Chair) Dr Doug Black Chairman NEMS Community Benefit Services Ltd Chairman EM Affiliated Commissioning Committee Honorary (Consultant) Assistant Professor, University of Nottingham, School of Medicine Jonathan Cummins Practice Manager, Middleton Lodge Lucy Dadge Chief Commissioning Officer Dr Subash Das GP, Sherwood Medical Partnership Sandy Hogg Director of Turnaround Ian Jackson Senior Lead Nurse, Roundwood Surgery Dr Hilary Lovelock GP, Brierley Park Medical Practice Dr Peter Macdougall GP, Ashfield House Surgery Luella Robb Nurse Practitioner, Lombard Medical Centre Amanda Sullivan Chief Officer Dr Milind Tadpatrikar GP, Roundwood Surgery In attendance: Rachel Bradley Executive Assistant to the Chief Officer (minutes) Sarah Clarke Consultant (observing) Rachel Whitaker Interim Board Secretary (observing) Di Butcher Head of Information and Performance (Items: CEC/18/27 – 31)

Item Action CEC/18/27 Apologies for absence

Apologies were received from:

• Michael Cawley • Dawn Jenkin • Gavin Lunn • Elaine Moss • Rosa Waddingham

CEC/18/28 Declarations of Interest Declarations of Interest were as reported on the Register of Interest made available at the meeting. It was noted there were no potential or actual conflicts declared in relation to the business to be transacted at the meeting and all present would remain in the meeting at this point. Declarations of interest from today’s meeting

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Item Action

The following update was received at the meeting: • Dr Tadpatrikar was newly appointed as Clinical Lead for

Mansfield South locality. ACTION: Clinical Leads for localities to be included on the Declarations of Interest.

CCG Governance Team

CEC/18/29 Minutes and actions from the Clinical Effectiveness Committee The minutes of the meeting held on 12 April 2018 were agreed as an accurate record of discussion. In response to a query in regard to whether practices received payment for their local or registered population in respect of the Prescribing Engagement Scheme, Dr Sullivan confirmed that funding was based on the registered population.

CEC/18/30

CCG Feedback Financial Position Dr Sullivan reported that the CCGs financial outturn had been achieved, with the delivery of 6% QIPP achieved across the CCGs in 2017/18. Joint planning processes with providers had commenced in 2018 with a collective effort in regard to implementation, placing the CCGs in a good position for 2018/19. Alliance Dr Sullivan reported that Better Together partners had undertaken a review of working arrangements within the Alliance Agreement and a number of refinements had been agreed. The work had been organised within four key programme areas: urgent care, proactive care and long-term conditions, healthy and independent living and elective care. The Citizens Board would now be known as the Citizens Council and would include oversight of patient and public engagement activities, working collaboratively with Healthwatch. In addition, a Transformation Board had been established in order to strengthen clinical leadership and oversight. CCG Time Out Dr Sullivan informed members that a Time Out had taken place for all CCG staff with the focus on how the CCG had progressed throughout the year and what had been learnt from the journey. Dr Sullivan welcomed Sarah Carter to the meeting and advised that she would be joining the CCGs on a consultancy basis to enable and facilitate the transition of the CCG from turnaround to embedding a business as usual approach. Sarah would also be enabling and facilitating best practice for the business support

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Item Action

functions; performance, finance, business intelligence, contracting and PMO, building on their strengths and developing a whole team approach Annual Public Meetings Dr Sullivan reported that planning was underway for the Annual Public Meetings in September. The format would be similar to previous meetings. It was noted the award ceremony would take place again this year. The Clinical Effectiveness Committee NOTED the CCG feedback.

CEC/18/31

Integrated Performance Report – April 2018 Mrs Butcher gave an overview of performance, quality and activity position as at Month 12. Areas of poor performance were noted as 52+ week waits, RTT, diagnostic waiting times, the cancer 62 day standard, IAPT access; the A&E 4 hours wait and delayed transfers of care. The actions being undertaken to address shortfalls were as detailed in the report. A discussion ensued in respect of access to Psychological Therapies (IAPT) and Mansfield and Ashfield CCG not achieving this standard since Q4 2016/17, and Q3 2017/18 not showing significant improvement. Reference was made to what was seen as a long-waiting list for patients, which meant an increase in patients returning to general practice. Mrs Butcher advised that IAPT had improved slightly in Q4 and had thought waiting times were good. Members acknowledged that there were now only 3 providers managing the service and waiting times did vary. A recovery plan with the provider Let’s Talk Wellbeing had been agreed with the CCG. Actions included recruitment of CBT workers and Counsellors, together with increased in-house capacity. It was noted that there had been conflicting information in respect of the Tier 4 service and whether it existed. In addition, it was felt that patients did not always access the service due to the Nottingham number detailed on the card provided to them which was felt made patients think there were no services available locally to them. ACTION: Mrs Butcher to look into waiting times and the Tier 4 service. Mr Ainsworth to include information for practices in ‘Snippets’ to clarify that there were Psychological Therapy services which could be accessed locally. The CCGs were currently undertaking a transformation of Mental Health services. The main focus of the transformation was to increase the integration of physical and mental health and the development of Primary Care Hubs. IAPT would be included in this work. In response to concern expressed in respect of patient flow

DB DA

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Item Action

appearing slower through the MSK pathway, Mr Ainsworth stated he would request feedback on waiting times and bring a formal response to the next meeting. ACTION: Mr Ainsworth to liaise with Ms Kim Ashall and request feedback on their waiting times. A formal response to be brought to the next meeting. Miss Bradley to include on the Forward Programme. In response to a query in regard to whether there had been improvements in ED following improvements in weather, Mrs Butcher advised that there had been improvements, but recruitment had also taken place which possibly could have had an impact. ACTION: Mrs Butcher to undertake mapping and review. Ms Hogg reported that the control total had been met. The great effort to achieve QIPP was acknowledged, particularly the clinical input via the committee and workshops that had taken place. Clinical input was encouraged going forward. The Clinical Effectiveness Committee RECEIVED the Integrated Performance Report and NOTED:

• the latest position for performance, quality, finance, QIPP and activity delivery.

• the CCG’s final year-end financial position £11.5m deficit, which represented an adverse movement from the planned £0.5m surplus of £12.0m (in line with the CCGs’ FRP).

DA

RB

DB

CEC/18/32 Progress Reports of CCG Sub-Committees Progress reports for the following meeting were circulated for information.

• Quality, Risk and Safeguarding Committee – 9 April 2018.

It was noted that the Committee received a report on 2017/18 Quality Premium requirement for a 10% reduction in all E.coli infections. The latest return indicated that Newark and Sherwood would meet this standard; however Mansfield and Ashfield were on track to miss the target. The Clinical Effectiveness Committee agreed a discussion was required in order to understand if there was anything that could be done to improve the situation and meet the standard. ACTION: Miss Bradley to ask Mrs Moss to bring a paper to a future meeting of the Clinical Effectiveness Committee.

• Mid-Notts Joint Prescribing Group – 17 January 2018. • IGMT – 23 March 2018.

RB/EM

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Schedule of Actions

Agenda ref Action Responsibility Progress

CEC/18/22 Prescribing Engagement

Scheme (PES) 2018/19

Mr Richards to produce paper for the Clinical Effectiveness Committee in regard to how 2017/18 monies were spent from the prescribing savings made.

PR Completed.

CEC/18//28 Declarations of Interest

Clinical Leads for localities to be included on the Declarations of Interest.

Corporate Governance

Team

Locality Clinical Leads included in Master version of Declarations of Interest, with reminder to declare DoI if attending.

CEC/18//31 Integrated Performance

Report – April 2018

Mrs Butcher to look into waiting times and the Tier 4 service. (Post meeting note: As part of the MH QIPP, the CCG reduced its spend on Step 4 Services by closing to referrals in Q4. Communications were sent out to GP Practices in January 2018 advising the following.

Psychology, Psychotherapy and Trauma Services – Nottinghamshire Healthcare NHS Foundation Trust • From the beginning of this month,

Nottinghamshire Healthcare NHS Foundations Trust’s Psychology, Psychotherapy Step 4 Psychological therapies & Trauma services will no longer be receiving patient referrals for the remainder of Quarter 4 ( ie up to 31/3/18). This is because the Trust has already reached its commissioned activity level and the waiting list is currently exceeding 12 months. The Trust will advise when they are able to accept referrals, which is anticipated to be from the 1st April.

• This service provides community based support to adults experiencing severe and complex psychological issues which will respond to long term psychological intervention; many of whom are also receiving secondary care MH services.

• This service is separate to the IAPT/Talking therapy provision.

The national Waiting Times targets for IAPT are: • 75% of patients finishing a course of

treatment within 6 weeks and • 100% of patients finishing a course of

DB In progress. Updated information requested.

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treatment within 18 weeks

The latest performance can be seen in the table below. Whilst waiting times are within the thresholds for these national targets and all patients are finishing their treatment within 18 weeks, some patients wait longer. In February 2018, the level of patients waiting between 6 and 18 weeks was 19% for M&A patients and 13.6% for N&S patients. The CCG would need to have further details of this patient’s experience to understand whether there were issues with availability and/or whether a specific service was required.



Mr Ainsworth to include information for practices in ‘Snippets’ to clarify that there were Psychological Therapy services which could be accessed locally.

DA Completed.



Mr Ainsworth to liaise with Ms Kim Ashall and request feedback on their waiting times. A formal response to be brought to the next meeting under Matters Arising. (Post meeting note: Regrettably waits have extended. Reasons provided are due to the introduction of self-referral, together with bringing the two teams from NHC and SFH to work together have had a negative impact. The longest wait for an urgent appointment w/c 28 May was 4 weeks. For a routine the longest wait was 10 weeks. There were plans to use the vanguard funds for a locum physio to support reducing the backlog, but this was only available until the end of March. Additional funding for locums is being sought).

DA

Feedback on waiting times received.



Mrs Butcher to undertake mapping and review of ED data in respect of improvements in weather and impact of recruitment.

DB Mapping completed and sent to Ms Dadge.

Page 6 of 6

Progress report from the

Mansfield & Ashfield CCG and Newark & Sherwood CCG Primary Care Commissioning Committees

Date of committee: 12 July 2018

Key Achievements At their meeting of 12 July the Committees:

• The Committees received a presentation on progress in the delivery of STP workforce plan, noting that the International GP Recruitment programme had failed to realise the number of anticipated GPs, both at the local and national level. It was agreed that the CCGs should swiftly explore a number of practical opportunities to increase recruitment and retention of GPs in the mid Nottinghamshire area.

• The Committees received an update on the progress of the Primary Care Transformation Programme, noting progress on the procurement exercise for Sunday and bank holiday GP practice opening; and progress towards the business case for the Newark South Strategy.

• The Committees noted that the Kings Medical Centre had successfully opened on 2 July and thanked the staff of both practices for their hard work.

• The month two financial positions for both CCGs was noted.

• The Committees approved the minutes of the meetings of 17 May and 14 June, which are enclosed for noting.

Issues Actions No issues to raise

Risks Actions The Committees agreed to close Assurance Framework Risk 2 and approve a new risk that focused on primary care workforce. It was agreed that the risk score should be 4x5, noting that the failure to transform primary care would lead to wider system impact.

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Minutes of the Mansfield & Ashfield CCG and Newark & Sherwood CCG

Primary Care Commissioning Committees

Thursday 17 May 2018 11.00-12.00

Birch House Rooms 2 and 3

Representing both CCG Primary Care Commissioning Committees (voting) Mr Jon Towler, Chair Mrs Eleri de Gilbert, Independent Lay Representative Mrs Lucy Dadge, CCG Chief Commissioning Officer Dr Amanda Sullivan, CCG Chief Officer Mr Tom Stanford, CCG Interim Associate Deputy Chief Finance Officer Mr David Ainsworth, CCG Director of Primary Care Mrs Andrea Brown, CCG Deputy Chief Commissioning Officer Mr Peter Clay, CCG Governing Body Lay member and Chair of the Audit Committee Mr Shaun Beebe, CCG Governing Body Lay Representative Mrs Elaine Moss, CCG Chief Nurse Mrs Sandy Hogg, CCG Director of Turnaround Dr Nigel Marshall, CCG Clinical Advisor In attendance (non-voting) Cathy Quinn, CCG Deputy Director of Primary Care Ms Paula Longden, CCG Assistant Director of Primary Care Ms Kerrie Woods, NHSE GP Contracts Manager, North Nottinghamshire Ms Jo Lunn, NHS England Ms Lucy Whitehall, Nottinghamshire Local Medical Committee Mrs Rachel Whitaker, CCG Interim Board Secretary Ms Sue Wass, CCG Corporate Governance Officer (minutes) Apologies representing both CCG Primary Care Commissioning Committees (voting) Ms Dawn Jenkin, Director, Nottinghamshire Public Health Mr Mick Cawley, CCG Chief Finance Officer Apologies in attendance (non-voting) Dr Hilary Lovelock, Local GP

JPC/18/26 Welcome a. Introductions b. Apologies for absence c. Declaration of interest

The Chair welcomed members to the meeting and a round of introductions was made. Apologies were noted as above and the meeting was declared quorate. No declarations of interest were made that were in addition to those detailed in the register of interests on any item on the agenda.

JPC/18/27 Questions from members of the public No questions were received.

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JPC/18/28 Minutes of the meeting held on 8 March 2018 The minutes of the meeting held on 8 March were taken as an accurate summary of discussions.

JPC/18/29 Actions arising from the meeting held on 8 March 2018 There was a discussion regarding JPC/18/17 concerning governance arrangements for the Nottinghamshire Integrated Care System (ICS); with a need noted for the Committees to be assured that the primary care workstream was driven forward in the most effective way. Mr Ainsworth noted that the Terms of Reference for the Workstream were due to be drafted shortly, which would provide greater clarity on the scope of the workstream and how the Committees related to it. Action ongoing. All other actions were noted as completed.

JPC/18/30 Forward plan The forward plan was NOTED.

JPC/18/31

Locality Care Hubs – Update Mr Ainsworth gave the background to the development of locality care hubs, which aimed to provide care closer to home for populations of between 30-50,000 patient populations. This was a national direction of travel in order to ensure the long term sustainability of general practice, which would also include other agencies and providers. The aim was to develop six GP networks and the appointment of clinical leads for these networks had recently been successfully concluded. A workshop was planned to develop a detailed project plan for the hubs, which would be brought to the next meeting. Some funding for the development of the hubs was potentially available via the GP Forward View Transformation Fund, subject to appropriate business cases. The discussion highlighted the following points:

• How to balance local need; • The need to be cognisant of the development of hubs in south

Nottinghamshire; • Potential for integrated back office functions, including call-handling and

prescription services, although not if this interfered with the timeline for the development of the hubs;

• Noting that the biggest single concern from patients was the availability of appointments, and how the hub model would respond to this challenge;

• To give clarity on governance arrangements and to ensure visibility of the development of hubs at governing body level.

• ACTION: Mr Ainsworth to bring a project plan for locality hubs to the next

meeting.

JPC/18/32 Primary Care Strategy Implementation Exception Report Ms Longden reported that the CCGs had now secured full extended access for both CCG areas. At the present time two services had interim solutions. Sherwood locality was currently covering Newark; however from June a partnership of Newark practices would take over. The Sunday and bank holiday service currently being provided by NEMS would require a procurement exercise to be undertaken as the provider did not want to continue the service for the long

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term. Regarding workforce issues, it was reported that there was some delay in the national timeline for international GP recruitment. A more detailed workforce report would be drafted for the July meeting. Mrs de Gilbert requested that abbreviations in the workforce report be explained going forward. Ms Longden reported that the 2017/18 QIPP plan had now concluded with an overall delivery of £1.7m against a £1.65m target. It was noted that an evaluation had been undertaken on the Best Practice Scheme, which had not performed as well as expected. It found that the limited amount of funding available had impacted on sign up to the scheme and a number of learning points had been taken. However the scheme had a positive impact on the facilitation of engagement with practices, which was of benefit to a number of other QIPP schemes. Mrs de Gilbert noted that NHS England had instigated a national consultation on on-line GP consultation and it was agreed that Ms Longden would investigate this further in order to ensure any feedback was fed into the local scheme. • ACTION: Ms Longden to investigate the national NHSE consultation on GP on-

line consultation in order to link with the local scheme. The Chair asked that the format of the next report be revised to highlight the principal issues for 2018/19, such as the plan to reduce unwarranted clinical variation. • ACTION: Ms Longden to revise the format of the next report to highlight the

core issues for 2018/19. The Primary Care Strategy Implementation Exception Report was NOTED.

JPC/18/33 Primary Care Quality Report Mrs Quinn reported that of the 41 practices in mid Nottinghamshire five required intense support and five were receiving intermediate support. No significant infection control issues had been reported since the last report; and recently three practices had received CQC inspection reports, all of which had received a rating of ‘good’. Overall activity had continued to reduce across both CCGs and was below the mean average. The Primary Care Quality and Performance Review Group had agreed that a letter be sent to practices to recognise those practices that had maintained a good quality position or had made a significant improvement in year. Mrs de Gilbert added that the Group would maintain a focus on the sharing of best practice, whether this was through visits to individual practices or through clinical networks and practice learning times. In response to a query at the last meeting regarding Peer Review, Mrs Quinn noted that even though not all practices had signed up to Peer Review, all practices were using it. In response to a query on IT issues relating to the Arden’s template, it was reported that NHIS had investigated and there was no evidence that the Arden’s software had caused the slowdown. NHIS was currently exploring ways to solve SystmOne ad hoc slowdowns. The Chair asked that practices should receive

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communication about this issue, which was agreed. Mrs Hogg requested a deeper understanding of the metrics in the primary care scorecard and it was agreed that Mrs Quinn would discuss this outside of the meeting. Mrs Moss requested a benchmark against the previous year for CQC inspections. The Chair asked for a report to be brought to the July meeting that described the check and challenge processes and reporting lines for scorecard data to give assurance to the Committees that the data was been appropriately acted upon. • ACTION: Mrs Quinn to bring a report to be brought to the July meeting that

described the check and challenge processes and reporting lines for scorecard data to give assurance to the Committees that the data was been appropriately acted upon.

The Primary Care Quality Report was NOTED.

JPC/18/34 Primary Care Risks Mr Ainsworth asked the Committees to note the updates to the primary care risk and proposed that the risk rating remained unchanged at the present time. Mrs Moss suggested that the risk had become too wide in scope and specifics should be drawn out to enable the Committees to monitor key areas of risk. It was agreed that Mrs Moss and Mr Ainsworth should meet to discuss this and for additional time to the built into the agenda for this item for discussion at the July meeting.

• ACTION: Mrs Moss and Mr Ainsworth to meet to discuss re drafting of the primary care risk prior to discussion at the July meeting.

The Primary Care Risk Report was NOTED.

JPC/18/35 Finance Reports Mr Stanford gave a synopsis of the reports. Mansfield and Ashfield CCG reported a £2.3m year end underspend, in the main comprising £1.5m of reserves; lower than expected premises costs and lower than expected activity. Newark and Sherwood CCG reported a 0.2m overspend, in the main comprising increases in the cost of a number of GMS contracts, locum costs and QOF. Following the approval of the opening co-commissioning budgets, the detail of the budgets was currently being finalised for distribution to teams. The finance reports were NOTED.

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Draft Minutes of the Mansfield & Ashfield CCG Primary Care Commissioning Committee

Thursday 14 June 2018

9.00-11.00 Birch House Rooms 2 and 3

Representing both CCG Primary Care Commissioning Committees (voting) Mr Jon Towler, Chair Mrs Eleri de Gilbert, Independent Lay Representative Mrs Lucy Dadge, CCG Chief Commissioning Officer Mr David Ainsworth, CCG Director of Primary Care Mr Peter Clay, CCG Governing Body Lay member and Chair of the Audit Committee Mr Shaun Beebe, CCG Governing Body Lay Representative Mr Mick Cawley, CCG Chief Finance Officer Mrs Sandy Hogg, CCG Director of Turnaround Mr Tom Stanford, CCG Interim Associate Director of Finance In attendance (non-voting) Mrs Cathy Quinn, CCG Deputy Director of Primary Care Ms Paula Longden, CCG Assistant Director of Primary Care Ms Kerrie Woods, NHSE GP Contracts Manager, North Nottinghamshire Ms Jo Lunn, NHS England Ms Lucy Whitehall, Nottinghamshire Local Medical Partnership Mrs Rachel Whitaker, CCG Interim Board Secretary Mrs Julie Andrews, CCG Engagement Manager Mrs Jacqui Kemp, CCG Primary Care Manager (item JPC/18/38 only) Ms Sue Wass, CCG Corporate Governance Officer (minutes) Apologies representing both CCG Primary Care Commissioning Committees (voting) Mrs Elaine Moss, CCG Chief Nurse Dr Nigel Marshall, CCG Clinical Advisor Ms Dawn Jenkin, Director, Nottinghamshire Public Health Dr Amanda Sullivan, CCG Chief Officer Apologies in attendance (non-voting) Dr Hilary Lovelock, Local GP

JPC/18/36 Welcome a. Introductions b. Apologies for absence c. Declaration of interest

The Chair welcomed members to the meeting and a round of introductions was made. Apologies for absence were noted as above and the meeting was declared quorate. Mrs Whitaker declared a conflict on item JPC/18/38, as her firm was advising the Harwood Close practice on the corporate deal. It was agreed that she remained in the meeting but would take no part in the discussion. No other interests were declared.

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JPC/18/37 Questions from members of the public No questions were received.

JPC/18/38 Proposal to merge Ashfield Medical Centre and Harwood Close – Patient Engagement Report Mrs Whitaker declared a conflict as her firm was advising the Harwood Close practice on the corporate deal. It was agreed that she remained in the meeting but would take no part in the discussion. Ms Longden gave the background to the engagement exercise. The Committee had approved the merger of Ashfield Medical Centre and Harwood Close at its meeting on 12 April, subject to a satisfactory period of patient engagement. The engagement commenced following the approval and ran until the end of May. Mrs Andrews gave an overview of the engagement process. Stakeholders targeted included patients of both practices, the staff of both practices, the PPI groups, local politicians, GPs from the Ashfield North locality, the Local Medical Council, Healthwatch and the Health Scrutiny Committee. A number of events were held, including an evening session; drop in sessions were held at the practices, including one for Polish speaking patients; and briefing notes, flyers and displays in the surgeries were produced. Briefing was also undertaken via social media. Over fifty people attended the drop in sessions and 109 individuals responded to the survey. Over 80% of respondents found it acceptable that the services moved to the Ashfield Medical Centre premises. The key concerns raised by respondents not in favour of the move related to access to appointments and transport. It was noted that the engagement also provided a positive opportunity to garner patients’ views on services, which would feed into the development of future working practices at the surgery. Ms Longden wished to put on record her thanks to Mrs Kemp and Mrs Andrews for their work on the engagement process and to all patients who took time to give their views. Mrs de Gilbert noted the comprehensive engagement process and asked to be assured that the concerns noted by the 20% of respondents who were not happy with the move had been taken into account. It was noted that there would be the same number of appointments available as at the previous surgery; that an additional GP partner had been recruited and the surgery was currently in the process of employing an additional ANP. The intention of the practice to deliver additional services was noted. Regarding transport issues, there was a regular bus service near the surgery, two car parks close to the surgery with free parking of up to one hour and on street parking outside of the surgery. It was noted that there was currently an application to NHS England to re-locate the pharmacy at Harwood Close to Ashfield Medical Centre. The Mansfield and Ashfield Primary Care Commissioning Committee APPROVED the merger of Harwood Close Surgery and Ashfield Medical Centre, including the relocation of Harwood Close patients to Ashfield Medical Centre, closure of Harwood premises and creation of combined service to be known as Kings Medical Centre with effective date 1st July 2018. It was agreed that a review be undertaken after a period of three months, with a report taken to the Quality, Risk and Safeguarding Committee, with any issues

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requiring escalation brought to the Committee. • ACTION: Mrs Kemp to provide a report on the merger to the October Quality,

Risk and Safeguarding Committee, which would escalate any concerns to the Primary Care Commissioning Committee.

JPC/18/39 Application to Close Underwood Surgery – A Branch of Jacksdale Medical

Centre Mr Towler introduced the item, confirming that the item was for approval. Mr Ainsworth gave the background to the request to close the Underwood branch of Jacksdale Medical Centre. This was due to the landlord of the Underwood branch giving notice to terminate the tenancy of the premises. It was noted that the branch surgery was a poor quality building, was not DDA compliant and could not be used for a number of procedures. From 2016 the branch surgery had only provided appointments on a Wednesday and there had been a recent prolonged period of closure following the breakdown of the boiler and the departure of a locum GP. In mitigation the Practice offered patients at Underwood appointments around the bus timetables and continued home visits to Underwood. No complaints had been received over this temporary closure. Mr Ainsworth had asked the Practice to find an alternative prescription postal box for Underwood patients, which had been undertaken. It was noted that if the Committee did not agree to the closure of the branch it would entail Jacksdale Medical Centre attempting to source alternative premises in Underwood. Mrs Hogg noted concern over the short notice of the eviction and it was agreed to undertake a review of GP estates in mid Nottinghamshire to highlight any other practices that occupied buildings with similar tenancy arrangements and propose any mitigations or contingencies that could be put in place. • ACTION: Mr Ainsworth to bring a report to the next meeting detailing other

practices that occupied buildings with similar tenancy arrangements to the Underwood branch surgery and to propose any mitigations or contingencies.

The Committee noted that it had previously considered the practice’s request to close the branch and had rejected it; however it was noted that a survey undertaken at the time had highlighted that there were no alternative premises in Underwood. The Committee discussed quality issues and it was noted that the current GP partner had improved services and had invested in Jacksdale Medical Centre. The Chair summarised the discussion: that although it was not an ideal situation, in reality there was no viable alternative other than to agree to the closure of the branch surgery: and there was a need for communication to the patient population to that effect. The Mansfield and Ashfield Primary Care Commissioning Committee APPROVED the closure of the Underwood Branch Surgery.

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Progress report from the Quality, Risk and Safeguarding Committee

Date of committee: 28 June 2018

Key Achievements The Committee APPROVED the following items:

• The Privacy Impact Assessment for the transfer of Continuing Healthcare provision to the CCG from Citycare.

• The Privacy Impact assessment for the ‘red bags’ Vanguard initiative, which provides a purpose specific identifiable red bag for use where a patient is transferred from a care home, to acute care via ambulance.

• The Equality and Quality Impact Assessment for the merger of Harwood Close and Ashfield Medical Centre; asking for an update report to be given in three months’ time to highlight any unforeseen quality issues.

• The Equality and Quality Impact Assessment for the closure of the Underwood branch surgery; asking for an update report to be given in three months’ time to highlight any unforeseen quality issues. A panel will be established to ensure the timely consideration of EQIAs in future

The Committee recommended a proposed option on the provision of support for sexual violence survivors. The Committee reviewed the Quality Performance Report, noting that the CQC recently visited SFHT to complete its inspection in April. The inspection findings are not expected until later in the year. The minutes of the meeting of 9 April were approved and are enclosed for noting. Issues Actions The Committee raised concern over the CCGs’ non-compliance with statutory deadlines for a number of Freedom of Information requests and statutory training rates.

The Committee will send a formal note to all staff reminding them of the reputational risk to the CCG of non-compliance.

Risks Actions The Committee agreed to close risk RR20 as there was no longer a risk relating to the operational arrangements of the MASH.

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QUALITY, RISK AND SAFEGUARDING COMMITTEE

Held on 9 April 2018, 1pm Birch House, Ransomwood

Present: Eleri de Gilbert Lay Member, NHS Mansfield & Ashfield CCG & NHS Newark and

Sherwood CCG (Chair) Suzy Crosby Lay Member, Newark and Sherwood CCG Elaine Moss Chief Nurse and Director of Quality and Governance, NHS

Mansfield & Ashfield CCG and NHS Newark & Sherwood CCG Ruth Lloyd Head of Corporate Governance, NHS Mansfield & Ashfield CCG

and NHS Newark & Sherwood CCG Sue Barnitt Head of Quality and Adult Safeguarding, NHS Mansfield &

Ashfield CCG and NHS Newark & Sherwood CCG Sally Bird Head of Infection and Prevention Control, Nottinghamshire CCGs Jane Brady Associate Designated Nurse Children’s’ Safeguarding,

Nottinghamshire CCGs Dr Gavin Lunn Clinical Chair, NHS Mansfield & Ashfield CCG (from 1pm-2pm) CCG Staff In attendance: Glenna Gash Sue Wass (minutes)

Quality and Patient Safety Manager (item QRC/18/29 only) Corporate Governance Officer, NHS Mansfield & Ashfield CCG and NHS Newark & Sherwood CCG

Apologies: Shelley-Louisa Colton Deputy Director of Contracting Sally Dore Head of Communications and Engagement, NHS Mansfield &

Ashfield CCG and NHS Newark & Sherwood CCG Dr Nigel Marshall Clinical Advisor, NHS Newark & Sherwood CCG David Ainsworth Director of Primary Care, NHS Mansfield & Ashfield CCG and

NHS Newark and Sherwood CCG Rosa Waddingham Deputy Chief Nurse, NHS Mansfield & Ashfield CCG and NHS

Newark & Sherwood CCG Coral Osborn Senior Prescribing (North) and Governance Advisor on behalf of

Mid and South Notts CCGs WELCOME AND INTRODUCTIONS (QRC/18/19) The Chair welcomed members to the meeting. APOLOGIES FOR ABSENCE (QRC/18/20) Apologies were noted as above and the meeting was declared quorate whilst Dr Lunn remained at the meeting. The items on the agenda would be taken out of order, with items for approval moving up the agenda to enable Dr Lunn to leave the meeting early. DECLARATIONS OF INTEREST (QRC/18/21) All members confirmed that their declaration of interests were as detailed on the register and no additional interests were declared. MINUTES OF THE QUALITY AND RISK COMMITTEE MEETING HELD ON 5 FEBRUARY 2018 (QRC/18/22) The minutes of the meeting held on 5 February were accepted as representing an accurate record of discussions.

LEARNING DISABILITIES MORTALITY PROGRAMME STANDARD OPERATING PROCEDURE (QRC/18/26) Mrs Barnitt introduced the report, which detailed the operational process for undertaking a Learning Disabilities Mortality Review (LeDeR), which was a recommendation of a national inquiry into premature deaths of individuals with a learning disability. The process of the review was detailed. In response to a query by the Chair, it was noted that the review did not replace other investigation processes; it would be a parallel process. A local Steering Group would comprise both providers and commissioners, which would provide oversight that learning was taken forward. There would also be a collation and dissemination of learning at the national level. It was noted that the process required the training of a number of reviewers . At the present time there was not the capacity in the system to undertake the reviews in a timely manner, which was a situation replicated nationally and there were concerns over the capacity of providers to allocate individuals to undertake the reviews. The Committee acknowledged this as a potential risk and agreed to revisit progress at their August meeting.

• ACTION: Ms Wass to add progress on the LeDeR process to the Committee workplan for the August meeting.

The Committee ENDORSED the process for undertaking LeDeR reviews. QUALITY PERFORMANCE REPORT (QRC/18/28) Mrs Moss reported on the issues that had been reported to the March Governing Body, noting that a number of metrics were not up to date and this would be investigated to ensure timely data for future meetings. Mrs Bird gave an update on infection control data. As at the end of February both CCG areas were under target for C.difficile cases, which demonstrated a continuing improvement. Mrs Moss asked that E Coli data needed to be added to the Integrated Performance Report going forward; and that a summary of the serious incidents reported should be added to the narrative. It was noted that CCG workforce indicators had raised some concern when reviewed at the last meeting. Gaps were being investigated and a further update would be given at the June Committee. Although an improving position was noted at United Lincolnshire Hospitals Trust, the Trust was still performing badly against a range of indicators. The Committee requested an understanding of the actual numbers of CCG patients using the Trust, both as elective and non-elective. Mrs Barnitt agreed to draft a report on her recent meetings with the trust for the next meeting, where assurance was received that Newark and Sherwood CCG residents using the service were not receiving as poor a service as the overall Trust picture showed.

• ACTION: Mrs Barnitt agreed to draft a report on her recent meetings with ULHT for the next meeting and to obtain data of the actual numbers of CCG patients using the hospital, both as elective and non-elective.

The Chair queried how confident the CCGs were that NEMS had no reported serious incidents. Mrs Moss noted that she attended their Clinical Audit and Quality Committees and was confident that processes were robust. The Chair, in light of issues highlighted in The Hospital documentary queried cancer data for Nottingham University Hospitals and it was agreed to ask the lead commissioner for a

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breakdown of data to ascertain whether there were any specific areas of concern as the data presented to the committee was overall performance across all cancer sites yet the documentary had identified concerns in some areas.

• ACTION: Mrs Barnitt to ask the lead Commissioner for Nottingham University Hospitals for their reports on cancer data.

Regarding East Midlands Ambulance Service, the significant drop in the number of complaints was queried. It was noted that this could be a result of the clearing of a backlog; however Mrs Waddingham would be asked to raise the query at the next performance meeting.

• ACTION: Mrs Waddingham to confirm the reason for the fall in the number of complaints at EMAS.

The Integrated Performance Report was NOTED. The Committee examined all risks relating to the Committee’s remit: Risk AF7 (EMAS): It was noted that the risk rating had been raised by the Governing Bodies in March and was currently being updated to be brought back to this Committee. Risk RR14 (SFHFT): Mrs Moss reported that following discussions at the Governing Bodies meeting, it had been agreed that the risk would be split to separate performance and quality issues, with the risk to quality remaining at its current rating until the outcome of the forthcoming CQC inspection. The separation of the two issues had been requested as although a number of concerns around the performance of the trust had been raised, there were no significant issues around the quality of services. This will be brought back to the next meeting Risk RR16 (A&E): Mrs Moss noted that there was no indication of a need to raise the level of this risk. Action was being undertaken to review the risk, as it was deemed too broad in its current format.this will be brought back to the next meeting Risk RR19 (Equinox): Mrs Moss reported that although the risk was low from a health perspective, there continued to be a requirement to respond to the needs of individuals who presented as victims of historical child abuse. There was now a need to ensure services were equitable across the county and work was underway via a task and finish group. The risk would be updated to reflect this. This will be brought back to the next meeting RR 20 (MASH): Mrs Moss reported that the risk regarded a process issue that would be resolved if a provider was appointed to oversee the MASH partnership. Although no incidents had been reported this would remain a risk until a provider was appointed. RR15 (mandatory training): It was noted that a review of training had been requested at the last meeting for discussion at the June meeting and the risk would be revised following discussions. CONFLICTS OF INTEREST MANDATORY TRAINING (QRC/18/33) Mrs Lloyd reported that NHS England had rolled out an online training package on the management of conflicts of interest, which had 3 levels and asked the Committee to approve the recommendation that Module 1 should be completed by all staff; Module 2 to be completed by those staff with decision-making roles in a CCG; and Module 3 to be completed by those staff leading on conflicts of interest.

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The recommendation was APPROVED. Dr Lunn left the meeting MATTERS ARISING (QRC/18/23) The following updates were noted on a number of outstanding actions: • QRC/17/165 Chatsworth Unit: It was noted that this action would be closed and a

revised EQIA would be drafted following a further development of the proposed model. • QRC/17/113 Terms of Reference: It was noted that the action to replace Dr Lunn on the

Committee remained outstanding and Mrs Moss would discuss the matter with Dr Bartholomeuz. The Chair stressed the importance of this as quoracy of the meetings continued to present a problem. Input from a GP was also invaluable given the scope of this committee

• QRC/17/114 Virtual approval of HR policies: All policies had been approved with the

exception of queries raised on the Dignity at Work policy and Special Leave policies. A response from Arden GEM had recently been received and would be reported to the June Committee.

• QRC/18/09 ULHT Risk: Mrs Waddingham to include explanatory wording on the

rationale for the current score for risk AF23 on ULHT for the June Committee.

All other actions were noted as complete. TRAINING: CHILDREN AND ADULT SAFEGUARDING (QRC/18/24) Following the expansion of the Committee’s remit, in order for the Committee to have a greater understanding of the safeguarding agenda Mrs Barnitt and Mrs Brady gave an overview of the current safeguarding reporting arrangements for the county. The number of strategic and operational groups were detailed, including the recently changed arrangements for CCG safeguarding oversight from the Safeguarding Executive Group and the proposed changes to the Nottinghamshire safeguarding children’s strategic arrangements. The Committee discussed the reporting requirements needed to give them assurance, noting the need for the Committee to embrace the ‘Think Family’ agenda. It was agreed that progress reports from the CCG Safeguarding Executive Group and CCG Assurance Group should be provided to the Committee, along with highlight reports from key strategic Nottinghamshire Boards, such as the Safeguarding Adults and Children’s Boards. It was also agreed that an overview of key policies, last year’s annual report and the work plan for this year should be brought to the next Committee. The Committee would also oversee an action tracker on learning from case reviews.

• ACTION: Mrs Barnitt to ensure the agreed safeguarding reporting arrangements are in place for future Committee meetings.

PERSONAL HEALTH BUDGET GUIDANCE (QRC/18/025) Mrs Moss asked the meeting to endorse the framework for patients who were eligible for CHC support, joint funded support to meet health care needs, fast track and Section 117 aftercare via a Personal Health Budget (PHB). It detailed the CCGs’ process for the allocation, implementation and operation of PHBs, along with the responsibilities of the parties involved. The aim was to ensure that a consistent and transparent approach was

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applied to the allocation, approval and review of all PHBs, which aimed to provide greater assurance and risk management as the roll out of PHBs continued to gather momentum. The Committee discussed how quality would be monitored. It was noted that as a direct payment to the patient to determine their own healthcare needs, any monitoring of quality would be limited, which was an acknowledged risk. However any patient safety concerns would be picked up via normal health channels. The Committee asked that Appendix nine, the reimbursement of CCG funds following the death of a patient, should be reviewed by the CCG’s legal representative to ensure the wording was correct.

• ACTION: The CCG’s legal representative to review appendix 9 of the PHB Guidance.

The PHB Guidance was ENDORSED by those present. QUALITY AND SAFETY TEAM ANNUAL REPORT (QRC/18/27) Mrs Barnitt introduced the report, which described how the CCG had met its statutory objectives of promoting the improvement of quality and patient safety. It also detailed priorities going forward. The Chair congratulated the quality and safety team on the huge amount of work that had been achieved during a challenging year. It was agreed that the report should be more explicit in the team’s role in driving improvements with providers and to detail the work of the Committee in this, with a view to putting the report on the agenda for the future meeting of the Governing Bodies. It was also agreed that a work plan with timescales should be drafted for next year’s priorities in order for the Committee to track progress. ACTIONS:

• Mrs Barnitt to update the annual report to include more explicit references to the team’s role in driving improvements and to detail the work of the Committee in this, with a view to putting the report on the agenda for the future meeting of the Governing Bodies.

• Mrs Barnitt to draft a work plan with timescales for next year’s priorities in order for the Committee to track progress.

The Quality and Safety Team Annual Report was NOTED. PATIENT STORY (QRC/18/29) Mrs Gash introduced the patient story, which was a positive story of a patient’s experiences of support following diagnosis of frontotemporal dementia. It was agreed to ask the patient and his wife to talk to the story at the next Governing Bodies meeting detailing both their positive and negative experiences. The Chair noted that the Governing Bodies had requested stories targeting the experience and frustrations of users of the women’s and children’s services and IAPT services. The difficulty and limitations of the collection of patient stories by commissioners was shared. It was agreed that some consideration would be given to address this. The Patient Story was NOTED. INFECTION PREVENTION AND CONTROL HIGHLIGHT REPORT (QRC/18/30) Mrs Bird provided an update on the 2017/18 Quality Premium requirements.The requirement was for a 10% reduction in all E.coli infections. The latest returns indicated that Newark and Sherwood would meet this standard; however Mansfield and Ashfield were on track to miss

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the target. Work had been undertaken to identify themes, but as yet none had been identified. Campaigns were on going, including the roll out of the ‘dip or not to dip’ campaign, which could be attributed to the recent reduction in outbreaks. Next year campaigns would be targeted wider than health professionals at the general public under the ‘self-care’ agenda. Mrs Moss noted the need for ongoing reporting to be undertaken through the Integrated Performance Report. The Infection, Prevention and Control Highlight Report was NOTED. SAFEGUARDING (QRC/18/31) The report from the Safeguarding Operational Working Group of 27 March was noted. The Committee asked that for future reports and issues in the ‘Alert’ section should be accompanied by actions to be undertaken. The Safeguarding report was NOTED. RISK MANAGEMENT POLICY (QRC/18/32) Mrs Moss asked the Committee to note the updated policy prior to approval by the Audit Committee. The Risk Management Policy was NOTED. CYBER ASSURANCE PROGRAMME BOARD OVERSIGHT (QRC/18/34) Mrs Lloyd reported that a newsletter would be circulated to the health community from NHIS on their approach to the ongoing security of networks and devices. CORPORATE GOVERNANCE REPORT (QRC/18/35) Mrs Lloyd reported that that currently compliance with information governance training stood at 85% for both CCGs. Work was underway to ensure compliance with the Toolkit training requirement of 95%. The CCGs had received ‘significant assurance’ from an internal audit on information governance. The Corporate Governance Report was NOTED. ANY OTHER BUSINESS (QRC/18/36) There was no other business. AGREEMENT OF KEY MESSAGES FOR FEEDBACK TO GOVERNING BODIES (QRC/18/37) LeDeR review, E-Coli reporting, safeguarding role of committee, Committee annual report, Patient Story, PHB Framework, Conflicts of Interest mandatory training. DATE OF NEXT MEETING: Monday 14 May, 1pm (Six monthly Risk Review Session)

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Documents

Meeting of the NHS Newark and Sherwood Commissioning Group ... · Yes Approve Dr Amanda S ullivan ... Mr Cawley gave a resume of the information contained within the report, asking