NHS Lambeth CCG Prospectus: 2013/14€¦ · Prospectus 2013/14 Page 7 of 83 2013/14 is the first year for Lambeth Clinical Commissioning Group (CCG). It will be a year of significant

Prospectus 2013/14 Page 0 of 83

NHS Lambeth CCG Prospectus: 2013/14

17th May 2013


Contents 1. EXECUTIVE SUMMARY

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2. INTRODUCTION 8 2.1 OUR MISSION, VISION & VALUES

JOINT STRATEGIC NEEDS ASSESSMENT OUR STRATEGIC HEALTH GOALS 2013/14 – ‘PLAN ON A PAGE’

10 2.2 11 2.3 13 2.4 15

3. LEADERSHIP AND GOVERNANCE 16 3.1 OUR GOVERNING BODY

OUR COMMITTEE STRUCTURE ENGAGEMENT PLAN

16 3.2 18 3.3 20

4. NHS ENGLAND MANDATORY REQUIREMENTS 23 4.1 NHS CONSTITUTION & NHS OUTCOMES FRAMEWORK

QUALITY PREMIUM DOMAIN 1 PREVENTING PEOPLE FROM DYING PREMATURELY

23 4.2 29 4.3 31 4.3.1 CANCER SERVICES 31 4.3.2 INNOVATION 33 4.3.3 PUBLIC SECTOR EQUALITY DUTY

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4.4 DOMAIN 2 ENHANCING QUALITY OF LIFE FOR PEOPLE WITH LONG TERM CONDITIONS

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4.4.1 INTEGRATED CARE 37 4.4.2 ROLL OUT OF 111 SERVICES 39 4.4.3 DEMENTIA AND CARE OF OLDER PEOPLE 40 4.4.4 CARERS 42 4.4.5 IMPROVING PRIMARY MEDICAL SERVICES

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4.5 DOMAIN 3 HELPING PEOPLE TO RECOVER FROM ILL HEALTH & INJURY

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4.5.1 MENTAL HEALTH

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4.6 DOMAIN 4 ENSURING PEOPLE HAVE A POSITIVE EXPERIENCE OF CARE

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4.6.1 PATIENT EXPERIENCE

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4.7 DOMAIN 5 TREATING AND CARING FOR PEOPLE IN A SAFE ENVIRONMENT

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4.7.1 SAFEGUARDING CHILDREN AND PROMOTING THEIR WELFARE

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4.7.2 SAFEGUARDING ADULTS AND LEARNING DISABILITIES 51 4.7.3 PATIENT SAFETY

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5. QIPP 60 6. CHOICE AND COMPETITION 62 7. EMERGENCY PREPAREDNESS, RESILIENCE AND RESPONSE 63 8. BUSINESS INFORMATICS 65 9. FINANCIAL PLANS 67 9.1 OVERVIEW OF FINANCIAL POSITION 67 9.2 FINANCIAL POSITION 68 9.3 INVESTMENT FRAMEWORK 69 9.4 2013/14 START BUDGETS 70 9.5 KEY BRIDGING MOVEMENTS FROM 2012/13 TO 2013/14 71 9.6 KEY CAPITAL SCHEMES 72 9.7 KEY FINANCIAL RISKS AND OPPORTUNITIES IN 2013/14 72 9.8 MANAGEMENT OF FINANCIAL RISK

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10. DEVELOPMENT PLAN 78 11. APPENDICES 81 11.1 QIPP DELIVERY PLANS

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1. Executive summary This is the first Prospectus for Lambeth Clinical Commissioning Group, which was formally established from 1st April 2013. Whilst this represents a significant change in how we will be commissioning health services in Lambeth it builds on strong foundations and takes forward the strategic commissioning approach set out in the Lambeth Commissioning Strategy Plan (2010/11 to 2014/15). 2013/14 represents the 4th year of our agreed 5 year strategic plan for Lambeth and enables a smooth transition from one commissioning system to another, without losing our focus on those priority health goals we previously identified as having the biggest impact on the health of Lambeth people. The Lambeth Clinical Commissioning Group mission:

‘To improve the health and reduce health inequalities of Lambeth people and to commission the highest quality health services on their behalf.’

Our aspiration is that clinical commissioning in Lambeth will give us the ability to place clinical leaders at the forefront of commissioning, working in collaboration with local people and with our partners to meet our shared goals to improve health, reduce health inequalities and improve the quality of local services. Lambeth is facing an exciting year and we welcome the continued commitment of key partners to work collaboratively to improve the health and well being of Lambeth people. The importance of building on our partnerships and continuing to strengthen our approaches to coproduction and engagement with local people become even more important as we enter an ever more complex health landscape and an ever more challenging economic environment. We have an established record of effective joint working with the London Borough of Lambeth and other local partners and we will continue to work in partnership to improve the health outcomes for Lambeth residents. Furthermore NHS Lambeth Clinical Commissioning Group (CCG) has an established partnership relationship with the other south east London CCGs putting us in a strong position to collaboratively deliver change on a broader system-wide basis, including addressing the recommendations of the Trust Special Administrator for South London Healthcare Trust and our shared ambitions for improved care out of hospital (our Community Based Care strategy). We work closest with Southwark CCG, in particular through our shared Planned and Unplanned Care Programmes. New relationships will however also need to be forged with new commissioning organisations such as NHS England specialist commissioning and primary care teams. We aim to make the best use of the academic and research excellence within our local NHS providers within King's Health Partners Academic Health Sciences Centre and work across South


London through the South London Local Education Training Board and South London Academic Health Sciences Network to promote the spread of best practice and innovation. The Lambeth CCG Prospectus describes what we will be doing over the next year to achieve our aim of improving health outcomes, delivering quality and securing value for money, in our commissioning of health services for Lambeth. We have had significant success in enabling people to live longer, men now live 5 years longer than in 1995 and women 2.7 years. Our challenge now is to work with people so they enter their later years healthier. We need to work with people to help prevent and better manage their long term conditions such as mental health, diabetes, Cardio Vascular Disease, HIV and Chronic obstructive pulmonary disease. A growing and ageing population and the additional opportunities brought about by medical advances at a time of resource constraint presents the CCG, and the wider NHS, with a significant challenge. This underpins our health and financial focus, working with local people and with partners to prevent ill health and reduce unnecessary demand on services, to better manage and support those with long term conditions, to ensure good quality care, to wherever possible avoid crisis and thus prevent unscheduled care episodes, and to provide compassionate and personalised care, to people as they approach the end of their of lives. By preventing the onset of ill health, and by better supporting individuals and their carers to manage their health conditions and remain independent we can reduce the demand on health and social care services. We expect that in future years the NHS in Lambeth will see lower levels of investment and it is an imperative that we are able to transform the way that local services, whether in community based or hospital settings, are provided so that they can earlier detect the risk of ill health, proactively support individuals and ensure high quality urgent or specialist care is available when people most need it. The CCG has an important commissioning role, working with local people to ensure their health services are enabled to develop so that they can continue to offer high quality care, responsive to local needs and support improved health outcomes. Whilst meeting the health and financial challenges we must ensure that we continue to improve local services, respond to feedback from patients and carers, that we continually drive up the quality of care and ensure that the money the CCG has to invest is spent in the most effective and patient centred way. We have seven clear priority health goals. These are better care for people with serious mental illness, improved management and support for people with diabetes and with cardiovascular disease, earlier detection for HIV, more people quitting smoking, less childhood obesity and better, earlier intervention for alcohol abuse. We have organised our work into four programmes to deliver upon our clear priority health goals and commission sustainable and effective local services;


1. Planned Care (run jointly with Southwark CCG) 2. Unplanned Care (run jointly with Southwark CCG) 3. Mental Health (run jointly with London Borough of Lambeth) 4. Staying Healthy(run jointly with London Borough of Lambeth)

Our key actions for 2013/14 include;

Planned care

Diabetes - expansion of intermediate care team - virtual clinics, education, and referral management and decommissioning through repatriation and improved GP management Cardio Vascular Disease/Cardiology – community cardiology service including specialist heart failure clinics, Specialist nurse community clinics in Atrial Fibrillation and primary prevention, Multi-professional virtual clinics in GP practices on Heart failure and Atrial Fibrillation and prevention focused primary care education and an Ambulatory blood pressure monitoring programme Chronic obstructive pulmonary disease (COPD) /Respiratory – integrated community respiratory team for COPD and adult asthma including a single point of referral, Multi-professional virtual clinics in GP practices and management of home oxygen Introduction of Telehealth care

Unplanned care

Re-commissioning urgent care centre at St Thomas' and reviewing price structure Work with the Primary Care Foundation to develop Primary Care Access Re-commissioning Patient Advice and Liaison Service at the front of A&E to support people to access same day GP services, including supporting them to register with a GP.

Mental Health

Reduction in acute placements - development of alternatives to acute inpatient stay - crisis retreat etc. through the Living Well Network Re-commission continuing care beds Reduction in rehab unit bed costs Increase rate of follow up assessments for spot placements to increase rate of move on from residential care (including 50/50 funded) placements Reduction in costs of high cost drugs

Staying Healthy

Reduce smoking rates Reduce obesity rates amongst children Improved detection of diabetes Earlier detection of HIV Prevention of Cardio Vascular Disease Reduced alcohol consumption


We place patient experience, outcomes and quality of service at the heart of how we commission. We will make use of CQUINs (Commissioning for Quality and Innovation) to promote quality improvement and have set clear expectations to deliver the new Quality Premium. We have robust systems in place to ensure that out commissioned services are of the highest quality and continually engage with and listen to patients and carers to ensure feedback on the experience of services. We take a ‘whole system approach’ to assuring that the services we commission are of high quality, engaging with local patients and stakeholders, including other NHS organisations, Lambeth HealthWatch and Lambeth Health and Wellbeing Board. Whilst we are proud of what we have achieved and are ambitious for the future we also recognize that Lambeth, alongside all NHS organisations are facing ongoing financial pressures, coupled with significant health improvement challenges. Our Prospectus includes our Quality, Innovation, Productivity and Prevention (QIPP) Plans for 2013/14. Our QIPP Initiatives address the quality of services, ill health prevention, improved productivity and efficiency. The QIPP plans represent a key element of our overall plans for 2013/14. A summary of QIPP initiatives by programme area 2013/14 are set out below:

QIPP Initiatives by programme area 2013/14 £’000


2013/14 is the first year for Lambeth Clinical Commissioning Group (CCG). It will be a year of significant financial challenge following years of growth in NHS funding and at the same time navigating a new and more complex landscape of NHS commissioning bodies at local, London-wide and national level. The pie chart below shows the CCG start budget 2013/14:

We face a number of in year financial risks including;

Growing demand for services in excess of funded and commissioned levels, including the impact of wider sociology economic environment.

Disaggregation of historic commissioning budgets across Lambeth CCG and NHS England.

Additional cost of delivering the NHS Constitution and other quality standards.

Delivery in full of our ambitious QIPP initiatives, including the key enabling work in workforce and information sharing to support transformation.

Provision of adequate enabling funds to support transformation, including through the Trust Special Administrator (TSA) programme.

Delivery of provider cost improvement programmes and viable primary care provision and at the same time sustain improvement in care quality.


Lambeth CCG remains ambitious and confident of our ability to continue to ensure delivery. We understand the health and financial challenges facing us, we have a robust QIPP plan and we have strong collaborative partnerships in place. There is a strong local commitment to work together to ensure we commission services that deliver care quality, value for money and improved health outcomes for local people.

2. Introduction Lambeth is facing an exciting year with the launch of its clinical commissioning group and continued commitment of key partners to work collaboratively to improve the health and well being of the residents of Lambeth. The importance of maintaining and building on our partnerships and continuing to strengthen our engagement and consultation approaches become even more important as we enter an even more complex health landscape. Lambeth Clinical Commissioning Group (CCG) has a long partnership relationship with the other south east London CCGs putting us in a strong position to collaboratively deliver the recommendations of the Trust Special Administrator (TSA) for South London Healthcare Trust. This history of joint working will be of particular benefit to the implementation of the Community Based Care strategy and is clearly demonstrated in the joint working already in place between Lambeth and Southwark on planned and unplanned care. Similarly the long history of joint working with the London Borough of Lambeth will continue as we work in partnership to improve the health outcomes for Lambeth residents. New relationship will need to be forged with new commissioning organisations such as NHS England and the specialist commissioning teams. This Prospectus sets out the annual plan of work for NHS Lambeth Clinical Commissioning Group (CCG) to help us achieve that aim. It builds on the history of strong working between the local NHS commissioners and the local population and has been developed by Lambeth clinical commissioners. The Prospectus describes our work going forward and builds on the achievements and foundations of previous years. The development of clinical commissioning in Lambeth has been a key means by which we have been able to enhance and extend clinical involvement in the development of our strategic plans and commissioning intentions. Clinical design and involvement has always been part of our strategic planning in Lambeth, and through the leadership of the CCG we have increased the depth of clinical involvement. We believe clinical commissioning gives us extra strength to deliver the changes we need to make to deliver the best services to the population of Lambeth. In developing this plan Lambeth CCG has built upon the wide range of stakeholder engagement in Lambeth extending back over many months and years. This engagement produced the Lambeth Clinical Commissioning Collaborative Strategy Plan Refresh 2012-15 in May last year;


includes the engagement exercises that enabled the CCG to become authorised; incorporates all the patient and clinical inputs that are an essential feature of improving clinical services; and, working closely with other CCGs crafted the response to the South London Healthcare Trust Special Administrator (TSA). In developing this plan over the last 3 months, the CCG has:

Met with Joint Health and Wellbeing Board on 6th February 2013 to discuss the CCG’s plans for 2013/14;

Met with the Area Team of NHS England in February 2013;

Discussed our plans for 2013/14 with all local providers as part of the contracting round of negotiations and planning;

Meeting with our GP Collaborative Forum in April to discuss the 2013/14 plan and obtain their input on key issues and concerns on clinical matters;

Met with Lambeth LINKs to discuss our plans for 2013/14 and obtain their specific input into the direction of travel.

Out of this engagement and analysis of the health needs of the Lambeth population we have confirmed the clear priority health goals for Lambeth CCG. We took the opportunity of moving from a Primary Care Trust (PCT) to a CCG to re-examine the key health needs for Lambeth to ensure that the CCG focus would be in the appropriate place. This plan therefore builds on strategic priorities set out in the Commissioning Strategy Plan (CSP) covering 2012-15 and uses the 4th year of the five year plan as its foundation to build upon. We have included new health priorities such as developing an alcohol misuse pathway. We have organized our programmes of work into four streams that target the clear priority health goals:


Each program of work has clear patient focused outcomes, a programme of work to enable delivery, support from the CCG team and a clinical lead from the clinical commissioning board. Whilst we are proud of what we have achieved and are ambitious for the future we also recognize that Lambeth, alongside all NHS organisations are facing ongoing financial pressures, coupled with significant health improvement challenges. 2013/14 is the first year for Lambeth clinical commissioning group (CCG). It will be a year of significant financial challenge following years of growth in NHS funding, whilst establishing new organisations and learning to navigate a new and complex landscape of NHS commissioning


bodies at local, regional and national level. Whilst we are proud of what we have achieved and are ambitious for the future we also recognize that Lambeth, alongside all NHS organisations are facing ongoing financial pressures, coupled with significant health improvement challenges. However Lambeth CCG is ambitious and confident. We understand the health and financial challenges facing us, we have a robust QIPP plan in place and have strong collaborative partnerships with neighbouring CCGs and healthcare providers. There is a strong local commitment to working together to ensure that across the piece we ensure that the best, value for money, health care system exists for the residents of Lambeth.

2.1 Our mission, vision and values Mission In the Lambeth CCG Commissioning Strategy Plan 2012-15 we set out our mission, vision and values. Our mission is: ‘To improve the health and reduce health inequalities of Lambeth people and to commission the highest quality health services on their behalf.’ Our vision

Health improvement is at the heart of all we do. We will increase life expectancy for all and reduce the difference in life expectancy between the most and least deprived in our diverse communities.

We will maintain a thriving, financially viable, health economy delivering safe and effective high quality care.

We will commission comprehensive integrated care that meets the needs of local people. We will value diversity amongst providers, but will expect excellent outcomes.

Our values

We will always tell the truth

We are fair

We are open

We recognise our responsibilities to service users and the wider public

We act responsibly as a public sector organisation

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2.2 Joint Strategic Needs Assessment (JSNA) Lambeth is an inner London borough with a growing population. Lambeth has 21 local authority wards. Key features include high relative deprivation, population mobility, diversity and density. It has a breadth of ethnic and cultural traditions which have established their presence in particular town centre areas and quarters. The census area classifications describe Lambeth as a London Cosmopolitan area similar to Southwark, Lewisham, Hackney, Islington, Haringey and Brent. Key Facts

303,100 residents in Lambeth (2011 Census). Population projected to grow by up to 15% by 2030.

380,000+ General Practice registered population in 2012.

An even split of males / females.

A younger population than seen nationally with over 50% aged 20-44.

37% of the population is from Black & Minority Ethnicity (BME) communities.

80,000 residents classified as Black African or Caribbean.

Increasing Black African population projected till 2031.

130+ different first languages spoken by children in schools

Lambeth was the 9th most deprived borough in London in 2010. In England, Lambeth is the 29th most deprived. Income deprivation is relatively worse in both older people and children compared to London and England.

Progress overall Life expectancy – Overall NHS Lambeth is one of the few areas to have increased life expectancy in both men and women as a result of reduced premature deaths from cardiovascular diseases, cancers, infant deaths and other causes. Between 1995-97 and 2008-10 life expectancy at birth increased:

for men by 5 years to 77 years

for women by 2.7 years to 81.1 years

Compared to England the gap in life expectancy has reduced in the same timeframe for both men (by 37%) and women (by 7%).

Infant mortality – Infant mortality (deaths of infants aged under 1 year) has reduced by 39% (from 8.8 per 1000 live births in 1995-97 to 5.4 per 1000 live births in 2007-09). Premature deaths from circulatory diseases (heart disease and strokes) – The 3-year average mortality rate for circulatory diseases (< 75 years) has fallen by 50%, from 175.3 deaths per 100,000 in 1995-7 to 87.7 in 2008-10. The absolute gap between Lambeth and England has reduced by 40% over


the same time period. Premature deaths from cancer – The 3-year average premature mortality (< 75 years) from all cancers has fallen by 15% from a baseline 161.8 per 100,000 in 1995-97 to 137.1 per 100,000 to 2008-10. However the overall absolute gap between Lambeth and England has worsened by 31% over the same time period suggesting that reductions in premature mortality in Lambeth are not as fast as at the national level. The refresh of our Joint Strategic Needs Assessment (JSNA) demonstrates that despite good progress in key areas, the health burden and inequalities remains a challenge. The main causes of death leading to the life expectancy gap are heart disease, stroke, cancer of the lung, respiratory disease and peptic ulcers and liver cirrhosis. In addition to the mortality gap people in Lambeth are living longer with one or more long term conditions. Mental illness forms the largest component of this burden but people are also living longer with cardiovascular disease, cancers, and chronic respiratory and digestive system disorders as survival improves. It is important to consider promotion of healthy lifestyles, prevention, early active case-detection, case management, improved medicines management, appropriateness of referral to avoid unnecessary hospital admissions, improve quality of end of life care and support to carers. Our Commissioning Strategy Plan (CSP) identifies our key health goals and associated outcome measures which we believe will, if achieved, have the biggest impact on the health of people in Lambeth within available resources. These health goals and the specific interventions to support their delivery were determined through a systematic process of prioritisation, working with Lambeth stakeholders. We have taken the opportunity of this refresh to assess delivery of these health goals and to review the goals, interventions and outcome measures. Our assessment is that the core goals should remain unchanged, but with an added partnership priority around addressing the impact of alcohol on health and more widely upon the wellbeing of our local communities. Within our existing health goals we have suggested some changes. The JSNA web pages are available here: http://www.selondon.nhs.uk/your_local_nhs/lambeth/your_health/joint_strategic_needs_assessment

Reference documents are numbered below: 1. Refer to Health Profile and Outcomes review document published in Oct 2012 for info on NHS & PH outcomes as a part of the JSNA. 2. Also refer to Public Health Outcomes Framework Summary for Lambeth published on www.phoutcomes.info 3. Also refer to Lambeth Outcomes benchmarking support pack (Local Authority level) and CCG info packs available at http://www.commissioningboard.nhs.uk/la-ccg-data/

http://www.selondon.nhs.uk/your_local_nhs/lambeth/your_health/joint_strategic_needs_assessment

http://www.commissioningboard.nhs.uk/la-ccg-data/


2.3 Our strategic health goals Our Commissioning Strategy Plan for 2012/13 to 2014/15: Improving Health, Improving Quality in Lambeth; set out some challenging health goals for the next 3 years. By 2014/15, we aim to achieve the following important health goals:

Serious mental illness: 98% of users in a Care Programme Approach with Health of the Nation Outcome Scales (HONOS) Cardiovascular disease management: 76% of people with hypertension with BP <= 150/90 Diabetes management: 74.5% of people with blood sugar HbA1c <8 HIV: 13% Lambeth residents diagnosed very late with HIV (<200 CD4 cells /mm3) Smoking: 1,190 quitters per 100,000 population Childhood obesity: Year 6 obesity prevalence in children 22.3% Alcohol: 90% of the identified frontline staff have received training in screening and brief intervention for alcohol abuse.

By the end of 2013/14 (a key milestone), we aim to have made the following progress:

Serious Mental Illness: 90% of users in care programme approach with HONOS Cardiovascular disease: 73% of people with hypertension with BP <=150/90 Diabetes: 71% of people with blood sugar HbA1c <8 HIV: 14% Lambeth residents diagnosed very late with HIV (<200 CD4 cells /mm3) Smoking: 1,186 smoking quitters per 100,000 population Childhood obesity: Year 6 obesity prevalence in children 23.25% Alcohol: 90% of the identified frontline staff have received training in screening and brief intervention for alcohol abuse.

The reasons for selecting these goals are: Smoking: Smoking is an important cause of health inequality and reduced life expectancy. Lambeth has made good progress in reducing smoking prevalence with the development of a Lambeth wide tobacco control strategy and sustained efforts to support smokers to quit. However smoking related deaths and hospital admissions remain high and smoking remains an important priority for Lambeth as it is a major risk factor for cancer and cardio-vascular disease and the main cause of Chronic Obstructive Pulmonary Disease (COPD). Cardiovascular disease: Good progress has been made in reducing cardiovascular disease (CVD) mortality; however heart disease and stroke remain important causes of premature mortality in both men and women. Hypertension is an important risk factor for cardiovascular disease. Key issues are under detection and variation in the management and control of people with CVD.


Diabetes: There are 13,765 people with diabetes in Lambeth and the prevalence and numbers of detected cases is increasing. Obesity is a major risk factor for type 2 diabetes. Early detection and reduced variation in the management and control of risk factors remains an important challenge. Key issues are the lower detection rates and the variation in management of diabetes (variation in blood sugar and cardiovascular risk factor control). Childhood obesity: Obesity in children aged 10-11 is high with up to 1 in 4 children obese (24%). 13.3% of children at reception level are obese in Lambeth compared with 11% in London, and 9.9% in England. Mental Health: Lambeth has one of the highest rates of diagnosis for serious and common mental illness compared with London and England. This is associated with our comparatively younger working age and more mobile population and higher rates of diagnosis in the black and ethnic minority population. Mental health is a key strategic priority in Lambeth for two reasons

Mental ill health is the biggest cause of years of life lost to disability locally. It is also a leading contributor to premature death in people with other long term conditions such as diabetes and cardiovascular disease

The costs of disability due to mental ill health are very high, not only to the NHS and social care but also to the wider economy and to families and individuals on a social level

HIV: Lambeth has identified HIV as a strategic priority. Lambeth, Southwark and Lewisham have one of the highest prevalence of HIV in the UK. Two main affected population groups are men having sex with men (MSM), and black African heterosexuals. Late diagnosis of HIV is the most important factor associated with HIV related morbidity and mortality and inpatient care in the UK. Alcohol: As part of the refresh of the CSP we have identified alcohol as a key strategic priority across Lambeth partners including the impact of alcohol on communities and the environment. This has been identified through Lambeth Clinical Commissioning Collaborative Board working with health partners, the Safer Lambeth Partnership and the Health and Wellbeing Board Partnership

2.4 2013/14 ‘Plan on a page’

Alcohol 90% of the identified frontline staff have received training in screening and brief intervention for alcohol misuse

To improve the health and reduce health inequalities of Lambeth people and to commission the highest quality health services on their behalf Health: Men will live 17 months longer and women 7 months longer; and the gap in life expectancy between most and least deprived will be reduced by 2 months Access: Comprehensive, round the clock access to integrated pathway based care, general and specialist; delivered through neighbourhood networks Affordability: A thriving, financially viable health economy delivering safe, effective, high quality care. Cutting edge: Local services grounded in world class research, innovation and clinical education; in partnership with Kings Health Partners

^Diabetes % of people with diabetes with HbA1c <8 = 71%

HIV % Lambeth residents diagnosed very late with HIV (<200 CD4 cells/mm3) = 14%

Smoking 1186 smoking quitters Per 100,000 population

^Serious mental illness % of users in care programme approach with HONOS = 90%

^Cardio vascular disease 73% of people with hypertension with BP <= 150/90

Childhood obesity Year 6 obesity prevalence in children 23.25%

Our mission & our vision

Achieving Lambeth health goals and associated equality targets in partnership with National Commissioning Board and London Borough of Lambeth ^ = Local priorities for Quality Premium

Managing our resources

£416m budget including £9m (2.3%) growth £12m QIPP Programme Requirement to achieve 1% target surplus CCG running costs £25 per head of population Investment in new facilities Financial risk share across South East London

Delivering the NHS Constitution

18 week non urgent referral to treatment 90% admitted 95% non admitted 92% incomplete No 52 week waits

99% diagnostic waits of < 6 weeks

95% of patients admitted, discharged or transferred within 4 hours of arrival at A&E

Patients referred urgently for cancer wait no more than 2 weeks for first outpatient appointment

Max 31 day wait from cancer diagnosis to treatment All cancers – 96% For surgery – 94% Anti cancer drugs – 98% Radiotherapy – 94%

Max 62 days wait from urgent referral to cancer treatment GP referral – 85% Screening – 90%

Cat A ambulance calls response Within 8 mins – 75% Within 19 mins – 95%

No hospital mixed sex accommodation breaches

Patients who have operations cancelled on day of admission offered new date within 28 days

95% of adults with mental illness on care prog approach followed up within 7 days

Monitoring against NHS Outcomes Framework and NICE guidelines

Preventing people dying prematurely Under 75 mortality rates for CVD, respiratory & liver disease & cancer

Quality of life for people with long term conditions % people feeling supported to manage their condition Unplanned hospitalisation rates Diagnosis rate for dementia

Helping people recover from episodes of ill health or injury Emergency admissions to hospital Emergency readmissions within 30 days Health gain assessed by patients – hips, knees, hernias, varicose veins

Ensuring people have a positive experience of care Patient experience of GP and out of hours care Patient experience of hospital care Friend & Families Test

Treating & caring for people in safe environment & protecting from harm Incidence of healthcare associated infection – MRSA & C.diff CCG response to Francis report & Winterbourne View Safeguarding

Lambeth & Southwark Planned Care Redesign of LTC pathways Moving from unplanned Improving care for people with multiple LTCs Developing non face to face consultations

Lambeth & Southwark Unplanned Care 24/7 emergency care Implementation of 111 Urgent Care Centres at St Thomas’ & Kings Admissions avoidance and care at home Urgent access to specialist care without admission

Mental Health with LB Lambeth Lambeth Living Well Collaborative Talking therapies Community based alternatives to forensic services Reprovision of dementia services

Staying Healthy led by LBL Childhood healthy weight Smoking cessation Health Checks Preventing harm from alcohol Healthy Living Pharmacies Health & wellbeing in Lambeth

Lambeth & Southwark Integrated Care

South East London Community Based Care Strategy Easy access to high quality, responsive primary & community care * Integrated care * Timely, convenient & effective planned care

Delivering the Plan

Lambeth Health & Wellbeing Board and Strategy supported by Joint Strategic Needs assessment

Working with people in Lambeth Co-production in service redesign* Online access to GP records* Real time patient experience of services and development of patient participation groups* Patient held budgets* Developing HealthWatch

Enablers for Innovation & change Supporting people to manage their own condition Workforce development & education Clinical leadership & engagement Information & IT including Telemedicine Medicines optimisation Procurement & contracting incl AQP Collab working with NCB, SEL CCGs, LETB & Acad Health Sci Network


3. Leadership & Governance

Lambeth Clinical Commissioning Group is fully authorised without conditions and commences with discharging its statutory responsibilities on 1st April 2013.

3.1 Our governing body

The Governing Body of the Lambeth Clinical Commissioning Group (CCG) is responsible for ensuring that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the CCG’s principles of good governance.

Adrian Mclachlan,

Chair John Balazs

GP, Clinical Member Patricia Kirkman

GP, Clinical Member

Raj Mitra

GP, Clinical Member Ray Walsh

GP, Clinical Member Gillian Ellsbury

GP, Clinical Member

Graham Laylee

Lay Member, Vice Chair & Audit Lead Sue Gallagher

Lay Member, Engagement and Quality Ruth Jeffery

Advanced Practice Nurse Clinical


Lead Member

Andrew Eyres Chief Officer

Christine Caton Chief Financial Officer

Ami David Registered Nurse

Suparna Das

Secondary Care Doctor Jo Cleary – Local Authority

Representative, Co-opted Member Ruth Wallis

Joint Director of Public Health

John Moxham King’s Health Partners Representative,

Co-opted Member

To be appointed Lay Healthwatch (LINk)

Representative, Co-opted Member


3.2 Our committee structure

Lambeth CCG Governing Body

Health & Wellbeing Board

Audit Committee Employment & Remuneration

Committee

Equality, Engagement & Comms. Committee

Staying Healthy Programme Board*

Children’s Trust Board

Safer Lambeth Partnership

Integrated Governance Committee

Pan London Committees

London Clinical Commissioning Council

London Cancer Network

Pan London Urgent Care Programme

Board

See follow chart


Integrated Governance Committee

Joint Boards with Southwark CCG

Lambeth CCG specific Committee

SEL wide Joint with LB Lambeth

Learning Disabilities Programme Board

Mental Health Programme Board

Older Peoples Partnership

Primary Care Commissioning &

Quality Group

Serious Incident Review Group

Finance & QIPP Group

Planned Care Programme Board

Unplanned Care Programme Board

Integrated Care Pilot

LSL Integrated Performance

Lambeth Borough Prescribing Group

Management Group (SE London)

Health & Safety Group

Information Governance Group

LSL Infection Control Committee

SEL Area Prescribing Committee (SE London)

SEL Commissioning Strategy Group


3.3 Engagement plan 2013/14

Our Communications and Engagement Strategy, published in July 2012, identifies stakeholder groups with whom we need to engage in order to deliver on our mission to improve health and reduce health inequalities in Lambeth and to commission the highest quality health services on behalf of the people of Lambeth. We employ a wide range of methods to ensure that we are in a position to listen to the views of local people. We aim to seek out views proactively and also to provide channels through which residents, patients and other local stakeholders can approach us to express their views, raise issues of concern to them or to ask questions. The Communications and Engagement Strategy identifies the following strands to our engagement activity throughout the year:

Engagement through the commissioning cycle:

Identifying needs and aspirations – we use a broad range of methods to connect with residents and stakeholders to identify health needs and aspirations; our work to develop the Joint Strategic Needs Assessment (JSNA) will continue to use insights from a wide range of community engagement activity and our role on the Health and Wellbeing Board will enable us to oversee a co-ordinated approach to the development of a Joint Health and Wellbeing Strategy for Lambeth; we will continue to work with our partners in the local authority to ensure that major insight exercises, such as the annual residents’ survey, continue to explore people’s perceptions of health services locally; and we will utilise the annual Lambeth festival,

Prospectus 2013/2014 Page 21 of 83 Page 21 of 83

the Country Show and public meetings & events to flesh out our understanding of local expectations of the NHS.

Strategies and priorities – we engaged comprehensively with LINk, the voluntary sector and patient and carer forums on the development of our 5-year Strategic Plan and its refresh in 2012; we will continue to engage systematically through Local HealthWatch, the voluntary sector and patient and carer forums on CCG strategies and priorities and will develop joint engagement plans with partners, for example, with Lambeth Council on the development of the Health and Wellbeing Strategy and with south-London CCGs on the development of the community-based care strategy. We will continue to engage with Lambeth Scrutiny Committee on our strategies and plans, both informally (briefings) and formally (presentations to Committee meetings in public), for both service redesign and strategy development.

Service redesign/improvement – Our QIPP programmes include engagement plans to ensure that, when change or development is proposed, we engage well and in a timely and effective manner with the relevant stakeholders; our approach to engagement is targeted and may involve 1:1 interviews, focus groups, online and paper surveys. Effective engagement of clinical colleagues across the care pathway is required to ensure that programmes have sign-up across all stakeholders and this is managed through our programme boards.

Procurement & monitoring of services – we will continue to monitor patient experience through our contracts with commissioned services as well as through complaints and other patient insight data/information that are communicated to us directly. Our Integrated Governance Committee will hold responsibility for this. We will provide opportunities for patients to influence service specifications through our redesign programmes and will work with HealthWatch and other patient groups who may be collecting/collating patient experience data to ensure that this is usable in quality monitoring processes.

Our governance and our Governing Body – we will continue to hold our Governing Body meetings in public and to hold open pre-meetings for residents and stakeholders to raise questions about local health services and how we commission them. HealthWatch Lambeth will have a seat on the Governing Body as a representative patient voice. Our engagement work will be assured by a sub-committee of the CCG’s Governing Body, the Engagement, Equalities and Communications Committee, which will have representation from the local authority, HealthWatch, the voluntary sector and GP practice—based patient groups, as well as the CCG. We will test the engagement audit tool we developed with partners during 2012. We have a designated lead for engagement on our Governing Body, and have appointed a lay member with responsibility for patient and public involvement, but additionally, engagement will be part of the broader Board development plan for 2013/14.

Developing Patient Participation Groups in GP practices – we funded Lambeth LINk to support practice-based patient groups to develop during 2012/13, and to explore routes for linking


these collective views into commissioning more effectively, as we see it as important that we have a ‘real-time’ ear to local experience as a means of alerting us to potential areas of improvement. We will be working closely with the NHS England to ensure that patients and patient groups are reassured that their local NHS is working collaboratively on primary care issues

Supporting shared decision-making and patient empowerment - we will continue to commission a range of self-help, self-care and peer support programmes for patients across Lambeth. The Expert Patient Programme, a structured course which supports people living with long-term health conditions more effectively to self-manage, has a new mental health component. For people living with HIV we are also developing a new structured peer-led self-management programme.


4. Mandatory requirements

4.1 NHS Constitution & NHS Outcomes Framework

NHS Constitution

The NHS Constitution sets out those rights to which patients, public and staff are entitled to and the with pledges that the NHS has made and committed itself to achieve. Full details are available at www.nhs.uk/nhsconstitution.

As a commissioning organisation, NHS Lambeth CCG has a responsibility to ensure that the services that it buys from healthcare providers meet the standards contained within the NHS Constitution. The relevant standards are shown below together with information on how well these standards are being met for Lambeth people:

PERFORMANCE MEASURE TARGET 2013/14

LATEST PERIOD

Referral to Treatment waiting times for non-urgent consultant-led treatment

Admitted patients to start treatment within a maximum of 18 weeks from referral

90.0% 92.5%

Non-admitted patients to start treatment within a maximum of 18 weeks from referral

95.0% 98.4%

Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks from referral

92.0% 93.7%

Diagnostic test waiting times

Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral

99.0% 95.5%

A&E waits

Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department

95.0% 94.58%

Cancer waits – 2 week wait

Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by GP

93.0% 96.5%

Maximum two-week wait for first outpatient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected)

93.0% 97.7%

Cancer waits – 31 days

Maximum one month (31 day) wait from diagnosis to first definitive treatment for all cancers

96.0% 98.2%

Maximum 31-day wait for subsequent treatment where that treatment is surgery

94.0% 95.9%

Maximum 31-day wait for subsequent treatment where that treatment is an anti-cancer drug regimen

98.0% 99.1%

http://www.nhs.uk/nhsconstitution


Maximum 31-day wait for subsequent treatment where that treatment is a course of radiotherapy

94.0% 92.6%

Cancer waits – 62 days

Maximum two month (62-day) wait from urgent GP referral to first definitive treatment for cancer

85.0% 87.5%

Maximum 62-day wait from referral from NHS screening service to first definitive treatment for all cancers

90.0% 88.9%

Maximum 62-day wait for first definitive treatment following a consultant’s decision to upgrade the priority of the patient (all cancers)

-- 88.2%

Category A ambulance calls

Category A calls resulting in an emergency response within 8 minutes 75.0% 76.6%

Category A calls resulting in an ambulance arriving at the scene within 19 minutes

95.0% 98.2%

Mixed Sex Accommodation Breaches

Minimise breaches

Cancelled operations

All patients who have operations cancelled, on or after the day of admission (including the day of surgery) for non-clinical reasons to be offered another binding date within 28 days, or the patient’s treatment to be funded at the time and hospital of the patient’s choice

--

Mental Health

Care Programme Approach (CPA). The proportion of people under adult mental illness specialties on CPA who were followed up within 7 days of discharge from psychiatric in-patient care during the period

95.0% 92.6%

Key quality, performance, finance and delivery areas

A&E 4 hour wait: In 2012 Guys St Thomas Trust (GSTT) failed to meet the Quarter (Q) 3 target. A recovery plan has been signed off with the Trust and this is being actively monitored. Winter monies have been identified to support the implementation of the action plan and the Trust has confirmed its commitment to delivering the 95% target over Q4. Monthly performance reviews and Chief Executive Emergency Summit meetings are taking place to oversee progress and unlock issues. Kings College Hospital (KCH) has met the all types target (Year to Date). Following performance issues during the summer, a detailed plan has been implemented and is being closely monitored by commissioners including via Chief Executive level Emergency Summit meetings. Winter pressures funding will support the delivery of A&E targets over Q4.

Referral to Treatment Times: During 2012/13 GSTT had waiting list backlogs in a number of specialities, predominantly in admitted care. For GSTT, the trust has been reducing the backlog of patients on the admitted pathway through a combination of extended days, weekend working and some outsourcing to private providers. The backlog is now down to a sustainable level and the trust has been delivering Referral to Treatment Times (RTT) standards at aggregate level since the end of Q2 2012/13. The Trust also has a plan to eliminate 52 week waiters by the end of the financial year.


KCH has provided revised trajectories for admitted performance, incomplete and long waiters (over 52 weeks) and backlog clearance (patients waiting over 18 weeks for admitted care). The Trust has initiated a programme of outsourcing for key specialties, due to issues with external providers the phasing of the backlog reduction has changed with more occurring in Q4, however the end point remains the same. This will result in performance below the threshold for admitted cases in Q4. KCH also has plans in place to address backlog of long waiters (over 52 weeks) using a combination of outsourcing and in-house capacity, the trust anticipates that it will now be able to significantly reduce the number of long waiters by the end of the year, with a planned 50 over 52 week waiters at year end. These will be cleared by the end of Q1 2013/14.

Diagnostics: During 2011/12 problems with waits for some diagnostic procedures emerged, as demand has outstripped available diagnostic capacity. Lambeth’s performance is largely determined by the GSTT and King’s position. GSTT and Kings have used a combination of additional in-house capacity mobile units and outsourcing to independent providers to redress the imbalance between capacity and demand for endoscopy. As at December 2012 the number of people waiting more than 6 weeks for diagnostics at GSTT has increased from 135 to 144. This is as a result of Paediatric MRI figures which had previously been excluded from the figures. An Action plan for clearing the paediatric MRI waiters and a trajectory for improvement has been agreed. The backlog will be cleared and the 1% target met from end of March 2013. At KCH the number of people waiting more than 6 weeks for diagnostics had increased from 77 to 147. The biggest increases between November and December were in echocardiography from 0 to 49, MRI 20 to 32 and flexi sigmoidoscopy 14 to 21. A recovery plan and revised trajectory has been agreed with KCH. The backlog will be cleared and the 1% target met from March 2013.

Mixed sex accommodation: At the start of 2012/13 all acute Trusts in South East London declared compliance with national single sex accommodation requirements. The expectation is that there would be no breaches of single sex accommodation compliance. This requirement is included in acute contracts with financial penalties for all breaches. However since April 2012 KCH has reported a number of mixed sex breaches. All of these breaches were due to the non-availability of beds in general wards for patients who no longer require intensive care. A follow-up assurance visit led by Southwark CCG was undertaken in November 2012. There is an agreed sustainable solution to this step-down bed issue from April 2013, when additional capacity on the KCH site opens. Prior to that additional capacity planned for the winter will help alleviate current pressure plus agreed actions to review bed allocation and prioritisation processes and improved discharge processes will further assist. Clinical assurance has been received that there are no associated patient safety issues with current breaches.

MRSA and CDiff: Lambeth continues to be above its trajectory for CDiff, but maintaining the MRSA target will be challenging for 2012/13. 4 cases of MRSA have already been recorded against a year end target. Of these cases two cases were diagnosed at Guy’s & St Thomas’ (May and October) and 2 were at St George’s (July and November). The first 3 cases were ‘not


attributable’ to the Trusts under the national rules. However, the fourth case (at St George’s) was an elective case (Colorectal Surgery) and attributable to the trust. Commissioners continue to monitor closely. A review of the Root Cause Analysis (RCAs) for these cases is ongoing.

Cancer 62 day waits. February 2013 Lambeth CCG continues to meet this target for Lambeth residents.

Other areas we know are in need of improvement include:

Alcohol consumption and related health problems including hospital admissions due to alcohol specific and attributable conditions and mortality due to alcohol related diseases including liver disease.

Prevalence of obesity in children. The National Child Measurement Programme has recorded 24% children aged 10-11 years in Year 6 at risk of clinical obesity in Lambeth.

Under detection of diabetes, hypertension in the community which may be affecting early intervention to prevent complications leading to avoidable hospital admissions as well as leading to premature mortality.

Prevalence of severe mental illness and expenditure on management of mental health problems in Lambeth population

HIV prevalence where Lambeth has highest number of detected HIV positive individuals in treatment.

Areas where we are improving but remain a concern for health and wellbeing of Lambeth population include:

Smoking prevalence and smoking attributable hospital admissions, cancer and mortality

Teenage conceptions – although reducing rapidly over past 5 years is still of concern as they have a significant health and social impact on the young female.

Years of life lost due to cancer and CVD – Premature mortality rates (death in <75 population) are improving but there is a gap between England and Lambeth which needs narrowing. Population diversity, deprivation are important factors affecting this indicator.

Emergency hospital admissions due to diabetes and stroke although improving are still higher and require monitoring

Life expectancy at birth for men


NHS Outcomes framework In addition to the NHS Constitution, NHS England sets out a number of standards against which it will monitor the performance of individual CCGs. These fall under five domains:

Preventing people from dying prematurely

Enhancing quality of life for people with long term conditions

Helping people to recover from episodes of ill health or following injury

Ensuring people have a positive experience of care

Treating and caring for people in a safe environment and protect them from avoidable harm

The summary spine chart overleaf illustrates how well Lambeth CCG is doing compared against the England median and against other CCGs in London. The summary also shows those areas that Lambeth is not doing as well in:



A summary of Lambeth’s performance against recently published NHS outcomes shows the following indicators where Lambeth is not performing well when compared to national performance is as follows:

<75 mortality rate from respiratory diseases

Unplanned hospitalisation in adults for chronic ambulatory care sensitive conditions

Unplanned hospitalisation for asthma, diabetes, epilepsy in under 19s

Emergency admissions for acute conditions that should not usually require hospital admissions as well as emergency readmissions within 30 days of discharge from hospital

Potential years of life lost from causes considered amenable to healthcare

Patients’ experience of GP services and GP out of hours services These areas of work will be incorporated into the work plans of the Planned and Unplanned Care Programme Boards. Public Health Outcomes Framework A summary of Lambeth’s performance against recently published public health outcomes framework indicators shows under performance in the following areas:

Mental health admissions

Mortality from COPD, stroke, and mortality attributed to smoking related illnesses in 35+ adults.

People killed or seriously injured on roads

Binge drinking – harmful alcohol consumption and drug misuse prevalence

Cancer screening coverage for breast and cervical cancer

Childhood immunisation coverage for under 2 and under 5 year old children

Slight drop in the 5 year survival lung cancer rates

4.2 Quality premium

Subject to Regulations, a Quality Premium will be paid in 2014/15 to clinical commissioning groups that in 2013/14 improve or achieve high standards of quality in the following four measures from the NHS Outcomes Framework:


Avoidable emergency admissions

The Friends and Family Test

Incidence of healthcare associated infections (MRSA and CDiff)


The Quality Premium will also include three locally identified measures. These measures focus on local issues and priorities, especially where outcomes are poor compared to other areas and where improvements will contribute to reducing health inequalities. NHS Lambeth CCG has decided on the following local measures from its commissioning strategy:

% users in Care Programme Approach (CPA) with HONOS >= 90%

Patients with BP <150/90 = 77.5%

% diabetics with HbA1c <= 8 = 72.4% The published example of the Quality Premium value is £5 per head of population; the final value has yet to be determined, notwithstanding final confirmation the award will be allocated as follows:

Reducing potential years of life lost from amenable mortality 12.5 % Reducing avoidable emergency admissions 25.0 % Improving patient experience of hospital services 12.5 % Preventing healthcare associated infection 12.5 % Local measure: % users in CPA with HONOS = 90% 12.5 % Local measure: Patients with BP <150/90 = 77.5% 12.5 % Local measure: % diabetics with HbA1c <= 8 = 72.4% 12.5 %

TOTAL: 100.0 % Where a CCG does not deliver the identified patients rights and pledges on waiting times a reduction of 25% for each relevant NHS constitution measure will be made to the Quality Premium payment.


4.3 Domain 1 Preventing people from dying prematurely

4.3.1 Cancer services Delivering the NHS Constitution Target

2013/14 Latest performance

Public Health Outcomes Framework ‘underperformance areas’

Patients referred urgently for cancer wait no more than 2 weeks for first outpatient appointment

93.0% 97.7%

Cancer screening coverage for breast and cervical cancer

Max 31 day wait from cancer diagnosis to treatment All cancers – 96% For surgery – 94% Anti cancer drugs – 98% Radiotherapy – 94%

96.0% 94% 98% 94%

98.2% 95.9% 99.1% 92.6%

Max 62 days wait from urgent referral to cancer treatment GP referral – 85% Screening – 90%

85.0% 90%

87.5% 88.9%

Our plans to improve cancer services through 2013/14 are listed below. One of the complexities of the new NHS is that many of these improvements will now be driven by the London Cancer Commissioning team on our behalf: Those that Lambeth CCG will lead on are indicated by a *

MILESTONES / KEY ACTIONS DATE DUE 1. Improving early detection - the CCG is aware of the pan-London work on

improving early detection that is taking place and, in particular, the focus on:-

(a) Completing the early detection pathways for colorectal, lung, and ovarian cancer. Once completed and signed-off, these pathways will be built into the best practice commissioning pathways that have already been signed-off;

(b) To roll out bowel cancer screening age extension. (c) GP access to diagnostic testing will be improved by ensuring that

specific direct access tests are available universally and effective access will be monitored by the Cancer Commissioning Team, on behalf of the CCG;

(d) Development of an endoscopy commissioning strategy – this will be completed by the end of March 2013 and will then be shared with the CCG in early 2013/14, with a view to developing provider implementation plans in mid 2013/14, for delivery in 2014/15.

June 2013 June 2013 June 2013, with ongoing monitoring September 2013

2. Delivering care closer to home – the CCG is aware of the pan-London


work and, in particular:- (a) Improving the provision of chemotherapy services – a pan-London

approach to chemotherapy services will be introduced, including a standard approach to coding and counting of activity and a pan-London approach to chemotherapy delivery pricing;

(b) Improving the consistency of palliative care services –

April 2013 To be developed for 2014/15

3. Consolidating specialist care – the CCG recognises that most work in 2013/14 will be preparatory changes for 2014/15 implementation:-

(a) Delivering appropriate consolidation of services, in line with the Model of Care – providers and Integrated Cancer Systems (ICSs) will agree consolidation plans with commissioners, for implementation in 2014/15 onwards;

(b) Planning consolidation of highly-specialist services – during 2013/14, the CCG will work with other CCGs, the ICSs and London Cancer Programme to plan for future consolidation of services in 2014/15 and beyond.

December 2013 December 2013

4. Improving the consistency in care provision – the CCG recognises the large variations in care between and within providers, and will include the following changes:-

(a) Implementation of the four best practice commissioning pathways – these four pathways – breast, lung, colorectal and brain – will be included in all secondary care provider contracts in 2013/14;

(b) Reduce unwarranted variation in care along pathways – to be monitored through the implementation of the best practice commissioning pathways and the cancer CQUIN focused on assessing compliance with the BPCPs;

(c) Recognising cancer as a long term condition* – To agree priority areas and include in work plan for new Macmillan GP and practice nurse. To be jointly overseen by cancer locality group and planned care programme board

(d) Improving services for people living with and beyond cancer, including implementation of the NCSI recommendations – the NCSI has a focus on implementing a small number of deliverables – Holistic Needs Assessment, Treatment Plan, Treatment Summary (offered to 50% of patients by March 2014);pilot exercise on referral for people living beyond cancer*

(e) Improving communication between secondary/tertiary and primary care* – Develop care pathway for men with prostate cancer requiring long term follow-up and shifting care from secondary to primary care

(f) Working towards the provision of seamless care for people with cancer* – To roll over contract for Community Head and Neck Cancer Team (CHANT) for a further year while lead commissioning arrangements are being put in place and decision made on future commissioning of the service

April 2013 April 2013 Ongoing to March 2014 July 2013 March 2014 March 2014 July 2013

5. Delivering productivity and efficiency – a series of cancer-specific contract levers will be included in all 2013/14 contracts. Providers are expected to work with their Integrated Cancer Services (ICS) to deliver these (including quality requirements, information

April 2013


requirements, CQUIN and contract monitoring). (a) Ensuring the effective use of financial and performance data for

commissioning purposes – a series of commissioning metrics has been prepared; providers and ICSs are expected to deliver these metrics, both those for implementation by April 2013 and those developed for implementation in-year.

March 2014

4.3.2 Innovation David Nicholson’s review: Innovation, Health and Wealth (DH, 2012) tasks the NHS to promote innovation for significantly better outcomes for patients within the available resources. CCGs have a duty to promote innovation and we will determine locally how best to focus and promote innovation, including its adoption and spread, as an important enabler for achieving better health and healthcare for the people of Lambeth. In 2013, we plan to:

MILESTONES / KEY ACTIONS DATE DUE Six high impact innovations We are currently agreeing plans as part of pre CQUIN requirements with local providers in the following areas Child in a chair in a day Wheelchair service benchmarked against best practice nationally Project plan agreed Review eligibility criteria Agree outcome measures

End April 2013 Completed End May 2013 Aug-Dec 2013 Aug-Dec 2013

Kings Health Partners Academic Health Science Centre (AHSC) is a new partnership across South East London that will drive lasting improvements in patient care by sharing innovations across the health system and capitalising on teaching and research strengths. The CCG will work closely with King’s Health Partners to ensure effective outcomes and support diffusion of best of best practice. The four main objectives of the Kings Health partners will be to: 1. bring academic and scientific rigour to service improvement; 2. focus on key public health issues in south London; 3. deliver lasting improvements on a wide scale across the whole of South London; 4. generate wealth for the local economy and improvements to patient care at the same cost or reduced investment

The four clinical themes identified in section six of the AHSC model are: • Diabetes • Dementia • Musculoskeletal


• Alcohol The short and long term milestones to improve value-based healthcare for each of these clinical priorities will be worked up in detail during the implementation of the clinical priority transformation programmes. These will be led by an identified Senior Responsible Officer with programme support.

NICE TA (technology appraisals) are systematically included (where clinically appropriate) in local formularies. CCGs have confirmed that all local trusts have included all NICE TAs in their formularies as part of the contracting round.

Agreed as part of contractual requirements from 1 April 2013 and reported quarterly to commissioners with action plans.

4.3.3 Public sector equality duty

NHS Lambeth has adopted the Equality Delivery System as its approach to meeting the Public Sector Equality Duty. A two year equalities strategy (2012-2014) was agreed in July 2012. The strategy encompasses the CCG’s roles and responsibilities as commissioner, partner and corporate citizen, employer, and provider of health services. The action plan is based on the Equality Delivery System cycle of activities and commitments.

NHS Lambeth CCG has adopted an equality objective for each of its seven health priorities which are the responsibility of the respective programme boards to drive, monitor and report on. The objectives are:

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To improve the physical health of people known to have mental health problems especially people with severe mental illness (SMI) as measured by: Reducing the numbers who smoke and narrow the gap between people with SMI (44.2% known to be smokers according to GP records) and the general adult population of Lambeth (23% smokers) Improving diabetic control from the beyond the Lambeth average (66% achieving good control as measured by HbA1C) towards that of the highest performing practices in Lambeth of 80% or above for people with SMI and diabetes Increase access to talking therapy services to those people over 55 and who have long term conditions Increase access to the memory service for people from ethnic minority communities


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To improve control of high blood pressure (defined as less than 150/90) in Lambeth, specifically to reduce the between practice variation by achieving measurable change in the poorest performing practices towards the Lambeth average of blood pressure controlled in at least 75% of people known to have hypertension, and to improve the quality of care for all.

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To improve the detection and control of diabetes in Lambeth (as defined by achieving HbA1c of less than 8), specifically to reduce the between practice variation in control achieving measurable change in the poorest performing practices towards the Lambeth average of 66% of people known to have diabetes achieving good control and between different population groups focusing on some ethnic minority populations and people with mental health problems known to have increased prevalence, earlier onset and higher rates of complications.

HIV

To ensure the revised HIV treatment and support services are informed both by detailed evidence on which populations are experiencing the highest prevalence, the highest transmission rates and the highest social needs profile, and by a diverse Service User Reference Group (SURG) indicative of the different communities affected in Lambeth

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To enable all smokers to have equal opportunity to quit through the Lambeth stop smoking service focusing particularly on particularly on lower socio economic groups who are more likely to smoke

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benefit from the Childhood Obesity Programme and to promote equality and equity as a key element to successful delivery of the Programme overall

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To promote equity of access to information on alcohol and safe drinking, and to alcohol misuse services for population groups at higher risk of alcohol related harm

In partnership with and the active support of the local Public Health service the CCG undertakes to: Be more transparent about equality in health services commissioning Ask more specific questions about equality and human rights in engagement activity Advocate on behalf of populations that are historically marginalised and/or discriminated against Promote more comprehensive equality monitoring; patients asked (with explanations and assurances about confidentiality) to give more information that assists services to demonstrate whether they are providing an equitable service Commission primary and secondary care services that are competent and considerate on equality and human rights e.g. staff do not make assumptions and address their own prejudices


MILESTONES / KEY ACTIONS DATE DUE Publish an updated review of the evidence the CCG has on equality and the CCG’s impact on equality including progress against equality objectives

31st January 2014

Stakeholder (particularly equality groups) engagement on progress against equality objectives and agreement of ‘grading’ of progress

31st March 2014

Publication of the stakeholder grading and updates to equality objectives. NB: This will be the 3rd annual update of a 4 year cycle.

4th April 2014


4.4 Domain 2 Enhancing quality of life for people with long term conditions

4.4.1 Integrated care in Lambeth & Southwark

Integrated Care is a programme of work designed to deliver sustainable integrated health and social care services to people in Lambeth and Southwark. This involves the redesign of services and the system to redefine the way professionals engage with each other. It is fundamentally changing the way in which people are supported in taking charge of their own care and conditions. Integrated Care is a partnership of people who live in Lambeth & Southwark, NHS Lambeth, NHS Southwark, London Boroughs of Lambeth and Southwark, Kings Health Partners Academic Health Sciences Centre, Lambeth and Southwark GP practices and is supported by the Guy’s & St Thomas’ Charity.

The programme’s initial focus has been on care of older people, broadening its scope systematically during the course of three years (2012-15). For 2013/14 the work will focus on care for people with multiple long term conditions, linked with the national demonstrator work on Year of Care for people with Long term Conditions (LTCs) and involving older people and people with long term conditions in the way care is provided to them and supporting them to self manage. From its third year onwards the initial changes made to the systems and to services will become self financing.

This will be achieved by integrating care and re-incentivising the system – driving up the quality and doing so at lower cost, improving the value of care we provide to people in Lambeth & Southwark by:

Joining up care around people, across providers

Identifying and managing people’s care needs better and intervening earlier

Ensuring care is provided in the most appropriate setting, particularly at times of acute crisis

The system is led by a federation of health and social care providers with an overarching Integrated Board Structure, working in partnership with commissioners and responsible for the shared delivery of care along agreed pathways.

During 2011/12 we established programme structures and plans and commissioned new admissions avoidance schemes such as the HomeWard, community based Enhanced Rapid Response and enhanced Reablement services. During 2012/13 we implemented registers of older people at risk, holistic health assessment (including mental health) and case management for older people through GP practices, urgent access telephone lines and ‘hot’ geriatric outpatient clinics for rapid diagnosis of older people. We also established a Citizen Board and


Citizen Forum to place the voice of people in Lambeth and Southwark at the heart of how we work to complement work with service users and carers.

We have submitted a successful bid to Guy’s & St Thomas’ Charity to pump prime the programme, but are also working together on use of emergency admissions and readmissions funding, community care and mental health contract resources and primary care. In particular we sought the charity’s support to deliver information technology that would allow a sophisticated single view of real time information related to the care of individuals and take the findings of the department of Health’s whole systems demonstrator pilots of telehealth and telecare and deliver them at scale.

Integrated Care is a foundation for the community based care approach outlined as part of the report of South London Healthcare Trust Special Administrator. The work we are doing in partnership with health and local government across South East London is in particular focusing on key enablers: Information & IT, contractual levers, communications & engagement, supporting self management and workforce development. We are developing our work with Health Education South London to ensure we build sustainable capacity and capability in primary and community services across health and social care to deliver improvements in care and support. This is supported by local work with councils to look at workforce on a locality basis to support multi-disciplinary working through Integrated Care.

A model for supporting self management is being developed through the Lambeth & Southwark Diabetes Modernisation Initiative with the aim of extending the approach to people with multiple Long Term Conditions (LTCs).

MILESTONES / KEY ACTIONS DATE DUE 1. Pilot shared information system based on development work to date (first stage towards shared electronic patient record)

April 2013

2. Roll out shared information system

June 2013

3. Completion of financial pathway analysis of people with multiple LTCs

June 2013

4. LTC business case to Guy’s & St Thomas Charity

September 2013

5. Test self management models for people with multiple LTCs

November 2013


4.4.2 Roll out of the NHS 111 service

The South East London (SEL) NHS 111 Pilot is the largest implementation of the service in London. The SEL CCGs have worked collaboratively to develop a coherent and comprehensive 111 service that will efficiently and effectively meet the needs of the local population.

The pilot is unique in including an additional GP clinical management as an integral part of the 111 service. This is included as specified by the clinical commissioners, as part of ensuring that the 111 service is embedded within and contributes to the unscheduled care system across SEL.

A key component of the SEL CCG’s strategy to achieve financial balance and improve system performance is to shift unscheduled care activity into more clinically appropriate and cost effective care pathways. The SEL CCGs believe that, as well as transforming access, a single point of access, such as 111, will help to manage demand for local urgent care services and reduce pressure on A&E services in particular. The work already underway as part of delivering SEL QIPP has further emphasised the need to manage demand for services. Implementation of the Single Point of Access supported by a CMS (Capacity Management System) Directory of Services by April 2013 (the London go live date) is included in the SEL QIPP Plan for 2012/13 and 2013/14.

SEL CCGs believe that the potential benefits to the SEL healthcare system of the introduction of 111 include:

Introduction of a consistent clinical assessment tool and referral management

Reduction in attendances at A&E and an increase in patients being directed and conveyed to the most appropriate care setting for their needs

Activity shifted to more clinically appropriate, lower cost care settings

Reduction in Ambulance “999” activations and conveyances to A&E

Reduction in unscheduled admissions by directing patients to home based nursing/care services

Information on capacity of and demand for urgent care provision enabling commissioners to respond more intelligently to local need / demand

Improved clinical governance of all general practice and community services through caller outcome information

Signposting of access to NHS dentistry in hours as well as out of hours

Improved end of life care services through coordination of individual patient care

An increased percentage of patients achieving preferred place of death

The primary aims of the SEL NHS 111 service are to improve the public’s access to and usage of urgent healthcare services; help people use the right service first time, including self care; and provide commissioners with management information regarding the usage of services. This


vision, principles and intentions of the SEL 111 service was borne out of extensive engagement within and across the SEL CCGs and represents a significant collaborative programme of work.

MILESTONES / KEY ACTIONS DATE DUE Public launch Qtr 1 - 2013/14

Review of service Qtr 2 – 2013/14

Launch GP clinical management Qtr 2 – 2013/14

4.4.3 Dementia and care of older people Our plans for improving services in this area include:

MILESTONES / KEY ACTIONS DATE DUE 1. Work with GPs and other clinical professionals to improve diagnostic rates, care and treatment

Use established Clinical Network Lead (CNL) for dementia to work with practices and acute mental and physical health colleagues to improve diagnosis rates and care and treatment of people with dementia and their carers

CNL for dementia will visit low/non referrers to Southwark and Lambeth Memory Service (SLMS) and use per practice profiles for dementia to include number of patients registered with dementia vs suggested prevalence for practice demographic to improve uptake of SLMS. Visit to include awareness raising of dementia pathway, and post-diagnosis support and advice.

CNL for dementia to provide clinical expertise and knowledge gained from NHS London Dementia Programme for GPs to support commissioning and contracting of SLMS and participate in stakeholder decision making via Mental Health Improvement Programme Board (MHIP).

Ongoing December 2013 Ongoing

2. Meet the quality standards set out in the NHS Outcomes Framework and NICE guidance

Actions completed following refresh of Lambeth Dementia Commissioning strategy via MHIP.

Service provision via SLMS, including post-diagnosis support and advice as per NHS Outcomes Framework and NICE guidance.

December 2013 Ongoing

3. Publish information regarding dementia in provider quality accounts

Ongoing monitoring of SLMS through established process of quality outcome review meetings and challenging providers to improve quality and improve efficiency.

Monitoring of South London and Maudsley NHS Trust (SLaM) data regarding continuing care activity.

Quarterly meetings 2013/13 Ongoing


4. Ensure participation in and publication of national clinical audits and other research initiatives

To implement a programme of local and national audits and research initiatives

Ongoing

5. Reduce inappropriate antipsychotic prescribing in the community and in care homes

To develop and implement an action plan following outcome of NHS London Primary Care Audit on use of antipsychotic medication, working with Medicines Management Team, local GPs, specialist mental health services, and voluntary and third sector providers.

December 2013

6. Eliminate Mixed Sex Accommodation

Ensure ongoing gender specific SLaM continuing care beds for >65 years.

Ongoing

7. Reduce inappropriate admissions including those directly to care homes from hospital

To develop action plan for support to care homes with Lambeth and Southwark Integrated Care Programme

Ensure care homes have access to admission avoidance services including enhanced Rapid Response and Virtual Ward

May 2013 May 2013

8. Develop care pathways consistent with End of Life Care Strategy

Care of people with dementia is included in Gold Standards Framework, and specifically regarding choice of place of death.

To continue the roll out of the Gold Standards Framework for Care Homes with the aim to have all 10 nursing homes in Lambeth GSF accredited by end of March 2014

Implementation of Coordinate My Care Register

Ongoing March 2014 April 2013

9. Ensure the provision of specialist in-reach teams to care homes including dentistry, primary care and pharmacy

To review current Local Enhanced Service for Primary Care Services

August 2013

10. Ensure the provision of appropriate Liaison mental health services

Both GSTT and KCH have older adult liaison services in place. Commissioners will continue to monitor and review effectiveness of teams

Ongoing


4.4.4 Carers

Carers’ services are jointly commissioned and managed by Lambeth CCG and Lambeth Council. It is estimated that there are 18,000 carers in Lambeth with approximately 3,000 registered with the borough’s carers’ hub and identifying themselves as carers to primary care practitioners.

The draft Care and Support Bill places specific obligations on local authorities to support carers in their caring responsibilities, and we will work with the Council to implement the new requirements when the bill passes into law.

A review of carers’ services is underway which will try to prepare for the implementation of the new bill by improving equity of service provision, improving access to services and broadening the opportunities for personalised services for carers. The review is underpinned by the principle that carers’ services are preventative and that by recognising the needs of carers’ when designing mainstream services it is possible to ensure those services work more effectively for all patients and service users.

Key actions will be agreed following the finalisation of the review of carers’ services.

4.4.5 Improving primary care services

NHS Lambeth CCG is committed to ensuring effective high quality and modern primary care services, which are responsive to people’s needs; provide greater access through a wider range of services delivered close to where people live and work; and more integrated across secondary and community care providers, making the best use of the skills of our health and social care professionals.

Primary Care is central to the range of health and social services provided to the local population. It acts both as a first point of contact and as a ‘gateway’ to a wide variety of services, both within the primary care system itself and to other parts of the wider health and social services system. It also has links with other agencies, for example in relation to housing and education.

In the future advances in medicine, care and technology will continue to drive change in the range of services that can be provided safely in the community. This will enable more people to be diagnosed, treated and cared for at home or close to where they live. This in turn will lead to greater specialisation in the primary care workforce.

Access to the Internet will also without doubt impact on the way services are delivered and accessed. Already many people are using it as a source of information and advice about their


condition. In the future it is likely to be more proactively used as a communication medium between people and their local primary care team. It would act not only as a source of general information about illnesses, but provide access to advice on self-management of chronic conditions, infections, or communicable disease control within the local community. It could also be used as a communication vehicle for the transfer of test results directly to individuals and the provision of advice and even diagnosis and treatment between care professionals and individuals working together remotely from different locations – again reducing the need for face-to-face consultations.

NHS Lambeth CCG is keen to use the key performance indicators within the PMS (Personal Medical Services) contract to provide higher quality care in general practice. The CCG will work in collaboration with colleagues in NHS England to review these KPIs (key performance indicators) on an annual basis. On-going contractual arrangements put in place for dental practitioners and community pharmacists will provide incentives for the provision of high quality care and treatment.

During 2012 NHS Lambeth CCG has undertaken a scoping exercise of the current provision of nursing in primary care. This builds on the Primary Care Education strategy developed in 2012, which identifies the training and development needs of our primary care teams so we have a workforce fit for purpose going forward. We are already taking positive steps to develop the new skills needed to work in multidisciplinary teams in line with the changing demands on the service as well as emerging best practice. In addition, it also enables primary care professionals to provide a wider range of services in the community, providing an enhanced capacity and alternative ways to meeting people’s needs.

In parallel with these developments in the future, patients will be encouraged and supported to take more responsibility for managing their own health and wellbeing through the provision of better information, advocacy and support services. From early years through to older age, patients will be helped to actively participate in decisions affecting their health and wellbeing. With the right support and information, patients will understand more about healthy lifestyles and understand the actions they need to take to reduce, or prevent, harm to their health and wellbeing. In addition, patients will be helped to acquire basic skills to help them manage any chronic conditions. This can only be achieved if the primary care system is able to provide effective programmes of health and lifestyle education, disease prevention and support to individuals in the management of their own conditions.

This approach will need to be undertaken in partnership with people in the community. Primary care will have a proactive role in encouraging and supporting people to take greater responsibility for their own health and wellbeing. A recent example of this developing role is the ‘Healthy Living Pharmacy’ initiative, which encourages pharmacies to support health and wellbeing to residents across Lambeth. Each site has a local Healthy Living Champion who has been trained and accredited to keep residents up-to-date with health services.


The key attributes that we would want to achieve are:

A service focused on providing comprehensive person-centred care

A first point of contact that is readily accessible and responsive to meet peoples’ needs day or night

A co-ordinated, integrated service employing a team approach with multi-agency linkages

An emphasis on engagement with people and communities about their care and the way services are designed and delivered; and

A focus on prevention, health education and effective self-care.

The challenges cannot be met simply by an increase in capacity. Significant change to the way services are delivered is also needed. We need to develop better ways of team working and consider changes in the traditional roles of primary care practitioners and service providers, creating the opportunity to design new ways of working which will reshape the boundaries between primary care, hospital and other associated services. We need to improve our infrastructure to ensure that it effectively supports the changes envisaged.

NHS Lambeth CCG has six High-Level Objectives for Primary Care:

Objective 1

To make primary care services more responsive and accessible and provide high quality primary care services that meet patients every day and urgent care health needs.

Objective 2

To develop more effective partnership working across organisational and professional boundaries to provide more effective and integrated team working;

Objective 3

To facilitate more informed, proactive engagement and involvement of people in local communities and practitioners in the use, planning and delivery of services;

Objective 4

To put in place a robust Primary Care Education strategy that secures a primary care workforce fit for purpose;

Objective 5

To reduce variation in the quality of Primary Care provision and reduce health inequalities across the borough;

Objective 6

To encourage and enable patients to positively manage their own health, in partnership with health professionals and their carers


4.5 Domain 3: Helping people to recover from ill health and injury Delivering the NHS Constitution Target

2013/14 Latest performance

Public Health Outcomes Framework ‘underperformance areas’

Care Programme Approach (CPA). The proportion of people under adult mental illness specialties on CPA who were followed up within 7 days of discharge from psychiatric in-patient care during the period

95.0% 92.6%

Mental health admissions

4.5.1 Mental health

Mental Health continues to be a high priority for Lambeth CCG as highlighted within its authorisation process; good progress is being made against the ambitions set out in No Health without Mental Health (NHWMH) and the NHS Outcomes Framework. Our work is incorporated within the Mental Health Programme which consists of six key work streams:

1. Transforming primary and community mental health services (for people with

severe mental illness) 2. Redesign of Criminal Justice mental health pathways 3. Development of Payment by Results in Mental Health 4. Integrated Talking Therapy Services 5. Mental Health Older Adults including dementia 6. Well being programme

Underpinning the programme is a commitment to addressing the significant inequalities that people with mental health problems experience. The following objectives have been agreed for 2012/13 onwards:

1. To improve the physical health of people known to have mental health problems

especially people with severe mental illness (SMI) 2. To increase access to talking therapy services to those people over 55 and who

have long term conditions 3. To increase access to the memory service for people from ethnic minority

communities


Highlights include:

Lambeth Living Well collaborative priority to redesign current “crisis” system of support to one which is based on early intervention, recover and personalisation – the “Living Well Network” will go live on a phased basis from April 2013.

The CCG was successful in being selected to participate in the Going Further Faster programme (December 2012) which aims to increase choice through access to personal health budgets for people with SMI. This will also contribute toward the aim of developing the workforce to embrace co-production and recovery and a more personalised approach to the delivery of care and support.

The Joint commissioning framework for children services is currently under review, a needs assessment is due for completion February 2013 with strategies for the early intervention and prevention and Child and Adolescent Mental Health Services (CAMHS) being developed through a co-production process over the next 6 months.

MILESTONES / KEY ACTIONS DATE DUE 1. Inequalities

1. Reducing smoking rates in clients of South London and Maudsley (SLaM)

(via contract 2013/14)

2. Review access/take up of new integrated talking therapy service (as

below)

3. Review of first year of memory service in progress to set baseline for

access by ethnicity & other parameters

Review quarterly As below As below

2. Transforming primary care and community services (via the Lambeth Living Well Collaborative) Implement Living Well Network from April 2013 within North Community Mental Health Team (CMHT) area and review Summer 2013 Undertake feasibility of alliance contracting framework for delivery of integrated services for people with SMI Reduce current acute overspill to nil and agree plans for reduction in current bed capacity by 10% from Quarter 4 Support 250 people to move on from secondary care and reduce caseloads within CMHT (Recovery and Support) by 15% Develop a crisis retreat / peer hotel service as an alternative to acute psychiatric bed provision Support 30 people to move on from residential care and access personalised

April 2013, Review July 2013 December 2013 April 2013 March 2014 Sept 2013 March 2014


package of care

3. Redesign of Criminal Justice mental health pathways Support the move on of 10 people within Low / medium secure provision in collaboration with NHS England, SLaM and Voluntary & Community Sector providers. Redesign pathways for people detained under Section 3 of Mental Health Act Review user / peer support engagement work and vocational services project Review community forensic services model in collaboration with SLaM

March 2014 Dec 2013 Sept 2013 March 2013

4. 4. Review Talking Therapies Undertake six month review of new (Nov 2012) Integrated Talking Therapies service Review take up by Black & Minority Ethnic communities and older people Deliver nos into treatment and recovery target

July 2013, Dec 2013 July 2013, Dec 2013 Review on monthly basis

6. Payment by Results Deliver key milestones in collaboration with Croydon, Lewisham and Southwark CCGs in accord with Department of Health Guidance Undertake review of two Needs based clusters (psychosis) through the LLWC Serve notice of intention to subject all Adult Mental services provided by SLaM to be recomissioned from April 2014

March 2104 Sept 2013 March 2013

7. Prevention and early intervention in children and young people Develop a strategy for early intervention and prevention Revise CAMHS strategy through a co-production process Develop service specifications (CAMHS etc) through a co-production process

June 2013 June 2013 Sept 2013


4.6 Domain 4 Ensuring people have a positive experience of care

4.6.1 Patient experience

Lambeth Clinical Commissioning Group (CCG) is committed to ensuring that Lambeth residents receiving health services have a positive experience of care. Assurance is obtained proactively through contract agreements and monitoring and reactively through softer intelligence sources including national survey information, provider complaints reports, Patient Advice and Liaison Service (PALs) feedback and CCG Board pre-meetings for members and public. The CCG is also committed to meeting legislative requirements for patient consultation in respect of procuring services where patient experience is important. Two examples include development of the community provider home ward and rapid response service.

Friends and Family Test Proactive patient feedback is sought through a number of means including via acute Trust led ‘real time’ feedback and annual patient surveys which are reported through clinical quality review meetings. This feedback includes the ‘friends and family’ test (FFT). The ‘real time’ feedback system will extended to community services in 2013/14. Guy’s and St Thomas’ NHS Foundation Trust is a pilot site for the ‘friends and family test’ within maternity services during 2013. Mental health services will implement the Friends & Family Test in 2014. The main mental health provider, South London and Maudsley NHS Foundation Trust undertake regular patient feedback via a local patient survey called Patient Experience Data Intelligence Centre (PEDIC). Findings are monitored via the mental health contract meeting. Implementation of the Friends and Family Test within mental health services is under discussion with the Lambeth, Lewisham and Southwark CCGs. Patient experience is also monitored through CQUINs for Acute, Community and Mental Health Contracts.

General Practice ‘Patient Participation Groups’ (PPGs) have been set up across our member practices. The PPGs have the opportunity to feed their issues into the Engagement, Equality and Communications Committee so this information can be shared with the relevant Programme Boards. Commissioning Leads are also made aware of any issues so these can be raised at the appropriate contract and quality meetings. The GP Out of Hours services carry out regular patient satisfaction surveys so the service can be adapted to meet key needs. Survey results are discussed at regular contract and quality meetings.

The CCG will work closely with NHS England arrangements to assure the quality of patient experience within specialised services for Lambeth patients with local providers.


Personalised, 1 to 1 care throughout pregnancy, childbirth and postnatal Acute providers are required to ensure that every woman has a named midwife responsible for ensuring personalised care throughout pregnancy, childbirth and during the postnatal period. They are also required to ensure that women receive one-to-one care during labour, birth and the period immediately after birth. These standards are included within contractual requirements for 2013/14. Guy’s and St Thomas’ NHS Foundation Trust (GSTT) and King’s College Hospital Foundation Trust (KCH) aspire to meet these standards and historically have performed well against the 1:1 care in labour. The CCG is working with the South London Commissioning Support Unit to tighten the monitoring process and ensure compliance in 2013/14.

Waiting Time Commitments Waiting time commitments as set out in the NHS Constitution and by the NHS England planning guidance form part of contractual requirements and are monitored by the CCG. Guy’s and St Thomas’ NHS Foundation Trust (GSTT) is currently failing to meet the 52 week waiting target for Lambeth residents and is looking to outsource treatment to address this gap. Lambeth CCG will continue to monitor this issue for 2013/14.

Waiting time for CPA (Community Programme Approach) follow-up within 7 days of discharge from acute mental health hospital admission is being met. In November 2012 the IAPT (Improving Access to Psychological Therapies) and counselling services were integrated to provide a comprehensive Talking Therapies service. It is anticipated the new service (3 year contract), delivered through a South London and Maudsley NHS Foundation Trust (SLaM) led consortium, will address equality issues identified in the previously separated services. The new service contract includes quicker access to treatment and increased recovery rates. A six-month review will be commissioned to assure the quality of service provision. The service is looking to further reduce waiting times through the development of a Saturday morning workshop programme and additional Cognitive Behavioural Therapy for depression and anxiety groups.

MILESTONES / KEY ACTIONS DATE DUE 1. Friends and Family Test (FFT) Implementation Maternity Pilot for FFT at GSTT Review out of hours GP contract to ensure robust patient engagement

October 2013 July 2013

2. Personalised 1 to 1 care throughout pregnancy, childbirth and postnatal Further develop monitoring process for these standards for use in 2013/14

March 2013

3. Maternity services: postnatal depression identification and management NSPCC report completed. Presentation to Accountable Officer, CCG Board lead for maternity services and Providers.

30 January 2013


Presentation of report and workplan to address key maternity and children’s recommendations to CCG Integrated Governance Committee and Children’s Trust Board Maternity service model multiagency development involving: maternity, CAMHS, Health Visitors and GPs Agree updated compliance monitoring standards and review process

IGC February 2013 Children’s Trust Board March 2013 September 2013 April 2013

4. Waiting time commitments Outsource acute service provision to meet 52 week targets Talking Therapies Service six month review Talking Therapies Service review feedback

March 2013 and ongoing as required June 2013 August 2013

5. Supporting young people with special needs – agreed care plans and personal budgets Development of Single Assessment Tool (Health; Education; Social Care) Review of Paediatric health therapies core offer (GSTT) Integrated Special Educational Needs (SEN) and Disability Commissioning Strategy

April 2013 April 2013 May 2013

4.7 Domain 5 Treating and caring for people in a safe environment

4.7.1 Safeguarding children and promoting their welfare

Lambeth CCG has robust assurance processes in place relating to the safeguarding of children. These include clear lines of accountability and these are properly reflected in the CCG’s governance arrangements as follows:

Lambeth CCG has in place a Quarterly Executive Safeguarding & Looked after Children group, chaired by the Director of Integrated Commissioning, the Executive Manager responsible for Safeguarding. This group reports into the Integrated Governance Committee (IGC), which reports to the Governing Board. This is clearly set out in the CCG governance arrangements. The Executive Safeguarding Children Group oversees the monitoring of effective safeguarding performance of commissioned services.

100% of CCG staff are trained in Level 1 Child Protection (CP), which is annually updated. The Designated Nurse and Doctor for Safeguarding provide regular training for GP’s and other contracted providers at Level 2 and 3 (April –Dec ‘12 162 independent contractors attended Level 2 CP training; April-December 2012 126 independent contractors attended Level 3 CP Training. Training dates are set out for 2013/14 and circulated in a weekly bulletin.


There is well established CCG representation and involvement with the Lambeth Safeguarding Children Board. Both the Clinical Commissioner with a lead for Children attends as the Executive lead for Safeguarding, and the Director of Integrated Commissioning as Executive Manager for Safeguarding. The CCG Designated Nurse for Safeguarding chairs the Lambeth Safeguarding Children Board Training & Development Sub-group.

The CCG has in place both a Designated Doctor and Nurse for Safeguarding Children. Both posts have clear work plans and work closely together to inform the commissioning process; train contracted providers and oversee any safeguarding issues or concerns

The CCG has in place both a designated nurse and doctor for looked after children and in December 2012 it was agreed that the Executive Safeguarding Children group would broaden its remit to include Looked after Children, to ensure effective governance process for this cohort. An integrated service specification for the Health of looked after children is being drafted between the CCG and Children & Young People Service and will be complete by April 2013.

The CCG has in place a designated paediatrician for unexpected deaths in childhood. This post links with the Child Death Overview Panel, chaired by Public Health

4.7.2 Safeguarding adults and learning disabilities

For 2012/13 Adults and Community Services (ACS) has focussed on delivering Safeguarding Alerter training for both staff and for managers of partner organisations across all client groups. Demand has been high throughout the year and ACS is extending this provision into the first quarter of 2013/14 as an interim measure, pending the findings of a borough wide training needs analysis. This analysis aims to identify the skills gap in other council departments, the private and voluntary sector as well as our statutory partners. The programme for the remainder of 2013/14 will be formulated with the aim of addressing need.

Adults and Community Services is also currently developing a joint Introduction to Adult and Children Safeguarding course with partners as well as exploring the possibility of using E-learning as an alternative method of improving awareness and knowledge

Annual Health Checks (AHC) The implementation of annual health checks for people with learning disabilities in England has been repeatedly recommended as one component of health policy responses to the poorer


health of people with learning disabilities. Lambeth performance on this priority has steadily improved over the last two years and increasing the number of health checks is an ongoing priority for Lambeth CCG, and to ensure that the information contained in them is embedded in GP practice records and systematic follow through.

The Community Learning Disability Nurse and Strategic Health Facilitator, continues to offer training to all GP practices to ensure practices that are fulfilling their responsibilities under the Learning Disability Direct Enhanced Service, and by March 2013 will have offered training to 65% of GP practices. Health Action Plans (HAP) A Health Action Plan is a personal plan that sets out what a person with learning disabilities can do to be healthy. It lists any help people might need to do those things. It helps to make sure people get the services and support they need to be healthy. Previously the HAP training was offered to service providers for a cost of £45 with minimal take up. For 2012/13 the Strategic Health Facilitator offered free sessions to managers and support staff from the main residential and supported living providers to roll out HAPS more. This will ensure more eligible service users have a Health Action Plan. A priority for 2013/14 is to ensure providers adopt the same HAP (Ok Health Check) to ensure consistency of HAPS being delivered, and to allow the Strategic Health Facilitator to better monitor the quality of the HAPs and the health needs of people with learning disabilities.

Clinical Nurse Specialist for Learning Disabilities

GSTT has employed a Clinical Nurse Specialist for Learning Disabilities to work in collaboration with the two acute hospitals, to enable open & easy access to health care services for people with learning disabilities and to work at a strategic level with health professionals, managers & commissioners to achieve the health agenda of the White Paper ‘Valuing People’ (Department of Health, 2001). The clinical nurse specialist role is to:

To ensure that people with learning disabilities have full and appropriate access to healthcare within the hospital setting and to liaise with all relevant parties to obtain information and plan effectively for all hospital visits and to ensure effective discharge planning.

To act as an expert in the field of learning disabilities providing appropriate training and advice to all hospital staff.

To play a key role in adult safeguarding cases involving a person with a learning disability and to liaise with both the hospital and social services safeguarding leads.

The nurse specialist will be available to support adults with learning disabilities who are admitted to GSTT for elective surgery or diagnostics to ensure that their care acknowledges


their different and additional needs and that reasonable adjustments are made to ensure that their time in hospital achieves the desired outcome. The nurse specialist will also be working with identified link nurses across the two hospitals to develop their knowledge, skills and confidence in supporting people with learning disabilities. The nurse specialist will also be leading some strategic initiatives to ensure that people with learning disabilities who use Guys Hospital or St Thomas’ Hospital get high quality and safe care.

Complex High Risk Case Meeting Lambeth has set up a complex high risk case meeting to provide a multi disciplinary forum, where information and expertise can be utilised to review high risk case issues where there is a concern related to risk raised by a professional and to identify key actions to address risk issues and to set a timescale for review within the meeting.

The group does not have a threshold for identifying high risk complex cases, as it wishes to ensure that the broadest notion and professional views towards risk are used so as to not exclude potential cases which would benefit from being referred to the meeting. Examples of possible risk would be e.g. at risk of placement breakdown, recent hospital admission, deteriorating health, social vulnerabilities, engagement issues, poor compliance with treatment, complex capacity decisions.

The complex high Risk Case meetings comprise a representative from the following disciplines and professionals; Speech and Language Therapy, Psychology, Occupational Therapy, Community Nursing, Physiotherapy, Head of Nursing and Therapies Guys and St Thomas Hospital and the Head of Service for Adults Learning Disabilities (ALD) Team.

The meetings are chaired on a rotating basis between SLaM, GSTT and ALD Social Care team managers / professional leads and do not replace existing processes e.g. CPA, Adult Safeguarding Procedures and process or individual case worker responsibilities in managing and co-ordinating case responses. Safeguarding issues and patters on concerns are monitored at the monthly JCEG meetings. The CCG gathers information on service provider’s policy, procedures and practise, attending and advising safeguarding meetings, monitoring provider’s uptake of Lambeth’s safeguarding training and promoting best practice. Any significant concerns resulting from quality visits, safeguarding concerns or complaints will result in a service improvement action plan being developed with the service provider. Out of Area Placement Monitoring Service (OOAPMS)


Lambeth has a clear policy on reducing out of area placements and inpatient care for people with learning disabilities and autism. Lambeth has identified 13 people who are detained under the Mental Health Act, in hospital settings and the CCG has commissioned SLaM to deliver a dedicated OOAPM service for patients detained under the mental health act. The OOAPMS aims to:

Create a closer and more harmonious working arrangement between Lambeth Social Care and SLaM with regard to client with mental health of learning disabilities

Develop a framework of highly effective, nurse led observation and monitoring of vulnerable adults placed out of our community

To improve care management, medication, health and well being outcomes with a focus on reducing length of stay, repatriating where appropriate and improving quality of life.

The OOAPMS monitors and makes clinical recommendations on care packages and facilitates return to area where possible in Lambeth, and has access to the safeguarding lead within the SLaM’s Clinical Academic Group (CAG) for support.

The OOAPMS has reviewed every patient on the detained register and is proactively care co-ordinating each patient’s care, with a view to inform future care pathway. All present with challenging behaviour and / or autism. Informal Patients Lambeth has identified four people who are in informal patients in hospital settings due to their challenging behaviour. They were recently reviewed by the Adults with Learning Disabilities Team and Adult Therapy Team to inform future pathway:

Two are being considered for stepped down move into more independent setting.

One requires a Prada Willis service.

One requires ongoing health input, due to mental health needs / psychotic disorder.

CCGs should outline work undertaken with local authorities to ensure that vulnerable people, particularly those with learning disabilities and autism, have access to appropriate, high quality care.

MILESTONES / KEY ACTIONS DATE DUE 1. The OOAPMS to review every patient on the detained register and proactively care co-ordinate each patient’s care, with a view to inform future care pathway

Completed

2. Learning Disabilities Partnership Board to hold a ‘‘Big Health Day’ event with adults with learning disabilities and family carers to get feedback on their

29 May 2013


experience of health services in Lambeth

3. Roll out of ‘Ok Health Check’ HAP to all providers 29 May 2013

4. Autism Steering Group to implement a clear and consistent pathway, using the NICE clinical guidelines.

June 2013

5. 100% of GP practices to have taken up training to fulfill their responsibilities under the Learning Disabilities Directly Enhanced Services (DES)

September 2013

6. Commissioning to review all current hospital placements and support everyone inappropriately placed in hospital to move to community-based support as quickly as possible and no later than 1 June 2014

June 2014

4.7.3 Patient safety

NHS Lambeth CCG have in place two framework documents - ’Governance Arrangements Framework’ and ‘Commissioning for Quality Framework’ which outline how priorities are informed, how early warnings of safety and quality issues requiring action are identified and how assurance on quality is delivered to the Governing Body. The systems and processes in place meet National Quality Board recommendations and subsequent legislative requirements for CCGs relating to ensuring care quality. The CCG recognises that quality governance relies on a combination of structures and processes at and below Governing Body level to assure organisation-wide quality performance

Incident reporting arrangements and serious incident improvements The CCG recognises that improving safety is broader than just reducing the number of incidents – it also involves having an understanding of how safety can be continuously improved and developing a culture that supports improvement. Provider contracts include performance measures and quality requirements, including incidents and serious incidents which are monitored via robust contract and quality meetings. There are clear performance measures and reporting cycles which providers must meet.

Provider incident reports are reviewed at quality meetings and established clinically led serious incident monitoring meetings for Guy’s and St Thomas’ NHS Foundation Trust (GSTT) and South London and Maudsley NHS Foundation Trust (SLaM). These meetings enable more serious incidents and improvements as a result of investigations to be discussed. There is evidence that providers with good incident reporting rates and investigation processes are more likely to be safer organisations that those who report less. With this in mind incident reports from the National Reporting and Learning System (NRLS), to which all provider organisations must submit patient safety incident information, provides nationally comparative information about both frequency of incident reporting but also issues being reported. Trend analysis reports across London hospitals and incident lessons have been shared through patient safety forums led by NHS England. These external sources of information also inform discussions at quality


and serious incident meetings. Trend analysis of incidents and shared learning forums will be established across South London by the Commissioning Support Unit during 2013.

A number of Never Events occurred during 2012 within local acute providers. The Governing Body have reviewed the actions taken to address identified issues, which included the poor use of the WHO (World Health Organisation) surgical checklist. Actions being taken are being closely monitored through the serious incident monitoring group and discussions are ongoing with the trust medical director for assurance. Further review of incident reporting and monitoring arrangements and early warning systems will be undertaken in light of the Francis Report recommendations. Achievable plans for reducing the incidence of avoidable harm Avoidable harm in this context relates to reductions in venous thrombosis embolism (VTE) i.e. a clot in the leg, severe pressure ulcers (grades 3 and 4) and medication errors in acute, primary and community settings.

Acute, community and mental health providers are required to report on all three areas of avoidable harm above. The incidence of VTE including risk assessment and prevention management is a CQUIN for the acute services. This will continue as a nationally mandated CQUIN for 2013/14.

The CCG actively promotes learning from medication errors and employ the CCG medicines team to promote safe prescribing and medicines use for Lambeth residents across acute, primary and community settings. The medicines team automatically receive medication incident information reported by general practices, institute root cause analysis where required and ensure any action required as a result of this is undertaken, working with the Issues of Concern team as appropriate. The CCG Chief Pharmacist actively participates in the GSTT Drug and Therapeutics Committee, where safe practice around medicines is a key element. The Lambeth Borough Prescribing Committee receives regular reports on medication incident themes where these incidents are discussed and learning shared. This is a committee which reports directly to the CCG Governing Body. It has been agreed that a South East London Area Prescribing Committee will be established in 2013, and cross borough learning from medicines incidents will be one of the areas discussed.

Achievable plans for improving safety for pregnant women and children The Maternity Quality Standards agreed through the Trust Special Administrator (TSA) process will be incorporated into contracts and monitored via the Quality schedules with Provider Trusts. Ongoing work with the Provider Trusts through the development of the South London Maternity Network will prioritise compliance with the quality standards and improving safety. The CCG and Public Health will undertake a Maternity Needs Assessment to better understand


the local impact of the TSA report and the Secretary of State response in respect of maternity service provision.

The CCG and South London Commissioning Support Unit are working together to strengthen the monitoring process, in particular working with GSTT and KCH to improve maternity serious incident monitoring.

The NSPCC recently reviewed Lambeth services for pregnant women and children aged 0-2years as part of their national ‘Every Baby Counts’ campaign. The review found Lambeth has good partnership working and effective safeguarding processes for 0-2year olds.

Reduction in the number of C.Difficile cases and zero tolerance to avoidable MRSA bloodstream infections from April 2013 All acute providers are set national targets for C.Difficile and MRSA reduction which are included within the contract. There is monthly monitoring with feedback through contract meetings and quality meetings. Lambeth CCG continues to be above its year to date trajectory for C.Difficile. GSTT are slightly over trajectory for C.Difficile but are working with UCL (University College London) and Brighton on best practices for reducing C.Difficile cases. This will be closely monitored by the Infection Control Committee. GSTT have an MRSA target of zero and is on target to meet this for 2012-13.

The Lambeth & Southwak Public Health (PH) Team take a lead on infection prevention and control across Lambeth and Southwark, attending the GSTT and KCH Trust Infection Control Committees. This role will continue as PH move into local authorities. PH provide advice to primary care and other settings as required. Infection control governance arrangements need to be reviewed with the transfer of PH into the LA as CCGs continue to have responsibility for local healthcare associated infections.

A C.Difficile summit involving primary care, acute and community trusts to agree collaborative working will take place in May 2013.

Reducing the number of suicides and incidents of serious self harm or harm to others, including effective crisis response. The established SLaM serious incident meeting is clinically led and receives updates from lead SLaM clinicians in respect of serious incidents and actions taken to address issues identified through the investigations. Additionally, the CCG is working with the Living Well Network to promote early intervention of mental health services at the front end. The pilot of a phased interactive approach is proposed for autumn 2013.


Identifying early warning signs of a failing service and processes to address these The findings of the Mid-Staffordshire NHS Foundation Trust Public Inquiry on hospital care between 2005 and 2008 (Frances Report) was published in February. It highlighted systemic failure of the provisions of good care and confirmed that providing good, safe care was about systems and people.

The CCG has arrangements in place to proactively identify early warning signs of a failing service and processes to address these including:

The use of qualitative and quantitative information including hard and soft intelligence to provide assurance on quality of care in our provider from numerous sources. These sources also act as early indicators of non compliance e.g.

o Patient and service user feedback through a number of well established, vibrant patient participation groups working with General Practice which act as an early warning system for potential failures in any health services.

o Feedback from GP Practices via our established locality meetings, Governing Body meetings

o Feedback from our GP Quality Alerts system which highlights provider system issues, where practices complete a simple on-line return and these are analysed for key issues and trends by local commissioners and fed into contract /quality meetings.

Proactive review of provider and national data e.g. Care Quality Commission (CQC) Quality and Risk Profiles, Annual staff /patient surveys; CQC mortality alerts; inspections and other reports. This information is collated and presented to the Integrated Governance Committee and used as part of contract and quality meetings.

Established robust contract monitoring arrangements including clear performance measures and reporting cycles.

Use of available data from national, regional and local sources such as the RIO system and national data set information.

Established an annual programme of quality performance meetings which involve clinical commissioners.

On (at least) an annual basis, each main provider presents to the Clinical Board on quality issues within their organisation. This usually involves the Chief Executive/ Medical/ Nursing Director. Actions for improvement are agreed and followed up.

Specific commissioner / provider meetings and risk summits where issues require attention outside of the contract monitoring arrangements.

Work closely with other relevant parts of the system including the Medical Director Local Area Team, Clinical Senates and networks to understand and share information on quality and risk. Joint Commissioning with Lambeth Local Authority and Public Health input into CCG plans e.g. Infection Control


MILESTONES / KEY ACTIONS DATE DUE 1.Improve practice following serious incidents Develop additional Quality Assurance processes including audit and quality visits for greater assurance of the quality of service provision, particularly in respect of Never Events Review incident reporting and monitoring arrangements and early warning systems in light of Francis Report

June 2013 May 2013

2. Avoidable harm Agree twice yearly feedback on medication errors to GSTT Clinical Quality Review meetings Establish South East London Area Prescribing Committee

May 2013 May 2013

3. Safety for pregnant women and children Develop multiagency approach to blood spot screening management Review maternity serious incident reporting with Acute Trusts Maternity Needs Assessment to be completed South London Maternity Network to be established NSPCC recommendations implemented

June 2013 May 2013 Autumn 2013 Autumn 2013 Autumn 2013

4. Mental health services Pilot phased interactive approach

Autumn 2013

5. Infection prevention and control C Difficle summit with primary care, acute and community providers in Lambeth, Lewisham and Southwark to discuss and agree collaborative working

May 2013


5. QIPP

Quality Innovation Productivity and Prevention (QIPP) schemes – the level of net savings is currently anticipated as outlined in the table below. Plans assume the delivery of QIPP savings initiatives of £11.880m gross, £10.016m net. Planned savings are set out below and detailed plans are being finalised. Updates are provided to the CCG Governing Body and will be closely monitored through the Programme Management Office. QIPP reporting requirements are being reviewed to ensure that they are robust, including an assessment against the recommendations of the recent South East London wide internal audit report.

QIPP Schemes £000s Planned Care and Long Term Conditions 2,502 Unplanned Care 1,250 Other Acute 2,086 Community and Other Client Groups 1,438 Mental Health 3,043 Prescribing 1,203 Corporate/Other 359 Total QIPP 11,880

The delivery of the QIPP Projects is managed through four work-streams as follows:


Planned care

Diabetes - expansion of intermediate care team - virtual clinics, education, and referral management and decommissioning through repatriation and improved GP management Cardio Vascular Disease/Cardiology – community cardiology service including specialist heart failure clinics, Specialist nurse community clinics in Atrial Fibrillation and primary prevention, Multi-professional virtual clinics in GP practices on Heart failure and Atrial Fibrillation and prevention focused primary care education and an Ambulatory blood pressure monitoring programme Chronic obstructive pulmonary disease (COPD) /Respiratory – integrated community respiratory team for COPD and adult asthma including a single point of referral, Multi-professional virtual clinics in GP practices and management of home oxygen


Introduction of Telehealth care

Unplanned care

Re-commissioning urgent care centre at St Thomas' and reviewing price structure Work with the Primary Care Foundation to develop Primary Care Access Re-commissioning Patient Advice and Liaison Service at the front of A&E to support people to access same day GP services, including supporting them to register with a GP.

Mental Health

Reduction in acute placements - development of alternatives to acute inpatient stay - crisis retreat etc. through the Living Well Network Re-commission continuing care beds Reduction in rehab unit bed costs Increase rate of follow up assessments for spot placements to increase rate of move on from residential care (including 50/50 funded) placements Reduction in costs of high cost drugs

Staying Healthy

Reduce smoking rates Reduce obesity rates amongst children Improved detection of diabetes Earlier detection of HIV Prevention of Cardio Vascular Disease Reduced alcohol consumption

These report to the CCG Integrated Governance Committee. The detail of the projects and milestones to support QIPP delivery can be found in Appendix A.


6. Choice and competition

MILESTONES / KEY ACTIONS DATE DUE 1. Any Qualified Provider (AQP): Continence

To continue to monitor activity and cost of new AQP contract To review activity and tariff price for service sustainability and efficiencies To evaluate impact on patient choice and experience, quality and outcomes To evaluate impact and open 3

rd AQP window if evidence shows that it would

be beneficial for patients to extend choice of provider

Ongoing April-June 2013 April-September 2013 December 2013

2. AQP: Continuing care

To ensure all contracts are finalised and signed To monitoring contract jointly with Lambeth Council To closely monitor the impact of AQP on patient choice and availability of providers and work with other London CCGs to inform decision to open further AQP windows

End of May 2013 Ongoing September 2013

3. AQP: Hearing To continue to monitor activity and cost of new AQP contract To review activity and tariff price for service sustainability and efficiencies To evaluate impact on patient choice and experience, quality and outcomes

Ongoing September 2013 December 2013

4. AQP and procurement AQP is a process that will be included in the range of procurement options available to the CCG, monitoring processes have been put in place to assess impact on the services we have subjected to the AQP process, and options to further expand the market and improve patient choice and outcomes

Ongoing

5. Personal Health Budgets (PHB)

To continue to offer PHB for patients who have been assessed as eligible for NHS funded continuing care and who are currently in receipt of social care package To roll out the offer of PHBs to all patients who have been assessed as eligible for NHS funded continuing care

Ongoing June 2013


7. Emergency preparedness and resilience

The roles and responsibilities of the CCG in relation to the Emergency Preparedness, Resilience and Response (EPRR) derive from the Civil Contingencies Act (CCA) 2004 and the Health and Social Care Act 2012 (s46 relates to emergencies). The guidance ‘Health Emergency Preparedness, Resilience and Response from 2013: Summary of the principle roles of health sector organisations (DH, July 2012, Gateway 17820)’ identifies the principle organisational roles and responsibilities of CCGs related to Emergency Preparedness, Resilience and Response.

The following outlines the assurance that the CCG and Providers of NHS Services are properly prepared to cope with emergencies and to monitor their compliance:

All contracts with provider organisations contain relevant emergency preparedness, resilience (including business continuity) and response elements; Lambeth CCG support the NHS Englandin discharging its EPRR functions and duties locally:

EPRR is integrated in CCG governance structures with a nominated Director and emergency preparedness lead. Issues are reflected within the organisational risk register and discussed at senior committee level.

The CCG EPRR roles and responsibilities are shared with staff within the CCG via Operational Group meetings.

CCG Director training for EPRR on call requirements is provided.

EPRR risks and threats are identified and assessed through a variety of routes with systems put in place to ensure these are managed. This includes working with local providers to ensure they have plans in place to manage winter.

The CCG have surge capacity management arrangements in place including an on-call roster and clear escalation and cascade arrangements.

Fully equipped incident control room in place

CCG has robust EPRR preparation activities in place (see below)

Lambeth CCG fulfil the responsibilities as a Category 2 responder under the Civil Contingencies Act (CCA) including:

Having two key incident response plans which are maintained namely: Internal Business Continuity Plan and Surge Capacity Management Plan

Participate in exercises facilitated by the NHS England, the Borough Resilience Forum or provider


MILESTONES / KEY ACTIONS DATE DUE Review and update EPRR reporting and integration within Lambeth CCG governance structures

April 2013

Formalise emergency preparedness, resilience and response requirements within a CCG Emergency Planning Policy

April 2013

Re establish Incident Control Room within Lower Marsh to manage the impact of a major incident i.e. the surge, rather than the actual incident

April 2013

Review Lambeth CCG EPRR external arrangements for exercising and feedback to ensure these are robust including representation on the Local Health Resilience Partnership

April 2013

Undertake emergency planning assessments across the newly formed CCG May 2013

Develop and deliver staff training on CCG EPRR roles and responsibilities May 2013 and ongoing

Participate in EPRR exercises with partners throughout the year Ongoing

Review delivery of surge and winter planning arrangements implemented for 2012/13

June 2013

Undertake desktop internal CCG emergency planning exercise to test Business Continuity Planning arrangements

July 2013

Review the effectiveness of internal and external EPRR arrangements for the CCG

September 2013

Review and update surge and winter planning arrangements in line with requirements for 2013-14

September 2013

Provide EPRR update paper for discussion to the Lambeth Integrated Governance Committee

October 2013

Review other CCG EPRR requirements January 2014


8. Business informatics

There are three components to the CCG’s approach to ensuring it has appropriate informatics capability and capacity:

Internal performance and information team

Business Intelligence and Information & Communications Technology (ICT) services purchased as scale from the South London Commissioning Support Unit (CSU)

Working collaboratively with South London CSU to evolve informatics capability in future

The CCG has a (small) internal performance and information team, who work in concert with the CSU to ensure there is timely business intelligence for our clinical commissioners. The internal team is focused on advanced analytics including:

Support for pathway redesign

QIPP scheme planning and monitoring

Ad-hoc analysis and reporting

Business Intelligence and ICT services purchased at scale from the South London CSU. The scope of these services includes: Business intelligence

Performance reporting and data management

Performance measurement of provider quality and delivery against Key Performance Indicators (KPIs) and the Commissioning Outcomes Framework

A suite of standard reports, dashboards and scorecards, covering provider and CCG performance, which includes performance comparisons to assurance frameworks and KPIs.

Data management including data source collation, quality assurance, integration and information governance compliance

Performance benchmarking against CCG peers using standardised metrics trend reports providing comparison to previous years

A monthly Integrated Report bringing together all the key information and analysis on contract activity and finance, quality monitoring, performance reporting on national standards and QIPP delivery and contract KPIs

Supporting urgent performance related queries, including attendance at key performance related meetings, in particular where there is an urgent need (e.g. emergency performance meetings)


Secure access to standard reports and data-sets through secure channels

Adding data-sets to the central repository to be accessible by CCGs

ICT support to the CCG

Key services such as email, telecoms, central storage and access to the South London CSU data warehouse

Support to desktops, printers and remote devices

Applications support, including ensuring that new systems introduced onto the network are compatible and training for new applications

Provision of the core IT infrastructure covering a fit for purpose resilient network (N3 connectivity and local network)

8am to 6pm service desk with resolution times subject to the Service Level Agreement

An appropriate disaster recovery provision such that IT services can be resumed within agreed times

Asset refresh programme moving to a standardised image for equipment, subject to successful capital funding application

Maintaining a database of all of the systems and suppliers

Primary Care ICT

Providing GPs with Information and Communications Technology to carry out day to day work effectively

Provision of the core ICT infrastructure covering a fit for purpose resilient network (N3/NGA connectivity, local network, internet) and NHS Mail. Applicable to those GPs that are on the network.

Support to desktops and printers.

Support moves and changes i.e. new practices and consolidations.

Core MS Office applications (Word, Excel, Outlook, PowerPoint)

Clinical systems provided under the GP Systems of Choice (SoC) framework

Primary Care IT facilitators helping practices to get the most out of ICT, their systems and primary care data.

8am to 6pm Service Desk with resolution times subject to the Service Level Agreement

Local Engineer support for desktops, laptops, printers and 1st line application support.

An appropriate disaster recovery provision such that ICT services can be resumed within agreed times.


9. Financial plans

9.1 Overview of financial position

Lambeth CCG’s recurrent baseline allocation for 2013/14 is £406.263m. This is after deductions of £225.535m for services transferring to other commissioners. In addition the CCG will receive an allocation of £8.253m for running costs.

This section is based on the Operating Plan financial templates as submitted to NHS England on 17th April 2013 and outlines the following:

The planned investment framework and resulting start budgets for 2013/14 for Lambeth CCG based on the CCG’s Operating Plan assumptions

A summary of the key financial assumptions used in setting start budgets.

Quality Premium

The Quality Premium is a new approach from National England for rewarding quality improvement. It will be paid in 2014/15 to clinical commissioning groups that in 2013/14 improve or achieve high standards of quality in the following measures from the NHS Outcomes Framework:


Avoidable emergency admissions

The Friends and Family Test

Incidence of healthcare associated infections (MRSA and C.Diff) In addition 37.5% of the Quality Premium will be based on achieving 3 local priorities for 2013/14 to be agreed with Lambeth Health & Wellbeing Board. Lambeth CCG is proposing to use its existing priorities of

Diabetes

Cardio-vascular disease

Mental Health

These were discussed with the Shadow Health and Wellbeing Board at its February meeting.


The priorities were selected on the basis of the following criteria:

Reflecting joint strategic needs assessment high priorities

Within existing stated priorities that we have consulted with the public and other stakeholders

Measurable and amenable to in year monitoring

Within the CCG commissioning remit

Engaging of member GP practices

Reflected parity of physical and mental health

Is credible with partner organisations, the Health & Wellbeing Board and NHS England.

9.2 Financial position

Lambeth CCG submitted its latest draft Operating Plan to the NHS England on 5th April. The Financial templates have been updated for the final submission on 17th April 2013. This set out our high level planning assumptions for 2013/14. The 2012/13 baseline budgets have been analysed for bringing forward as opening budgets in 2013/14. The following adjustments have been made in order to arrive at the 2013/14 opening budgets summarised below:

Current 2012/13 budget

Non recurrent funding

2012/13 projected outturn.

2013/14 demographic and non-demographic (population and incidence) growth.

2013/14 tariff uplift and efficiency assumptions.

An assessment of expected 2013/14 cost and service pressures and investments.

2013/14 QIPP assumptions including savings modelled at both 100% and stretch targets.

These assumptions and budgets reflect the 2013/14 Operating Plan to reflect national Operating Framework and PbR (Payment by Results) tariff guidance for 2013/14.

Start budgets for each service area have therefore been agreed based on the planning assumptions. However for these start budgets, the detail is still being negotiated into contracts with providers for 2013/14. They cannot therefore be finalised until the contract negotiations are complete. It is hoped to complete this process by the end of March 2013 although this represents a challenging timetable particularly given the work that is ongoing with the NHS England and providers to establish Specialised Services budgets for 2013/14. At this stage the impact of NHS England Specialised Services commissioning is assumed to be cost neutral on CCG baselines and this position will be kept under review.


9.3 Investment Framework The table below shows the application of available sources of funds or income for 2013/14, splitting out planned expenditure in line with the key planning assumption headings for 2013/14, 2012/13 outturn, generic uplift (inflation and tariff deflator), demographic and non demographic growth, service and cost pressures and QIPP. Investment proposals include funding for the recurrent costs of the Akerman and Norwood Developments and the costs of implementing the Operating Framework. The required 1% surplus has also been built into the Lambeth CCG plans.

CCG Income and Expenditure changes 2013/14

£'000

Income

Recurrent Uplift 9,344

Prior Year Surplus brought forward 4,623

Total Income Changes 13,967

Expenditure

Full year effect of 2012/13 outturn 10,370

Net Generic Uplifts

Tariff and generic uplifts 10,518

Efficiency with Tariff -14,120

Net Tariff/ Generic Uplift -3,602

Demographic & Non-Demographic Growth 8,225

Investment Proposals and cost pressures 6,231

QIPP Savings Initiatives -11,880

Change in Recurrent Expenditure 9,344

Surplus/ (Deficit) 4,623

Surplus as % of Recurrent RRL 1.1%


9.4 2013/14 Start Budgets1

The application of the planning assumptions set out above, result in the following start budgets, split by service area - acute, client groups, primary care and corporate and other budgets, which includes reserves established as part of the Operating Plan to provide flexibility for both the outcome of the negotiating round and also managing potential in-year financial pressures.

LAMBETH CCG OPERATING PLAN

2013/14

Acute

Client Groups

Primary Care (Prescribing & Other PC)

Corporate and Other Budgets

and Reserves

Total

Applications £'000 £'000 £'000 £'000 £'000

2012/13 Closing Recurrent Budget 217,472 129,921 40,656 18,215 406,263

2012/13 Cost Pressures 14,064 (126) (3,432) (136) 10,370

Sub Total 231,536 129,795 37,224 18,079 416,633

Tariff and generic uplifts 6,251 3,504 373 390 10,518

Efficiency with Tariff (8,798) (4,932) 0 (390) (14,120)

Net Tariff/ Generic Uplift (2,547) (1,428) 373 0 (3,602)

Sub Total 228,989 128,367 37,596 18,079 413,031

Population & Incidence Growth 4,877 2,734 613 0 8,225

Investment Proposals 2,095 2,572 1,564 0 6,231

Total Expenditure before QIPP 235,961 133,673 39,773 18,079 427,486

QIPP Savings Initiatives (5,838) (4,480) (1,203) (359) (11,880)

2012/13 Recurrent Budget 230,123 129,193 38,570 17,720 415,606

Anticipated Recurrent Resource Limit 0 1,128 1,629 2,100 4,857

Anticipated Non Recurrent Resource Limit 5,903 4,809 10,712

Total 2013/14 Start Budgets (March 2013) 236,026 135,130 40,199 19,820 431,175

Adjustments to Recurrent Resource Limit (12,224) 0 0 0 (12,224)

Adjustments to Non Recurrent Resource Limit 0 (424) 0 0 (424)

Total 2013/14 Budgets (April Operating Plan Submission 223,802 134,706 40,199 19,820 418,527

1 Note - adjustments to Recurrent Resource Limit include £11.8m related to the transfer of Specialised Commissioning to NHS

England


9.5 Key bridging movements from 2012/13 to 2013/14 plan

The Bridge analysis provided below shows an initial overview of the expected movements from the forecast 2012/13 surplus of £4,623k to the planned surplus for 2013/14 of £4,623k. The key bridge analysis follows broadly the assumptions categories stated above. The plan funds outturn pressures and includes zero basing of budgets where appropriate. In line with the planning guidance from NHS England, growth of 2.3% has been included. The tariff deflator for both PbR and Non PbR items is comprised of a pay and price inflation assessed at 2.7% and an efficiency requirement of 4%. In addition tariffs have been increased by 0.2% in recognition of changes in underlying costs faced by providers. The change in tariff prices used is therefore -1.1%. Population and other growth for Acute and Non Acute services of 2% on average has been applied. Prescribing growth of 4% has been used. QIPP for 2013/14 totals £11.8m.


9.6 Key capital schemes

The Capital Programme included within the Operating Plan identifies the range of requirements across the former Lambeth PCT estate. The estates priority is funding of backlog maintenance, especially relating to updating CQC and statutory compliance work which is needed on an ongoing basis. The ongoing programme of improvement grants across the private sector providers via capital grants allows for compliance and statutory levels to be maintained. The primary care IT rolling programme is ongoing, with the intention of covering all GP practices across Lambeth. The Norwood LIFT Capital bids relate to the Business Case commitments approved by the Lambeth PCT and NHS London. These include furniture, equipment and ICT but also the cost of meeting the IFRS (finance reporting standards) requirement of £9.004m. The construction of Norwood is well underway with completion due in spring 2014. The programme also includes Ambleside Avenue a Learning Disabilities property that is held by the Secretary of State and due to transfer to the London Borough of Lambeth via a grant arrangement.

9.7 Key financial risks and opportunities in 2013/14

All NHS organisations are facing ongoing financial pressures, after many years of unprecedented growth in available funds, in the context of the complexity of establishing new commissioning bodies and the disaggregation of the PCT’s allocation. The implementation of the CCG allocation formula is expected to take effect from 2014/15 and it is anticipated that Lambeth CCG, as an over-target PCT, is likely to receive a reduced level of growth for 2014/15 onwards to reduce its distance from the target allocation value. We are expecting the allocation formula to be published during 2013/14. The implication of this is a potential £5m reduction over the 2013/14 average growth levels which will increase the QIPP requirement for future years and necessitate planning for 2014/15 to start now.

The main risks and mitigating actions are explained further below.

It is important to note that the risk assessment will be updated following the finalisation of contract negotiations with providers within which the balance between upfront investment and savings and in-year financial risk will change.


CCG allocation adjustments – NHS Transfer transfer impact There remain a number of financially significant issues associated with the transfer of Specialised Services to NHS England commissioners. The latest version of the Operating Plan includes a reduction in allocation of £11.870m relating to this transfer. It is currently assumed that this transfer will be cost neutral to CCGs and discussions are ongoing with NHS England to ensure consistent triangulation of contract agreements and to control the management of in-year risk. The split of NHS England and CCG commissioned activity is likely to change in year as the Information Rules for identification of specialised services work though and provider coding improves, the impact of which is currently unclear.

We are working closely with the NHS England, Local Authority and NHS Property Services to address any baseline mapping issues that have emerged since allocations were issued in December 2012 and are seeking to minimise the financial impact of these changes.

2012/13 Outturn

In the Operating Plan we have sought to fund 2012/13 outturn based on the latest forecasts, taking into account the use of non-recurrent savings or sources of funds and the impact of this in 2013/14, as well as seasonality, working days and Referral to Treatment requirements. The extent to which actual outturn deviates from this may provide some financial risks, which will present itself as over-performance against contracted levels of activity in 2013/14, which would need to be funded from contingency reserves.

In year risks - Over Performance

The risk of over performance against planned levels of activity and expenditure in the acute sector continues to be a significant financial risk facing commissioners.

There has been significant underlying growth in acute demand and activity over 2012/13, across virtually all areas of the contract. Demand pressures are likely to continue in to 2013/14. Whilst some high risk volatile areas will have transferred to the NHS England the remaining CCG based contract will be smaller and more prone to fluctuation.

In addition, population and incidence reserves have been established to provide a funding source for increased demand during 2013/14. Contracts will include agreements in relation to QIPP implementation, supported by contractual commitments to deliver to commissioners a level of guaranteed savings for Trust led initiatives and robust implementation and contingency plans for CCG led initiatives. The CCGs working with the South London CSU will continue to deliver robust, timely contract monitoring and management to ensure action is taken to contain demand in year as appropriate.


QIPP

QIPP initiatives across acute, mental health and community contracts are significant in the context of reduced budgets arising from the transfer of commissioning to the NHS England and Local Authority. For acute services it needs to be acknowledged that providers have already made significant financial commitments in relation to the Lambeth and Southwark Admissions Avoidance programme which needs to be taken due account of in our overall negotiations for 2013/14.

All QIPP initiatives have been risk-assessed to increase confidence that the savings will be achieved in 2013/14. For those initiatives that are owned by the provider we expect our contract terms to mitigate the risk of non-delivery from the CCG perspective and Trusts are equally committed to ensuring full delivery of agreed targets. Processes are in place to ensure the effective monitoring and management of QIPP delivery in-year. A risk rated approach has been applied to start plans, so plans are being implemented to deliver on a full year effect basis more than 100% of 2013/14 requirements. We are reviewing our systems for QIPP monitoring to ensure that they continue to be fit for purpose in the new commissioning environment and enable robust, real-time monitoring of QIPP delivery during 2013/14 with recovery plans to be implemented as appropriate early in the contract year.

Non Acute Pressures – Continuing Care

A key area of risk in 2013/14 relates to continuing care clients across a number of client groups including older adults, learning disabilities, young physical disabled and children. For these clients the numbers are increasing and the cost of a continuing care package can vary significantly by client. We are developing measures to ensure that we are achieving value for money in the packages of care commissioned both in an out of borough.

Mental Health The financial and service pressures associated with acute overspill remain a significant risk during 2013/14 and commissioners will be working to agree a risk share, with close monitoring and actions to manage this in year. Some Mental Health specialist services will continue to be commissioned by the CCG and measures implemented during 2012/13 such as Clinical Commissioner representation on the inpatient tertiary panel will be maintained to ensure that risk is minimised.


2% Non-Recurrent Funds

Plans assume and include use of the 2% funds in full as an enabler for QIPP delivery and to effectively manage the transition to the new commissioning environment. Lambeth CCG will work closely with other south east London CCGs to make sure that robust plans are in place to enable access to funds at an earlier stage in the financial year. The 2% Non Recurrent Investment Fund is recognised as being important to deliver QIPP targets and ensure the achievement of underlying financial balance for 2013/14 onwards as expected levels of growth are expected to reduce with the implementation of the CCG allocation formula.

At this stage access to the 2% funding is assumed to be limited to non recurrent issues that are anticipated to include the following:

Existing non-recurrent expenditure associated with prior approved schemes, for example, Norwood Hall Neighbourhood Resource Centre

Implementation of the TSA recommendations and in particular the Community Based Care Strategy.

Acceleration of QIPP schemes

Repayable mutual financial support of challenged CCGs

The purpose of use of the non-recurrent funds is to minimise any ongoing risk or liability and recurrent commissioning reserves have been set at levels as high as possible to cover potential in year pressures and issues.

South East London CCGs have produced a Collaborative Risk Sharing Framework based on pooling 2% Non Recurrent investment funds and 0.5% contingency for the following purposes:

Implementing the Community Based Care Transformation Strategy

Meeting CCG obligations from TSA recommendations

Pump priming local CCG QIPP transformational plans

Providing CCG Mutual Financial Assistance

Managing local CCG risks

This is being discussed with the Lambeth CCG Governing Body with a view to approval being sought in early 2013/14.


The impact of Payment by Results (PbR) tariffs in 2013/14, including for mental health providers.

The impact of the new tariffs will differ by provider and for each CCG any deviation from the assumed -1.1% presents financial risks. The final impact and timing of the introduction of Mental Health Payment by Results (PbR) remains unclear. Commissioners have agreed principles across the four boroughs, including Croydon, for rebasing the contract baselines in negotiation with SLaM associated with the introduction of PbR full implementation of responsible commissioner guidance, to minimise risk across both commissioners and provider. Joint work, will continue to be undertaken in 2013/14, the introductory year, to ensure that activity and financial information is robust and forms a strong base for the implementation of PbR.

9.8 Management of financial risk Financial balance and the delivery of the CCG’s planned financial position is a core priority and a statutory requirement for Lambeth CCG.

The financial position is reviewed regularly by the Lambeth CCG Governing Body and the Integrated Governance Committee (IGC). The Finance and QIPP Working Group meets monthly, comprising Governing Body (clinical and lay) members and CCG/CSU finance and commissioning staff. The Group is accountable for: overseeing a robust organisation-wide system of financial management, including QIPP delivery; for ensuring that budgets are set in an appropriate and timely manner and that the Governing Body is fully aware of any financial risks which may materialise throughout the year. The Finance and QIPP Working Group reports to the Integrated Governance Committee.

QIPP schemes are aligned to our Programme Boards that report into the IGC. Oversight is delegated to the Programme Boards and Medicines Management Committee. The operational management of the delivery and governance of our programme management arrangements is overseen by the CCG’s Operations Group, which is chaired by the Chief Officer and comprises all Directors and senior managers engaged in programmes, meeting fortnightly to review progress, drive delivery and address cross-programme issues.

The NHS England in its assurance role meets with the CCG to provide executive assurance of finance and performance including QIPP delivery and delivery against national performance targets. Internal and external audit review the CCG’s financial management, reporting and controls. Further external assurance is also put in place where this is needed.


The achievement of in-year and underlying financial balance is supported by the delivery of an agreed Recovery Plan. These plans are kept under Board review as part of overall financial reporting arrangements. Given the level of risk outlined the focus is on delivery of stretch QIPP targets and acceleration of QIPP plans and as well as developing contingency proposals which include the following:

Enhanced claims management and activity validation for acute services

Make best use of social care and reablement funding to deliver service change and manage risk across organisational boundaries.

Withholding any potential fortuitous savings identified.

Delay of planned 2013/14 investment, although the implications of this on QIPP delivery will need to be considered.

Agreement, with partners, of mitigating actions, recovery measures and demand management plans to reduce anticipated over performance. Review all available resources and flexibilities across all budgets, which is being done as part of the budget setting process.

The implementation of the Health and Social Care Act 2012 and the associated period of transition brings significant changes in the responsibilities of individual staff members, different reporting lines and changes in key personnel as functions are transferred to newly established commissioning bodies. The CCG finance team is working closely with the CSU to ensure that the CCG’s scheme of delegation and associated systems of budgetary control are embedded, including:

Revised budgetary framework

Refreshed budgetary delegation to budget holders

Refreshed authorised signatory lists

Enhanced reporting arrangements

Budget holder guidance and training. This includes training in the use of the Integrated Single Financial Environment (ISFE) an oracle based financial system operated by NHS Shared Business Services

The South London CSU actively pursues debtor management to ensure any income due to the CCG is recovered. Processes are in place to ensure that creditors are paid efficiently and on time so that the Better Payment Practice Code (BPPC) can be met and outstanding creditor balances are, wherever possible, minimised. This involves regular reporting of outstanding invoices supported by staff training in the use of electronic workflow systems.


10. Development plan In order to thrive as a commissioning organisation beyond authorisation we are ensuring that our excellent clinical leadership, management and commissioning support is built on during 2013/14. Our ambition is to be responsive to the priorities of CCG Member Practices and of the CCG Governing Body and work effectively across all our partnerships in order to commission the required healthcare for the population of Lambeth. We recognise that if we are to maximise the opportunity for clinicians and managers to work in the most effective partnership then this will require the development of new ways of working for our teams and for all individuals to grow and develop new skills and behaviours. The wider context of embedding our new organisation structures during a time of economic restraint will be of clear significance in the coming year.

Throughout the authorisation process we have welcomed the opportunities to reflect on our capacity and capability and capture the learning for future development. NHS Lambeth CCG has six development work streams:

• Governing Body Development • Developing the membership • Strong Clinical Networks • Lambeth Commissioning Teams • Stakeholder relationships • Governance and quality

Clinical leadership is fundamental to our success as a commissioning organisation and so using and developing the skills and expertise of our clinicians throughout Lambeth is crucial. Succession planning is taking place on a number of levels and is embedded into all our Organisational Development priorities. At Governing Body level we have individual and collective arrangements in place to ensure Governing Body members feel supported and capable to carry out their roles in a way that is sustainable and dovetails with clinical commitments. At Locality level we have appointed individuals who are working in the primary care setting to lead collaborative working with their colleagues or neighbouring practices. These roles include undertaking practice visits or chairing locality meetings and they are supported with development interventions such as action learning sets and master-classes covering core commissioning skills. The Lambeth Clinical Network formalises engagement in clinical pathway work or other contracting arrangements. Being a member of the Clinical Network or undertaking a key Locality role is seen as an opportunity to develop skills and competencies and therefore be potential clinical commissioning leaders of the future. Through this work, we continue to be


committed to finding innovative and sustainable ways to build on our existing networks and maximise our clinical leadership potential for the future.

MILESTONES / KEY ACTIONS DATE DUE 1. Governing Body development

Evaluate value of coaching arrangements offered in 2012/13

Review Governing Body effectiveness

Election/Selection of new Governing Body members

Develop and implement Governing Body development programme

May 2013 Sept 2013 Sept 2013

March 2014

2. CCG as a membership organisation Establish Chair of Collaborative Forum and cycle of meetings

for 2013/14

Launch new Lambeth CCG website Embed and evaluate action learning sets and other continuous

improvement areas launched in 2012/13

Undertake survey of member practices Work with practices to identify innovative communication

channels for engaging member practices

April 2013

April 2013 Aug 2013

Sept 2013 Dec 2013

3. Strong clinical network

Establish work and development plans for clinical network members

Set trajectory for future clinical network engagement e.g. number of practices, range of professionals, geographical coverage

Succession planning in place for Clinical Network and Governing Body elections

May 2013 Sept 2013

March 2013

4. Developing the capacity and capability of Lambeth commissioning teams

CCG launched

Ensure PDPs and objectives are in place for all staff and reflect the values of the organisation

Establish programme of away time

Define the governance arrangements for the clinical network to support clinical and managerial commissioners

Review business systems in use within Lambeth CCG and priorities for improvement e.g. use of email, meetings,

Address capacity and capability requirements for the delivery of the TSA recommendations

Training and development needs for staff are assessed and addressed

April 2013 May 2013

May 2013 June 2013

Sept 2013

Dec 2013

March 2014

5. Stakeholder relationships

Establish action plan to develop stakeholder management arrangements

June 2013


Establish new working relationships with NHS England, CQC and Monitor

Establish new working relationships for integrated commissioning arrangements with Local Authority (incl Public Health)

Develop action plan to develop collaborative commissioning arrangements across SE London, including SEL Programme Management Office

Develop CCG as an intelligent customer of commissioning support services

Ensure robust governance processes for collaborative commissioning arrangements (e.g. across South East London) are embedded

July 2013

July 2013

June 2013

March 2014

March 2014

6. CCG governance and quality arrangements Develop action plan in response to Francis enquiry

Embed and evaluate governance framework, including Lambeth Constitution

Implement systematic risk appetite approach at all levels of the CCG

June 2013

Jan 2014

September 2013


11. Appendix one 11.1 QIPP Delivery Plans


Documents

NHS Lambeth CCG Prospectus: 2013/14€¦ · Prospectus 2013/14 Page 7 of 83 2013/14 is the first year for Lambeth Clinical Commissioning Group (CCG). It will be a year of significant